Transformative Innovations in Reproductive, Maternal, Newborn, and Child Health over the Next 20 Years

Engmann, Cyril; Khan, Sadaf; Moyer, Cheryl A.; Coffey, Patricia S.; Bhutta, Zulfiqar A

doi:10.1371/journal.pmed.1001969

Cited by 25 publications

(23 citation statements)

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“… 40 The simultaneous focus of the Millennium Development Goals on maternal and child mortality appears to have led to closer association between them since 2000 via alignment of funding streams, targeting of common risk factors between mothers and their children, an increased focus on delaying the age of parenthood by increasing education, contraception, and increased birth spacing, and catalyzing improved gender equity. 41 , 42 , 43 , 44 , 45 , 46 , 47 There are strong ties between the physical health of women (eg, high body mass index, NCDs, nutrition) and neonatal outcomes (such as pregnancy complications, short gestational age, and low birth weight), which are in turn linked with poorer health outcomes and delayed development. 3 , 6 This is to say nothing of the potential epigenetic connections between mothers and the health of their children that have the potential to extend beyond the neonatal period into childhood, adolescence, adulthood, and the next generation.…”

Section: Discussionmentioning

confidence: 99%

Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017

Child¹,

et al. 2019

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Key Points Question How have the levels, trends, and leading causes of child and adolescent mortality and nonfatal health loss changed from 1990 to 2017? Findings This study found that child and adolescent mortality decreased throughout the world from 1990 to 2017, but morbidity has increased as a proportion of total disease burden, because the major causes of nonfatal health loss during childhood and adolescence have not changed dramatically. Meaning As the global health community continues to prioritize child and adolescent health during the Sustainable Development Goal era, careful attention should also be placed on examining and addressing nonfatal illness and disability across the development spectrum.

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Section: Discussionmentioning

confidence: 99%

Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017

Child¹,

et al. 2019

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“…Key strategies to facilitate access to testing identified from the survey were: awareness raising about viral hepatitis among the general population; decentralization of hepatitis testing with quality assurance on laboratory tests, and expanding access to technologies such as point of care NAT such as GeneXpert, dried blood spots sampling, use of oral RDT and self-testing; improving the training and capacity of staff in management of hepatitis; and incorporation of hepatitis testing and treatment into national health reimbursement programmes. Other diagnostic innovations to promote testing include multi-analyte testing, multiplex analysis or multi platforms for testing combined with syphilis [ 3 , 89 , 90 ]. Dried blood spot sampling may enhance access to both serological (using laboratory based EIA assays) and virological (using nucleic acid tests) testing [ 91 ].…”

Section: Discussionmentioning

confidence: 99%

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries

et al. 2017

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BackgroundThere have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatitis testing guidance and in particular the feasibility of proposed recommendations, we undertook a survey across a range of organisations engaged with hepatitis testing in low- and middle-income countries (LMICs). Our objective was to describe current hepatitis B and C testing practices across a range of settings in different countries, as well as key barriers or challenges encountered and proposed solutions to promote testing scale-up.MethodsHepatitis testing programmes in predominantly LMICs were identified from the WHO Global Hepatitis Programme contacts database and through WHO regional offices, and invited to participate. The survey comprised a six-part structured questionnaire: general programme information, description of hepatitis testing, treatment and care services, budget and funding, data on programme outcomes, and perceptions on key barriers encountered and strategies to address these.ResultsWe interviewed 22 viral hepatitis testing programmes from 19 different countries. Nine were from the African region; 6 from the Western Pacific; 4 from South-East Asia; and 3 from Eastern Europe. All but four of the programmes were based in LMICs, and 10 (45.5%) were supported by non-governmental or international organizations. All but two programmes undertook targeted testing of specific affected populations such as people living with HIV, people who inject drugs, sex workers, health care workers, and pregnant women. Only two programmes focussed on routine testing in the general population. The majority of programmes were testing in hospital-based or other health facilities, particularly HIV clinics, and community-based testing was limited. Nucleic acid testing (NAT) for confirmation of HCV and HBV viraemia was available in only 30% and 18% of programmes, respectively. Around a third of programmes required some patient co-payment for diagnosis. The most commonly identified challenges in scale-up of hepatitis testing were: limited community awareness about viral hepatitis; lack of facilities or services for hepatitis testing; no access to low cost treatment, particularly for HCV; absence of national guidance and policies; no dedicated budget for hepatitis; and lack of trained health care and laboratory workers.ConclusionsAt this early stage in the global scale-up of testing for viral hepatitis, there is a wide variation in testing practices and approaches across different programmes. There remains limited access to NAT to confirm viraemia, and patient self-payment for testing and treatment is common. There was consensus from implementing organizations that scale-up of testing will require increased community awareness, health care worker training, development of national strategies and guidelines, and improved access to low cost NAT virological testing.Electronic supplementary materialThe online ver...

