Addressing Gaps in Maternal, Neonatal, and Child Health for Achieving SDG 2030 in West Africa.

Post-2015 health goals: could country-specific targets supplement global ones?

Roots of Iraq's maternal and child health crisis run deep

Maternal fetal and infant mortality and morbidity are among the most significant public health problems in developing and resource-poor nations. In most developing countries important contributing factors to perinatal and maternal mortality are the lack of adequate diagnostic and pathology facilities inadequate or absent postmortem examination poor diagnostic pathology and microbiology capabilities and deficiency in surveillance systems statistical reporting and diagnostic accuracy of adverse maternal and perinatal health events. Most resource-poor nations have no pathologist trained in perinatal pathology who is available to address the clinical diagnostic public health and research aspects of these mortality and morbidity issues which are so prevalent in the developing world. The following article highlights some of the most important global perinatal health problems - including malaria low birth weight HIV/AIDS maternal malnutrition maternal death unsafe abortion and political turmoil - which would benefit by increased contributions from collaborations with physicians trained in perinatal pathology.

The Government of India is committed to achieve Sustainable Development Goals (SDG) Agenda 2030 consisting of 17 goals and 169 targets, span­ning the three dimensions of economic, social and environmental development. Since the Government of India is the biggest entity with the most resources to ensure achievement of the Sustainable Development Goals (SDG) and targets that have been set, the legal and policy framework already in place in the country has to be critically reviewed to see how capable it is of achieving the SDGs and identify the gaps and challenges, if any, for rectification. In this context, the basic objective of the present paper is to review the efforts made by the Government of India for the development of health facilities throughout the country in order to achieve the targets of Sustainable Development Goals (SDG), to examine the trends in the annual compound reduction rates in the selected Maternal and Child Mortality Rates in India during the first 7/8 years of the Sustainable Development Goals (SDP) period, project the Maternal and Child Mortality Rates based on the existing annual compound reduction rates up to the target year of 2030 and then compare the projected values of selected Maternal and Child Mortality Rates with the SDG targets fixed for achievement by 2030. The paper found that the Maternal Mortality Rate (MMR) has the annual compound reduction rate of 6.4%, Under 5 Mortality Rate (U5MR) has the annual compound reduction rate of 5.0%, Infant Mortality Rate (IMR) has the annual compound reduction rate of 4.9% and Neonatal Mortality Rate (NMR) has the annual compound reduction rate of 4.3% in India during the period between 2015 and 2021/2022. By assuming that the Government of India will continue its efforts to maintain the existing annual compound reduction rates in the Maternal and Child Mortality Rates during the remaining period of Sustainable Development Goals, the paper has projected that India is on the track of achieving the SDG targets of MMR at 70/lakh live births by 2025 (5 years before the target year), U5MR at 25/thousand live births by 2026 (4 years before the target year), IMR at 20/thousand live births by 2027 (3 years before the target year) and NMR at 12/thousand live births by the target year 2030.

Building resilient societies after COVID-19: the case for investing in maternal, neonatal, and child health

BackgroundInequality in maternal and child health seriously hinders the overall improvement of health, which is a concern in both the United Nations Sustainable Development Goals (SDGs) and Healthy China 2030. However, research on the equality of maternal and child health is scarce. This study longitudinally assessed the equality trends in China’s maternal and child health outcomes from 2000 to 2013 based on place of residence and gender to improve the fairness of domestic maternal and child health.MethodsData on China’s maternal and child health monitoring reports were collected from 2000 to 2013. Horizontal and vertical monitoring were performed on the following maternal and child health outcome indicators: incidence of birth defects (IBD), maternal mortality rate (MMR), under 5 mortality rate (U5MR) and neonatal mortality rate (NMR). The newly developed HD*Calc software by the World Health Organization (WHO) was employed as a tool for the health inequality assessment. The between group variance (BGV) and the Theil index (T) were used to measure disparity between different population groups, and the Slope index was used to analyse the BGV and T trends.ResultsThe disparity in the MMR, U5MR and NMR for the different places of residence (urban and rural) improved over time. The BGV (Slope BGV = -32.24) and T (Slope T = -7.87) of MMR declined the fastest. The gender differences in the U5MR (Slope BGV = -0.06, Slope T = -0.21) and the NMR (Slope BGV = -0.01, Slope T = 0.23) were relatively stable, but the IBD disparity still showed an upward trend in both the place of residence and gender strata. A decline in urban-rural differences in the cause of maternal death was found for obstetric bleeding (Slope BGV = -14.61, Slope T = -20.84). Improvements were seen in the urban-rural disparity in premature birth and being underweight (PBU) in children under 5 years of age. Although diarrhoea and pneumonia decreased in the U5MR, no obvious gender-based trend in the causes of death was observed.ConclusionWe found improvement in the disparity of maternal and child health outcomes in China. However, the improvements still do not meet the requirements proposed by the Healthy China 2030 strategy, particularly regarding the rise in the IBD levels and the decline in equality. This study suggests starting with maternal and child health services and focusing on the disparity in the causes of death in both the place of residence and gender strata. Placing an emphasis on health services may encourage the recovery of the premarital check and measures such as prenatal and postnatal examinations to improve equality.

