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REDUCING PERINATAL AND NEONATAL
MORTALITY
REDUCING PERINATAL AND NEONATAL
MORTALITY
Dr R Soerjo Hadijono SpOG(K), DTRM&B(Ch)
Jaringan Nasional Pelatihan Klinik Kesehatan ReproduksiSub Bagian Obginsos Bagian Obgin FK Undip – RSUP Dr Kariadi
Semarang
Dr R Soerjo Hadijono SpOG(K), DTRM&B(Ch)
Jaringan Nasional Pelatihan Klinik Kesehatan ReproduksiSub Bagian Obginsos Bagian Obgin FK Undip – RSUP Dr Kariadi
Semarang
● Over 9 million deaths occur each year in the perinatal and neonatal periods;
● 98% of these deaths take place in the developing world;
● Most of these deaths are caused by infectious diseases; pregnancy-related complications; or delivery-related complications.
● Over 9 million deaths occur each year in the perinatal and neonatal periods;
● 98% of these deaths take place in the developing world;
● Most of these deaths are caused by infectious diseases; pregnancy-related complications; or delivery-related complications.
In most of the world, under-5 year and infant (under-1 year) mortality rates have declined substantially in the past three
decades.
In most of the world, under-5 year and infant (under-1 year) mortality rates have declined substantially in the past three
decades.
● Neonatal mortality has declined less rapidly than other child mortality;
● Neonatal deaths now account for 40 -70% of all infant mortality;
● Neonatal mortality has declined less rapidly than other child mortality;
● Neonatal deaths now account for 40 -70% of all infant mortality;
20
40
60
80
100
120
140
1975 1980 1985 1990 1995
Year
Rat
e pe
r 100
0
Infant Mortality
Neonatal Mortality
Comparison of Infant and Neonatal Mortality Decline in
Nepal 1975-1995
Comparison of Infant and Neonatal Mortality Decline in
Nepal 1975-1995
20
40
60
80
100
120
140
1975 1980 1985 1990 1995
Year
Rat
e pe
r 100
0
Infant Mortality
Neonatal Mortality
Comparison of Infant and Neonatal Mortality Decline in
Turkey 1975-1995
Comparison of Infant and Neonatal Mortality Decline in
Turkey 1975-1995
20
40
60
80
100
120
140
1975 1980 1985 1990 1995
Year
Rat
e pe
r 100
0
Infant Mortality
Neonatal Mortality
Comparison of Infant and Neonatal Mortality Decline in
Egypt 1975-1995
Comparison of Infant and Neonatal Mortality Decline in
Egypt 1975-1995
20
40
60
80
100
120
140
1975 1980 1985 1990 1995
Year
Rat
e pe
r 100
0
Infant Mortality
Neonatal Mortality
Comparison of Infant and Neonatal Mortality Decline in
Ghana 1975-1995
Comparison of Infant and Neonatal Mortality Decline in
Ghana 1975-1995
20
40
60
80
100
120
140
1975 1980 1985 1990 1995
Year
Rat
e pe
r 100
0
Infant Mortality
Neonatal Mortality
Comparison of Infant and Neonatal Mortality Decline in
Peru 1975-1995
Comparison of Infant and Neonatal Mortality Decline in
Peru 1975-1995
To further reduce child mortality, a new focus of
programs will have to be on reducing neonatal deaths,
particularly those in the first week of life.
To further reduce child mortality, a new focus of
programs will have to be on reducing neonatal deaths,
particularly those in the first week of life.
