- LiST (Lives Saved Tool) is a mathematical model that estimates the impact of scaling up maternal, newborn and child health interventions in low-income countries.
- It uses country-specific health and demographic data as well as evidence-based effectiveness estimates for 68 interventions to predict changes in mortality rates.
- LiST has been used globally and in several countries for strategic planning, evaluating the impact of interventions, and estimating lives saved by health programs.
Maternal and neonatal mortality remain major global public health issues. The document discusses definitions of maternal mortality and its causes. Nearly 99% of maternal deaths occur in developing countries. The three delays model outlines reasons for delays in seeking and obtaining care. Historical interventions like traditional birth attendants and antenatal care alone were not effective in reducing mortality. Skilled attendance at delivery is now recognized as the most important intervention, as major complications cannot be predicted and timely, effective emergency care is critical.
1) Interventions to reduce under 5 mortality include improving maternal health, vaccination programs, proper nutrition, and increasing access to clean water and sanitation.
2) Pneumonia is a leading cause of death that can be addressed through vaccination, breastfeeding, and ensuring access to antibiotics.
3) Diarrhea can be reduced by 25-85% through handwashing, water/sanitation improvements, oral rehydration, and rotavirus vaccines.
4) Malaria interventions focus on preventing mosquito bites through nets/repellents and larvaecide as well as early diagnosis and treatment of cases.
Dr. Eugene Declercq: "Maternal Mortality as a Public Health Challenge" 10.04.17reportingonhealth
Dr. Eugene Declercq's slides from the webinar "America's High Maternal Mortality and What Can Be Done
For info: https://www.centerforhealthjournalism.org/content/america%E2%80%99s-high-maternal-mortality-what-can-be-done
Dr. Elliott Main: "Reducing Maternal Mortality: Building on the California Ex...reportingonhealth
This document discusses efforts in California to reduce maternal mortality rates through quality improvement initiatives. It notes that California saw a rise in maternal mortality that led to the creation of the California Maternal Quality Care Collaborative (CMQCC) in 2006. The CMQCC works with various partners to implement toolkits and collaboratives focused on the most common causes of mortality and severe morbidity - obstetric hemorrhage and preeclampsia. Through these statewide initiatives, California saw a reduction in its maternal mortality rate compared to the national rate. The document advocates expanding this approach nationally through the Alliance for Innovation on Maternal Health (AIM) partnership.
Maternal mortality rates in Ghana are high, with over 99% of maternal deaths occurring in developing countries like Ghana. Access to healthcare is more limited in rural areas of Ghana, where 63% of Ghanaians live, and pregnant women may have to walk long distances to reach care. Efforts are being made to increase the number of skilled birth attendants visiting remote villages to help reduce mortality. Complications from unsafe abortions also contribute to 11% of maternal deaths in Ghana, though abortion is legal under certain conditions. Achieving the UN Millennium Development Goals for maternal healthcare by 2015 will require coordinated efforts across sectors.
This is an individual project showing strategies of addressing pregnant women labor delays in St. Paul's Hospital Millennium Medical College , Addis Ababa, Ethiopia
Infectious minds canadian institutes of health research, international infect...Gordon Otieno Odundo
Canadian Institutes of Health Research, International Infectious Disease and Global Health Training Programme (CIHR, IID & GHTP).This is a scholarship program run across four countries: Canada, Colombia, Kenya and India where advanced level students (PhD, Post Doctoral and Clinical fellows) undertake additional training on Infectious Diseases all geared towards being experts in matters pertaining to Global Health. Every month an 'Infectious Minds' sessionis held for two hours via a videoconference link across the four sites. On 15th May 2014 Gordon Otieno Odundo was the Guest Speaker presenting on infectious diseases in children the venue was at the University of Nairobi Institute of Tropical and Infectious Diseases, College of Health Sciences, Kenyatta National Hospital. The audience was primarily Doctoral (PhD) and Post-Doctoral students across the four sites; from Basic Science and Social Science disciplines.
website: http://www.iidandghtp.com/
Maternal and neonatal mortality remain major global public health issues. The document discusses definitions of maternal mortality and its causes. Nearly 99% of maternal deaths occur in developing countries. The three delays model outlines reasons for delays in seeking and obtaining care. Historical interventions like traditional birth attendants and antenatal care alone were not effective in reducing mortality. Skilled attendance at delivery is now recognized as the most important intervention, as major complications cannot be predicted and timely, effective emergency care is critical.
1) Interventions to reduce under 5 mortality include improving maternal health, vaccination programs, proper nutrition, and increasing access to clean water and sanitation.
2) Pneumonia is a leading cause of death that can be addressed through vaccination, breastfeeding, and ensuring access to antibiotics.
3) Diarrhea can be reduced by 25-85% through handwashing, water/sanitation improvements, oral rehydration, and rotavirus vaccines.
4) Malaria interventions focus on preventing mosquito bites through nets/repellents and larvaecide as well as early diagnosis and treatment of cases.
Dr. Eugene Declercq: "Maternal Mortality as a Public Health Challenge" 10.04.17reportingonhealth
Dr. Eugene Declercq's slides from the webinar "America's High Maternal Mortality and What Can Be Done
For info: https://www.centerforhealthjournalism.org/content/america%E2%80%99s-high-maternal-mortality-what-can-be-done
Dr. Elliott Main: "Reducing Maternal Mortality: Building on the California Ex...reportingonhealth
This document discusses efforts in California to reduce maternal mortality rates through quality improvement initiatives. It notes that California saw a rise in maternal mortality that led to the creation of the California Maternal Quality Care Collaborative (CMQCC) in 2006. The CMQCC works with various partners to implement toolkits and collaboratives focused on the most common causes of mortality and severe morbidity - obstetric hemorrhage and preeclampsia. Through these statewide initiatives, California saw a reduction in its maternal mortality rate compared to the national rate. The document advocates expanding this approach nationally through the Alliance for Innovation on Maternal Health (AIM) partnership.
Maternal mortality rates in Ghana are high, with over 99% of maternal deaths occurring in developing countries like Ghana. Access to healthcare is more limited in rural areas of Ghana, where 63% of Ghanaians live, and pregnant women may have to walk long distances to reach care. Efforts are being made to increase the number of skilled birth attendants visiting remote villages to help reduce mortality. Complications from unsafe abortions also contribute to 11% of maternal deaths in Ghana, though abortion is legal under certain conditions. Achieving the UN Millennium Development Goals for maternal healthcare by 2015 will require coordinated efforts across sectors.
This is an individual project showing strategies of addressing pregnant women labor delays in St. Paul's Hospital Millennium Medical College , Addis Ababa, Ethiopia
Infectious minds canadian institutes of health research, international infect...Gordon Otieno Odundo
Canadian Institutes of Health Research, International Infectious Disease and Global Health Training Programme (CIHR, IID & GHTP).This is a scholarship program run across four countries: Canada, Colombia, Kenya and India where advanced level students (PhD, Post Doctoral and Clinical fellows) undertake additional training on Infectious Diseases all geared towards being experts in matters pertaining to Global Health. Every month an 'Infectious Minds' sessionis held for two hours via a videoconference link across the four sites. On 15th May 2014 Gordon Otieno Odundo was the Guest Speaker presenting on infectious diseases in children the venue was at the University of Nairobi Institute of Tropical and Infectious Diseases, College of Health Sciences, Kenyatta National Hospital. The audience was primarily Doctoral (PhD) and Post-Doctoral students across the four sites; from Basic Science and Social Science disciplines.
website: http://www.iidandghtp.com/
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
Vital statistics are systematically collected facts related to vital events like births, deaths, and marriages. They are compiled from sources like censuses, registration records, and health surveys. Vital statistics are used for policymaking, administration, research, and public health programs. Some key vital statistics include birth rate, death rate, crude death rate, maternal mortality ratio, and infant mortality rate. Recent advancements in contraceptives allow individuals to plan their families and avoid unwanted births. Natural family planning methods like rhythm method and basal body temperature tracking require abstaining from sex during fertile periods, while barrier methods like condoms use physical barriers.
