Abstract

BackgroundMaternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associatedContextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care.DiscussionThe final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income CountriesConclusionIn shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in LICS.

Highlights

  • Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes

  • Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in low income countries (LICS)

  • While it is recognized that many LICS have fallen short of the set targets within the millennium development goals (MDGs) time frame, appreciable gains have been documented in reducing maternal and neonatal mortality

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Summary

Discussion

The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. It is likely that in such a healthcare system where effort is limited to only preventing deaths at the initial client-facility contact, immediate neonatal care and outcomes may improve This may be spurious, resulting from shifting a large share of the mortality burden to the post-discharge period and further creating an epidemic of severe impairment in fragile healthcare systems in LICS [48]. Moving forward it is evident that continuing to ignore the need to strengthen the post discharge aspects of the healthcare systems in LICS will hamper any set goals, especially on reducing maternal and neonatal morbidity and mortality and improving the overall health and survival of children

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