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“…These findings, though not directly covered during the interview, it might explain the preference for births to take place at home. 9 Traditional health beliefs of Ghanaian population may also play an important role in the selection of services related to pregnancy, 10 because they provide something that the formal services do not, which are valued by the mothers, such as Int J Med Res Prof.2016; 2(5); 75-79. www.ijmrp.com preference of birthing positions, hot baths after delivery among others. 11 Understanding these factors is critical to improving the accessibility and utilization of health care by adolescents during pregnancy and childbirth.…”

Section: Discussionmentioning

confidence: 99%

Exploring Factors Influencing Perinatal Outcomes among Adolescent Pregnancies in Northern Ghana-The Case of Kassena-Nankana Municipality in the Upper East Region

Laari¹,

Laar²

2016

IJMRP

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Introduction: It is estimated that about 11% of births worldwide are to adolescents aged 15-19 years, and more than 90% of these births occur in low and middle-income countries with an increased risk of adverse pregnancy outcomes such as perinatal mortality. Aims and Objectives: The purpose of the study was to explore the factors that influence perinatal outcomes in adolescent pregnancies. Materials and Methods: A facility-based cross-sectional study with 200 adolescent mothers who delivered. Multistage sampling method was used to select the facilities. Simple random sampling technique was used to select the participants at the facilities. The data were analysed using STATA version 11 software programme. Results: The majority of the participants (71%) were between 18-19 years. Perinatal mortality rate was 30 per 1000 births. The following were found to be associated with high perinatal mortality rate: gestational age less than 37 weeks, harmful traditional practices, mothers who never used family planning service. Also, mothers who consumed alcohol had a highest odds of 5.9 perinatal mortality compared to other predictors. The results also showed that women living in a rural area {OR=0.41, 95%CI (0.1-2.3)} and those delivering at home {OR=3.91, 95%CI (0.6-22.5} were more likely to experience adverse perinatal outcomes. Finally, perinatal mortality rate (33 per 1000 births) among the mothers aged between 15 and 17 years appears high compared to between 18 and 19 years category (28 per 1000 births). Conclusion: The results reported in this study indicate that mothers who engaged in harmful traditional practices, had less than 37weeks gestation, used alcohol during pregnancy and never used family planning services prior to their pregnancies had increased odds of experiencing perinatal mortality. The combined effect of these factors needs to be taken into account when counseling women about healthy behaviour before and during pregnancy at health facilities.

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Transformative Innovations in Reproductive, Maternal, Newborn, and Child Health over the Next 20 Years

Abstract: As part of the "Grand Convergence: Aligning Technologies and Realities in Global Health" Collection, Cyril Engmann and colleagues discuss promising innovations that have the potential to move the RMNCH agenda forward.

Cited by 25 publications

References 73 publications

Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017

Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries

Exploring Factors Influencing Perinatal Outcomes among Adolescent Pregnancies in Northern Ghana-The Case of Kassena-Nankana Municipality in the Upper East Region

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