Approximately 85 percent of the land area of the ECOWAS (Economic Community of West African States) region is covered by basement rocks (igneous and highly metamorphosed rocks) or relatively thin layers of Paleozoic, Upper Precambrian, and Continental Intercalaire sedimentary rocks. These areas have little or no petroleum potential. The ECOWAS region can be divided into 13 sedimentary basins on the basis of analysis of the geologic framework of Africa. These 13 basins can be further grouped into 8 categories on the basis of similarities in stratigraphy, geologic history, and probable hydrocarbon potential. The author has attempted to summarize the petroleum potential within the geologic framework of the region. The coal discoveries can be summarized as follows: the Carboniferous section in the Niger Basin; the Paleocene-Maestrichtian, Maestrichtian, and Eocene sections in the Niger Delta and Benin; the Maestrichtian section in the Senegal Basin; and the Pleistocene section in Sierra Leone. The only proved commercial deposits are the Paleocene-Maestrichtian and Maestrichtian subbituminous coal beds of the Niger Delta. Some of the lignite deposits of the Niger Delta and Senegal Basin, however, may be exploitable in the future. Published literature contains limited data on heat-flow values in the ECOWAS region. It is inferred,more » however, from the few values available and the regional geology that the development of geothermal resources, in general, would be uneconomical. Exceptions may include a geopressured zone in the Niger Delta and areas of recent tectonic activity in the Benue Trough and Cameroon. Development of the latter areas under present economic conditions is not feasible.« less

Reproductive, maternal, newborn, and child health (RMNCH) has been a priority for both governments and civil society in low- and middle-income countries (LMICs). This priority was affirmed by world leaders in the Millennium Development Goals (MDGs) that called for countries to reduce child mortality by 67 percent and maternal mortality by 75 percent between 1990 and 2015. Although substantial progress on these targets has been made, few countries achieved the needed reductions. The United Nations (UN) Secretary-General’s Global Strategy for Women’s and Children’s Health, launched in 2010 and expanded in 2015 to include adolescents, is an indication of the continued global commitment to the survival and well-being of women and children (Ban 2010). Annual official development assistance for maternal, newborn, and child health has increased from US$2.7 billion in 2003 to US$8.3 billion in 2012, when there was an additional US$4.5 billion for reproductive health (Arregoces and others 2015). A continued focus on RMNCH is needed to address the remaining considerable burden of disease in LMICs from unwanted pregnancies; high maternal, newborn, and child mortality and stillbirths; high rates of undernutrition; frequent communicable and noncommunicable diseases; and loss of human capacity. Cost-effective interventions are available and can be implemented at high coverage in LMICs to greatly reduce these problems at an affordable cost.RMNCH encompasses health problems across the life course from adolescent girls and women before and during pregnancy and delivery, to newborns and children. An important conceptual framework is the continuum-of-care approach in two dimensions. One dimension recognizes the links from mother to child and the need for health services across the stages of the life course. The other is the delivery of integrated preventive and therapeutic health interventions through service platforms ranging from the community to the primary health center and the hospital.This volume presents the levels and trends of RMNCH indicators, proven interventions for prevention of mortality, costs of these interventions and potential health service delivery platforms, and system innovations. Other volumes in the third edition of Disease Control Priorities also cover topics of importance to women and children that are related to the RMNCH health services packages (box 1.1). These topics include the following:

Reducing Maternal and Perinatal Mortality Through a Community Collaborative Approach: Introduction to a Special Issue on the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP)

From MDGs to SDGs: Implications for Maternal Newborn Health in Africa.

In the village of Nodapara, in Brahamanbaria district in eastern Bangladesh, 19-year-old Sharifa Akter is a healthy mother of a robust five-month-old baby boy. An important decision she made during pregnancy may just have saved her life. Reducing maternal and neonatal mortality is a big part of the UN’s Sustainable Development Goal 3 (SDG 3), which requires nations to ensure healthy lives and promote well-being for all ages. While Bangladesh has seen a significant decline in maternal and infant mortality rates over the years, the struggle to further reduce maternal and neonatal deaths continues. Subgoal 3.1 (SDG 3.1) specifically calls on countries to reduce maternal mortality to less than 70 per 100,000 live births by 2030. At present, the maternal mortality ratio in Bangladesh is 173 per 100,000 live births, while under-5 mortality is 29.1 deaths per 1,000 live births, and the infant mortality rate is 24 deaths per 1,000 live births. 1 The key to addressing this challenge — especially in the more rural areas of the country — may lie in increasing awareness of and promoting community education on maternal health.

