Newborn Deaths Research Articles

Pengaruh Terapi Murotal Al-Quran Surah Ar Rahman Terhadap Kestabilan Saturasi Oksigen BBLR Dengan Asfiksia di Ruang NICU

Background: LBW babies face difficulties adapting to life outside the womb because their organs, such as the lungs, heart, kidneys, liver and digestive system, are not fully mature. The neonatal period is the most vulnerable period for a baby's survival, and one of the causes of newborn deaths is asphyxia. One of the complementary therapy techniques that can be used to increase saturation and hemodynamics in LBW babies is music therapy and murrotal therapy. Research method: The research method used in the intervention is a case report using the intervention method. The research was carried out in the NICU room at Tjitrowardojo Regional Hospital, Purworejo, when the research was carried out on 01-05 May 2024. The research participants were one neonate patient with a diagnosis of LBW accompanied by asphyxia. Oxygen saturation measurements were carried out before and after Murottal Surat Ar-Rahman Therapy was given. Results: After being given the Murotal Al-Qur'an Surah Ar-rahman therapy intervention within 30 minutes for five days, there was an increase in oxygen saturation in LBW babies with asphyxia on the first day from 88% to 93%, and on the fifth day there was an increase in oxygen saturation from 99 % becomes 100%.Conclusion: Murottal Al-Qur'an Surah Ar-Rahman therapy has a positive effect on oxygen saturation in patients with LBW accompanied by asphyxia

Celastrol ameliorates hypoxic-ischemic brain injury in neonatal rats by reducing oxidative stress and inflammation.

Hypoxic-ischemic encephalopathy (HIE) is caused by perinatal hypoxia and subsequent reductions in cerebral blood flow and is one of the leading causes of severe disability or death in newborns. Despite its prevalence, we currently lack an effective drug therapy to combat HIE. Celastrol (Cel) is a pentacyclic triterpene extracted from Tripterygium Wilfordi that can protect against oxidative stress, inflammation, and cancer. However, whether Cel can alleviate neonatal hypoxic-ischemic (HI) brain damage remains unclear. Here, we established both in vitro and in vivo models of HI brain damage using CoCl2-treated PC12 cells and neonatal rats, respectively, and explored the neuroprotective effects of Cel in these models. Analyses revealed that Cel administration reduced brain infarction size, microglia activation, levels of inflammation factors, and levels of oxidative stress markers by upregulating levels of p-AMPKα, Nrf2, HO-1, and by downregulating levels of TXNIP and NLRP3. Conversely, these beneficial effects of Cel on HI brain damage were largely inhibited by AMPKα inhibitor Compound C and its siRNA. We present compelling evidence that Cel decreases inflammation and oxidative stress through the AMPKα/Nrf2/TXNIP signaling pathway, thereby alleviating neonatal HI brain injury. Cel therefore represents a promising therapeutic agent for treating HIE. We firstly report that celastrol can ameliorate neonatal hypoxic-ischemic brain injury both in in vivo and in vitro, which represents a promising therapeutic agent for treating related brain injuries. Celastrol activates the AMPKα/Nrf2/TXNIP signaling pathway to relieve oxidative stress and inflammation and thereby alleviates neonatal hypoxic-ischemic brain injury.

Meta Analysis of Factors Determining Postnatal Care Utilization

Background: Maternal and infant morbidity and mortality continue to be a challenge today. Most maternal and newborn deaths occur during the early postnatal period. This condition can be caused by low utilization of postnatal care services. This study aims to analyze and estimate the influence of determining factors on the utilization of postnatal care services. Subjects and Method: Meta-analysis was conducted using PRISMA guidelines and PICO format. Population: Postpartum Mothers. Intervention: high antenatal care, high maternal education, high family income and delivery in hospital. Comparison: low antenatal care, low maternal education, low family income, home birth. Outcome: postnatal care services. Cross-sectional study articles were collected from Google Scholar, PubMed, and Science Direct databases. The search strategy used the keywords: "Determinant Postnatal Care" AND "Maternal Health Service" AND "Cross-Sectional". The inclusion criteria for this study were full-text, cross-sectional studies published from 2014 to 2023. Data from articles were extracted with RevMan 5.3. Results: The meta-analysis included 16 cross-sectional studies from Ethiopia, Ghana, Kenya, and Malawi. The total sample was 29,165 postpartum mothers. Postnatal mothers with high antenatal care visits (aOR= 2.64; 95% CI= 1.87 to 3.71; p = 0.001), high education (aOR= 2.09; 95% CI= 1.67 to 2.63; p = 0.001), high family income (aOR= 1.63; 95% CI= 1.25 to 2.11; p = 0.002), and hospital delivery (aOR= 1.58; 95% CI= 1.15 to 2.97; p = 0.010) allow the utilization of postnatal care services and these results were statistically significant. Conclusion: The results of this study reveal that high antenatal care, high maternal education, high family income and delivery in hospital have a positive effect on the utilization of postnatal care services.

