End Preventable Newborn Deaths Research Articles

Incidence of and risk factors for small vulnerable newborns in north India: a secondary analysis of a prospective pregnancy cohort

Globally, recent estimates have shown there have been 3·6 million stillbirths and neonatal deaths in 2022, with nearly 60% occurring in low-income and middle-income countries. The Small Vulnerable Newborn Consortium has proposed a framework combining preterm birth (<37 weeks of gestation), small for gestational age (SGA) by INTERGROWTH-21st standard, and low birthweight (<2500 g) under the category small vulnerable newborns (SVN). Reliable data on SVN from sub-Saharan Africa, central Asia, and south Asia are sparse. We aimed to estimate the incidence of SVN and its types, and quantify risk factors, both overall and trimester-specific, from a pregnancy cohort in north India. In the GARBH-Ini (Interdisciplinary Group for Advanced Research on Birth Outcomes-DBT India Initiative) pregnancy cohort, 8000 participants were enrolled with less than 20 weeks' gestation between May 11, 2015, and Aug 8, 2020, at a secondary-care hospital in north India. The cohort was followed up across the antenatal period for a detailed study on preterm birth. We conducted a secondary analysis of cohort data for the outcome of SVN, classified into its types: preterm-SGA, preterm-nonSGA, and term-SGA. We estimated the relative risk and population attributable fraction of candidate risk factors for SVN (modified Poisson regression) and its types (multinomial regression). 7183 (89·9%) of 7990 participants completed the study. Among 6206 newborns included for analysis, the incidence of SVN was 48·4% (35·1% term-SGA newborns [n=2179], 9·7% preterm-nonSGA newborns [n=605], and 3·6% preterm-SGA newborns [n=222]). Compared with term-nonSGA newborns, proportions of stillbirths and neonatal deaths within 72 h of birth among SVN were three times and 2·5 times higher, respectively. Preterm-SGA newborns had the highest incidence of stillbirth (15 [6·8%] of 222) and neonatal deaths (six [4·2%] of 142). Low body-mass index (BMI <18·5 kg/m2) of participants at the start of pregnancy was associated with higher risk for preterm-SGA (adjusted relative risk [RR] 1·61 [95% CI 1·17-2·22]), preterm-nonSGA (1·35 [1·09-1·68]), and term-SGA (1·44 [1·27- 1·64]), with population attributable fraction ranging from 8·7% to 13·8%. Pre-eclampsia (adjusted RR 1·48 [95% CI 1·30-1·71]), short cervical length (1·15 [1·04-1·26]), and bacterial vaginosis (1·13 [0·88-1·45]) were other important antenatal risk factors. In a comprehensive analysis of SVN and its types from north India, we identified risk factors to guide prioritisation of interventions. Complemented with risk-stratification tools, this focused approach will enhance antenatal care, and accelerate achievement of Sustainable Development Goals-namely, to end preventable deaths of newborns and children younger than 5 years by 2030 (target 3·2). Department of Biotechnology, Government of India and Grand Challenges India-Biotechnology Industry Research Assistance Council, Government of India. For the Hindi translation of the abstract see Supplementary Materials section.

Update on the practice of premarital screening for sickle cell traits in Africa: a systematic review and meta-analysis

BackgroundScreening for sickle cell traits before marriage or producing children is one of the outstanding preventive measures for sickle cell disease (SCD).The disease is a collection of inherited blood disorders that impact millions globally, with a predominant 75% occurrence in the sub-Saharan region. With increasing burden of SCD on the continent amidst a cost effective prevention method, no study has systematically reviewed or presented meta-analytic uptake or practice of premarital sickle cell trait screening.MethodsThis review systematically explored the uptake or practice of premarital genotype screening in Africa. We searched PubMed and Scopus databases for African studies on premarital screening for sickle cell traits.ResultsOur results indicate that the pooled uptake of premarital sickle cell trait screening in Africa is 47.82% (95% CI: [46.53–49.11]; I2: 98.95% [98.74–99.13]). Our review observed, a significant relationship between the awareness of sickle cell disease and the uptake of genotype screening; F(1, 13) = 12.04, p = 0.004). The model explained approximately 48.08% of the variation in genotype screening (R² = 0.4808) and predicted a 0.729 increase in the likelihood of genotype screening uptake for every unit rise in sickle cell disease awareness (β = 0.729, p = 0.004). Additionally, Pearson correlation (r = 0.6934) indicated a moderately strong positive correlation between the two variables.ConclusionWith over 75% of the global burden of sickle cell disease domiciled in Africa, the continent cannot overlook the cost of hemoglobinopathies. The uptake of sickle cell traits screening is suboptimal across the continent. To achieve the mandate of sustainable development goal number (3); to end preventable deaths of newborns and children under 5 years of age by 2030, there is need to intensify campaigns on premarital genetic screening through education and other health promotion tools.

