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Implementing Interventions to Reducethe Burden of Preterm and Stillbirth:How do we do it?Courtney Gravett, MPHResearch Ass...
Preterm deaths and Stillbirths canbe prevented now• Effective implementation of current, known  interventions can reduce p...
Many premature babies can be saved before intensive becomes available...                                                  ...
Continuum of Care   Source: Kerber K, et al. Continuum of care for maternal, newborn and child health: from slogan to deli...
Interventions for preterm birth and stillbirthalong the continuum of care        PRE-                    PREGNANCY        ...
Prevention of preterm birth and stillbirth     must be accelerated         Care before and between pregnancy              ...
Prevention of preterm birth and stillbirth         Care during pregnancy and childbirth                            Impleme...
Care of the premature newborn                                                              COMMUNITY LEVEL/HOMEHome and lo...
Moving Forward to ReducePreterm Deaths andStillbirths
Examples of Barriers to Scaling UpInterventions• Community/Household level   – Sociocultural barriers (eg stigma), financi...
Prevention and management ofpreterm birth and stillbirth must beincluded in the wider agenda• Functional health systems ar...
Start where you areSource: Born Too Soon
8 Countries have reduced pretermdeath in the last decade• Sri Lanka     Contributing factors:• Turkey                •Nati...
Some middle income countries have    halved deaths due to preterm birth in a    decade                       Sri Lanka    ...
Factors contributing to successfulimplementation of interventions• Buy-in by key stakeholders• Intervention is context spe...
Who is involved?• Government and policy makers at local, national  and global levels• United Nations and other multilatera...
Conclusion: Advance a Coordinated Agendafor Preterm and Stillbirth Prevention andCare• Scale up what works – practical and...
Important Resources      Global report on preterm birth & stillbirth: the foundation      for innovative solutions and imp...
Increase Awareness and Visibility ofthe ProblemNovember 17th is World Prematurity DayFor more information visit the March ...
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Implementing Interventions to Reduce the Burden of Preterm and Stillbirth_Gravett NEW_10.10.12

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Implementing Interventions to Reduce the Burden of Preterm and Stillbirth_Gravett NEW_10.10.12