Contextual factors associated with diarrhea among under-five children in the Gambia: a multi-level analysis of population-based data

BackgroundDiarrhea poses a significant threat to the lives of children in The Gambia, accounting for approximately 9% of all deaths among children under the age of five. Addressing and reducing child mortality from diarrhea diseases is crucial for achieving the Sustainable Development Goal (SDG) 3, specifically target 3.2, which aims to eliminate preventable deaths in newborns and children under the age of five by 2030. Thus, this research aims to assess the prevalence and contextual factors associated with diarrhea among under-five children in The Gambia.MethodsThis research employed secondary data from the 2019/20 Gambia Demographic Health Survey (GDHS). The study initially involved 8,362 women aged between 15 and 49 years. Of these, 6,929 women with children under five were included in this analysis. Data were analyzed using STATA with cross-tabulation and model fitting. Multilevel logistic regression was applied to accommodate the hierarchical structure of the demographic health survey data. The model comparison parameters were BIC, AIC, deviance, and LLR. Variables with a p-value less than 0.05 were selected for multivariable analysis. The statistical significance of the factors was determined using an adjusted odds ratio with a 95% confidence interval (CI) and a p-value of less than 0.05.ResultsThe prevalence of diarrhea in under-five children was 53.2% in males and 46.8% in females. In the final model, Kerewan (aOR = 0.58; 95% CI = 0.33–0.98) and Basse (aOR = 0.59; 95% CI = 0.35–0.98) have significantly lower odds of childhood diarrhea compared to Banjul, female children show slightly lower, yet significant, odds of diarrhea compared to males (aOR = 0.96; 95% CI = 0.86–0.98), deliveries at government health centers are associated with higher odds of childhood diarrhea compared to home births (aOR = 1.24; 95% CI = 1.01–1.52). Mothers with post-secondary education had significantly lower odds of having children with diarrhea than those without any education (aOR = 0.50; 95% CI = 0.26–0.99) after controlling for confounders.ConclusionThe study findings indicate that several factors significantly impact the risk of childhood diarrhea in The Gambia. These factors include region of residence, sex of the child, place of delivery, and education level of the mother. The study suggests that existing interventions aimed at improving child health outcomes in the country should take into consideration these influential factors. Addressing these modifiable factors can enhance the effectiveness of interventions and promote better health outcomes for children in Gambia.

Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure

The prevalence of cannabis use in pregnancy is rising and is associated with adverse perinatal outcomes. In parallel, combined prenatal use of cannabis and nicotine is also increasing, but little is known about the combined impact of both substances on pregnancy and offspring outcomes compared with each substance alone. To assess the perinatal outcomes associated with combined cannabis and nicotine exposure compared with each substance alone during pregnancy. This retrospective population-based cohort study included linked hospital discharge data (obtained from the California Department of Health Care Access and Information) and vital statistics (obtained from the California Department of Public Health) from January 1, 2012, through December 31, 2019. Pregnant individuals with singleton gestations and gestational ages of 23 to 42 weeks were included. Data were analyzed from October 14, 2023, to March 4, 2024. Cannabis-related diagnosis and prenatal nicotine product use were captured using codes from International Classification of Diseases, Ninth Revision, Clinical Modification, and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification. The main outcomes were infant and neonatal death, infants small for gestational age, and preterm delivery. Results were analyzed by multivariable Poisson regression models. A total of 3 129 259 pregnant individuals were included (mean [SD] maternal age 29.3 [6.0] years), of whom 23 007 (0.7%) had a cannabis-related diagnosis, 56 811 (1.8%) had a nicotine-use diagnosis, and 10 312 (0.3%) had both in pregnancy. Compared with nonusers, those with cannabis or nicotine use diagnoses alone had increased rates of infant (0.7% for both) and neonatal (0.3% for both) death, small for gestational age (14.3% and 13.7%, respectively), and preterm delivery (<37 weeks) (12.2% and 12.0%, respectively). Moreover, risks in those with both cannabis and nicotine use were higher for infant death (1.2%; adjusted risk ratio [ARR], 2.18 [95% CI, 1.82-2.62]), neonatal death (0.6%; ARR, 1.76 [95% CI, 1.36-2.28]), small for gestational age (18.0%; ARR, 1.94 [95% CI, 1.86-2.02]), and preterm delivery (17.5%; ARR, 1.83 [95% CI, 1.75-1.91]). These findings suggest that co-occurring maternal use of cannabis and nicotine products in pregnancy is associated with an increased risk of infant and neonatal death and maternal and neonatal morbidity compared with use of either substance alone. Given the increasing prevalence of combined cannabis and nicotine use in pregnancy, these findings can help guide health care practitioners with preconception and prenatal counseling, especially regarding the benefits of cessation.

Risk factors for acute kidney injury in very-low birth weight newborns: a systematic review with meta-analysis.

This study aims to analyze the main risk factors for acute kidney injury in the subgroup of very-low birth weight newborns, using the diagnosing criteria of the Kidney Disease Improving Global Outcomes (KDIGO) or the Acute Kidney Injury Network (AKIN). A systematic review of the literature was performed on the EMBASE® and PubMed® platforms. Studies that evaluated the risk factors for developing AKI in VLBW newborns were included. For the meta-analysis, we only included the risk factors that were associated with AKI in the univariate analysis of at least two studies. After an initial screening, abstract readings, and full-text readings, 10 articles were included in the systematic review and 9 in the meta-analysis. The incidence of AKI varied from 11.6 to 55.8%. All the studies have performed multivariate analysis, and the risk factors that appeared most were PDA and hemodynamic instability (use of inotropes or hypotension), sepsis, and invasive mechanical ventilation. After the meta-analysis, only cesarian delivery did not show an increased risk of AKI, all the other variables remained as important risk factors. Moreover, in our meta-analysis, we found a pooled increased risk of death in newborns with AKI almost 7 times. Conclusion: AKI in VLBW has several risk factors and must be seen as a multifactorial disease. The most common risk factors were PDA, hemodynamic instability, sepsis, and invasive mechanical ventilation. What is known: • Acute kidney injury is associated with worst outcomes in all ages. It´s prevention can help diminish mortality. What is new: • A synthesis of the main risk factors associated with AKI in very low birth weight newborns.

SHOULD STAKEHOLDERS OF MATERNAL AND CHILD HEALTH CONSIDER DIGITAL HEALTH INNOVATIONS TO REDUCE INFANT MORTALITY RATES IN DEVELOPING COUNTRIES? - A WAKE UP CALL NEEDED TO ACHIEVE SDG 3.2.1

This article draws attention to the need to prioritize the national budgets towards health planning and the importance of integrating innovative digital health solutions into thehealthcare systems especially in developing countries. It throws light on the increasing Infant Mortality Rates, especially newborn related deaths. Two countries Nigeria and India were chosen as the representative countries from among the developing countries to describe the Infant mortality rates and the need for digitalization. Examples of digital solutions and their impacts in creating awareness and reducing the infant mortality rates are quoted in this article. Digitalization is considered as easy to use, accessible way to improve health through proper implementation and political commitment of the nations.