A landscape analysis of the key global stakeholders working on interventions around preterm birth that improve neonatal mortality and morbidity.

Background Over a decade after the landmark ‘Born too Soon’ report, preterm birth remains a leading cause of under-five mortality. Addressing its global burden is key to meeting United Nations Sustainable Development Goal 3; to end preventable deaths of newborns and children by 2030. We conducted a landscape analysis to explore the types of organisations addressing preterm birth, highlight the scope of interventions and initiatives, and identify gaps and opportunities for shared learning. Methods We combined google searches with citation searching, and opinion of experts in child health, to identify the major global stakeholders working to improve outcomes of preterm birth, with evidence of activity since 2012. We conducted a thematic analysis and narrative synthesis of key stakeholder websites to categorise their functions and priorities, and the types of interventions they were implementing. Results A total of 38 key organisations and 28 interventions were derived from the searches. Organisations were thematically grouped into knowledge sharing (n = 15), knowledge production (n = 12), funders (n = 6), legislation and advocacy (n = 15), implementer (n = 14) and network organisations (n = 11). Interventions covered a wide scope of functions including education (n = 11), research (n = 10), resources (n = 7), legislation (n = 2), and health systems (n = 2) interventions. The majority of global stakeholders were funded from and headquartered within high-income settings. Discussion There is scope for significant learning across global stakeholders, in particular to support carers in low-resource settings. Further opportunities for impact include a need for community-based initiatives and whole systems approach that address the long-term needs of preterm babies and their families, particularly in low- and middle-income countries (LMIC) settings. Greater knowledge production and funding from LMICs is needed to create contextually relevant resources and address implementation challenges.

Deploying ADVISER: Impact and Lessons from Using Artificial Intelligence for Child Vaccination Uptake in Nigeria

More than 5 million children under five years die from largely preventable or treatable medical conditions every year, with an overwhelmingly large proportion of deaths occurring in underdeveloped countries with low vaccination uptake. One of the United Nations' sustainable development goals (SDG 3) aims to end preventable deaths of newborns and children under five years of age. We focus on Nigeria, where the rate of infant mortality is appalling. In particular, low vaccination uptake in Nigeria is a major driver of more than 2,000 daily deaths of children under the age of five years. In this paper, we describe our collaboration with government partners in Nigeria to deploy ADVISER: AI-Driven Vaccination Intervention Optimiser. The framework, based on an integer linear program that seeks to maximize the cumulative probability of successful vaccination, is the first successful deployment of an AI-enabled toolchain for optimizing the allocation of health interventions in Nigeria. In this paper, we provide a background of the ADVISER framework and present results, lessons, and success stories of deploying ADVISER to more than 13,000 families in the state of Oyo, Nigeria.

Constraints to maternal healthcare access among pastoral communities in the Darussalam area of Mudug region, Somalia "a qualitative study".