Child Malnutrition, Consumption Growth, Maternal Care & Price ShocksThe Transfer Project
How much can the underlying determinants of malnutrition contribute to a reduction in stunting?
Presented by Richard de Groot at IFAD, ICID and Site Ideas International Development Conference in Rome in October 2018.
This document discusses guidelines for treating HIV in older patients, women, and perinatal transmission. For newly diagnosed older patients, it notes they often have a more severe disease course and shorter survival than younger patients. It recommends ART for all older than 50. For adherence in older patients, it recommends combining pill counts, self-reports, viral load checks, and refill records. For pregnant women, it recommends the same regimens as non-pregnant adults, and starting ART in the first trimester or delaying until 12 weeks depending on factors. It recommends ZDV for intrapartum transmission prevention and starting infant ART prophylaxis with ZDV within 6-12 hours of birth.
Sex in Three Cities Lecture 2014, Our Reproductive Future 2013UoN
This document discusses the future of human reproduction and fertility. It notes that while assisted reproductive technologies are increasingly used by older couples, contraceptive research and development has been neglected. Over 44 million abortions occur worldwide each year due to lack of effective contraception. The author argues we should invest more in contraceptive research given its potential impact. The document also examines how female fertility sharply declines after age 35, while male fertility is more stable with age. It concludes that while IVF cannot overcome the effects of age on eggs, freezing eggs may help preserve fertility.
Maternal mortality is defined as the death of a woman during pregnancy or within 42 days of termination of pregnancy. The three main causes of maternal death are hemorrhage, infection, and hypertensive disorders, which together account for 75-80% of direct maternal deaths. India accounts for 25% of global maternal deaths despite having only 16% of the world's population. Every year approximately 8 million women suffer from pregnancy related complications worldwide and over half a million die. Maternal mortality can be greatly reduced by ensuring access to quality emergency obstetric care services and family planning programs.
1. The document discusses interventions to reduce neonatal mortality and morbidity in preterm infants in resource-scarce settings, specifically addressing the problem of hypothermia.
2. It describes two case studies of community intervention programs that provided neonatal care packages in rural India and sub-Saharan Africa/Southeast Asia. These programs emphasized increasing access through home visitation and interventions like kangaroo mother care.
3. The studies found that community care programs were highly effective and that care packages were often less costly than individual interventions. Addressing unequal access to healthcare through these types of programs can help reduce inequities in health outcomes.
Sorry this presentation is not great, because all the animations just stockpiled. If you want to see a better version, please go to http://tinyurl.com/pat48ks
Thanks!
This document summarizes field test results of the "motherhood method" used to measure maternal mortality in Nepal. The motherhood method is a direct technique that estimates births and deaths within a geographic area through group discussions with pregnant women and community health workers, without visiting every household. The method was tested in Nepal's Bara district over 2 years, collecting information on 15,161 births. The results provided an estimate of the maternal mortality ratio within 30% margin of error. The study employed the "pregnant women group" approach, where pregnant women and health workers discussed mother and child health issues to identify maternal and infant births and deaths.
This document provides an orientation on quality maternal health care services in Myanmar. It discusses the global and national situations regarding pregnancy and childbirth, highlighting key maternal and neonatal mortality statistics. It outlines Myanmar's progress toward achieving Millennium Development Goals related to improving maternal health. The document defines essential reproductive health services, including safe motherhood, post-abortion care, birth spacing, sexually transmitted infections/HIV, and adolescent reproductive health. It emphasizes the need for skilled birth attendance and emergency obstetric care to reduce maternal and newborn deaths. The document also discusses focused antenatal care and the basic and comprehensive emergency obstetric care services required.
Innovation and integration dr eric silfenCORE Group
Maternal and child health is a significant issue in Africa, where complications during pregnancy and childbirth contribute to over 350,000 maternal deaths annually. Community health workers aim to address this through education, training, appropriate technologies, and partnerships. Philips Healthcare works with various organizations on mHealth initiatives using low-cost ultrasound integrated with telecommunications to improve health outcomes for at-risk mothers and newborns in remote areas of Africa. Studies show this approach can help identify women at high risk of obstetric fistula and assess fetal growth, allowing for better nutrition and care. The goal is to strengthen maternal and child care through sustainable community-level health systems regardless of geography.
Maternal and child health care servicesKailash Nagar
This document discusses maternal and child health care. It begins by introducing the topic and defining maternal and child health services according to the WHO. The objectives of maternal and child health programs are then outlined, including reducing mortality and morbidity for mothers and children. Key health problems, indicators, and recent trends are also summarized. The document goes on to provide details on antenatal, intranatal, and postnatal care services as well as child health services. Causes of maternal and under-five deaths in India are also presented.
Lisa Bohmer worked as the HIV/AIDS Director for UNICEF in Ethiopia and presented on challenges and opportunities for preventing mother-to-child transmission of HIV/AIDS in Africa. Key points included: HIV transmission can occur during pregnancy, labor, delivery or breastfeeding; Ethiopia faces high infection rates particularly among young people and women; and challenges include stigma, improving safer birthing practices, counseling on infant feeding options, and ensuring a steady supply of drugs and testing kits. Opportunities lie in increased funding, integrating PMTCT into other health programs, and engaging communities to promote testing and reduce stigma.
The document discusses expanding sexual and reproductive health services in Haiti. It notes that Haiti has the highest fertility rate and lowest contraceptive use in Latin America/Caribbean. Expanding family planning programs could reduce Haiti's fertility rate and unmet need for contraception, leading to improvements in health outcomes like reduced infant/maternal mortality and increased economic benefits through a potential "demographic dividend" from changes in Haiti's population age structure. However, it is unclear if evidence of family planning programs' positive impacts in other countries would generalize to Haiti. The document calls for benefit-cost analyses to evaluate potential outcomes of expanding such services in Haiti.
Universal Immunization Program is a vaccination program launched by the Government of India in 1985.
It became a part of Child Survival and Safe Motherhood Program in 1992 and is currently one of the key areas under National Rural Health Mission(NRHM) since 2005.
Program consists of vaccination for 12 diseases -
Tuberculosis
Diphtheria
Pertussis
Tetanus,
Poliomyelitis,
Measles,
Hepatitis B,
Diarrhea,
Japanese-Encephalitis,
Rubella,
Pneumonia
Pneumococcal diseases
This document discusses breastfeeding and HIV infection. It notes that approximately one-third of infants born to HIV-positive mothers contract HIV, often through breastfeeding. The risks of HIV transmission through breastfeeding can be decreased by shorter duration of breastfeeding (6 months has a lower risk than 2 years), exclusive breastfeeding for the first few months, and preventing and treating breast problems. However, for HIV-infected mothers in developing countries, not breastfeeding increases the risk of other infectious diseases in infants. The decision to breastfeed or use breastmilk substitutes presents difficulties for these mothers.
Every two hours in Kenya, a woman dies during pregnancy or childbirth, devastating her family. A new study in Kenya calculated the economic and social impact of maternal death on families. The study found that when a woman dies, her family faces medical and funeral costs greater than their total yearly household spending. Families also lose the woman's contributions to household work and income generation. The death pushes many families into poverty and debt from which it is difficult to recover.