Reducing the Burden of Neonatal Mortality in Pakistan

The chances of dying on the first day of life are second only to the last day of life. Newborns, thus, represent a very vulnerable subset of population. This is especially the case in low- and middle-income countries like Pakistan. Although our Neonatal Mortality Rate has declined during the last few decades, it failed to keep pace with the targets set in the Millennium Development Goals (MDGs). Pakistan continues to have one of the highest neonatal Mortality Rates in the world. As we enter the era of Sustainable Development Goals, every effort should be made to meet the new targets set in the SDGs.With the ever-increasing financial burden of healthcare (especially in a struggling economy like ours), careful thought should be given to adopting measures to save newborn lives and improve their health status. These measures should not only be efficacious but also cost effective and sustainable. Keeping in mind the mother newborn dyad, measures to improve neonatal outcome must address maternal health simultaneously. Reducing neonatal mortality in low- and middle income countries (LMICs) is thus a multifaceted challenge that requires a combination of strategies addressing various factors contributing to newborn deaths. Here are some effective approaches

Exploring gestational age, and birth weight assessment in Thatta district, Sindh, Pakistan: Healthcare providers' knowledge, practices, perceived barriers, and the potential of a mobile app for identifying preterm and low birth weight.

Reliable methods for identifying prematurity and low birth weight (LBW) are crucial to ending preventable deaths in newborns. This study explored healthcare providers' (HCPs) knowledge, practice, perceived barriers in assessing gestational age and birth weight and their referral methods for preterm and LBW infants. The study additionally assessed the potential of using a mobile app for the identification and referral decision of preterm and LBW. This qualitative descriptive study was conducted in Thatta District, Sindh, Pakistan. Participants, including doctors, nurses, lady health visitors, and midwives, were purposefully selected from a district headquarter hospital, and private providers in the catchment area of Global Network's Maternal and Newborn Health Registry (MNHR). Interviews were conducted using an interview guide after obtaining written informed consent. Audio recordings of the interviews were transcribed and analyzed using NVIVO® software with an inductive approach. The HCPs had extensive knowledge about antenatal and postnatal methods for assessing gestational age. They expressed a preference for antenatal ultrasound due to the perceived accuracy, though accept practical barriers including workload, machine malfunctions, and cost. Postnatal assessment using the Ballard score was only undertaken sparingly due to insufficient training and subjectivity. All HCPs preferred electronic weighing scales for birth weight Barriers encountered included weighing scale calibration and battery issues. There was variation in the definition of prematurity and LBW, leading to delays in referral. Limited resources, inadequate education, and negative parent past experiences were barriers to referral. Foot length measurements were not currently being used. While mobile apps are felt to have potential, unreliable electricity supply and internet connectivity are barriers. The HCPs in this study were knowledgeable in terms of potential tools, but acknowledged the logistical and parental barriers to implementation.

DISTANCE TO HEALTH FACILITIES WITH LOW DELIVERY ASSISTANCE BY HEALTH PERSONNEL IN THE WORKING AREA OF BIBIDA HEALTH CENTER PANIAI DISTRICT CENTRAL PAPUA

Maternal and newborn complications and deaths mostly occur in the period around childbirth. This is partly because help is not provided by health workers who have midwifery competence. In 2021, 56.3% of births were assisted by health workers in Papua Province. At the Bibida Community Health Center, 32% of births were assisted by health workers. The aim of this research is to examine the relationship between the distance to health facilities and the low level of birth assistance by health workers in the Bibida Health Center working area. The type of research used is quantitative, employing a descriptive design with a cross-sectional approach. This research was conducted from October 2023 to November 2023 in the Bibida Health Center working area, Paniai Regency, Central Papua. The population in this study consisted of all postpartum mothers in the Bibida Community Health Center working area in July, August, and September. Samples were selected using a total population technique, resulting in 35 samples. Computerized univariate and bivariate data processing was conducted using the chi-square statistical test. The research findings showed that the percentage of births assisted by non-health workers was 62.9%, while the percentage of births in relation to the distance to health facilities was 54.3%. The statistical analysis results indicated a significant relationship between the distance to health facilities (p-value = 0.000) and the level of birth assistance by health workers.