While countries embrace efforts to achieve Sustainable Development Goals (SDG) goal 3.1 (to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 and end preventable deaths of new-borns and children), an estimated 2.5 million pastoralists in Somalia are struggling to access maternal and child healthcare services. Institutional delivery and access to antenatal care remained to be a challenge in Somalia, where pastoralism is a common means of livelihood. The aim of this study is to explore the maternal health services available for settled pastoralists (transhumant) and their families who still practice nomadic pastoralism in the Mudug region of Somalia. A qualitative study, including 14 interviews and one FGD, was conducted in Darussalam village (a transhumant village along the border between Somalia and Ethiopia), Puntland State, from December 2022 to January 2023. The study participants were community members who support the maternal and child health clinic (MCH), village administration, and health providers. We found that the efficiency of the health facilities that serve for pastoralist women and children are hampered by staff-related, supply-related, patients-related and referral-related constraints. This study highlights that the absence of essential supplies, the unmet need for training among the staff as well as the absence of important facilities in the MCH such as ambulance and blood bags. Numerous strides could be made in the provision of affordable maternal healthcare to pastoralist communities in Darussalam areas of the Mudug region when organizations that support health care in Somalia and the Ministry of Health include pastoralists' healthcare in their priorities.

Benefits of Investing on Mother and Child Healthcare in Tanzania

Purpose: Maternal and child healthcare play crucial role in reducing global mortality rates, with a significant impact on the overall burden of disease. The Sustainable Development Goal 3 aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030. Sub-Saharan Africa, including Tanzania, carries a high burden of mortality rates and experiences a significant share of maternal and child deaths, exacerbating the global figures. The average prevalence of below 5 years mortality in SSA between 2010 and 2018 was 4.10% according to Ahinkorah (2021). Recognizing the severity of this issue, the government of Tanzania through the Development Agenda 2025, Draft health policy 2020 and the current Health Sector strategic plan 2021-2026 plans to reduce infant and maternal mortality rates through mother and child healthcare investment. The Health Sector Strategic Plan focuses on strengthening the health systems in the country and aims to sustain the achievements made in enhancing the health of reproductive, maternal, newborn, children, and adolescent populations. This study sought to assess the benefits of investing on mother and child healthcare in Tanzania. The study was guided by the investment commodity theory developed by the economist John Maynard Keynes in 1936. The study evaluated the current status of mother and child health indicators, the benefits of investing in mother and child health on overall health outcomes and identified the existing gaps and challenges in the provision, access and utilization of mother and child healthcare services in Tanzania.&#x0D; Methodology: The study was a desktop review-based study which relied on existing published information, data, and literature.&#x0D; Findings: The study found out that there have been improvements in certain areas of mother and child health indicators but maternal and child mortality rates remain high. Health interventions such as vaccination programs, improved access to healthcare services, and the use of maternal and child health insurance cards showed positive effects on reducing child mortality, improving child health outcomes, and enhancing maternal healthcare utilization. The significant gaps and challenges in the provision, access, and utilization of mother and child healthcare services include disparities in access to healthcare services based on factors such as education level and wealth status, inadequate healthcare infrastructure, long distances to health facilities, sociocultural barriers, and financial constraints.&#x0D; Unique contribution to theory, practice and policy: The study recommends strengthening of healthcare infrastructure, enhancing access to maternal and child healthcare services, especially for vulnerable populations, promoting health education and raising awareness about maternal and child healthcare practices, addressing the shortage of skilled healthcare professionals, improving data collection and use and monitoring of maternal and child health indicators, addressing socio-cultural barriers that hinder access and utilization of healthcare services and increasing investment in mother and child health care programs through allocate adequate resources.

A landscape analysis of the key global stakeholders working on interventions around preterm birth that improve neonatal mortality and morbidity.

Background Over a decade after the landmark ‘Born too Soon’ report, preterm birth remains a leading cause of under-five mortality. Addressing its global burden is key to meeting United Nations Sustainable Development Goal 3; to end preventable deaths of newborns and children by 2030. We conducted a landscape analysis to explore the types of organisations addressing preterm birth, highlight the scope of interventions and initiatives, and identify gaps and opportunities for shared learning. Methods We combined google searches with citation searching, and opinion of experts in child health, to identify the major global stakeholders working to improve outcomes of preterm birth, with evidence of activity since 2012. We conducted a thematic analysis and narrative synthesis of key stakeholder websites to categorise their functions and priorities, and the types of interventions they were implementing. Results A total of 38 key organisations and 28 interventions were derived from the searches. Organisations were thematically grouped into knowledge sharing (n = 15), knowledge production (n = 12), funders (n = 6), legislation and advocacy (n = 15), implementer (n = 14) and network organisations (n = 11). Interventions covered a wide scope of functions including education (n = 11), research (n = 10), resources (n = 7), legislation (n = 2), and health systems (n = 2) interventions. The majority of global stakeholders were funded from and headquartered within high-income settings. Discussion There is scope for significant learning across global stakeholders, in particular to support carers in low-resource settings. Further opportunities for impact include a need for community-based initiatives and whole systems approach that address the long-term needs of preterm babies and their families, particularly in low- and middle-income countries (LMIC) settings. Greater knowledge production and funding from LMICs is needed to create contextually relevant resources and address implementation challenges.