Medium-Term Trends in Neonatal Mortality in Asia
Medium-Term Trends in Neonatal Mortality in Asia
Medium-Term Trends in Neonatal Mortality in Latin
America
Medium-Term Trends in Neonatal Mortality in Latin
America
Ne
on
ata
l M
ort
ali
ty R
ate
Year
1975 1980 1985 1990 19950
25
50
75
Yemen Morocco
EgyptTunisia
Jordan
Medium-Term Trends in Neonatal Mortality
in the Middle East and North Africa
Medium-Term Trends in Neonatal Mortality
in the Middle East and North Africa
Neo
nata
l Mor
talit
y R
ate
Year
1975 1980 1985 1990 1995 0
25
50
75
Nigeria
Ghana Senegal
Cameroon
Kenya
Medium-Term Trends in Neonatal Mortality
in Sub-Saharan Africa
Medium-Term Trends in Neonatal Mortality
in Sub-Saharan Africa
Ear
ly N
eona
tal D
eath
/Neo
nata
l Mor
talit
y
Infant Mortality Rate
0 50 100 150 .5
.6
.7
.8
.9
bot
brk
burcam
col
col
col
dr
egy
gha
gha
ido
ido
ken
ken
lib
mad
malmli
mor
mor
nam
nep
nga
ngr
pakper
per
phi
rwa
sensen
sritha
tog
tun
tur
uga zam
zim
Early Neonatal Deaths as a Proportion of Neonatal Mortality in Developing
Countries
Early Neonatal Deaths as a Proportion of Neonatal Mortality in Developing
Countries
Antepartum Hemorrhage
Intrauterine Growth
RetardationFetal
Abnormality
Infection
Preterm Birth
Other
34%
14%
12%
7%
8%6%
Direct Causes of Perinatal Mortality
in Tygerberg, South Africa
Direct Causes of Perinatal Mortality
in Tygerberg, South Africa
Obstructed Labor
7%
Other Indirect 20%
Hemorrhage25%
Sepsis14%
Hypertension13%
Unsafe Abortion
13%
Other Direct8%
Joint WHO-UNICEF-UNFPA-WB statement
Causes of Perinatal Mortality
Causes of Perinatal Mortality
Neonatal Tetanus
14%
Asphyxia21%
Injuries11% Congential
abnormalities11%
Sepsis7%
Prematurity10%
Other5%
Diarrhea2%
Pneumonia19%
WHO Mother and Baby Package, 1993
Direct Causes of Neonatal Mortality
Direct Causes of Neonatal Mortality
Stoll, BJ. The global impact of infection, in Clin Perinatol 1997; 24:1-21.(14)
Infection Number ofCases
Case Fatality Rate (%) Number ofDeaths
Acute RespiratoryInfections
2,500,000 30 750,000
Neonatal Tetanus 438,000 85 372,000Sepsis 750,000 40 300,000Diarrhea 25,000,000 .6 150,000Meningitis 126,000 40 50,400
Estimated Global Burden of Disease of
Major Neonatal Infections
Estimated Global Burden of Disease of
Major Neonatal Infections
Estimated Global Burden of Disease of Major Neonatal
Infections
Estimated Global Burden of Disease of Major Neonatal
Infections
InfectionNumber of
casesCase Fatality
Rate (%)Number
of Deaths
Acute Respiratory InfectionNeonatal TetanusSepsisDiarrheaMeningitis
2,500,000
438,000750,000
25,000,000126,000
30
85400.640
750,000
372,000300,000150,00050,400
InterventionsInterventions
● Prior to or During Pregnancy● During Delivery● After Delivery
● Prior to or During Pregnancy● During Delivery● After Delivery
Interventions Prior to or During Pregnancy
Interventions Prior to or During Pregnancy
● Nutritional Interventions● Malaria Prophylaxis● Maternal Immunization
● Nutritional Interventions● Malaria Prophylaxis● Maternal Immunization
BMJ 1997 Sept 27;315(7111):786-90
Nutritional Interventions I
Nutritional Interventions I
● Low birthweight by 35%● Stillbirths by 55%● Perinatal deaths by 49%● Neonatal deaths by 40%
● Low birthweight by 35%● Stillbirths by 55%● Perinatal deaths by 49%● Neonatal deaths by 40%
Ceesay et al supplemented pregnant women in The Gambia with 900 additional calories per day, and reduced:
Atukorala TM et al AJCN 1995 Aug;60(2):286-92
Nutritional Interventions II
Nutritional Interventions II
● Low birthweight by 50%● Perinatal deaths by 45%
● Low birthweight by 50%● Perinatal deaths by 45%
In Sri Lanka, iron supplementation along with antihelminthic therapy reduced:
In Sri Lanka, iron supplementation along with antihelminthic therapy reduced:
Malaria - Effects on Perinatal and Neonatal
Mortality
Malaria - Effects on Perinatal and Neonatal
Mortality● In 1994, 45 million pregnant women
were living in malarious areas, with over 23 million in Sub-Saharan Africa;
● Malaria may cause up to 30% of preventable low birth weight, and 3-5% of neonatal mortality in highly endemic areas, and
● Malaria is also associated with an increased risk of spontaneous abortions and stillbirths
● In 1994, 45 million pregnant women were living in malarious areas, with over 23 million in Sub-Saharan Africa;
● Malaria may cause up to 30% of preventable low birth weight, and 3-5% of neonatal mortality in highly endemic areas, and
● Malaria is also associated with an increased risk of spontaneous abortions and stillbirths
Shulman CE et al, Lancet 1999 Feb 20; 353(9153):632-6
Malaria ProphylaxisMalaria Prophylaxis
● Perinatal deaths by 22%● Neonatal deaths by 38%
● Perinatal deaths by 22%● Neonatal deaths by 38%
In Kilifi District, Kenya, an area of high malaria transmission, Shulman et al presumptively treated pregnant women with Fansidar which reduced:
In Kilifi District, Kenya, an area of high malaria transmission, Shulman et al presumptively treated pregnant women with Fansidar which reduced:
Black RE et al Bull WHO 1980 58:927-930 & Shahid et al, Lancet 1995;346(8985):1252-7.
