Eliminating maternal and neonatal tetanus and closing the immunity gap

Burgess, Craig; Gasse, François; Steinglass, Robert; Yakubu, Ahmadu; Raza, Azhar Abid; Johansen, Kari

doi:10.1016/s0140-6736(17)30635-9

Cited by 23 publications

(30 citation statements)

References 5 publications

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“…21 Between 1999 and 2016, more than 150 million women received at least two doses of tetanus-containing vaccines through this initiative and supplementary vaccination programs. 22 As of March 2018, 45 of 59 countries have achieved elimination (less than 1 case per 1000 live births per year), with an estimated 96% reduction in tetanus-related neonatal deaths compared with the late 1980s. 22,23 Maternal influenza vaccination has been recommended in the United States (US) since the 1960s.…”

Section: Pathogen Specific Overviewmentioning

confidence: 99%

“…22 As of March 2018, 45 of 59 countries have achieved elimination (less than 1 case per 1000 live births per year), with an estimated 96% reduction in tetanus-related neonatal deaths compared with the late 1980s. 22,23 Maternal influenza vaccination has been recommended in the United States (US) since the 1960s. 24 Reports from the pandemic influenza in 2009 suggested that pregnant women were at higher risk of complications and adverse neonatal outcomes.…”

Section: Pathogen Specific Overviewmentioning

confidence: 99%

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Key considerations for successful implementation of maternal immunization programs in low and middle income countries

Krishnaswamy

Lambach

Giles

2019

Human Vaccines & Immunotherapeutics

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The Maternal Neonatal Tetanus Elimination program is proof of concept for the feasibility and potential for maternal immunization to reduce neonatal mortality particularly in low and middle-income countries. Introduction of any additional vaccine into the antenatal space, such as Influenza and Pertussis, and potentially Respiratory Syncytial Virus and Group B Streptococcus vaccines in the future, requires strengthening of antenatal care and immunization services. Successful implementation also requires robust disease surveillance in pregnant women and neonates and active surveillance for adverse events following immunization to monitor the impact and ensure the safe use of the vaccine. This review outlines five key elements essential for successful implementation of a maternal immunization program focusing particularly on low and middle-income countries. These include; relevant considerations in supporting a decision to undertake a maternal immunization program including knowledge of local disease epidemiology, involvement of the consumer, healthcare provider recommendation, equitable access to maternal vaccination, and systems for disease surveillance, program evaluation and safety monitoring.

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Section: Pathogen Specific Overviewmentioning

confidence: 99%

Section: Pathogen Specific Overviewmentioning

confidence: 99%

Key considerations for successful implementation of maternal immunization programs in low and middle income countries

Krishnaswamy

Lambach

Giles

2019

Human Vaccines & Immunotherapeutics

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“…The majority of these deaths occur in low-and middle-income countries, particularly in sub-Saharan Africa (sSA). Recent projections indicate that achievement of child-related sustainable development goals (SDGs) may be di cult, especially in sSA, if the current mortality trend continues (4)(5)(6). According to the World Data Atlas, Ethiopia records the highest neonatal mortality rate (29 deaths/1000 live births) with a slower rate of decline (41%) than infant, child and under ve mortality declines (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo Zone, Northeast Ethiopia.  

Tessema

Gebeyehu

Mekonnen

et al. 2020

Preprint

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Background: Home and community-based implementation of focused antenatal care intervention packages have significantly reduced neonatal mortality particularly in resource constrained settings. However, due to evidence-practice gaps, thousands of neonates are still losing their lives every day mostly from preventable causes. This study aimed to assess focused antenatal care package intervention fidelity and its determinant factors in South Wollo Zone, Northeast Ethiopia. Methods: A cross-sectional study design was employed and a total of 898 women who gave birth in the last six months prior to data collection were included. Also 16 health extension workers working in health posts and 10 health posts for facility audits were included. Interviews and self-administered questionnaires were used to collect data from mothers and health extension workers. Facility audits were used to assess availability and functionality of drugs and supplies in the health posts to provide focused antenatal care. Mothers were asked whether or not the required level of care was provided. Health extension workers were provided self-administered questionnaires to assess socio-demographic characteristics, reception of training, facilitation strategies and ability to classify danger signs. Multilevel linear regression analysis was performed to identify individual and organizational levels factors influencing focused antenatal care package intervention fidelity. Results: Overall weighted average focused antenatal care package intervention fidelity (implemented as intended/planned) was 49.8% (95% CI: 47.7 – 51.8); of which 55.1% was implemented by health extension workers and 44.9% by skilled providers (nurses, midwives, health officers or medical doctors). Overall antenatal care coverage, irrespective of frequency, was 83.7% (95% CI: 81.3–86.1); 35.0% (95% CI: of 31.6 – 38.4) of them received at least four antenatal visits and 46 (6.1%, 95% CI: 4.4 - 7.8) received all recommended components of focused antenatal care. Previous pregnancy-related medical problems, paternal education, and implementation of supportive/facilitation strategies were found to be significant factors enhancing focused antenatal care package intervention fidelity.Conclusion: Focused antenatal care package intervention fidelity in the study area was low; this may imply that stagnation of neonatal mortality reduction might be partly due to the low level of focused antenatal care fidelity. Improving implementation of facilitation strategies is highly required to contribute in neonatal mortality reduction.