Tackling post-discharge mortality in children living in LMICs to reduce child deaths

The Sustainable Development Goal (SDG) target 3·2 is to end preventable deaths of newborns and children younger than 5 years by 2030. However, in 2020, more than 5 million children younger than 5 years died, mostly from preventable causes, and mainly in sub-Saharan Africa (54%) and southern Asia (26%).1 As increasing numbers of children with life-threatening illnesses seek care from hospitals, the role of high-quality facility-based care becomes increasingly crucial for achieving this SDG target.

Challenges on the road to achieving the SDG 3.2 targets in resource-limited settings

The Sustainable Development Goals (SDG)s adopted by all UN member states in 2015 represent a shared dream of an ideal life for all people worldwide. The second target of SDG 3, achieve good health and wellbeing for all, is to end preventable deaths of newborns and children younger than 5 years, with all countries aiming to reduce neonatal mortality rate (NMR) by 2030 to at least as low as 12 per 1000 livebirths and under-5 mortality rate (U5MR) to at least as low as 25 per 1000 livebirths.1 This target, which focuses on children younger than 5 years who are particularly affected by the higher mortality burden in low-income and middle-income countries, requires continued monitoring of U5MR and NMR to identify regions of the world where efforts need to be strengthened.

Postmortem investigations and identification of multiple causes of child deaths: An analysis of findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) network.

BackgroundThe current burden of >5 million deaths yearly is the focus of the Sustainable Development Goal (SDG) to end preventable deaths of newborns and children under 5 years old by 2030. To accelerate progression toward this goal, data are needed that accurately quantify the leading causes of death, so that interventions can target the common causes. By adding postmortem pathology and microbiology studies to other available data, the Child Health and Mortality Prevention Surveillance (CHAMPS) network provides comprehensive evaluations of conditions leading to death, in contrast to standard methods that rely on data from medical records and verbal autopsy and report only a single underlying condition. We analyzed CHAMPS data to characterize the value of considering multiple causes of death.Methods and findingsWe examined deaths identified from December 2016 through November 2020 from 7 CHAMPS sites (in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa), including 741 neonatal, 278 infant, and 241 child <5 years deaths for which results from Determination of Cause of Death (DeCoDe) panels were complete. DeCoDe panelists included all conditions in the causal chain according to the ICD-10 guidelines and assessed if prevention or effective management of the condition would have prevented the death. We analyzed the distribution of all conditions listed as causal, including underlying, antecedent, and immediate causes of death. Among 1,232 deaths with an underlying condition determined, we found a range of 0 to 6 (mean 1.5, IQR 0 to 2) additional conditions in the causal chain leading to death. While pathology provides very helpful clues, we cannot always be certain that conditions identified led to death or occurred in an agonal stage of death. For neonates, preterm birth complications (most commonly respiratory distress syndrome) were the most common underlying condition (n = 282, 38%); among those with preterm birth complications, 256 (91%) had additional conditions in causal chains, including 184 (65%) with a different preterm birth complication, 128 (45%) with neonatal sepsis, 69 (24%) with lower respiratory infection (LRI), 60 (21%) with meningitis, and 25 (9%) with perinatal asphyxia/hypoxia. Of the 278 infant deaths, 212 (79%) had ≥1 additional cause of death (CoD) beyond the underlying cause. The 2 most common underlying conditions in infants were malnutrition and congenital birth defects; LRI and sepsis were the most common additional conditions in causal chains, each accounting for approximately half of deaths with either underlying condition. Of the 241 child deaths, 178 (75%) had ≥1 additional condition. Among 46 child deaths with malnutrition as the underlying condition, all had ≥1 other condition in the causal chain, most commonly sepsis, followed by LRI, malaria, and diarrheal disease. Including all positions in the causal chain for neonatal deaths resulted in 19-fold and 11-fold increases in attributable roles for meningitis and LRI, respectively. For infant deaths, the proportion caused by meningitis and sepsis increased by 16-fold and 11-fold, respectively; for child deaths, sepsis and LRI are increased 12-fold and 10-fold, respectively. While comprehensive CoD determinations were done for a substantial number of deaths, there is potential for bias regarding which deaths in surveillance areas underwent minimally invasive tissue sampling (MITS), potentially reducing representativeness of findings.ConclusionsIncluding conditions that appear anywhere in the causal chain, rather than considering underlying condition alone, markedly changed the proportion of deaths attributed to various diagnoses, especially LRI, sepsis, and meningitis. While CHAMPS methods cannot determine when 2 conditions cause death independently or may be synergistic, our findings suggest that considering the chain of events leading to death can better guide research and prevention priorities aimed at reducing child deaths.