Maternal ImmunizationMaternal Immunization
● Maternal immunization with tetanus toxoid reduced neonatal mortality (from days 4 to 14) from 30/1000 to 10/1000, and reduced deaths for three years after vaccination.
● Maternal immunization with pneumococcus produced antibody levels in infants twice that of infants of unimmunized mothers.
● Maternal immunization with tetanus toxoid reduced neonatal mortality (from days 4 to 14) from 30/1000 to 10/1000, and reduced deaths for three years after vaccination.
● Maternal immunization with pneumococcus produced antibody levels in infants twice that of infants of unimmunized mothers.
Interventions During Delivery
Interventions During Delivery
● Prevention and Management of Delivery Complications
● Resuscitation of the newborn
● Prevention and Management of Delivery Complications
● Resuscitation of the newborn
.
Yan et al. Int J Gynaecol Obstet 1989 Sep;30(1):23-6
Prevention and Management of Delivery
Complications
Prevention and Management of Delivery
Complications
● Training a community member to recognize early warning signs of pregnancy problems, and refer the woman to a township doctor;
● Improvements in transportation services for referral;
● Education campaigns specifically targeted at newly married couples and their families, and the general public through television and radio messages
● Training a community member to recognize early warning signs of pregnancy problems, and refer the woman to a township doctor;
● Improvements in transportation services for referral;
● Education campaigns specifically targeted at newly married couples and their families, and the general public through television and radio messages
A study in Shunyi, China reduced perinatal mortality by 34% and early neonatal mortality by 25% by implementing the following interventions:
A study in Shunyi, China reduced perinatal mortality by 34% and early neonatal mortality by 25% by implementing the following interventions:
Resuscitation of the newborn
Resuscitation of the newborn
● Asphyxia due to prolonged labor or small infant size continues to claim the lives of nearly 1 million neonates each year.
● Infants born at home are those at greatest risk.
● Midwives and community health workers must be authorized and trained to give bag and mask resuscitation to newborns.
● Complex interventions such as intubation, chest compression and drugs are rarely needed.
● Asphyxia due to prolonged labor or small infant size continues to claim the lives of nearly 1 million neonates each year.
● Infants born at home are those at greatest risk.
● Midwives and community health workers must be authorized and trained to give bag and mask resuscitation to newborns.
● Complex interventions such as intubation, chest compression and drugs are rarely needed.
Interventions After Delivery
Interventions After Delivery
● Kangaroo Care Method● Breastfeeding and Nutritional
Support● Prevention and Management of
Infections
● Kangaroo Care Method● Breastfeeding and Nutritional
Support● Prevention and Management of
Infections
Bergman & Jurisoo Trop Doct 1994;24(2):57-60 & Kambarami et al. Ann Trop Paediatr 1998 Jun;18(2):81-6.
Kangaroo Care MethodKangaroo Care Method
In Zimbabwe, Kangaroo Care babies had:
● Improved survival● Faster growth;● A higher median weight and hospital
discharge weight;● A lower frequency of illness, and● A lower median duration of hospital
stay.