Maternal mortality remains a significant global issue, with nearly 830 women dying daily from preventable causes related to pregnancy and childbirth. The majority (99%) of maternal deaths occur in developing countries, where access to skilled healthcare is limited. Key factors that influence a woman's risk include her location (rural areas pose higher risk), economic status (poorer communities at higher risk), and age (adolescents at highest risk). While the global maternal mortality ratio has declined 44% between 1990-2015, many countries still show no progress. Reliable data remains scarce but interventions like skilled birth attendance and access to family planning can significantly reduce maternal deaths.
A powerpoint presentation on maternal mortality during a resident's presentation at Komfo Anokye Teaching Hospital, obstetrics and gynecology directorate.
definitions, causes, prevention and way forward for maternal mortality in Ghana
The document describes different types of blood cells and blood disorders through images from a blood smear. It shows normal red blood cells having a pale center, and normal white blood cells. Images then show the pale and smaller red blood cells of iron-deficiency anemia. Sickle cell anemia is indicated by sickled, crescent-shaped red blood cells. Chronic myelogenous leukemia shows increased white blood cells. Hairy cell leukemia features white blood cells with hair-like projections. Hodgkin lymphoma features large owl-like Reed-Sternberg cells.
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
Vital statistics are systematically collected facts related to vital events like births, deaths, and marriages. They are compiled from sources like censuses, registration records, and health surveys. Vital statistics are used for policymaking, administration, research, and public health programs. Some key vital statistics include birth rate, death rate, crude death rate, maternal mortality ratio, and infant mortality rate. Recent advancements in contraceptives allow individuals to plan their families and avoid unwanted births. Natural family planning methods like rhythm method and basal body temperature tracking require abstaining from sex during fertile periods, while barrier methods like condoms use physical barriers.
Child Malnutrition, Consumption Growth, Maternal Care & Price ShocksThe Transfer Project
How much can the underlying determinants of malnutrition contribute to a reduction in stunting?
Presented by Richard de Groot at IFAD, ICID and Site Ideas International Development Conference in Rome in October 2018.
This document discusses guidelines for treating HIV in older patients, women, and perinatal transmission. For newly diagnosed older patients, it notes they often have a more severe disease course and shorter survival than younger patients. It recommends ART for all older than 50. For adherence in older patients, it recommends combining pill counts, self-reports, viral load checks, and refill records. For pregnant women, it recommends the same regimens as non-pregnant adults, and starting ART in the first trimester or delaying until 12 weeks depending on factors. It recommends ZDV for intrapartum transmission prevention and starting infant ART prophylaxis with ZDV within 6-12 hours of birth.
Sex in Three Cities Lecture 2014, Our Reproductive Future 2013UoN
This document discusses the future of human reproduction and fertility. It notes that while assisted reproductive technologies are increasingly used by older couples, contraceptive research and development has been neglected. Over 44 million abortions occur worldwide each year due to lack of effective contraception. The author argues we should invest more in contraceptive research given its potential impact. The document also examines how female fertility sharply declines after age 35, while male fertility is more stable with age. It concludes that while IVF cannot overcome the effects of age on eggs, freezing eggs may help preserve fertility.
Maternal mortality is defined as the death of a woman during pregnancy or within 42 days of termination of pregnancy. The three main causes of maternal death are hemorrhage, infection, and hypertensive disorders, which together account for 75-80% of direct maternal deaths. India accounts for 25% of global maternal deaths despite having only 16% of the world's population. Every year approximately 8 million women suffer from pregnancy related complications worldwide and over half a million die. Maternal mortality can be greatly reduced by ensuring access to quality emergency obstetric care services and family planning programs.
1. The document discusses interventions to reduce neonatal mortality and morbidity in preterm infants in resource-scarce settings, specifically addressing the problem of hypothermia.
2. It describes two case studies of community intervention programs that provided neonatal care packages in rural India and sub-Saharan Africa/Southeast Asia. These programs emphasized increasing access through home visitation and interventions like kangaroo mother care.
3. The studies found that community care programs were highly effective and that care packages were often less costly than individual interventions. Addressing unequal access to healthcare through these types of programs can help reduce inequities in health outcomes.
Sorry this presentation is not great, because all the animations just stockpiled. If you want to see a better version, please go to http://tinyurl.com/pat48ks
Thanks!
This document summarizes field test results of the "motherhood method" used to measure maternal mortality in Nepal. The motherhood method is a direct technique that estimates births and deaths within a geographic area through group discussions with pregnant women and community health workers, without visiting every household. The method was tested in Nepal's Bara district over 2 years, collecting information on 15,161 births. The results provided an estimate of the maternal mortality ratio within 30% margin of error. The study employed the "pregnant women group" approach, where pregnant women and health workers discussed mother and child health issues to identify maternal and infant births and deaths.
This document provides an orientation on quality maternal health care services in Myanmar. It discusses the global and national situations regarding pregnancy and childbirth, highlighting key maternal and neonatal mortality statistics. It outlines Myanmar's progress toward achieving Millennium Development Goals related to improving maternal health. The document defines essential reproductive health services, including safe motherhood, post-abortion care, birth spacing, sexually transmitted infections/HIV, and adolescent reproductive health. It emphasizes the need for skilled birth attendance and emergency obstetric care to reduce maternal and newborn deaths. The document also discusses focused antenatal care and the basic and comprehensive emergency obstetric care services required.
Innovation and integration dr eric silfenCORE Group
Maternal and child health is a significant issue in Africa, where complications during pregnancy and childbirth contribute to over 350,000 maternal deaths annually. Community health workers aim to address this through education, training, appropriate technologies, and partnerships. Philips Healthcare works with various organizations on mHealth initiatives using low-cost ultrasound integrated with telecommunications to improve health outcomes for at-risk mothers and newborns in remote areas of Africa. Studies show this approach can help identify women at high risk of obstetric fistula and assess fetal growth, allowing for better nutrition and care. The goal is to strengthen maternal and child care through sustainable community-level health systems regardless of geography.
Maternal and child health care servicesKailash Nagar
This document discusses maternal and child health care. It begins by introducing the topic and defining maternal and child health services according to the WHO. The objectives of maternal and child health programs are then outlined, including reducing mortality and morbidity for mothers and children. Key health problems, indicators, and recent trends are also summarized. The document goes on to provide details on antenatal, intranatal, and postnatal care services as well as child health services. Causes of maternal and under-five deaths in India are also presented.
Lisa Bohmer worked as the HIV/AIDS Director for UNICEF in Ethiopia and presented on challenges and opportunities for preventing mother-to-child transmission of HIV/AIDS in Africa. Key points included: HIV transmission can occur during pregnancy, labor, delivery or breastfeeding; Ethiopia faces high infection rates particularly among young people and women; and challenges include stigma, improving safer birthing practices, counseling on infant feeding options, and ensuring a steady supply of drugs and testing kits. Opportunities lie in increased funding, integrating PMTCT into other health programs, and engaging communities to promote testing and reduce stigma.
The document discusses expanding sexual and reproductive health services in Haiti. It notes that Haiti has the highest fertility rate and lowest contraceptive use in Latin America/Caribbean. Expanding family planning programs could reduce Haiti's fertility rate and unmet need for contraception, leading to improvements in health outcomes like reduced infant/maternal mortality and increased economic benefits through a potential "demographic dividend" from changes in Haiti's population age structure. However, it is unclear if evidence of family planning programs' positive impacts in other countries would generalize to Haiti. The document calls for benefit-cost analyses to evaluate potential outcomes of expanding such services in Haiti.
Universal Immunization Program is a vaccination program launched by the Government of India in 1985.
It became a part of Child Survival and Safe Motherhood Program in 1992 and is currently one of the key areas under National Rural Health Mission(NRHM) since 2005.