Newborns and Under-5 Mortality in Ethiopia: The Necessity to Revitalize Partnership in Post-COVID-19 Era to Meet the SDG Targets.

The Sustainable Development Goals (SDGs) were adopted during the United Nations meeting in 2015 to succeed Millennium Development Goals. Among the health targets, SDG 3.2 is to end preventable deaths of newborns and children under 5 years of age by 2030. These 2 targets aim to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. Ethiopia is demonstrating a great reduction in child mortality since 2000. In the 2019 child mortality estimation which is nearly 5 years after SDGs adoption, Ethiopia’s progress toward reducing the newborns and under-5 mortality lie at 27 and 50.7 per 1000 live births, respectively. The generous financial and technical support from the global partners have helped to achieve such a significant reduction. Nevertheless, the SDG targets for newborns and under-5 mortality reduction are neither attained yet nor met the national plan to achieve by the end of 2019/2020. The partnership dynamics during COVID-19 crisis and the pandemic itself may also be taken as an opportunity to draw lessons and spur efforts to achieve SDG targets. This urges the need to reaffirm a comprehensive partnership and realignment with other interconnected development goals. Therefore, collective efforts with strong partnerships are required to improve the determinants of child health and achieving SDG target reduction until 2030.

Single Digit NMR and SBR: Ways to Achieve

India has reached even the most hard-to-reach area and vulnerable children with affordable life-saving interventions despite numerous challenges with significant rural-urban, poor-rich, gender, socio-economic, and regional differences, which is evident by its triumph over polio. The country has acted to reduce maternal and child mortality rates and witnessed dramatic reduction in it over the past two decades. But success was not found up to the desired level in neonatal &amp; still birth rate. Neonatal mortality has reduced much less than post-neonatal deaths, thereby increasing the contribution of neonatal deaths from 41% of under-5 deaths in 1990 to 56% in 2012. The estimated Stillbirth rate (SBR) in the country is 22 per 1000 live births. Unavailable history about pregnancy for women and misclassification of deaths have posed a real challenge to valid estimation of SBR in our country. The neonatal mortality rate is not uniform across India. While the state of Kerala has already attained Single Digit NMR (7/1000 live births); Odisha, Madhya Pradesh, Uttar Pradesh, Rajasthan, and Chhattisgarh have experienced a higher neonatal mortality rate at 30 or more per 1000 live births. As a result, newborn health has drawn the attention of policymakers at the highest level in India. This has resulted in strong political commitment to end preventable newborn deaths and stillbirths, and recognize newborn health as a national priority.1

Malnutrition and Socio-economic Factors in HIV Infected and Uninfected Under 5 Children in Zambia