Predictors of neonatal mortality among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama regional state, Ethiopia

BackgroundDespite promising efforts, substantial deaths occurred during the neonatal period. According to estimates from the World Health Organization (WHO), Ethiopia is among the top 10 nations with the highest number of neonatal deaths in 2020 alone. This staggering amount makes it difficult to achieve the SDG (Sustainable Development Goals) target that calls for all nations to work hard to meet a neonatal mortality rate target of ≤ 12 deaths per 1,000 live births by 2030. We evaluated neonatal mortality and it’s contributing factors among newborns admitted to the Neonatal Intensive Care Unit (NICU) at Hawassa University Comprehensive Specialized Hospital (HUCSH).MethodsA hospital-based retrospective cross-sectional study on neonates admitted to the NICU from May 2021 to April 2022 was carried out at Hawassa University Comprehensive Specialized Hospital. From the admitted 1044 cases over the study period, 225 babies were sampled using a systematic random sampling procedure. The relationship between variables was determined using bivariate and multivariable analyses, and statistically significant relations were indicated at p-values less than 0.05.ResultsThe magnitude of neonatal death was 14.2% (95% CI: 0.099–0.195). The most common causes of neonatal death were prematurity 14 (43.8%), sepsis 9 (28.1%), Perinatal asphyxia 6 (18.8%), and congenital malformations 3 (9.4%). The overall neonatal mortality rate was 28 per 1000 neonate days. Neonates who had birth asphyxia were 7.28 times more probable (AOR = 7.28; 95% CI: 2.367, 9.02) to die. Newborns who encountered infection within the NICU were 8.17 times more likely (AOR = 8.17; 95% CI: 1.84, 36.23) to die.ConclusionThe prevalence of newborn death is excessively high. The most common causes of mortality identified were prematurity, sepsis, perinatal asphyxia and congenital anomalies. To avert these causes, we demand that antenatal care services be implemented appropriately, delivery care quality be improved, and appropriate neonatal care and treatment be made available.

Barriers to use of institutional childbirth services: a qualitative study in the rural Jimma Zone, Ethiopia

Background/Aims Institutional birth and skilled birth attendants are two important elements of preventing maternal and newborn deaths. In Ethiopia, despite improved health access, many women give birth without skilled assistance. This study was conducted to identify barriers to institutional childbirth in the Jimma Zone, Ethiopia. Methods An exploratory qualitative case study was conducted, incorporating 16 focus group discussions and 18 in-depth interviews carried out in the Jimma Zone, Ethiopia in 2019. The participants were purposefully recruited and included members of the Women's Development Army, religious leaders, health extension workers, midwifery nurses, primary healthcare unit directors and women of reproductive age. Data were transcribed and translated into English and thematically analysed. Results Five themes emerged from the data: knowledge gaps, beliefs about pregnancy and childbirth, poor access to healthcare services, lack of resources and poor community involvement in institutional childbirth. Conclusions Healthcare services should be aware of local beliefs and cultural norms when encouraging the use of institutional childbirth services. The Ministry of Health must ensure that all services are equipped with adequate resources, both in terms of medical supplies and staff.

IJCM_404A: Newborn deaths in Maharashtra: A qualitative thematic analysis of newspaper articles

Background: As per statistics on infant mortality, the State of Maharashtra has done well in bringing down IMR from 33 to 16 per 1000 live births. However, in recent years many incidents come to light, especially in the case of institutional deliveries where newborns die either due to infrastructure failure or dysfunctional equipment. On a programmatic level, this has serious implications. Schemes such as Janani Suraksha Yojana promote institutional deliveries, but the institutes are unable to tend to the patient load efficiently. Analysing newspaper articles covering such incidents will throw light on actionable points for policy change. Experts from various fields tend to author such articles. Therefore it’s imperative to search every source available to bottleneck the areas for improvement. Objective: 1. To understand the perspectives of authors about newborn deaths in Maharashtra 2. To derive major areas of concern raised by such articles possibly causing newborn deaths in Maharashtra Methodology: All newspaper articles published in the last 2 years about newborn deaths in Maharashtra were identified. They were segregated according to the Name of the newspaper, author, incident, period etc. A thematic analysis was performed on 12 such articles to uncover different themes and sub themes. Results: Major themes that emerged were related to infrastructure issues and equipment failure. Another important theme was the higher patient load on secondary care due to excessive referrals from primary health facilities. The schemes promoting institutional deliveries did not anticipate the additional workload on district and subdistrict hospitals. Strengthening primary care remains the major area of concern. Conclusion: Lack of quality assurance is the major bottleneck at the infrastructure level. Strengthening primary care will reduce the excessive workload on district and subdistrict hospitals. All these are part of the same chain of events.