Program consists of vaccination for 12 diseases -
Tuberculosis
Diphtheria
Pertussis
Tetanus,
Poliomyelitis,
Measles,
Hepatitis B,
Diarrhea,
Japanese-Encephalitis,
Rubella,
Pneumonia
Pneumococcal diseases
This document discusses breastfeeding and HIV infection. It notes that approximately one-third of infants born to HIV-positive mothers contract HIV, often through breastfeeding. The risks of HIV transmission through breastfeeding can be decreased by shorter duration of breastfeeding (6 months has a lower risk than 2 years), exclusive breastfeeding for the first few months, and preventing and treating breast problems. However, for HIV-infected mothers in developing countries, not breastfeeding increases the risk of other infectious diseases in infants. The decision to breastfeed or use breastmilk substitutes presents difficulties for these mothers.
Every two hours in Kenya, a woman dies during pregnancy or childbirth, devastating her family. A new study in Kenya calculated the economic and social impact of maternal death on families. The study found that when a woman dies, her family faces medical and funeral costs greater than their total yearly household spending. Families also lose the woman's contributions to household work and income generation. The death pushes many families into poverty and debt from which it is difficult to recover.
Maternal mortality remains a significant global issue, with nearly 830 women dying daily from preventable causes related to pregnancy and childbirth. The majority (99%) of maternal deaths occur in developing countries, where access to skilled healthcare is limited. Key factors that influence a woman's risk include her location (rural areas pose higher risk), economic status (poorer communities at higher risk), and age (adolescents at highest risk). While the global maternal mortality ratio has declined 44% between 1990-2015, many countries still show no progress. Reliable data remains scarce but interventions like skilled birth attendance and access to family planning can significantly reduce maternal deaths.
A powerpoint presentation on maternal mortality during a resident's presentation at Komfo Anokye Teaching Hospital, obstetrics and gynecology directorate.
definitions, causes, prevention and way forward for maternal mortality in Ghana
The document describes different types of blood cells and blood disorders through images from a blood smear. It shows normal red blood cells having a pale center, and normal white blood cells. Images then show the pale and smaller red blood cells of iron-deficiency anemia. Sickle cell anemia is indicated by sickled, crescent-shaped red blood cells. Chronic myelogenous leukemia shows increased white blood cells. Hairy cell leukemia features white blood cells with hair-like projections. Hodgkin lymphoma features large owl-like Reed-Sternberg cells.
1) The document presents 25 cases of patients with various neurological visual field defects seen at the Baroda Ophthalmic Society between 2003-2013. The cases describe the patient's history, examination findings, visual fields, imaging results and progression over time.
2) Case examples include patients with gradual or sudden vision loss, optic atrophy, optic neuropathy, occipital lobe tumors, pituitary adenomas and other conditions affecting the visual pathway. Serial visual fields are presented to track the progression of defects for several patients over multiple years.
3) Different types of visual field defects are documented, including centro-caecal defects, hemianopic defects, and those combining glaucoma and neurological components. The cases
Getting to the Heart of the Matter: Communities and Health Systems Strengtheningjehill3
Getting to the Heart of the Matter: Communities and Health Systems Strengthening
The State of CORE
Karen LeBan, Executive Director, CORE Group
CORE Spring Meeting, April 27,2010
El documento describe las fórmulas para calcular el área y perímetro de varias figuras geométricas básicas como triángulos, cuadrados, rectángulos, rombos, trapecios y círculos. Explica que el área de un triángulo se calcula como base por altura dividido por dos, mientras que el perímetro es la suma de los tres lados. Para un cuadrado, el área es el lado al cuadrado y el perímetro es cuatro veces el lado. El área de un rectángulo es el producto de la
This document provides information about the distribution of European Financial News to key financial press in 30 countries across Europe. It is distributed in English, French and German, with translations included. Marketwire reaches multiple editors per publication, with full contact details available. It provides data on 3,318 media outlets and 5,857 editors across Europe that receive the distributed financial news.
El documento habla sobre el sistema general de riesgos profesionales y la salud ocupacional. Explica que el ARP es el seguro que cubre riesgos como invalidez para los trabajadores. La EPS se encarga de afiliar y dar la atención médica a los trabajadores. La salud ocupacional busca promover el bienestar de los trabajadores. También define conceptos como factores de riesgo, accidentes de trabajo e incidentes, y explica la investigación de accidentes.
The document discusses a retail market analysis for downtown development. It includes analyzing existing retail services and trade areas, mapping current stores and vacancies, and making recommendations targeted towards filling gaps. Components of successful downtowns discussed include streetscapes, retail, and public spaces. Various strategies are presented for improving the pedestrian experience, attracting the right retail mix, and developing public spaces to attract private investment.
Alain ozan keynote zagreb.ppt [compatibility mOracle Hrvatska
This document outlines Oracle's general product direction and provides information on its applications, middleware, database, infrastructure and management products. It discusses Oracle's leadership in key markets and industries. The document also discusses Oracle's strategy around cloud computing, including how enterprises can evolve their IT environments from private to public clouds through a hybrid approach.
Incidence of posterior capsular opacification in rigid pmmaDr. Anand Sudhalkar
1. The document compares the incidence of posterior capsular opacification (PCO) in different groups who received rigid PMMA intraocular lenses (IOLs) through either extracapsular cataract extraction (ECCE) or phacoemulsification surgery.
2. The results showed that males had a higher incidence of PCO than females, and ECCE patients using three-piece convex-plano IOL designs or IOLs with heparin surface modifications had lower rates of PCO.
3. Phacoemulsification patients had a higher incidence of PCO compared to ECCE patients, and within phaco patients, those with heparin surface modified IOLs
This document discusses how good things come in 3s and outlines 3 types of people and 3 types of actions related to social media. Specifically, it notes there are 3 kinds of people and social media focuses on the social rather than the media. It then lists 3 kinds of actions for social media - communication, collaboration, and open innovation.
Presentatie over SEO (Zoekmachine Optimalisatie) waarin gekeken worden naar de basis van vindbaarheid in Google. Naast een aantal SEO trends aandacht voor een aantal praktische tips.
De presentatie is gegeven voor ondernemers van CJB Water & Glas.
Wil je dat ik eens bij jou kom vertellen over online marketing thema's als zoekmachine optimalisatie (SEO), zoekmachine adverterteren / Google AdWords (SEA) of een ander (online) marketing gerelateerd thema?
Neem dan contact op. Kijk op http://xpertmarketing.nl/spreker-online-marketing/ of mail naar wieger.waardenburg@xpertmarketing.nl
Topical bevacizumab in combination with flurbiprofen eye drops and punctal occlusion for 4 weeks after pterygium excision and conjunctival autograft showed no recurrence of pterygium in any of the 17 patients over a 2 year follow up period. No patients experienced any ocular or systemic side effects from the topical bevacizumab treatment. This prospective case series suggests that topical bevacizumab may be a safe and effective adjuvant therapy to prevent recurrence of primary pterygium after surgery. Larger controlled studies are still needed.
Architecting Your Site For Search Engine Performance: And We Ain't Talkin' Ju...Dottie Hodges
Effective strategies for SEO from strategic planning, keyword research, effective architecture and navigation and content, on and off page factors, and care and feeding of an SEO effort over time. Not to mention Dottie's fabulous boots.
La contaminación está deteriorando nuestro entorno y es un problema evidente. Nuestra actitud y acciones son determinantes para reducir el impacto ambiental. Debemos esforzarnos por cuidar el medio ambiente.