Abstract Malnutrition contributes to more than one third of all child deaths, although hardly listed as the direct cause. In sub-Saharan Africa, malnutrition accounts for about 2% of deaths and 3% of Disability adjusted life years (DALYs) among under-5 children. In Zambia, 35% of under-5 children are stunted, 4% wasted, 12% underweight and 5% overweight. Malnutrition and HIV interact in complex ways that increase vulnerability to and worsen each condition therefore we sought to determine factors associated with malnutrition among under 5 children in Zambia. Using Stata version 14.2, we extracted and analysed sample data of 159 children aged 0-59 months from the 2016 ZAMPHIA population-based survey, that used a two-stage cluster sampling design. We used Generalised Linear Models to measure socio-economic factors associated with malnutrition. P-value of less than 0.05 was set as level of statistical significance. Factors associated with malnutrition included gender, child's HIV status and wealth index which showed an association with stunting, wasting and being underweight. The 16 (10%) under-5 children living with HIV were significantly more affected by stunting (38% vs 33%), wasting (19% vs 11%) and underweight prevalence (38% vs 10%) than the remaining 143 who were HIV negative. Our sample prevalence was similar to national stunting (33% vs 35%) and underweight prevalence (13% vs 12%) but had three times higher wasting prevalence (12% vs 4%). A high prevalence of malnutrition was found in HIV positive compared to negative under 5 children, wealth index showing an association with malnutrition. Eliminating malnutrition is key to attaining SDG 3 which is to end preventable deaths of newborns and children under 5 years of age. Key messages All types of malnutrition had a higher prevalence in HIV infected than uninfected under five children in Zambia. Wealth index is a socio-economic factor that is associated to all types of malnutrition in under-five children in Zambia.

Preventable newborn deaths: analysis of the newborn infection component in Brazil from 2007 to 2017

Abstract The Universal Agenda 2030 was developed by representatives of all countries as an action plan covering the three dimensions of sustainable development: economic, social and environmental. 17 objectives were agreed upon, highlighting objective 03, which aims to ensure a healthy life and promote well-being for all at all ages, having as one of the established goals to end preventable deaths of newborns by 2030. Infections neonatal care reflects deficits in health care, covering the entire perinatal period, and it is necessary to understand its causes in order to promote quality preventive and health promotion actions. The question is: what are the causes that make up the indicator of early neonatal mortality, due to preventable causes in Brazil between 2007 to 2017? Retrospective study carried out between September and October 2019 using secondary data collection from Department of Informatics of the Unified Health System - SUS (DATASUS). The outcome variable was early neonatal mortality from preventable causes and the independent variable was the infections component of the newborn). Twelve preventable causes of death have been identified in this category: congenital rubella syndrome; congenital syphilis; neonatal tetanus; diphtheria; haemophilus and non-haemophilus meningitis; human immunodeficiency virus diseases; neonatal infections; pneumonia; acute infections of lower airways; bacterial diseases and intestinal infectious diseases. The main cause of preventable death was infections from the neonatal period, which include congenital viral diseases (cytomegalovirus and herpes simplex); newborn bacterial septicemia; congenital parasitic diseases; omphalitis of newborn with or without mild hemorrhage; intra-amniotic infection of the fetus, neonatal infection of the urinary tract and/or skin. There is a need for more effective public health actions to modify the neonatal mortality situation, as well as health surveillance actions. Key messages Warn about causes of perinatal mortality that can be avoided. Strengthen the fulfillment of objective 3 of the 2030 Agenda to ensure and promote health in the perinatal period.

Early essential newborn care (EENC): The prioritized intervention to end preventable newborn deaths

Newborn death accounts for half of under 5 child death in China. Decreasing neonatal mortality and improving health status of children at early stage of life have great significance on public health. This is also a solution to accomplish the goal of "ending preventable newborn deaths" of the 2030 Agenda for Sustainable Development. According to the World Health Organization, many causes leading to newborn deaths can be prevented and avoided by simple interventions. "Early Essential Newborn Care (EENC) " is a package of simple interventions that include early mother to child skin to skin contact, delayed umbilical cord clamping, breast feeding, kangaroo mother care for preterm, neonatal resuscitation, and infection identifying and treatment. These prioritized evidence-based interventions can improve the content and quality of newborn health care, which are bound to be promoted and implemented throughout the country. Future research should be conducted to explore solutions to solve difficulties and challenges of EENC implementation.

Review of the evidence for interventions to reduce perinatal mortality in low- and middle-income countries.

