Your search found 57 Results

  1. 1
    374728

    Basic newborn resuscitation: highlights from the World Health Organization 2012 guidelines.

    Maternal and Child Survival Program [MCSP]

    [Washington, D.C.], MCSP, 2017 Jun. 5 p. (USAID Cooperative Agreement No. AID-OAA-A-14-00028)

    This brief complements the 2012 WHO Guidelines on Basic Newborn Resuscitation, and highlights key changes and best practices for newborn resuscitation in resource-limited settings. Successful implementation of these recommendations at the time of birth is intended to improve the quality of care for newborns, and contribute to better health outcomes and reduce preventable newborn deaths and disabilities due to birth asphyxia.
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  2. 2
    388097
    Peer Reviewed

    Signs of eclampsia during singleton deliveries and early neonatal mortality in low- and middle-income countries from three WHO regions.

    Bellizzi S; Sobel HL; Ali MM

    International Journal of Gynaecology and Obstetrics. 2017 Oct; 139(1):50-54.

    OBJECTIVE: To determine the prevalence of eclampsia symptoms and to explore associations between eclampsia and early neonatal mortality. METHODS: The present secondary analysis included Demographic and Health Surveys data from 2005 to 2012; details of signs related to severe obstetric adverse events of singleton deliveries during interviewees' most recent delivery in the preceding 5 years were included. Data and delivery history were merged for pooled analyses. Convulsions-used as an indicator for having experienced eclampsia-and early neonatal mortality rates were compared, and a generalized random effect model, adjusted for heterogeneity between and within countries, was used to investigate the impact of presumed eclampsia on early neonatal mortality. RESULTS: The merged dataset included data from six surveys and 55 384 live deliveries that occurred in Colombia, Bangladesh, Indonesia, Mali, Niger, and Peru. Indications of eclampsia were recorded for 1.2% (95% confidence interval [CI] 1.0-1.3), 1.7% (95% CI 1.5-2.1), and 1.7% (95% CI 1.5-2.1) of deliveries reported from the American, South East Asian, and African regions, respectively. Pooled analyses demonstrated that eclampsia was associated with increased risk of early neonatal mortality (adjusted risk ratio 2.1 95% CI 1.4-3.2). CONCLUSION: Increased risk of early neonatal mortality indicates a need for strategies targeting the early detection of eclampsia and early interventions. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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  3. 3
    377434

    Validation of maternal and neonatal tetanus elimination in Equatorial Guinea, 2016. alidation de l'elimination du tetanos maternel et neonatal en Guinee equatoriale, 2016.

    Releve Epidemiologique Hebdomadaire. 2017 Jun 16; 92(24):333-44.

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  4. 4
    372966

    MDGs 4 and 5: maternal and child health/reproductive health in LAC.

    Gordillo-Tobar A

    [Washington, D.C.], World Bank, 2012 Jun. 4 p. (en breve No. 177)

    The Latin America and Caribbean (LAC) region fares well on achievement of the MDG targets when compared with other regions, but the region has great disparities between and within countries on these goals. The region is also performing better than the rest of the developing world in relation to child mortality, having achieved more than 70% of the progress needed to reduce under-five mortality by two-thirds. However, LAC still faces serious challenges regarding maternal mortality, achieving good public and individual health and alleviating poverty. For LAC, the MDGs are a historic opportunity to address all forms of inequality and attain the political will needed to achieve these goals. (excerpt)
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  5. 5
    372965

    Maintaining momentum to 2015? an impact evaluation of interventions to improve maternal and child health and nutrition in Bangladesh.

    World Bank. Operations Evaluation Department

    Washington, D.C., World Bank, 2005 Aug. [248] p. (World Bank Report No. 34462)

    Improving maternal and child health and nutrition is central to development goals. The importance of these objectives is reflected by their inclusion in poverty-reduction targets such as the Millennium Development Goals (MDGs) and Bangladesh’s Interim Poverty Reduction Strategy Paper, supported by major development partners, including the World Bank and the U.K. Department for International Development (DFID). This report addresses the issue of what publicly supported programs and external assistance from the Bank and other agencies can do to accelerate attainment of such targets as reducing infant mortality by two-thirds. The evidence presented here relates to Bangladesh, a country that has made spectacular progress, but needs to maintain momentum in order to achieve its own poverty-reduction goals. The report addresses the following issues: (1) What has happened to child health and nutrition outcomes and fertility in Bangladesh since 1990? Are the poor sharing in the progress being made? (2) What have been the main determinants of maternal and child health (MCH) outcomes in Bangladesh over this period? (3) Given these determinants, what can be said about the impact of publicly and externally supported programs—notably those of the World Bank and DFID—to improve health and nutrition? (4) To the extent that interventions have brought about positive impacts, have they done so in a cost-effective manner? (excerpt)
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  6. 6
    369352
    Peer Reviewed

    WHO calls for efforts to prevent newborn deaths in South East Asia.