  1. 1. Implementing Interventions to Reducethe Burden of Preterm and Stillbirth:How do we do it?Courtney Gravett, MPHResearch Associate IIGlobal Alliance to Prevent Prematurityand Stillbirth (GAPPS)Seattle Children’scourtney.gravett@seattlechildrens.orgOctober 2012
  2. 2. Preterm deaths and Stillbirths canbe prevented now• Effective implementation of current, known interventions can reduce preterm deaths by 75% and stillbirths by 45%• Many preterm deaths and stillbirths are due to lack of action, or an inability to act• Prevention and intervention is possible all along the continuum of care
  3. 3. Many premature babies can be saved before intensive becomes available... Public health approaches Improved individual neonatal care eg feeding, warmth, hygiene, antibiotics, resuscitation Neonatal intensive care introduction and scale up Over 60% reduction can be achieved before neonatal intensive care and history shows the impact would be hugeData sources for UK and US historical data: (CDC, 2012, Office for National Statistics, 2012, NIH, 1985, Smith et al., 1983, Jamison et al., 2006, Lissauer and Fanaroff, 2006, Baker,2000, Philip, 2005, Wegman, 2001). With thanks to Boston Consulting Group
  4. 4. Continuum of Care Source: Kerber K, et al. Continuum of care for maternal, newborn and child health: from slogan to delivery. Lancet 2007; 370:1358=69
  5. 5. Interventions for preterm birth and stillbirthalong the continuum of care PRE- PREGNANCY BIRTH POSTNATAL/ CHILDHOOD PREGNANCY NEWBORN •Family planning/ •Prevent & treat •Antenatal •Essential & Extra care birth spacing sexually steroids • Kangaroo Mother Care PTB •Prevent & treat transmitted •Tocolytics to •Management of sick sexually transmitted infections slow labor newborns infections •Nutrition •Identify preterm •Neonatal resuscitation •Nutrition babies •Prevent & treat •Screen& treat •Active management of •Postnatal sexually for syphilis labor follow-up transmitted •Nutrition •Emergency obstetric infections care, including c-section SB •Magnesium sulfate •Nutrition •Antibiotics •Induction of labor after 41 weeks
  6. 6. Prevention of preterm birth and stillbirth must be accelerated Care before and between pregnancy Implement: • Family planning strategies, including birth spacing and provision of adolescent-friendly services • Prevention and management of STIs and NCDs • Education and health promotion for girls and women of childbearing age • Promotion of healthy nutrition and addressing life-style risks like smokingSource: Born Too Soon
  7. 7. Prevention of preterm birth and stillbirth Care during pregnancy and childbirth Implement: • Antenatal care for all pregnant women • Screening & treatment of sexually transmitted infections, especially syphilis • Management of pregnant women at higher risk of preterm labor • Management of preterm labor with provision of essential equipment and drugs • Reduce non-medically indicated early induction of labor and cesarean • Promotion of healthy behaviors and life-style risks during pregnancy • Active management of the third stage of labor • Comprehensive emergency obstetric careSource: Born Too Soon
  8. 8. Care of the premature newborn COMMUNITY LEVEL/HOMEHome and low levels of health system•Essential newborn care (warmth, cleanliness, feeding)•Support for early breastfeeding and cup feeding if needed•Facilitated referral, transport schemesHospital•Kangaroo Mother Care FACILITY LEVEL/OUTREACH•Neonatal resuscitation with bag and mask if needed•Supportive care for RDS eg safe oxygen therapy•Other supportive care eg NG tube feeding, IV fluids•Treatment of infections with antibioticsReferral hospital•Increased nursing and medical support REFERRAL LEVEL/DISTRICT•Phased introduction of intensive care eg ventilation•Surfactant (cost issues) Source: Born Too Soon
  9. 9. Moving Forward to ReducePreterm Deaths andStillbirths
  10. 10. Examples of Barriers to Scaling UpInterventions• Community/Household level – Sociocultural barriers (eg stigma), financial constraints• Health service level – Lack of resources and trained providers• Health sector and management level – Weak supply management – Lack of competent district health management teams• Lack of political will
  11. 11. Prevention and management ofpreterm birth and stillbirth must beincluded in the wider agenda• Functional health systems are a prerequisite for comprehensive antenatal and childbirth care• Implementation research is needed• Must integrate with other RMNC health programs – Antenatal corticosteroids• The steps for scaling up interventions are highly context specific
  12. 12. Start where you areSource: Born Too Soon
  13. 13. 8 Countries have reduced pretermdeath in the last decade• Sri Lanka Contributing factors:• Turkey •National commitment to improved obstetric and• Belarus neonatal care• Croatia• Ecuador •Systematic referral systems for neonatal care• El Salvador •Strengthened equipment and personnel• Oman •Re-invigorated community-based healthcare• China •Promotion and training of skilled birth attendants
  14. 14. Some middle income countries have halved deaths due to preterm birth in a decade Sri Lanka •Lower middle-income country Turkey that reduced NMR from 13 to 10 and halved preterm specific•Upper middle-income country that reduced NMR mortalityfrom 21 to 10 •Long term investment in primary care with free health•Implemented demand and supply strategies, care at government facilitiesincluding cash incentives for expectant women •Reinvigorated community- based care, including referral•Invested in quality care improvements, such as networks for women in pretermfocusing on nursing staff skills, resuscitation, laborbasic care of preterm babies •Recent introduction of advanced care at tertiary centers Source: Born Too Soon Source: Analysis conducted using data from Liu et al., 2012. Credit: Boston Consulting Group with the Global Preterm Birth Mortality Reduction Analysis Group
  15. 15. Factors contributing to successfulimplementation of interventions• Buy-in by key stakeholders• Intervention is context specific i.e., culturally sensitive, locally adapted to staffing levels, burden of disease, causes of mortality, etc.• Intervention builds on/ complements existing programs• Intervention is supported by national policies, service guidelines, training materials, job aids, supervisory systems and indicators to track outcomes• Robust supply chain
  16. 16. Who is involved?• Government and policy makers at local, national and global levels• United Nations and other multilateral organizations• Donors• Private Sector• Academic and research institutions• Healthcare workers and professional associationsCoordination, collaboration, and commitment among all the players is crucial to success
  17. 17. Conclusion: Advance a Coordinated Agendafor Preterm and Stillbirth Prevention andCare• Scale up what works – practical and feasible interventions for care• Improve integration with existing programs• Address common challenges in the wider reproductive, maternal, newborn and child health agenda: • Access and utilization of quality healthcare
  18. 18. Important Resources Global report on preterm birth & stillbirth: the foundation for innovative solutions and improved outcomes www.biomedcentral.com/bmcpregnancychildbirth/supplements/ Born Too soon: The Global Action Report on Preterm Birth www.who.int/pmnch/media/news/2012/preterm_birth_report/en/index.html Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health www.who.int/pmnch/topics/part_publications/201112_essential_inter ventions/en/index.html
  19. 19. Increase Awareness and Visibility ofthe ProblemNovember 17th is World Prematurity DayFor more information visit the March of Dimes website:http://www.marchofdimes.com/mission/prematurity_wpd.html

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