Incidence and predictors of mortality among neonates admitted with birth asphyxia to neonatal intensive care unit of West Shewa Zone Public Hospitals, Central Ethiopia

BackgroundBirth asphyxia is still one of the primary causes of newborn mortality worldwide. Similarly, the risk of newborn asphyxia in Ethiopia remains unacceptably high. Thus, studies on the incidence and...

The Evaluation Of Universal Child Immunization (UCI) Management In The Work Area Of Bah Kapul Health Center, Siantar Sitalasari District In 2023

Background: Immunization is the governments promise to get Sustainable Development Goals (SDGs), especially to decrease the number of infant death rates. Universal Child Immunization (UCI) is an indicator of success in basic immunization in babies immune against a disease. Purpose: To analyze the process of management in achieving UCI. Research Methods: The research used qualitative phenomenological methods. The objective of the research was to analyze the process of management in achieving UCI. The research used qualitative phenomenological methods. It was done in the working area of Bah Kapul Puskesmas. The data were gathered by conducting in-depth interviews with 8 Informantts from Surveillance and Immunization Section Head, the Heads of Puskesmas, participants of immunization program, and practice midwife. Result : The result of the research showed that human resources were inadequate since their qualification was not in accordance with the standards, training was only done by the participants, facility and infrastructure such as KMS preparation and the facility outside the building were inadequate, lacked of staff cars for immunization personnel, there was no counseling about immunization in the field, people were not interested in the program, there were ignorance and lack of involvement of cross-sectors, and there was no monitoring from the Heads of Puskesmas for immunization outside the building. Conclusion : The Heads of Puskesmas should monitor directly immunization service outside the building and not only monitor through the report. The management of Puskesmas should provide counseling about the importance of immunization for targeted parents before posyandu service is done. The cross-sectors should support the implementation of immunization, actively play and collaborate in its implementation.

FEATURES OF THE PHYSIOLOGY OF THE POSTPARTUM PERIOD AFTER CAESAREAN SECTION

The main principle of perinatal obstetrics is to ensure the health of the mother, fetus and newborn, which in some cases requires quick and gentle delivery. Therefore, during the last decades, cesarean section (CS) in obstetric practice has become a tool that allows you to preserve the health of both the mother and the child.&#x0D; Despite its wide distribution, CS is classified as a category of complex operations with a high frequency of postoperative complications (3.3%-54.4%), which are associated with the intervention technique, obstetric and neonatal reasons. Potential structural and functional complications include: the risk of pulmonary, gastrointestinal and vascular complications; postoperative pain and discomfort; pelvic organ prolapse; posture change; pelvic floor dysfunction; weakness of the abdominal wall; diastasis of rectus abdominis muscles; umbilical hernia; general functional limitations.&#x0D; Scientific progress in medicine, social and cultural changes have led to fundamental transformations in the attitude to CS among women and doctors. In fact, the consensus regarding indications for caesarean section has changed in many countries, now including psychosocial factors such as anxiety about childbirth or the mother's desire for caesarean section in the absence of any medical indication.&#x0D; The postpartum period is a critical, but often overlooked, period in the lives of new parents. According to the WHO, the majority of maternal and newborn deaths occur during this period, so proper management and care of parents and newborns is vitally important.&#x0D; The postpartum period is usually divided into three separate but continuous phases: acute phase (early postpartum period) - 24 hours immediately after childbirth; subacute phase (late postpartum period): can last 2-6 weeks after childbirth; late phase - can last from 6 weeks to 6 months after childbirth.&#x0D; The postpartum period is characterized by a wide range of new states of women's life and increased sensitivity to external factors. The whole range of postnatal changes can be considered as an integrative combination of psychological, physiological and endocrine factors that affect the physical and mental activity of women, as well as determine their relationship with the child.&#x0D; Therefore, a caesarean section should be performed according to indications with a mandatory justification.&#x0D; The presence of a postoperative scar in women who underwent an abdominal delivery causes changes in the postpartum period in the form of a specific limitation of mobility during its formation. This aspect is all the more important from the point of view of the onset of future pregnancies, which requires the formation of a full-fledged elastic strong scar on the uterus and soft tissues.&#x0D; The formation of a scar in the postpartum period, in connection with the need for care and feeding of the child, changes as a result of sleep and rest regimes, additionally increases the metabolic, physical, psycho-emotional load, which causes pressure on the adaptive capabilities of the regulatory systems of the woman's body against the background of reconstruction and recovery structural and hormonal components.&#x0D; A woman's condition directly affects her ability to care for and raise a child, return to work and social activity, as well as the quality of life, both personally and within the framework of the environment. Therefore, certain recovery measures are necessary for their normalization as soon as possible.