    Travasso C

    BMJ. 2016; 352:i8.

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  7. 7
    368337

    Levels and trends in child mortality. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation (IGME). Report 2015.

    You D; Hug L; Ejdemyr S; Beise J

    New York, New York, United Nations Children's Fund [UNICEF], 2015. 36 p.

    Child mortality is a core indicator for child health and well-being. In 2000, world leaders agreed on the Millennium Development Goals (MDGs) and called for reducing the under-five mortality rate by two thirds between 1990 and 2015 - known as the MDG 4 target. In recent years, the Global Strategy for Women's and Children’s Health launched by United Nations Secretary- General Ban Ki-moon and the Every WomanEvery Child movement boosted global momentum in improving newborn and child survival as well as maternal health. In June 2012, world leaders renewed their commitment during the global launch of Committing to Child Survival: A Promise Renewed, aiming for a continued post-2015 focus to end preventable child deaths. With the end of the MDG era, the international community is in the process of agreeing on a new framework - the Sustainable Development Goals (SDGs). The proposed SDG target for child mortality represents a renewed commitment to the world's children: By 2030, end preventable deathsof newborns and children under five years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-five mortality to at least as low as 25 deaths per 1,000 live births.
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  8. 8
    386812
    Peer Reviewed

    Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America.

    Ye J; Torloni MR; Ota E; Jayaratne K; Pileggi-Castro C; Ortiz-Panozo E; Lumbiganon P; Morisaki N; Laopaiboon M; Mori R; Tuncalp O; Fang F; Yu H; Souza JP; Vogel JP; Zhang J

    BMC Pregnancy and Childbirth. 2015; 15(1):324.

    BACKGROUND: No consensus definition of macrosomia currently exists among researchers and obstetricians. We aimed to identify a definition of macrosomia that is more predictive of maternal and perinatal mortality and morbidity in low- and middle-income countries. METHODS: We conducted a secondary data analysis using WHO Global Survey on Maternal and Perinatal Health data on Africa and Latin America from 2004 to 2005 and Asia from 2007 to 2008. We compared adverse outcomes, which were assessed by the composite maternal mortality and morbidity index (MMMI) and perinatal mortality and morbidity index (PMMI) in subgroups with birthweight (3000-3499 g [reference group], 3500-3999 g, 4000-4099 g, 4100-4199 g, 4200-4299 g, 4300-4399 g, 4400-4499 g, 4500-4999 g) or country-specific birthweight percentile for gestational age (50(th)-74(th) percentile [reference group], 75(th)-89(th), 90(th)-94(th), 95(th)-96(th), and >/=97(th) percentile). Two-level logistic regression models were used to estimate odds ratios of MMMI and PMMI. RESULTS: A total of 246,659 singleton term births from 363 facilities in 23 low- and middle-income countries were included. Adjusted odds ratios (aORs) for intrapartum caesarean sections exceeded 2.0 when birthweight was greater than 4000 g (2 . 00 [95 % CI: 1 . 68, 2 . 39], 2 . 42 [95 % CI: 2 . 02, 2 . 89], 2 . 01 [95 % CI: 1 . 74, 2 . 33] in Africa, Asia and Latin America, respectively). aORs of MMMI reached 2.0 when birthweight was greater than 4000 g, 4500 g in Asia and Africa, respectively. aORs of PMMI approached to 2.0 (1 . 78 [95 % CI: 1 . 16, 2 . 74]) when birthweight was greater than 4500 g in Latin America. When birthweight was at the 90(th) percentile or higher, aORs of MMMI and PMMI increased, but none exceeded 2.0. CONCLUSIONS: The population-specific definition of macrosomia using birthweight cut-off points irrespective of gestational age (4500 g in Africa and Latin America, 4000 g in Asia) is more predictive of maternal and perinatal adverse outcomes, and simpler to apply compared to the definition based on birthweight percentile for a given gestational age.
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  9. 9
    381666
    Peer Reviewed

    Quality maternal and newborn care to ensure a healthy start for every newborn in the World Health Organization Western Pacific Region.

