How many child deaths can we prevent this year

Maternal mortality: who, when, where, and why

Evidence-based, cost-effective interventions: how many newborn babies can we save?

https://evolution.binghamton.edu/evos/wp-content/uploads/2010/08/who-keeps.pdf

Who keeps children alive? A review of the effects of kin on child survival

Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning. Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies. Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care. Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in neonatal health.

/pdf/community-based-interventions-for-improving-perinatal-and-17rlant020.pdf

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Studies were carried out by the Cholera Research Laboratory to investigate maternal mortality in rural Bangladesh. In the 1st study field workers interviewed the closest relative of every reported deceased female in the reproductive age group to diagnose the probable cause of death. The 2nd investigation involved an analysis of all registered birth and death reports in a specified population. In the 2 studies the maternal mortality rates were found to be 7.7 and 5.7 deaths/1000 live births. Nearly 1/3 of all deaths of adult females aged 10-49 years were maternity related. At high risk to maternal mortality were high-parity women and especially primigravida women. A family planning program antenatal health services and instruction in home delivery could reduce the mortality rate.

https://www.jstor.org/stable/pdfplus/1965185.pdf

Maternal mortality in rural Bangladesh.

This paper reports findings from a study of maternal mortality in Matlab, Bangladesh during the 1976-85 period. The study employed a multiple-step procedure to identify maternity-related deaths to all reproductive-aged women within the study area during this period. A total of 387 maternal deaths were identified, resulting in an overall maternal mortality ratio of 5.5 per 1,000 live births. The introduction of a family planning program in half of the Matlab study area led to a moderate but significant reduction in maternal mortality rates, relative to the comparison area. This appears to have been primarily due to a reduction in the overall number of pregnancies in the treatment area, since among women who became pregnant, mortality risks remained high. The results of this study underscore the need for a broad-based service strategy that includes but is not limited solely to family planning, in order to achieve significant reductions in maternal mortality levels in settings such as rural Bangladesh.

Maternal mortality in Matlab, Bangladesh: 1976-85.

Of a total of 1037 women of reproductive age who died during the period 1976-85 in the Matlab area that was under demographic surveillance, 387 (37%) were maternal deaths. The mean maternal mortality over the 10-year period was 5.5 per 1000 live births (101 per 100 000 women of reproductive age). Major causes of maternal death, which were assessed using a combination of record review and field interviews, included postpartum haemorrhage (20%), complications of abortion (18%), eclampsia (12%), violence and injuries (9%), concomitant medical causes (9%), postpartum sepsis (7%), and obstructed labour (6.5%). Deaths caused by postpartum haemorrhage were positively associated with both maternal age and parity, whereas those caused by eclampsia and injuries were more common among young and low-parity women. If maternal deaths arising from complications of abortion are disregarded, 20% of all maternal deaths occurred during pregnancy, 44% during labour and the two days following delivery, and 36% during the remaining postpartum period.

These findings support the need to develop a service strategy to address the risks of childbearing and childbirth in areas such as rural Bangladesh, where almost all deliveries take place at home. This strategy must be based not only on preventive and educational interventions, including family planning and antenatal care, but also on systematic attendance at home deliveries by trained professional midwives, backed up by an effective chain of referral.

Causes of maternal mortality in rural Bangladesh, 1976-85

PIP: 1 approach to the prevention of tetanus neonatorum (a leading cause of infant death throughout the world) is improving the quality of prenatal, obstetric, and postnatal maternal and child health services. Another complementary approach is the active immunization of women before or during pregnancy with tetanus toxoid. Work in progress at the Matlab field station of the International Center for Diarrheal Disease Research in Bangladesh (ICDDR,B) provided a unique opportunity to study the effectiveness of certain aspects of these 2 strategies. In 1974, during a field trial of cholera toxoid vaccine, 2 injections of an aluminum phosphate tetanus-diphtheria toxoid were provided as a control to a randomly assigned group of nonpregnant women. Beginning in June 1978, a program of immunizing women during pregnancy with aluminum phosphate-absorbed tetanus toxoid was initiated in conjunction with the implementation of a village based maternal and child health and family planning program in half of the same Matlab surveillance area. Throughout the period of these 2 programs, the ICDDR,B maintained an independent, longitudinal, vital registration system, identifying all births and deaths in the study area. In this analysis, all live births registered in the Maternal and Child Health-Family Planning and comparison areas during the September 1, 1978 until December 31, 1979 period were identified. These records were linked with any deaths recorded within 28 days of birth. The acceptance of tetanus vaccination during the 1974 cholera vaccine trial, by the mothers of these live births, was ascertained from the 1974 vaccine registers. The acceptance of vaccination during the 1978-1979 program was obtained from the field registers. For infants whose mothers had received 2 tetanus injections 48-64 months prior to delivery, the neonatal mortality rate was 63.8/l000 live births compared with 78.3/1000 for infants whose mothers did not receive tetanus immunization. Immunization of women with 2 tetanus injections during pregnancy reduced neonatal mortality rates to 42.8/1000, a reduction of 35.5/1000. Mortality on days 4-14 was reduced by about 70%. 1 injection during pregnancy did not appear to provide protection against tetanus neonatorum.

Use of tetanus toxoid for the prevention of neonatal tetanus. 1. Reduction of neonatal mortality by immunization of non-pregnant and pregnant women in rural Bangladesh.

Since 1977 the International Centre for Diarrhoeal Disease Research Bangladesh has conducted a field experiment in family planning in its Matlab research station. The project began with an emphasis on family planning; maternal-child health (MCH) services were added in stages. This analysis aims to determine whether additional health and MCH services enhance effectiveness of a comprehensive family planning program that contained limited MCH components from the beginning. Initial Family Planning and Health Services Project (FPHSP) effects on contraceptive prevalance were pronounced. Use prevalence increased to 25% in the 1st 6 months and to 32% within a year. This was followed by a general fertility decline of 25%. Prevalence gradually converged to 43%. The tetanus toxoid program--introduced to prevent tetanus neonatorum--did not discrup the contraceptive prevalence trend. Prevalence increased until 2 interventions for treating diarrhea were introduced: 1) packets consisting of a premixed sugar and electrolyte powder that is dissolved in water; and 2) "labon-gur"--a homemade mixture of locally available salt and molasses that has been shown to be as effective as the packets and costs less. The tetanus program was changed to as mass maternal immunization program. A measles immunization program was launched. This result in rising prevalence. Household insertion of IUDs (Copper T) resulted in a pronounced increase in IUD prevalence and concomitant decline in the prevalance of other methods. An antenatal care program was launched. It was followed by a program to train traditional birth attendants. This did not have much of an effect on contraceptive prevalence.

A. I. Chowdhury

Papers

Maternal mortality in rural Bangladesh.

Maternal mortality in Matlab, Bangladesh: 1976-85.

Causes of maternal mortality in rural Bangladesh, 1976-85

Use of tetanus toxoid for the prevention of neonatal tetanus. 1. Reduction of neonatal mortality by immunization of non-pregnant and pregnant women in rural Bangladesh.

Integrating health services into an MCH-FP program: lessons from Matlab, Bangladesh.