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“…Majority of these newborn deaths occur in low and middle income countries especially in sub-Saharan Africa. Projections indicate that achievement of child related sustainable development goal will be difficult especially in sub-Saharan Africa if the current mortality trend continues (5)(6)(7). According to world data atlas, Ethiopia is among the top countries with highest neonatal mortality rate (29deaths/1000 live births) with a slower rate of decline (41%) since 2000 (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo, Northeast Ethiopia

Tessema

Gebeyehu²,

Mekonnen

et al. 2020

Preprint

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Background: Evidences show that intervention packages at home-community setting are found to reduce neonatal mortality significantly. But millions of neonates are still dying by preventable causes with the implementation of these effective interventions. This might be due to evidence-practice gap.Therefore, this study aimed at assessing the intervention fidelity and factors influencing focused antenatal care package.Methods:Cross-sectional study design was employed in this study. In the selected kebeles', a total of 898 mothers who gave birth within six months before data collection, ten health posts with their health extension workers were employed. Interview-administered, self-administered and facility audit checklist were used for collecting data from all mothers, health extension workers and health posts respectively. Mothers were asked whether or not the required level of care were provided to them.Health extension workers & health posts were assessed for the competency and organizational drivers. Multilevel linear regression model were used to identify the possible moderating factors at individual and organizational level for intervention fidelity.Result: The overall weighted average focused antenatal care package intervention fidelity was 49.78% (95% CI: 47.73 -51.83). The weighted average focused antenatal care package intervention fidelity by health extension workers was 62.02% (95% CI: 59.71 -64.32) and skilled providers were 56.57% (95% CI: 53.94 -59.19). The overall antenatal care coverage were 83.7% (95% CI: 81.28 -86.12) with 34.97% (95% CI: of 31.56 -38.39) of mothers received at least four antenatal visit and 6.12% (95% CI: 4.40-7.83) of them received all the recommended components of focused antenatal care. Previous maternal problem, paternal education and implementation of supportive/facilitation strategy were significant facilitators for focused antenatal care package intervention fidelity.Conclusion: In this study, focused antenatal care package intervention fidelity was low. This implies that the stagnation of neonatal mortality reduction might be partly due to the low focused antenatal care packages intervention fidelity. Paternal education and implementation of supportive/facilitation strategies were statistically significant facilitators of focused antenatal care intervention package fidelity. Therefore, improvement of implementation of facilitation strategy is recommended. Contribution To The LiteratureThis study tries to compute complex public health intervention fidelity as a composite variable (composite indexing) using the concepts of weighting and conditional probability.The hierarchical or nested nature of intervention customers from the health institutions or health care providers were treated properly using multilevel statistical technique.The effect of facilitation/supporting strategy to the complex public health intervention fidelity was statistically quantified or measured.

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Eliminating maternal and neonatal tetanus and closing the immunity gap

Cited by 23 publications

References 5 publications

Key considerations for successful implementation of maternal immunization programs in low and middle income countries

Key considerations for successful implementation of maternal immunization programs in low and middle income countries

Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo Zone, Northeast Ethiopia.

Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo, Northeast Ethiopia

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Eliminating maternal and neonatal tetanus and closing the immunity gap

Cited by 23 publications

References 5 publications

Key considerations for successful implementation of maternal immunization programs in low and middle income countries

Key considerations for successful implementation of maternal immunization programs in low and middle income countries

Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo Zone, Northeast Ethiopia.&nbsp;&nbsp;

Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo, Northeast Ethiopia

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Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo Zone, Northeast Ethiopia.