    Obara H; Sobel H

    BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Sep; 121 Suppl 4:154-9.

    In the World Health Organization Western Pacific Region, the high rates of births attended by skilled health personnel (SHP) do not equal access to quality maternal or newborn care. 'A healthy start for every newborn' for 23 million annual births in the region means that SHP and newborn care providers give quality intrapartum, postpartum and newborn care. WHO and the UNICEF Regional Action Plan for Healthy Newborn Infants provide a platform for countries to scale-up Early Essential Newborn Care (EENC). The plan emphasises the creation of an enabling environment for the practice of EENC; thereby, preventing 50,000 newborn deaths annually. (c) 2014 Royal College of Obstetricians and Gynaecologists.
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  10. 10
    335903

    Every Newborn: an action plan to end preventable deaths.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 2014. [58] p.

    The action plan sets out a vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential. Nearly 3 million lives could be saved each year if the actions in the plan are implemented and its goals and targets achieved. Based on evidence of what works, and developed within the framework for Every Woman Every Child, the plan enhances and supports coordinated, comprehensive planning and implementation of newborn-specific actions within the context of national reproductive, maternal, newborn, child and adolescent health strategies and action plans, and in collaboration with stakeholders from the private sector, civil society, professional associations and others. The goal is to achieve equitable and high-quality coverage of care for all women and newborns through links with other global and national plans, measurement and accountability.
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  11. 11
    365577
    Peer Reviewed

    Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study.

    Ganchimeg T; Ota E; Morisaki N; Laopaiboon M; Lumbiganon P; Zhang J; Yamdamsuren B; Temmerman M; Say L; Tuncalp O; Vogel JP; Souza JP; Mori R

    BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Mar; 121 Suppl 1:40-8.

    OBJECTIVE: To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. DESIGN: Secondary analysis using facility-based cross-sectional data of the World Health Organization Multicountry Survey on Maternal and Newborn Health. SETTING: Twenty-nine countries in Africa, Latin America, Asia and the Middle East. POPULATION: Women admitted for delivery in 359 health facilities during 2-4 months between 2010 and 2011. METHODS: Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes. MAIN OUTCOME MEASURES: Risk of adverse pregnancy outcomes among adolescent mothers. RESULTS: A total of 124 446 mothers aged
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  12. 12
    365574
    Peer Reviewed

    Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

    Vogel JP; Souza JP; Mori R; Morisaki N; Lumbiganon P; Laopaiboon M; Ortiz-Panozo E; Hernandez B; Perez-Cuevas R; Roy M; Mittal S; Cecatti JG; Tuncalp O; Gulmezoglu AM

    BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Mar; 121 Suppl 1:76-88.

    OBJECTIVE: We aimed to determine the prevalence and risks of late fetal deaths (LFDs) and early neonatal deaths (ENDs) in women with medical and obstetric complications. DESIGN: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS). SETTING: A total of 359 participating facilities in 29 countries. POPULATION: A total of 308 392 singleton deliveries. METHODS: We reported on perinatal indicators and determined risks of perinatal death in the presence of severe maternal complications (haemorrhagic, infectious, and hypertensive disorders, and other medical conditions). MAIN OUTCOME MEASURES: Fresh and macerated LFDs (defined as stillbirths >/= 1000 g and/or >/=28 weeks of gestation) and ENDs. RESULTS: The LFD rate was 17.7 per 1000 births; 64.8% were fresh stillbirths. The END rate was 8.4 per 1000 liveborns; 67.1% occurred by day 3 of life. Maternal complications were present in 22.9, 27.7, and 21.2% [corrected] of macerated LFDs, fresh LFDs, and ENDs, respectively. The risks of all three perinatal mortality outcomes were significantly increased with placental abruption, ruptured uterus, systemic infections/sepsis, pre-eclampsia, eclampsia, and severe anaemia. CONCLUSIONS: Preventing intrapartum-related perinatal deaths requires a comprehensive approach to quality intrapartum care, beyond the provision of caesarean section. Early identification and management of women with complications could improve maternal and perinatal outcomes. (c) 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
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  13. 13
    365573
    Peer Reviewed

    Mode and timing of twin delivery and perinatal outcomes in low- and middle-income countries: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health.