Epidemiological aspects of maternal and child healthnew 3Sinmayee Kumari
"maternal and child health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children"
this topic is very essential for all the health care personnel
The document discusses common bacterial infections in children. The most common bacterial infections in babies are skin, ear, and throat infections, while the most common viral infections are respiratory infections such as RSV. Over 44% of child deaths under age 5 occur during the neonatal period, with approximately 2.6 million neonatal deaths worldwide in 2015. Bacterial infections and sepsis are major causes of neonatal mortality. Prevention strategies discussed include immunization of mothers and children, breastfeeding, hygiene practices like chlorhexidine cord care, and education of health professionals in neonatal resuscitation. Prudent antibiotic use and stewardship programs are important to prevent antibiotic resistance.
This document discusses several issues related to HIV/AIDS in Kenya:
- Kenya has one of the world's worst HIV/AIDS epidemics, with an estimated 1.5 million people living with HIV. While prevalence has declined, only about half of those eligible receive treatment.
- Access to antiretroviral treatment has increased in recent years but remains low for children. Post-exposure prophylaxis and voluntary medical male circumcision can help reduce transmission rates.
- Breastfeeding provides crucial health benefits for infants and mothers but introduces risks for HIV-positive mothers, requiring antiretroviral interventions to reduce transmission through breast milk. Proper support is needed for breastfeeding to succeed.
Neonatal infections and sepsis remain significant causes of neonatal mortality worldwide. Prevention through maternal immunization, breastfeeding promotion, hygiene practices and education can reduce incidence. Treatment requires prompt empiric antibiotics guided by local resistance patterns. Antibiotic stewardship including optimized dosing, duration and diagnostics like biomarkers can improve outcomes while minimizing resistance. Public awareness, access to care and recognition of danger signs are also important to address this leading killer of young infants.
This document discusses epidemiology and how it was used to identify smoking as a cause of lung cancer. It shows that lung cancer rates increased dramatically between 1937-1950 in the US. A case-control study found that smokers were over 20 times more likely to develop lung cancer than non-smokers. A later British study found that lung cancer risk increased with the number of cigarettes smoked per day. Through observational epidemiological studies, researchers were able to establish smoking as a major risk factor and cause of lung cancer.
This document is a public health assignment submitted by Sagun Paudel to Diphendra Kumar Yadav on July 11, 2011. It contains summaries of prevention strategies for malnutrition, sexually transmitted infections, and cancer at different levels including individual, community, national, and international levels. Prevention approaches include health education, screening, immunization, nutrition supplementation, and treating infections early.
1) The document discusses eliminating pediatric HIV/AIDS through preventing mother-to-child transmission (PMTCT). It outlines the four components of the WHO's PMTCT strategy and improvements in reducing new HIV infections among children from 600,000 in 1990 to 370,000 in 2009.
2) While PMTCT programs have expanded, only about half of pregnant women and infants receive antiretroviral drugs. Early diagnosis and lifelong treatment are critical for infants to survive.
3) Goals for HIV care programs include preventing opportunistic infections, early identification and management of complications, and engaging patients in care, treatment and prevention through education and support. With continued progress, the document argues that virtual elimination of pediatric HIV
1. Introduction to Family planning methodGalassaAbdi
This document provides an introduction to family planning in Ethiopia. It defines family planning and describes the components of family planning services. It identifies the contraceptive methods available in Ethiopia, including natural methods, barrier methods, hormonal methods, implants, IUDs, sterilization procedures, and discusses updates to contraceptive technology. Key statistics are presented on Ethiopia's population growth, total fertility rate, contraceptive use, unmet need, and maternal and child health indicators. Progress is noted in increasing contraceptive prevalence and decreasing unmet need from 2000 to 2011.
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Can you please go over the power point you’ve provided & make sure these 3 corrections required are successfully completed please? If you can add in more cited references please.
13
Assessing Current Approaches to Childhood Immunizations
Department of Psychology, Grand Canyon University
PSY-550: Research Methods
Dr. Shari Schwartz
May 19, 2021
Introduction
Immunization is the process in which an individual is protected against disease, and it is done via vaccination. On the other hand, vaccination is the action of a vaccine being introduced into the body to produce immunity to a particular disease. A vaccine is a product that arouses the immune system of an individual, thus the production of immunity to a particular disease. The immunity thus protects the individual from that disease. Immunity is the protection from a disease that is infectious. Child immunization is the primary public health approach in the reduction of child mortality and morbidity. Assessment of the current approaches that are linked to the immunization of a child is essential. Globally, primary immunization is estimated to prevent approximately 2.5 million childhood deaths annually from tetanus, diphtheria, measles, and pertussis (Dube et al., 2013). Immunization succession is always accompanied by rejection of public health practices, and reasons for these have never been straightforward. Some of the motivations are religious, scientific, or even political. To reduce the incidence and prevalence of vaccine-preventable diseases, vaccination programs depend on a high uptake level. Vaccination offers protection for vaccinated individuals. When there are high vaccination coverage rates, the indirect protection rate is stimulated for the overall community (Dube et al., 2013).Literature Review
Despite this massive use, immunization coverage in countries still developing has been reported to be still low. If mothers were educated on the importance of these vaccine services to their children, all the children would receive immunization as per the Expanded Program on the Immunization schedule, hence preventing mortality and morbidity. According to Thapar et al., in 2014, approximately an 18.7million children could not get the third dose of the Diphtheria-Pertussis-Tetanus (DPT3) vaccine. The total percentage of children who are one year and below and have to receive their dosses of DPT3 vaccine is seen as a proxy indicator regarding full immunization. The DPT3 estimates assess the health system performance and measure the immunization program effectiveness regarding service delivery. These strategies are thus used in the implementation of strategies for the elimination and eradication of diseases. According to Thapar et al., the global coverage for DPT1 and DPT3 was 90% and 86%, respectively, while that of measles first dose at 86%.
The above estimates thus do not replicate the seen differences in vaccine coverage. The coverage of DPT1 and DPT3 varied ...
What's New for Newborns_Claudia Morrissey & Allyison Moran_10.14.11CORE Group
1) The document discusses new developments in reducing newborn mortality over the past decade. Deaths have declined 28% since 2000, due in part to low-cost interventions like home-based neonatal care in India.
2) It also summarizes evidence for interventions to address the three main causes of newborn deaths: birth asphyxia (Helping Babies Breathe training), preterm/low birthweight babies (kangaroo mother care), and infections (chlorhexidine cord care and community case management).
3) Ongoing research aims to simplify antibiotic treatment regimens for neonatal infections and evaluate strategies for scaling up newborn health programs.
The document summarizes the key aspects of the Indian Newborn Action Plan (INAP). It was launched in 2012 to accelerate the reduction of preventable newborn deaths and stillbirths in India by 2030. The goals are to achieve single digit neonatal and stillbirth rates by 2030. It discusses the current trends showing geographical and rural-urban differences. The major causes of neonatal deaths are also provided. The document then describes the 6 strategic intervention packages of INAP covering preconception to postnatal newborn care. It highlights targets and principles of integration, equity and quality. Monitoring and evaluation are important components to track progress of the plan.
Save the Children is focused on reducing newborn mortality globally. It has three main goals:
1. Getting newborn health on global and national agendas through research showing the major causes of newborn deaths and effective interventions.
2. Supporting country programs that have led to important declines in newborn mortality rates in places like Bangladesh, Bolivia, and Tanzania.
3. Continuing to scale up high-impact newborn interventions through health systems, strengthen implementation, and institutionalize newborn survival within countries and organizations.
The document discusses strategies to improve child survival globally and reduce child mortality. It states that nearly 10 million children die before their 5th birthday annually, mostly from preventable causes like pneumonia, diarrhea, malaria, measles and malnutrition. Over 8 in 10 of these deaths could be avoided with timely access to basic healthcare. The document then outlines several evidence-based interventions to improve child survival, including integrated management of childhood illnesses (IMCI), community case management (CCM), immunizations, and preventative measures like breastfeeding and insecticide-treated bednets. It emphasizes scaling up access to essential services, improving quality of care, increasing demand for healthcare, and supporting innovation and policies to promote child survival.
