Impact of ANCS and Other WHO-Recommended Interventionsa to Prevent Preterm Mortality From RDS, IVH, and NEC, Sub-Saharan Africa, 2015
| Scenario No. | Scenario | Incremental Change Modelb | Universal Coverage Modelc | ||
|---|---|---|---|---|---|
| Preterm Deaths, No.d | Preterm Deaths Prevented Compared With Current Level of Care, No. (%) | Preterm Deaths, No. | Preterm Deaths Prevented Compared With Current Level of Care, No. (%) | ||
| 1 | Current levels of prevention, diagnosis, and treatment | 303,400 | N/A | 303,400 | N/A |
| Improved WHO single interventions | |||||
| 2 | Increased surfactant in hospital settings for RDS | 303,300 | 100 (<0.1) | 303,100 | 300 (0.1) |
| 3 | Increased ANCS in hospital settings for RDS, IVH, and NEC | 302,300 | 1,100 (0.4) | 298,400 | 5,000 (1.7) |
| 4 | Increased oxygen/CPAP in hospital and clinical settings for RDS | 295,300 | 8,100 (2.7) | 261,100 | 42,300 (13.9) |
| Improved diagnosis of preterm labor and transfer with current care | |||||
| 5 | Increased diagnosis of preterm labor birth, with current levels of care for RDS, IVH, and NEC | 302,400 | 1,000 (0.3) | 299,900 | 3,500 (1.2) |
| 6 | Increased diagnosis of imminent preterm birth and transfer to hospitals, with current levels of care for RDS, IVH, and NEC | 301,300 | 2,100 (0.7) | 287,100 | 16,300 (5.4) |
| Improved diagnosis and transfer with WHO single interventions | |||||
| 7 | Increased diagnosis of respiratory distress, transfer, and surfactant (hospitals only) for RDS | 299,900 | 3,500 (1.2) | 282,800 | 20,600 (6.8) |
| 8 | Increased diagnosis of imminent preterm birth, transfer to hospitals, and ANCS (hospitals only) for RDS, IVH, and NEC | 298,600 | 4,800 (1.6) | 236,700 | 66,700 (22.0) |
| 9 | Increased diagnosis of respiratory distress, transfer, and oxygen/CPAP for preterm RDS | 287,400 | 16,000 (5.3) | 176,100 | 127,300 (42.0) |
| Improved diagnosis and transfer with WHO packaged interventions | |||||
| 10 | Improved diagnosis of imminent preterm birth, transfer to hospitals, ANCS (hospitals only), and treatment with surfactants (hospitals only) and oxygen/CPAP for RDS, IVH, and NEC | 289,700 | 13,700 (4.5) | 191,300 | 112,100 (37.0) |
| 11 | Increased diagnosis of respiratory distress, transfer to hospitals, and treatment, including surfactants (hospitals only) and oxygen/CPAP for RDS | 286,900 | 16,500 (5.4) | 155,700 | 147,711 (48.7) |
| 12 | Hospital delivery for all preterm birth, with ANCS (hospitals only), improved diagnosis and treatment of respiratory distress, including surfactants (hospitals only) and CPAP for RDS, IVH, and NEC | 223,300 | 80,100 (26.4) | 112,800 | 190,600(62.8) |
Abbreviations: ANCS, antenatal corticosteroids; CPAP, continuous positive airway pressure; IVH, intraventricular hemorrhage; NEC, necrotizing enterocolitis; RDS, respiratory distress syndrome; WHO, World Health Organization.
↵a Assumptions regarding baseline penetration and utilization of interventions including ANCS, surfactant, and CPAP as shown in Table 1. Assumptions regarding diagnostics and transfers found in Table 2.
↵b The incremental change model assumes 20% increase from baseline penetration and utilization.
↵c The universal coverage model assumes 98% penetration and utilization of interventions.
↵d All estimates rounded to nearest 100.