    Ganchimeg T; Morisaki N; Vogel JP; Cecatti JG; Barrett J; Jayaratne K; Mittal S; Ortiz-Panozo E; Souza JP; Crowther C; Ota E; Mori R

    BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Mar; 121 Suppl 1:89-100.

    OBJECTIVE: To describe the mode and timing of delivery of twin pregnancies at >/=34 weeks of gestation and their association with perinatal outcomes. DESIGN: Secondary analysis of a cross-sectional study. POPULATION: Twin deliveries at >/=34 weeks of gestation from 21 low- and middle-income countries participating in the WHO Multicountry Survey on Maternal and Newborn Health. METHODS: Descriptive analysis and effect estimates using multilevel logistic regression. MAIN OUTCOME MEASURES: Stillbirth, perinatal mortality, and neonatal near miss (use of selected life saving interventions at birth). RESULTS: The average length of gestation at delivery was 37.6 weeks. Of all twin deliveries, 16.8 and 17.6% were delivered by caesarean section before and after the onset of labour, respectively. Prelabour caesarean delivery was associated with older maternal age, higher institutional capacity and wealth of the country. Compared with spontaneous vaginal delivery, lower risks of neonatal near miss (adjusted odds ratio, aOR, 0.63; 95% confidence interval, 95% CI, 0.44-0.94) were found among prelabour caesarean deliveries. A lower risk of early neonatal mortality (aOR 0.12; 95% CI 0.02-0.56) was also observed among prelabour caesarean deliveries with nonvertex presentation of the first twin. The week of gestation with the lowest rate of prospective fetal death varied by fetal presentation: 37 weeks for vertex-vertex; 39 weeks for vertex-nonvertex; and 38 weeks for a nonvertex first twin. CONCLUSIONS: The prelabour caesarean delivery rate among twins varied largely between countries, probably as a result of overuse of caesarean delivery in wealthier countries and limited access to caesarean delivery in low-income countries. Prelabour delivery may be beneficial when the first twin is nonvertex. International guidelines for optimal twin delivery methods are needed. (c) 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
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  14. 14
    365572
    Peer Reviewed

    Development of criteria for identifying neonatal near-miss cases: analysis of two WHO multicountry cross-sectional studies.

    Pileggi-Castro C; Camelo JS Jr; Perdona GC; Mussi-Pinhata MM; Cecatti JG; Mori R; Morisaki N; Yunis K; Vogel JP; Tuncalp O; Souza JP

    BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Mar; 121 Suppl 1:110-8.

    OBJECTIVE: To develop and test markers of neonatal severe morbidity for the identification of neonatal near-miss cases. DESIGN: This is a database analysis of two World Health Organization cross-sectional studies: the Global Survey on Maternal and Perinatal Health (WHOGS) and the Multicountry Survey on Maternal and Newborn Health (WHOMCS). SETTING: The WHOGS was performed in 373 health facilities in 24 countries (2004-2008). The WHOMCS was conducted in 359 health facilities in 29 countries (2010-2011). POPULATION: Data were collected from hospital records of all women admitted for delivery and their respective neonates. METHODS: Pragmatic markers (birthweight <1750 g, Apgar score at 5 minutes <7, and gestational age <33 weeks) were developed with WHOGS data and validated with WHOMCS data. The diagnostic accuracy of neonatal characteristics and management markers of severity was determined in the WHOMCS. RESULTS: This analysis included 290 610 liveborn neonates from WHOGS and 310 436 liveborn neonates from WHOMCS. The diagnostic accuracy of pragmatic and management markers of severity for identifying early neonatal deaths was very high: sensitivity, 92.8% (95% CI 91.8-93.7%); specificity, 92.7% (95% CI 92.6-92.8%); positive likelihood ratio, 12.7 (95% CI 12.5-12.9); negative likelihood ratio, 0.08 (95% CI 0.07-0.09); diagnostic odds ratio, 163.4 (95% CI 141.6-188.4). A positive association was found between the frequency of neonatal near-miss cases and Human Development Index. CONCLUSION: Newborn infants presenting selected markers of severity and surviving the first neonatal week could be considered as neonatal near-miss cases. This definition and criteria may be seen as a basis for future applications of the near-miss concept in neonatal health. These tools can be used to inform policy makers on how best to apply scarce resources for improving the quality of care and reducing neonatal mortality. (c) 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
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  15. 15
    335863

    Every Newborn: An action plan to end preventable deaths. Executive summary.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 2014. [16] p.

