Maternal, Newborn, and Child Health
- Maternal and Neonatal Directed Assessment of Technologies (MANDATE): Methods and Assumptions for a Predictive Model for Maternal, Fetal, and Neonatal Mortality Interventions
MANDATE is a mathematical model designed to estimate the relative impact of different interventions on maternal, fetal, and neonatal lives saved in sub-Saharan Africa and India. A key advantage is that it allows users to explore the contribution of preventive interventions, diagnostics, treatments, and transfers to higher levels of care to mortality reductions, and at different levels of penetration, utilization, and efficacy.
- Re-Evaluating the Possible Increased Risk of HIV Acquisition With Progestin-Only Injectables Versus Maternal Mortality and Life Expectancy in Africa: A Decision Analysis
Our model suggests that removing progestin-only injectables in Africa would have a net negative effect on maternal health, life expectancy, and mortality under a variety of scenarios.
- Harmonizing Methods for Estimating the Impact of Contraceptive Use on Unintended Pregnancy, Abortion, and Maternal Health
Five models estimate the impact of family planning on health outcomes, but the estimates previously have diverged because the models used different assumptions, inputs, and algorithms. After a collective harmonization process, the models now produce more similar estimates although they retain some minimal differences. These models assist in planning, resource allocation, and evaluation.
- High Background Congenital Microcephaly in Rural Guatemala: Implications for Neonatal Congenital Zika Virus Infection Screening
A variety of microcephaly case definitions detect high background prevalence in rural Guatemala, which complicates congenital Zika screening efforts. In addition, gestational age is needed for most screening tools but is usually unknown in low-resource settings. Fenton growth curves, originally designed for use in preterm infants, offer a standardized approach to adjust for unknown gestational age and may improve screening efforts.
- Maternal Death Surveillance and Response: A Tall Order for Effectiveness in Resource-Poor Settings
Most countries with high maternal (and newborn) mortality have very limited resources, overstretched health workers, and relatively weak systems and governance. To make important progress in reducing mortality, therefore, they need to carefully prioritize where to invest effort and funds. Given the demanding requirements to effectively implement the maternal death surveillance and response (MDSR) approach, in many settings it makes more sense to focus effort on the known drivers of high mortality, e.g., reducing geographic, financial, and systems barriers to lifesaving maternal and newborn care.
- Seeking Synchrony Between Family Planning and Immunization: A Week-10 DMPA Start Option for Breastfeeding Mothers
Many mothers initiate DMPA injectables at 6 weeks postpartum, at the time of their baby's first immunization visit. Offering an optional delayed DMPA start at the next (10-week) immunization visit has potential advantages including a reduced follow-up schedule with DMPA visits synchronized with other immunization visits, and, possibly, improved contraceptive and immunization outcomes.
- Implementing Maternal Death Surveillance and Response in Kenya: Incremental Progress and Lessons Learned
A national coordinating structure was established but encountered significant challenges including: (1) a low number of estimated maternal deaths identified that only included some occurring within facilities, (2) only half of those identified were reviewed, (3) reviewers had difficulties assessing the cause of death largely because of limited documentation in clinical records; and (4) resulting actions were limited. Successful implementation will require addressing many issues, including building support for the process lower down in the health system.
- Geographic Access Modeling of Emergency Obstetric and Neonatal Care in Kigoma Region, Tanzania: Transportation Schemes and Programmatic Implications
32% of estimated live births in the region may not be able to reach emergency obstetric and neonatal care (EmONC) services within 2 hours in dry season, regardless of the type of transportation available. However, bicycles, motorcycles, and cars provide a significant increase in geographic accessibility in some areas. Achieving good access may require upgrading non-EmONC facilities to EmONC facilities in some districts while incorporating bicycles and motorcycles into the health transportation strategy in others.
- Infant Feeding Policy and Programming During the 2014–2015 Ebola Virus Disease Outbreak in Sierra Leone
Policies on breastfeeding and possible mother-to-child transmission of Ebola Virus Disease (EVD) during the outbreak evolved depending on public health priorities and the evidence available at that particular time. To improve responses to future outbreaks, research on vertical transmission of EVD should be prioritized; infant and young child feeding experts should be integrated into the outbreak response; and a digital repository of national policies and associated messages should be created.