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.

Trends and population attributable risk estimates for individual and community-level factors of neonatal mortality in Pakistan (1990–2018)

PurposePakistan ranks third globally in terms of newborn deaths occuring within the first 24 hours of life. With a neonatal mortality rate of 42.0%, it carries the highest burden compared to neighboring countries such as Bangladesh (17%), India (22.7%) and Afghanistan (37%). While there has been a decline in neonatal mortality rates in Pakistan, the pace of this decline is slower than that of other countries in the region. Hence, it is crucial to conduct a comprehensive examination of the risk factors contributing to neonatal mortality in Pakistan over an extended period. This study aims to analyze the trends and determinants of neonatal mortality in Pakistan over three decades, providing valuable insights into this persistent issue.Design/methodology/approachThe study focused on neonatal mortality as the response variable, which is defined as the death of a live-born child within 28 days of birth. Neonates who passed away during this period were categorized as “cases,” while those who survived beyond a specific timeframe were referred to as “noncases.” To conduct a pooled analysis of neonatal mortality, birth records of 39,976 children born in the five years preceding the survey were extracted from four waves (1990–2018) of the Pakistan Demographic and Household Survey. The relationship between risk factors and the response variable was examined using the Cox Proportional Hazard Model. Neonatal mortality rates were calculated through the direct method using the “syncmrates” package in Stata 15.FindingsDuring the extended period in Pakistan, several critical protective factors against neonatal mortality were identified, including a large family size, improved toilet facilities, middle-aged and educated mothers, female children, singleton live births, large size at birth and longer birth intervals. These factors were found to reduce the risk of neonatal mortality significantly.Originality/valueThis study makes the first attempt to analyze the trends and patterns of potential risk factors associated with neonatal mortality in Pakistan. By examining a large dataset spanning several years, the study provides valuable insights into the factors influencing neonatal mortality.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-09-2022-0604

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.

Toward Advancing Women’s Health in Least Developed Countries: Evaluating Contraceptive Distribution Models in Senegal

Problem definition: Improving access to contraceptives is one of the most effective interventions to prevent unintended pregnancies and save the lives of women in least developed countries (LDCs), where the overwhelming majority of maternal deaths occur. However, access to reproductive health commodities is often limited in LDCs because of frequent stock-outs at last-mile health facilities. In this study, we evaluate and compare the effect of two distribution models on last-mile contraceptive availability and key public health outcomes (e.g., unintended pregnancies, maternal and newborn deaths). These distribution models are (i) the commonly used pull distribution model, in which health facilities are fully responsible for managing inventory, and (ii) an alternative model known as the informed push distribution model, which delegates inventory management tasks to external logistics providers. Methodology/results: We leverage the staggered transition from pull distribution to informed push distribution in Senegal, a country that redesigned its contraceptive distribution system. We conduct empirical analyses, including a triple differences estimation, on novel field data compiled from multiple sources to evaluate the effect of the transition. We find that the transition significantly reduces contraceptive stock-outs, frontline health worker workload, unintended pregnancies, and maternal and newborn mortalities and also improves client satisfaction, especially in health facilities with less mature inventory management practices and less developed road infrastructure. A comprehensive cost–benefit analysis shows that the aforementioned benefits are achieved in a cost-efficient manner at these facilities, making them prime candidates for the transition. However, for facilities with less mature inventory management practices but more developed road infrastructure, upgrading the inventory management system is a substantially more cost-efficient alternative than transitioning to a new distribution model without compromising the benefits. Managerial implications: Given the resource constraints faced by the public health sector in LDCs, it is imperative to understand how the operational and public health benefits of the transition to the informed push model vary based on facility characteristics. Our findings offer actionable insights for resource allocation by identifying health facilities that benefit the most from the transition. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2021.0488 .