    The action plan sets out a vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential. Nearly 3 million lives could be saved each year if the actions in the plan are implemented and its goals and targets achieved. Based on evidence of what works, and developed within the framework for Every Woman Every Child, the plan enhances and supports coordinated, comprehensive planning and implementation of newborn-specific actions within the context of national reproductive, maternal, newborn, child and adolescent health strategies and action plans, and in collaboration with stakeholders from the private sector, civil society, professional associations and others. The goal is to achieve equitable and high-quality coverage of care for all women and newborns through links with other global and national plans, measurement and accountability. Strategic objectives and targets to achieve the goal of ending preventable maternal deaths have also been prepared. The objectives are complementary to those of the Every Newborn action plan and intended for coordinated implementation.
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  16. 16
    359699
    Peer Reviewed

    Generating political priority for neonatal mortality reduction in Bangladesh.

    Shiffman J; Sultana S

    American Journal of Public Health. 2013 Apr; 103(4):623-31.

    The low priority that most low-income countries give to neonatal mortality, which now constitutes more than 40% of deaths to children younger than 5 years, is a stumbling block to the world achieving the child survival Millennium Development Goal. Bangladesh is an exception to this inattention. Between 2000 and 2011, newborn survival emerged from obscurity to relative prominence on the government's health policy agenda. Drawing on a public policy framework, we analyzed how this attention emerged. Critical factors included national advocacy, government commitment to the Millennium Development Goals, and donor resources. The emergence of policy attention involved interactions between global and national factors rather than either alone. The case offers guidance on generating priority for neglected health problems in low-income countries.
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  17. 17
    348960
    Peer Reviewed

    Don't forget family planning.

    Gillespie D

    Lancet. 2011 Jul 2; 378(9785):29.

    This letter stresses the importance of contraceptives as a proven, cost-effective way to reduce mortality substantially and is shocked by the absence of contraceptives on the "first ever priority medicines list" to save the lives of mothers and children launched by WHO, UNICEF, and UNFPA.
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  18. 18
    348853
    Peer Reviewed

    Prenatal care associated with reduction of neonatal mortality in Sub-Saharan Africa: evidence from Demographic and Health Surveys.

    McCurdy RJ; Kjerulff KH; Zhu J

    Acta Obstetricia et Gynecologica Scandinavica. 2011 Jul; 90(7):779-90.

    OBJECTIVE: To determine whether prenatal care by a skilled provider (physician, nurse or midwife) and specific prenatal interventions were associated with decreased neonatal mortality. DESIGN: Mothers' reports in nationally representative surveys (conducted 2003-2009) about their most recent delivery were analyzed. Setting. Sub-Saharan Africa, 17 least developed countries (UN designation). POPULATION: 89 655 women aged 15-49 years with a singleton birth within 3 years prior to survey. Methods. Logistic regression models were used to measure the associations between having a skilled prenatal provider, as well as specific interventions, and neonatal mortality. MAIN OUTCOME MEASURES: Neonatal mortality, defined as a live birth ending in death at less than one month of age. RESULTS: Overall, 70.7% of women saw a skilled prenatal provider during their previous pregnancy. Prenatal care from a skilled provider was associated with a decreased neonatal mortality risk compared with no provider [adjusted odds ratio (AOR) 0.70, 95% confidence interval (CI) 0.62-0.80] and compared with an unskilled provider (AOR 0.81, 95% CI 0.68-0.96). The most effective prenatal interventions were weight (AOR 0.71, 95% CI 0.64-0.80) and blood pressure measurements (AOR 0.77, 95% CI 0.69-0.86), and two or more tetanus immunizations (AOR 0.78, 95% CI 0.70-0.86). Four or more prenatal visits compared with none were associated with decreased neonatal mortality risk (AOR 0.68, 95% CI 0.59-0.79). CONCLUSIONS: Prenatal care provided by skilled providers, at least four prenatal visits, weight and blood pressure assessment, and two or more tetanus immunizations were associated with decreased neonatal mortality in Sub-Saharan African countries. (c) 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica(c) 2011 Nordic Federation of Societies of Obstetrics and Gynecology.
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  19. 19
    331966