Reproductive, Maternal, Newborn, Child and Adolescent Health RMNCHAKailash Nagar
This document outlines India's strategic approach to reproductive, maternal, newborn, child, and adolescent health called RMNCH+A. It was launched in 2013 to be at the heart of India's National Health Mission. The goals are to reduce infant mortality to 25 per 1000 live births, maternal mortality to 100 per 100,000 live births, and total fertility rate to 2.1 by 2017. It identifies 184 high priority districts and outlines coverage targets and interventions across the lifespan from adolescence to reproductive years. Key interventions include antenatal care, institutional deliveries, postnatal care, newborn care, child nutrition, immunization, and family planning.
The National Family Welfare Programme was launched in 1952 to promote family planning and improve quality of life. It aims to encourage small family sizes and use of spacing methods. Key strategies include integrating family welfare services with health services, focusing on rural areas, and using mass media campaigns. The programme monitors indicators like contraceptive use, antenatal care coverage, and immunization rates. Maternal and Child Health programmes were also launched to reduce mortality and morbidity rates by providing reproductive health services, nutrition programmes, and disease prevention.
13 Assessing Current Approaches to Childhood ImmunizatioChantellPantoja184
13
Assessing Current Approaches to Childhood Immunizations
Department of Psychology, Grand Canyon University
PSY-550: Research Methods
Dr. Shari Schwartz
May 19, 2021
Introduction
Immunization is the process in which an individual is protected against disease, and it is done via vaccination. On the other hand, vaccination is the action of a vaccine being introduced into the body to produce immunity to a particular disease. A vaccine is a product that arouses the immune system of an individual, thus the production of immunity to a particular disease. The immunity thus protects the individual from that disease. Immunity is the protection from a disease that is infectious. Child immunization is the primary public health approach in the reduction of child mortality and morbidity. Assessment of the current approaches that are linked to the immunization of a child is essential. Globally, primary immunization is estimated to prevent approximately 2.5 million childhood deaths annually from tetanus, diphtheria, measles, and pertussis (Dube et al., 2013). Immunization succession is always accompanied by rejection of public health practices, and reasons for these have never been straightforward. Some of the motivations are religious, scientific, or even political. To reduce the incidence and prevalence of vaccine-preventable diseases, vaccination programs depend on a high uptake level. Vaccination offers protection for vaccinated individuals. When there are high vaccination coverage rates, the indirect protection rate is stimulated for the overall community (Dube et al., 2013).Literature Review
Despite this massive use, immunization coverage in countries still developing has been reported to be still low. If mothers were educated on the importance of these vaccine services to their children, all the children would receive immunization as per the Expanded Program on the Immunization schedule, hence preventing mortality and morbidity. According to Thapar et al., in 2014, approximately an 18.7million children could not get the third dose of the Diphtheria-Pertussis-Tetanus (DPT3) vaccine. The total percentage of children who are one year and below and have to receive their dosses of DPT3 vaccine is seen as a proxy indicator regarding full immunization. The DPT3 estimates assess the health system performance and measure the immunization program effectiveness regarding service delivery. These strategies are thus used in the implementation of strategies for the elimination and eradication of diseases. According to Thapar et al., the global coverage for DPT1 and DPT3 was 90% and 86%, respectively, while that of measles first dose at 86%.
The above estimates thus do not replicate the seen differences in vaccine coverage. The coverage of DPT1 and DPT3 varied from 84% and 76% in Africa and 97% and 94% in the European countries. In India, the routine has been lower than in the rest of the countries. Following the 2013 outbreak in Israel, many paren ...
13 Assessing Current Approaches to Childhood ImmunizatioCicelyBourqueju
This document presents a research proposal assessing current approaches to childhood immunization. The study will use a community-based cross-sectional design to examine factors associated with partial immunization of children under five, such as mothers' knowledge, beliefs, religion, and education level. A sample of mothers will be surveyed using random stratified sampling. Correlation analyses will examine relationships between vaccination hesitancy and demographic factors. The results could help identify digital methods for tracking under-vaccinated children and inform future health policy. Limitations include potential recall bias and the time needed for data collection.
The Philadelphia Department of Public Health's Kathleen Brady presented on Philadelphia's Fetal Infant Mortality Rate (FIMR) process at the January 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
This document outlines the RMNCH+A framework in India, which aims to improve reproductive, maternal, newborn, child and adolescent health through an integrated approach. It discusses the problem statement, goals and targets, strategic interventions across the lifecycle from adolescence to reproductive years. These include adolescent health services, antenatal care, skilled birth attendance, essential newborn care, immunization, and family planning. The framework also covers health system strengthening, program management, priority actions in vulnerable areas, and partnerships to support RMNCH+A service delivery in India.
PSI Diarrhea Prevention and Safe Water Approaches jehill3
Unsafe water and lack of sanitation are major global problems, contributing to over 1.5 million child deaths from diarrhea each year. Household water treatment (HWT) options like sodium hypochlorite, Aquatabs, and PUR can provide low-cost solutions, treating water for a family of 6 for less than a penny per day. Social marketing approaches that combine communications and product access have helped programs in over 30 countries treat over 60 billion liters of water, improving health behaviors and reducing diarrhea prevalence in places like Madagascar. Lessons show that focusing on key behavior drivers, partnerships, and multiple communication channels can enable HWT to effectively and affordably scale up safe water access.
The document discusses global sanitation issues and innovative solutions being piloted by USAID's Hygiene Improvement Project in various countries. 2.6 billion people lack basic sanitation and 1.1 billion still practice open defecation. New approaches are needed beyond subsidized latrines. Projects in Ethiopia, Madagascar, Peru, and Uganda aim to create demand, strengthen local markets and entrepreneurs, and link sanitation to hygiene. Monitoring tools also developed to measure access and behaviors. Handwashing promotion highlighted as a way to reduce diarrhea by 50%.
Wellness and Agriculture for Life Advancement (WALLA)jehill3
This document summarizes a food security program in Malawi called Wellness and Agriculture for Life Advancement (WALA). The program aimed to reduce food insecurity for over 214,000 households. Key activities included improving maternal and child health, smallholder farming, and community capacity. The program was implemented by several organizations and involved conservation agriculture, village savings and loans, and direct food assistance. Lessons learned stressed the importance of clear targeting, planning, understanding of synergies between sectors, and monitoring mechanisms to promote integration across activities and organizations.
This document discusses the potential for mobile health (mhealth) technologies to help address healthcare challenges in remote areas with limited resources. It provides examples of how SMS and other mobile technologies have been used in a pilot project in Kenya to:
1) Provide patient follow-up, adherence tracking, and reporting of new symptoms to improve information sharing and care. This saved fuel costs and staff time.
2) Enable remote care requests, drug information, and point-of-care support to enhance patient care. This led to more patients enrolling in health programs.
3) Help manage drug and supply stockouts, support group coordination, training, and CHW communication to improve healthcare logistics and operations.
Preliminary results from a survey on the use of metrics and evaluation strate...jehill3
Preliminary results from a survey on the use of metrics and evaluation strategies among mHealth projects
Patricia Mechael, Nadi Kaonga
Center for Global Health and Economic Development at the Earth Institute, Columbia University
CORE Group Spring Meeting, April 30, 2010
This document discusses using mobile health (mhealth) applications to address challenges in community health programs. It outlines mhealth ideas from working groups in areas like integrated community case management (ICCM), nutrition, tuberculosis, HIV, and monitoring and evaluation. Examples of proposed mhealth interventions include using phones to answer community health worker questions, improve referral systems, collect and transfer data, monitor adherence, and reduce stigma. The document concludes by sharing the results of an mhealth competition in Malawi and providing prompts for small groups to design an mhealth checklist to assess whether and how mhealth should be integrated into different community health topics and settings.
