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      Sub-Saharan Africa's Mothers, Newborns, and Children: Where and Why Do They Die?

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      Author(s): 1 , 1 , 2 , 3 , 4 , 5 , 6 , 1 , * , on behalf of the Science in Action: Saving the lives of Africa's mothers, newborns, and children working group
      Publication date (Electronic):
      Journal: PLoS Medicine
      Publisher: Public Library of Science

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          Abstract

          In the first article in a series on maternal, newborn, and child health in sub-Saharan Africa, Joy Lawn and colleagues outline where and why deaths among mothers and children occur and what known interventions can be employed to prevent these deaths.

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

          Gary Darmstadt, Zulfiqar Bhutta, Simon Cousens … (2005)
          In this second article of the neonatal survival series, we identify 16 interventions with proven efficacy (implementation under ideal conditions) for neonatal survival and combine them into packages for scaling up in health systems, according to three service delivery modes (outreach, family-community, and facility-based clinical care). All the packages of care are cost effective compared with single interventions. Universal (99%) coverage of these interventions could avert an estimated 41-72% of neonatal deaths worldwide. At 90% coverage, intrapartum and postnatal packages have similar effects on neonatal mortality--two-fold to three-fold greater than that of antenatal care. However, running costs are two-fold higher for intrapartum than for postnatal care. A combination of universal--ie, for all settings--outreach and family-community care at 90% coverage averts 18-37% of neonatal deaths. Most of this benefit is derived from family-community care, and greater effect is seen in settings with very high neonatal mortality. Reductions in neonatal mortality that exceed 50% can be achieved with an integrated, high-coverage programme of universal outreach and family-community care, consisting of 12% and 26%, respectively, of total running costs, plus universal facility-based clinical services, which make up 62% of the total cost. Early success in averting neonatal deaths is possible in settings with high mortality and weak health systems through outreach and family-community care, including health education to improve home-care practices, to create demand for skilled care, and to improve care seeking. Simultaneous expansion of clinical care for babies and mothers is essential to achieve the reduction in neonatal deaths needed to meet the Millennium Development Goal for child survival.
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            Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

            Emily Banks, Olav Meirik, Tim Farley … (2006)
            Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome. 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital. Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries. Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.
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              Estimating the causes of 4 million neonatal deaths in the year 2000.

              Katarzyna Wilczynska, Joy E. Lawn, S N Cousens (2006)
              Information on cause-of-death is lacking for 98% of the world's 4 million neonatal deaths that occur in countries with inadequate vital registration (VR). Our aim was to estimate, by country for the year 2000, the distribution of neonatal deaths across programme-relevant causes including: asphyxia, preterm birth, congenital abnormalities, sepsis/pneumonia, neonatal tetanus, diarrhoea, and 'other'. Two sources of neonatal cause-of-death data were examined: VR datasets for countries with high coverage (>90%), and published and unpublished studies identified through systematic searches. Multinomial regression was used to model the distribution of neonatal deaths. A VR-based model was used to estimate the distribution of causes of death for 37 low-mortality countries without national data. A study-based model was applied to obtain estimates for 111 high-mortality countries. Uncertainty estimates were derived using the jackknife approach. Data from 44 countries with VR (96 797 neonatal deaths) and from 56 studies (29 countries, 13 685 neonatal deaths) met inclusion criteria. The distribution of reported causes of death varied substantially between countries and across studies. Based on 193 countries, the major causes of neonatal death globally were estimated to be infections (sepsis/pneumonia, tetanus, and diarrhoea, 35%), preterm birth (28%), and asphyxia (23%). Regional variation is important. Substantial uncertainty surrounds these estimates. This exercise highlights the lack of reliable cause-of-death data in the settings in which most neonatal deaths occur. Complex statistical models are not a panacea. Representative data with comparable case definitions and consistent hierarchical cause-of-death attribution are required.
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                Author and article information

                Journal
                Journal ID (nlm-ta): PLoS Med
                Journal ID (publisher-id): PLoS
                Journal ID (pmc): plosmed
                Title: PLoS Medicine
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Print): 1549-1277
                ISSN (Electronic): 1549-1676
                Publication date Collection: June 2010
                Publication date (Print): June 2010
                Publication date (Electronic): 21 June 2010
                Volume: 7
                Issue: 6
                Electronic Location Identifier: e1000294
                Affiliations
                [1 ]Saving Newborn Lives/Save the Children, Cape Town, South Africa
                [2 ]John Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
                [3 ]United States National Academy of Sciences, Washington, DC, United States of America
                [4 ]Ghana Academy of Arts and Science, Accra, Ghana
                [5 ]The Universities of Kwazulu-Natal and the Witwatersrand, Durban, South Africa
                [6 ]Uganda National Academy of Sciences, Uganda
                Author notes

                ICMJE criteria for authorship read and met: MVK KJK REB BC FN HC PMN JEL. Agree with the manuscript's results and conclusions: MVK KJK REB BC FN HC PMN JEL. Analyzed the data: MVK REB PMN JEL. Wrote the first draft of the paper: MVK JEL. Contributed to the writing of the paper: MVK KJK REB BC FN HC PMN. Responsible for data integrity: MVK.

                Article
                Publisher ID: 10-PLME-PF-4404R2
                DOI: 10.1371/journal.pmed.1000294
                PMC ID: 2888581
                PubMed ID: 20574524
                SO-VID: 11a19fc3-5da2-4c38-a429-5c80d7e47c5e
                Copyright © Kinney et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Page count
                Pages: 9
                Categories
                Subject: Policy Forum
                Subject: Evidence-Based Healthcare
                Subject: Evidence-Based Healthcare/Health Services Research and Economics
                Subject: Evidence-Based Healthcare/Statistical Methodologies and Health Informatics
                Subject: Obstetrics/Labor and Delivery
                Subject: Pediatrics and Child Health/Child Development
                Subject: Pediatrics and Child Health/Neonatology
                Subject: Public Health and Epidemiology
                Subject: Public Health and Epidemiology/Global Health
                Subject: Public Health and Epidemiology/Health Policy

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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