    Home visits for the newborn child: a strategy to improve survival. WHO / UNICEF joint statement.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 2009. 7 p. (WHO/FCH/CAH/09.02)

    This new statement provides critical new guidance to governments, USAID missions, UN agencies, non-governmental organizations (NGOs) and other development partners on prevention and management approaches that can be delivered through home visits in the baby’s first week of life. Of the estimated 8.8 million children under 5 that die each year – 3.7 million are newborn infants who die within the first four weeks after birth. Up to two-thirds of these deaths can be prevented through existing effective interventions delivered during pregnancy, childbirth and in the first hours, days and week after birth. A growing body of knowledge has shown that home visits by appropriately trained workers to provide newborn care can significantly reduce neonatal mortality even where health systems are weak. WHO and UNICEF therefore recommend home visits for the care of the newborn child in the first week of life (within 24 hours, on the third day and, if possible, on the seventh day of life) as a complementary strategy to facility-based postnatal care in order to improve newborn survival.
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  20. 20
    340233

    Effect of WHO Newborn Care Training on neonatal mortality by education.

    Chomba E; McClure EM; Wright LL; Carlo WA; Chakraborty H

    Ambulatory Pediatrics. 2008 Sep-Oct; 8(5):300-304.

    Background.-Ninety-nine percent of the 4 million neonatal deaths per year occur in developing countries. The World Health Organization (WHO) Essential Newborn Care (ENC) course sets the minimum accepted standard for training midwives on aspects of infant care (neonatal resuscitation, breastfeeding, kangaroo care, small baby care, and thermoregulation), many of which are provided by the mother. Objective.-The aim of this study was to determine the association of ENC with all-cause 7-day (early) neonatal mortality among infants of less educated mothers compared with those of mothers with more education. Methods.-Protocol- and ENC-certified research nurses trained all 123 college-educated midwives from 18 low-risk, first-level urban community health centers (Zambia) in data collection (1 week) and ENC (1 week) as part of a controlled study to test the clinical impact of ENC implementation. The mothers were categorized into 2 groups, those who had completed 7 years of school education (primary education) and those with 8 or more years of education. Results.-ENC training is associated with decreases in early neonatal mortality; rates decreased from 11.2 per 1000 live births pre- ENC to 6.2 per 1000 following ENC implementation (P <.001). Prenatal care, birth weight, race, and gender did not differ between the groups. Mortality for infants of mothers with 7 years of education decreased from 12.4 to 6.0 per 1000 (P < .0001) but did not change significantly for those with 8 or more years of education (8.7 to 6.3 per 1000, P ¼.14). Conclusions.-ENC training decreases early neonatal mortality, and the impact is larger in infants of mothers without secondary education. The impact of ENC may be optimized by training health care workers who treat women with less formal education.
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  21. 21
    328891
    Peer Reviewed

    Child health and mortality.

    El Arifeen S

    Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):273-9.

    Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality.
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  22. 22
    323254

    Newborn survival.

    Lawn JE; Zupan J; Begkoyian G; Knippenberg R

    In: Disease control priorities in developing countries. 2nd ed., edited by Dean T. Jamison, Joel G. Breman, Anthony R. Measham, George Alleyne, Mariam Claeson et al. Washington, D.C., World Bank, 2006. 531-549.

    This chapter provides an overview of neonatal deaths, presenting the epidemiology as a basis for program priorities and summarizing the evidence for interventions within a health systems framework, providing cost and impact estimates for packages that are feasible for universal scale-up. The focus of the chapter is restricted to interventions during the neonatal period. The priority interventions identified here are largely well known, yet global coverage is extremely low. The chapter concludes with a discussion of implementation in country programs with examples of scaling up, highlighting gaps in knowledge. (excerpt)
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  23. 23
    321236
    Peer Reviewed

    Poverty and neonatal outcomes: How nurses around the world can make a difference.

    Kenner C; Sugrue NM; Finkelman A

    Nursing for Women's Health. 2007 Oct-Nov; 11(5):468-473.