Working with the “institutional” health system: HAI’s model of health systems...jehill3
This document outlines HAI's model of health systems strengthening which focuses on working with public sector institutional health systems. It discusses the importance of strong public health systems for scalability, equity, and specialized services. HAI works in key areas like integrating services, leadership and management, health systems research, and community linkages. Examples from Timor-Leste and Côte d'Ivoire show HAI's work improving maternal and child health services, developing health facilities, training health workers, and strengthening community outreach. The document concludes by discussing opportunities to further strengthen whole health systems through integrated services, workforce issues, information systems, and leadership coordination.
This document discusses improving community health through an integrated community case management (ICCM) approach. The ICCM approach has 3 components: improving case management by health staff, strengthening the overall health system, and engaging families and communities through practices. A key part of the community component is utilizing community health workers and mobilizing communities.
Boosting Nutrition Impact via Integrated Program Strategiesjehill3
The document summarizes an integrated nutrition program in Bangladesh called Jibon o Jibika that targeted 200,000 children under age 2. It showed that reducing undernutrition was more effective when all program components, such as food production, marketing, health, water and sanitation, were implemented together. Stunting, wasting, and being underweight declined more in areas where all components worked together. Dietary diversity and income also increased more in integrated areas. The document discusses proven interventions to reduce undernutrition and calls for more evidence on how best to integrate different sector approaches, prioritize interventions, and strengthen programs targeting mothers and children under age 2.
Retention, attrition and motivation of voluntary workers in community-based p...jehill3
Retention, attrition and motivation of voluntary workers in community-based programs
Peter Winch and Anne Palaia, Johns Hopkins Bloomberg School of Public Health
CORE Group Spring Meeting, April 29, 2010
Community Directed Interventions to Improve Malaria in Pregnancy Control Serv...jehill3
The document summarizes a community-directed intervention project in Nigeria to improve malaria control among pregnant women. Key points:
- The project trained community volunteers to provide intermittent preventive treatment (IPTp) and insecticide-treated bednets in their communities, in addition to clinic services. This increased access to malaria prevention and treatment.
- Evaluation found higher uptake of IPTp and bednets in intervention areas compared to control areas relying solely on clinics. However, stockouts of commodities and user fees reduced impact.
- Community involvement through volunteers was effective but regular support is needed. Advocacy is also key to ensure free services and continuous supply of medicines and bednets.
HBLSS: Improving on Innovation
American College of Nurse Midwives
Safe Motherhood and Reproductive Health Working Group Showcase
CORE Group Spring Meeting, April 29, 2010
Meeting the Water, Sanitation and Hygiene Needs of People Living with HIV/AID...jehill3
Meeting the Water, Sanitation and Hygiene Needs of People Living with HIV/AIDS and their Families
Elizabeth Younger, USAID
SBC Working Group Showcase
CORE Group Spring Meeting, April 29, 2010
Barrier Analysis Survey: Working Group Participationjehill3
Barrier Analysis Survey: Working Group Participation
Mitzi Hanold, Food for the Hungry
SBC Working Group Showcase
CORE Group Spring Meeting, April 29, 2010
Barrier Analysis Survey: Working Group Participation
Using li st_to_estimate_impact
1. Lives Saved Analyses for Child Survival Projects: Using LiST to Estimate the Impact of Maternal, Newborn and Child Health Interventions Debra Prosnitz, MPH; Rebecca Levine, MPH; James Ricca MD, MPH; and Ingrid Friberg, PhD
22. Malaria Mortality Disease Specific Treatments Disease Specific Preventions Risk factors ITN/IRS Antimalarials Stunting
23. Stunting Post-Neonatal Diarrheal Mortality Rotavirus vaccine Vitamin A Zinc Water/Sanitation (5) Zinc Antibiotics for dysentery ORS Disease Specific Treatments Disease Specific Preventions Risk factors IUGR Syphilis detection and treatment IPTp Maternal energy and/or micronutrient supplementation Zinc Complementary Feeding Complementary feeding education and/or supplementation Diarrhea incidence Improved H 2 O source within 30 minutes Hand washing with soap Water connection in the home Improved excreta disposal (latrine, toilet) Hygienic disposal of children’s stools Distant Factors Breast Feeding Breast Feeding Promotion
“ At the turn of the millenium, there was a wide-spread feeing in the child health community that the over 10 million annual deaths of under five children were not receiving the attention they deserved. A group of concerned scientists and policymakers gathered for a week in Bellagio, Italy, to prepare a series of articles arguing for increased funding for child survival actions, which became known as the Lancet Child Survival Series. The second article in the series included a formal attempt to estimate how many deaths could be saved by each intervention then available.” “ The Bellagio spreadsheets were sufficiently accurate for the purposes of this initial exercise and made an important contribution to placing child survival back on the international agenda. However, from a methodological standpoint there was substantial room for improvement.” “ This software was inspired by the Bellagio exercise, but went much further in terns of the background mortality data used, the quality of the literature reviews on intervention effectiveness and of the modelling process itself.
This tool is a multi-cause model, in which we assume an interaction between causes. This means that we assume that people who are ‘saved’ from one cause of death are still at risk of dying from a separate cause at the standard population risk.
LiST was built into Spectrum, a software from the Future’s Institute which is already used by many organizations for family planning and HIV projections, among other things. The first benefit of this is that we can start with DemProj, which is the demographic platform underlying Spectrum. The data in this module is based on the 2008 UN population projections which allow estimates of population through 2050. By using this platform, links have been built into other modules within Spectrum. AIM, which models UNAIDS data for each country and FamPlan which estimates of the impact of family planning on the number of births. The Child survival module itself is a cohort based model in which each child goes through time periods at risk of dying, ensuring that each child cannot be saved more than once, and cannot die more than once. This also allows the impacts of the interventions to be lagged to the future. For example, IUGR and past stunting both affect the probability of future stunting.
The general framework of the model starts with the UN estimates and projections of population, which allows us to estimate the number of child deaths in each year. We overlay this number with information on the cause of death in individual countries as well as information on both the current and future status of a wide variety of child survival interventions. These allow us to calculate the impact of each intervention and present the number of deaths averted by both cause and intervention. These results then get fed back into the model to adjust population projections for the future year. We can also enter country specific data on the health status of the population, including nutritional status and this also feeds into the impacts of the interventions, the resultant stunting and the numbers of deaths averted.
CHERG (Child Health Epidemiology Reference Group) was responsible for reviews of effectiveness of interventions. To do this, they first they defined an intervention: a biological agent or action that is intended to reduce morbidity or mortality. Then, they only looked at interventions which would typically be implemented by the health department. This meant that they ignored distal causes of mortality such as poverty, lack of education and household crowding or birth spacing. They also looked only at interventions which would be feasible to implement in a low-income country. That meant that technologically intensive or expensive interventions, such as secondary care of newborns was excluded. So yes, some effective interventions were excluded simply because it is unlikely that they could be easily implemented in one of the priority countries. Finally, all the interventions had to have cause-specific evidence of an effect on child mortality. The evidence was only included in the model if there was sufficient or limited data that was suggestive of efficacy. Interventions with inadequate data to assume efficacy were not included even if the general impression of the intervention was of a positive impact. One example is immediate initiation of breastfeeding after birth. To reiterate, since the initial publication of the efficacy data, a series of reference groups have been convened, focusing on the efficacy of interventions in their field, such as newborn health or nutrition and they are continually reviewing and refining this data. Thus if new data is available which changes the results of a meta-analysis or review, then these interventions can be added to or removed from the model easily.