Low- and middle-income countries contribute to the overwhelming majority of the global perinatal and neonatal mortality. There is a growing amount of literature focused on interventions aimed at reducing the healthcare gaps and thereby reducing perinatal and neonatal mortality in low- and middle-income countries. The current review synthesizes available evidence for interventions that have shown to improve perinatal and neonatal outcomes. Reduction in important gaps in the availability and utilization of perinatal care practices is needed to end preventable deaths of newborns.

Testing the socioeconomic and environmental determinants of better child-health outcomes in Africa: a cross-sectional study among nations

ObjectiveWe sought to test hypotheses regarding the principal correlates of child-health performance among African nations based on previous evidence collected at finer spatial scales.DesignRetrospective, cross-sectional study.SettingAll countries in Africa, excluding...

Achieving the targets of sustainable development goals (2030 agenda) for congenital disorders in Asia: Bottlenecks and interventions.

The United Nations General Assembly adopted the 2030 Agenda for Sustainable Development in November 2015 which included a set of 17 measurable "sustainable development goals" (SDGs). The SDGs included targets to end preventable deaths of newborns and children under 5 years of age by 2030, universal health care coverage, reduction of premature mortality from noncommunicable diseases (NCDs) by 33% as well as support the development and research for medicines for both communicable and NCDs. Although some successes were achieved in combating communicable diseases and improved childhood mortality rates, health systems in Asia are generally characterized by lack of accurate epidemiological information on congenital disorders, lack of human and financial resources, and inadequate focus on public health strategies to ensure targeted interventions, low level knowledge on congenital disorders amongst the community and healthcare providers and the ethical dilemma of managing rare congenital disorders in an environment of low national health expenditures. These bottlenecks must be addressed systematically and interventions such as the use of innovative epidemiological tools to overcome lack of data, increased efforts to standardize rare disease nomenclature and classification and renewed interest in birth defects registries by countries in the region must be considered. Targeted curative and public health approaches currently used in thalassaemia and neural tube defects may be used for other congenital disorders in Asian countries. The implementation of congenital disorders-related research, prevention, care, and treatment delivery services must be integrated into existing health systems in order to be effective to achieve the targets of SDG2030.

Value of sharing and networking among birth defects surveillance programs: an ICBDSR perspective.

Birth defects (BD), also known as congenital anomalies, are structural or functional abnormalities present at birth as a result of abnormal prenatal development. Their cause can be broadly categorized as genetic, environmental, or a combination of both. It is estimated that approximately 3-6% of newborn infants worldwide are affected by BD, many of which are associated with serious morbidity, mortality, and lifelong disabilities. The International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), founded in 1974, promotes worldwide birth defect surveillance, research, and prevention through the ongoing sharing of data, expertise, and training. In this review, we show value and contribution of BD surveillance systems in pursuing these aims. In the time of personalized medicine for many rare and common diseases, there are still massive gaps in our understanding of the causes and mechanisms of many birth defects, especially structural congenital anomalies. The main aim of the Sustainable Development Goals (SDGs), adopted by the United Nations in 2015, is to ensure healthy lives and promote well-being for all children. One specific goal is to end preventable deaths of newborns and children less than 5years of age by 2030. The SDGs also underscore the need to consider BD as a priority in the global child health agenda. It can be said that counting BD helps BD to count. By sharing data and expertise and joining in surveillance and research, BD surveillance programs can play a major role in increasing our understanding of the causes of BD, and promoting prevention.

Development of Quality Measures in Perinatal Care — Priority for Developing Countries

The 'Every Newborn Action Plan' envisions to end preventable newborn deaths and stillbirths by 2035. One important objective to realize this vision is improvement in quality of maternal and neonatal healthcare. Monitoring the performance of the healthcare systems and conducting quality improvement activities need reliable systems for data collection, analysis and interpretation. Measures chosen to monitor quality are about problems accounting for a significant health burden, for which effective interventions are available, there is evidence of variable or substandard care, and for which improvement can be undertaken by stakeholders. Data can be collected about safety, effectiveness, efficiency, equity, patient-centeredness and timeliness of care. These data can be collected by direct observation, from existing records, and by interview of the involved stakeholders. Healthcare facilities and governments need to identify core sets of quality of care indicators, regularly measure and track their performance and carry out informed quality assurance and quality improvement efforts.