    The United Nations (UN) adopted a set of Millennium Development Goals (MDGs), which are aimed at obliterating some of the worst health and social welfare inequities in the world. Significantly, reducing childhood mortality is one of the most important goals, making neonatal nursing care one of today's most important global health policy issues. Determining the adequate numbers of neonatal nurses required and ascertaining the most appropriate training and education levels are central to the international health care agenda. Over the past decade, neonatal nurses from around the globe have expressed an interest in forming an international council of neonatal nurses. The impetus for wanting this group is the need for access to curriculum, research, continuing education, consulting experts and patient information. Globally, neonatal nurses recognize the need for continuous education and training as well as access to research in a field with an ever-changing and growing knowledge base. The demand is fora group devoted to improving the care and lives of infants, most especially neonates. Focus on neonates is essential because approximately 40 percent of the mortality for children under the age of 5 years occurs in the first 28 days of life. (excerpt)
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  24. 24
    320242

    Workshop on Gender and Rights in Reproductive and Maternal Health, convened by World Health Organization, Regional Office for the Western Pacific, Kuala Lumpur, Malaysia, 28 November - 2 December 2005. Report.

    World Health Organization [WHO]. Regional Office for the Western Pacific

    Manila, Philippines. WHO, Regional Office for the Western Pacific, 2006 Mar. 40 p. ((WP)RPH/ICP/RPH/3.4/001/RPH(3)/2005-E; Report Series No. RS/2005/GE/43(MAA))

    More than a decade after the International Conference on Population and Development (ICPD) in 1994 and the Fourth World Conference on Women in 1995, governments are expressing their commitment to women's health, in particular to sexual and reproductive health. Unfortunately, high maternal and neonatal mortality remains a feature in many countries in the Western Pacific Region. The complex issues of reproductive and maternal health extend beyond technical and medical factors. Social determinants, such as gender and rights, though recognized as important factors in maternal mortality and morbidity, have not been considered in health services planning, perhaps because of a lack of understanding and inadequate capacity to operationalize the concepts. To achieve the Millennium Development Goals (MDG), it is essential that the gender and rights dimensions are fully understood and mainstreamed in policy, programmes and services. Recognizing the urgency of the situation, the WHO Western Pacific Regional Office decided to organize a workshop in collaboration with the Ministry of Health Malaysia as the host in Kuala Lumpur from 28 November to 2 December 2005. The Workshop on Gender and Rights in Reproductive and Maternal Health was the first ever organized by the Regional Office. Unlike other workshops, this was a training workshop aimed at introducing Concepts as well as some basics kills and tools to enable participants to bring a gender and rights perspective in to their programme services. (excerpt)
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  25. 25
    314889

    The costs of maternal-newborn illness and mortality.

    Islam MK; Gerdtham UG

    Geneva, Switzerland, World Health Organization [WHO], 2006. 37 p. (Moving Towards Universal Coverage. Issues in Maternal-Newborn Health and Poverty No. 2)

    The aim of this paper is to provide a systematic review of the estimation of the cost of illness (COI) related to maternal-newborn ill-health (MNIH). The methodology used for the review includes a systematic search on electronic databases for published literature and manual searches for the identification of grey (unpublished) literature. Searches are based on the major electronic databases and also on the home pages of some major international organizations. While the problems of MNIH are well known and the importance of conducting COI studies is understood, knowledge is still lacking about the magnitude of the costs of MNIH at the societal level. After a search of the existing electronic databases, only one published paper was found to be relevant for the review; four grey studies (using REDUCE Safe Motherhood model) were also directly relevant. The published study estimates most of the cost components associated with a particular complication of MNIH -- emergency obstetric care (EmOC) -- and reports a total average cost per user of EmOC in the range of US$ 177-369 in Bangladesh. The unpublished studies based on the REDUCE model illustrate the MNIH issue more directly and elaborately; however, they estimate merely the productivity cost for four African countries. The model estimates a huge amount of productivity losses associated with MNIH: an annual total of about US$ 95 million for Ethiopia and about US$ 85 million for Uganda. To formulate an idea of issues related to data, measurement and methodology the present study also reviews COI studies on other related diseases that are similar to those on MNIH. The review reveals some difficulties in measurement and proposes to incorporate some relevant cost components that MNIH cause society and also suggests probable data sources for COI studies of MNIH. Although it is evident that MNIH results in suffering for women and children and hinders economic development through its huge burden for society, in order to stimulate further policy debate regarding its significance future research efforts should be directed towards theoretically sound and comprehensive COI studies with use of longitudinal and experimental data. (author's)
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