We can look at the interventions that are included in the model in a variety of ways. One is as part of a continuum of care. Thus there are interventions which can impact the health of the child peri-conceptually, ante-natally, during the birthing process and post-natally. We could also look at the interventions as being either preventive or curative.
Over 40 interventions are included in the model
ential Care: % of women with essential care during delivery and immediate newborn care. Includes: monitoring labor progress with partograph, detection of complications and infection control via a clean delivery. Episiotomy is available if needed. For the neonate, this includes immediate drying and wrapping, skin-to-skin contact and thermal care as well as immediate breastfeeding initiation BEmOC: Refers to management of delivery at health center and covers case mgmt of direct obstetric complications. Includes: Case mgmt of abortion, ectopic pregnancy, hypertensive diseases of pregnancy, ante-partum hemorrhage, prolonged/obstructed labor, PPH, and severe infection. Methods include: shock mgmt, MgSO4, pain relief, ABC, parenteral antibiotiocs, parenteral oxytocis, IV fluids, instrumental delivery and manual removal of the placenta and retained products, CEmOC: This refers to the mgmt of delivery at a hospital and covers case management of direct obstetric complications. This is in addition to all interventions included in Basic Emergency Obstetric Care. Additional methods include: ultrasound, culdocentesis, induction, laparotomy, salpingectomy, blood transfusion, caesarian section, hysterectomy, symphisiotomy, ballon tamponade, uterine ligature, MROP, surgical infection control and episiotomy. Clean practices & Immediate ENC: ie clean delivery kit
There are two kinds of data that are needed to get LiST to work: Country-specific data and global data. For the country-specific data, first we have the national population data and trends which are built into Spectrum. We also have a cause of death structure for each country, estimated for the year 2003. We also need intervention coverage data both past and present. This default data in LiST is the data that was available from the date closest to the year 2003. However, it varies from country to country based on the quality of the data available. In addition, we use global estimates of intervention efficacies which was developed by the CHERG. It is really important to realize that this data can and should be changed to use the program to fit your exact needs. We only have baseline data to make things easy, but anytime you use it, you should make sure that the data fits what you are planning on doing with the software. For example, some people use DHS data, others prefer UNICEF values. Which one you use depends on your situation.
The pieces of the model include preventions, treatments and risk factors. Each prevention prevents a death. Each treatment stops a death from occurring. And each risk factor modifies the probability of a child dying from that specific cause. Each of these individual interventions has an impact on a specific cause of death, such as Hib vaccination on pneumonia, or on a specific risk factor, such as breast feeding on stunting, which then affects several causes of death. So if you are working with one intervention, it is very straightforward, but how do we deal with multiple interventions. First, all the preventions are entered into the model and the proportionate deaths averted are calculated to prevent double counting of deaths averted. Only then is the same done for the all of the treatments. Thus, treatments only impact lives which were not already saved by a prevention (treatment only saves residual lives).
The impact of the interventions is also age specific. LiST uses 5 different age categories. We have a cause of death profile which is divided into neonatal and post-neonatal. We would like to have the cause of death profile match the effectiveness data, but right now, the data just isn’t available.
There are three sets of interventions which are tied to other interventions. Each one has been dealt with slightly differently because of the types of interventions that we are dealing with. Antenatal care, where the three components that are part of the model are a proportion of the total women receiving at least 4 ANC visits. For antenatal care, the coverage actually refers to the percentage of pregnant women with at least 4 ANC visits. The three components are calculated to be a proportion of those women. So the number that is displayed, reflects the percent of women with each component. For example, in 2003, syphilis detections and treatment is expected to have occurred for 6% of pregnant women. Child birth care is divided into two parts, which are forced to sum to 100% - facility based deliveries and home based deliveries. For each of these, there are several component interventions. The value seen is a proportion of the facility delivery or home delivery with access to the intervention. Births are divided into two categories: facility and home based births. These are forced to add to 100%. There are 4 different interventions associated with facility birth. Instead of indicating the percent of women who had access to corticosteroids, we indicate the percent of women delivering in a facility who have access to corticosteroids. We did this so that countries who were improving the quality of their child birth care could reflect that in the numbers. Water: Two different interventions are associated with clean water, use of an improved water source within 30 minutes of the home or use of a water connection in the home (which included water piped into the home or a protected source in the yard). However, these are not independent - Piped water is a subset of improved water. So, the impact of an improved source is the difference between improved and piped.
This is a diagram which depicts the interventions which can affect stunting, a risk factor for mortality. Although not explicitly shown here, you should realize that stunting has a time lag built in as well. A child who was stunted in a previous time period has a higher risk of currently being stunted than one who was not previously stunted. The pink for appropriate complementary feeding indicates that this is not something that is directly observed, only that this is the actual link between the education and the stunting.
This diagram is an example of one of the most simple flow-charts depicting the associations in the model. Note that the blue indicates a treatment while green is a prevention. And red represents a risk factor which modifies the probability of a child dying of this particular disease. This means that reducing stunting will reduce the probability of getting the disease. Thus in the model, it acts like a prevention.
And finally, just to show that this is not just a simplistic model, you can see all of the associations that are built in. This is just the model of post-neonatal diarrhea. You can see the obvious preventions and treatments as well as the risk factors for mortality that modulate the probability of a child dying. And each of these risk factors is associated with a variety of more distal factors which modulate the probability of having that particular risk factor.
LiSt is linked to FamPLan, a Family planning module that can reduce the number of births with an increase in used of contraception. To demonstrate this are 4 projections of mortality. Each is identical except for the child survival and family planning interventions. The first is a baseline model with neither family planning nor child survival scaled up in the final year. The second has only family planning coverage increased in the final year. In the third projection, only child survival interventions have been scaled up. In the final projection, both family planning and child survival interventions have been increased. As you can see, in the first row, the number of deaths in each year increases due to population increases. If you scale up family planning, you can reduce the number of deaths by about 7000 children, but these are mostly due to fewer births. In reality, we also save fewer lives than with the same level of child survival interventions just because fewer children are being born. Also note that the under 5 mortality rate has not changed. However, in the third projection, we have only scaled up the child survival interventions and have saved approximately 31,000 deaths due to the child survival interventions. This does not reflect any decrease in the number of children born as family planning is not yet scaled up, however there is a dramatic reduction in the under 5 mortality rate. In the final model, both family planning and child survival have been scaled up. So we have a reduced number of births as well as an increase in children surviving. Although once again fewer children are saved with the child survival interventions because of the reduced number of births.
Emphasize: LiST is a Multi-Cause Model NOT a Natural History Model. As a multi-cause model, it does calculations on residual deaths, and therefore does not save children multiple times. As it is NOT a natural history model, it does not take into account disease transmission rates, etc.
NOTE: Child Survival Interventions have been validated in LiST. Maternal Health interventions have NOT been validated – modeling and validation of MH interventions is ongoing; please refer to the limitations of MH previously noted.
Modeled between 20-25 interventions ACSD: UNICEF’s Accelerate Child Survival and Development Initiative
Trainings and Orientations have also been done for several additional organizations, including UN groups, development organizations and external organizations.
LiST is not complete. Maternal mortality links are being worked on, and should be available soon. We also know that family planning has benefits beyond just reducing births, it may also have additional benefits to families and these will be included in the near future as well. The programmers are working to tie in the mortality impact to both the MBB and CHOICE costing and budgeting approaches. As new data and reviews are available, the software will be updated with that new information. Finally, right now, the only baseline data in the model is from 2003. They are working on getting models which are current through 2008 entered into the system. We also want to do the same for districts within some larger countries such as India and Pakistan.
These are the websites where you will be able to get access to the software, although the final versions are not available yet.