Background & objectives:Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital registration is extremely deficient. Currently available methods to measure maternal mortality, such as the sisterhood method, pose problems with respect to validity, precision, cost and time. We conducted this field study to test a community-based method (the motherhood method), to measure maternal and child mortality in a developing country setting.Methods:Motherhood method was field tested to derive measures of maternal and child mortality at the district and sub-regional levels in Bara district, Nepal. Information on birth, death, risk factors and health outcomes was collected within a geographic area as in an unbiased census, but without visiting every household. The sources of information were a vaccination registry, focus group discussions with local health workers, and most importantly, interview in group setting with women who share social bonds formed by motherhood and aided by their peer memory. Such groups included all women who have given birth, including those whose babies died during the measurement period.Results:A total of 15161 births were elicited in the study period of two years. In the same period 49 maternal deaths, 713 infant deaths, 493 neonatal deaths and 679 perinatal deaths were also recorded. The maternal mortality ratio was 329 (95%CI:243-434)/100000 live birth, infant mortality rate was 48(44-51)/1000LB, neonatal mortality rate was 33(30-36)/1000LB, and perinatal mortality rate was 45(42-48)/1000 total birth.Interpretation & conclusions:The motherhood method estimated maternal, perinatal, neonatal and infant mortality rates and ratios. It has been field tested and validated against census data, and found to be efficient in terms of time and cost. Motherhood method can be applied in a time and cost-efficient manner to measure and monitor the progress in the reduction of maternal and child deaths. It can give current estimates of mortalities as well as averages over the past few years. It appears to be particularly well-suited to measuring and monitoring programmes in community and districts levels.

To correlate international official data on Cesarean delivery rates to infant and maternal mortality rates and low weight-at-birth rates; and to test the hypothesis that Cesarean rates greater than 15% correlate to higher maternal and infant mortality rates. Analyses were based on the most recent official data (2000-2009) available for 193 countries. Exponential models were compared to quadratic models to regress infant mortality rates, neonatal mortality rates, maternal mortality rates, and low weight-at-birth rates to Cesarean rates. Separate regressions were performed for countries with Cesarean rates greater than 15%. In countries with Cesarean rates less than 15%, higher Cesarean rates were associated to lower infant, neonatal, and maternal mortality rates, and to lower rates of low weight-at-birth. In countries with Cesarean rates greater than 15%, Cesarean rates were not significantly associated with infant or maternal mortality rates. There is an inverse exponential relation between countries' rates of Cesarean deliveries and infant or maternal mortality rates. Very low Cesarean rates (less than 15%) are associated with poorer maternal and child outcomes. Cesarean rates greater than 15% were neither correlated to higher maternal nor child mortality, nor to low weight-at-birth.

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Significant progress has been made in maternal, newborn, and child health (MNCH) in recent decades. Between 1990 and 2015, the global mortality rate for children under age five years dropped by 53 percent, from 90.6 deaths per 1,000 live births in 1990 to 42.5 in 2015 (Liu and others 2016). Maternal mortality is also on the decline globally.Despite progress, maternal, neonatal, and under-five mortality remain high in many low- and middle-income countries (LMICs). In 2015, approximately 303,000 women died as a result of complications from pregnancy and childbirth (WHO 2015). Globally, an estimated 5.9 million children under age five years die each year, including 2.7 million within the first month of life (Liu and others 2016).Health indicators differ across countries, regions, and socioeconomic levels (Lozano and others 2011). Approximately 99 percent of all newborn deaths occur in LMICs (Bayer 2001). Maternal mortality is concentrated in Sub-Saharan Africa (Hogan and others 2010), where mortality rates for the poor are double those for the nonpoor, and they are higher among rural populations and women with low levels of education (PLoS Medicine Editors 2010). Children living in low-income countries are three times more likely to die before age five years than children living in high-income countries (HICs) (Black and others 2013).Pneumonia, diarrhea, malaria, and inadequate nutrition drive early childhood deaths around the world. In 2015, an estimated 526,000 episodes of diarrhea and 922,000 cases of pneumonia in children under age five years led to death (Liu and others 2016). Undernutrition is a primary underlying cause of 3.5 million maternal and child deaths each year (Black and others 2013); stunting, wasting, and micronutrient deficiencies are responsible for approximately 35 percent of the disease burden in children under age five years and 11 percent of the total global disease burden (Lozano and others 2011). Although maternal mortality is caused chiefly by postpartum hemorrhage, preeclampsia and eclampsia, and sepsis, a large proportion of maternal deaths can be attributed to limited access to skilled care during childbirth and the postnatal period (Lozano and others 2011) as well as to limited access to family planning services and safe abortions (UNFPA and Guttmacher Institute 2010).An appropriate mix of interventions can significantly reduce the burden of maternal and child mortality and morbidity. However, these interventions often do not reach those who need them most (Bayer 2001; Sines, Tinker, and Ruben 2006). An integrated approach that includes community-based care as an essential component has the potential to substantially improve maternal, newborn, and child health outcomes.This chapter provides a summary of community-based programs for improving MNCH. The chapter discusses strategies to improve the supply of services, including through community-based interventions and home visitations implemented by community health workers (CHWs), and strategies to increase demand for services, including through community mobilization efforts. The chapter summarizes the evidence about the impact of such interventions, describes contextual factors that affect implementation, and considers issues of cost-effectiveness. It concludes by highlighting research gaps, the challenges of scaling up, and the way forward.