In Zimbabwe, Kangaroo Care babies had:
● Improved survival● Faster growth;● A higher median weight and hospital
discharge weight;● A lower frequency of illness, and● A lower median duration of hospital
stay.
Breastfeeding and Nutritional SupportBreastfeeding and Nutritional Support
● Breastfeeding protects against late neonatal deaths (from 8 - 28 days) which are primarily due to infections, such as sepsis, ARI, meningitis, umbilical infection (omphalitis), and diarrhea.
● Breastfeeding protects against late neonatal deaths (from 8 - 28 days) which are primarily due to infections, such as sepsis, ARI, meningitis, umbilical infection (omphalitis), and diarrhea.
13.1
24.7
0
5
10
15
20
25
Breastmilk Only Breastmilk + Formula No Breastmilk
Victora et al Lancet 1987;Aug;8:319-21
Relative Risk for Mortality (0-1 Month) by Breastfeeding,
Pelotas, Brazil
Relative Risk for Mortality (0-1 Month) by Breastfeeding,
Pelotas, Brazil
Prevention and Management of Infections
Prevention and Management of Infections
● To protect immature epithelial barriers from infection, a topical emollient such a Aquaphor may be applied to the skin of pre-term infants.
● In clinical trials, Aquaphor reduced positive blood and cerebrospinal fluid cultures to 3.3% (controls = 26.7%).
● Studies are currently in progress to examine the safety and efficacy of inexpensive and locally available vegetable oil substitutes for use in the developing world.
● To protect immature epithelial barriers from infection, a topical emollient such a Aquaphor may be applied to the skin of pre-term infants.
● In clinical trials, Aquaphor reduced positive blood and cerebrospinal fluid cultures to 3.3% (controls = 26.7%).
● Studies are currently in progress to examine the safety and efficacy of inexpensive and locally available vegetable oil substitutes for use in the developing world.
Sepsis52%
Asphyxia20%
Prematurity15%
Other13%
A Bang, Personal Communication
Primary Causes of Neonatal Deaths in the
Community
Primary Causes of Neonatal Deaths in the
Community
Sepsis22%
Asphyxia26%Prematurity
31%
Other12%
Congenital abnormality
9%
Report on the Neonatal-Perinatal Database, 1995. New Delhi
Primary Causes of Death in Hospital-Borne Neonates
Primary Causes of Death in Hospital-Borne Neonates
Implications for Research and Programs
Implications for Research and Programs
● Community and Health System Barriers
● Adapting IMCI to the Neonatal Period
● Community-Based Neonatal Care in India
● Community and Health System Barriers
● Adapting IMCI to the Neonatal Period
● Community-Based Neonatal Care in India
Community and Health System Barriers
Community and Health System Barriers
● A study in Guatemala of perinatal and neonatal deaths by McDermott and colleagues showed that 83% of mothers sought care, but most received care only from TBAs.
● In neonatal deaths, hypothermia was noted in 89%, the umbilical cord was cut with scissors in 86%, and nothing was applied to the cord wound in 53%.
● A study in Guatemala of perinatal and neonatal deaths by McDermott and colleagues showed that 83% of mothers sought care, but most received care only from TBAs.
● In neonatal deaths, hypothermia was noted in 89%, the umbilical cord was cut with scissors in 86%, and nothing was applied to the cord wound in 53%.
ArgentinaBrazilBoliviaColombiaEcuadorParaguayPeruVenezuela
EgyptIranMoroccoPakistanSudanSyriaTurkeyYemen
Status of implementation
Dominican Rep.El SalvadorHaitiHondurasNicaragua
Discussions had started in at least another 8 countries
ArmeniaAzerbaijanBelarusGeorgiaKazakhstan
KyrgyzstanMoldovaTadjikistanTurkmenistanUzbekistan
BangladeshBhutanCambodiaChinaIndiaIndonesiaLaosMyanmarNepalPhilippinesViet Nam
Expansion (12 countries)
Early implementation (31 countries)
Introduction (20 countries)
*Based on information available in June 1999
BeninBotswanaCote d'IvoireEritreaEthiopiaGhanaKenyaMadagascarMalawiMaliMozambique
NamibiaNigerNigeriaSenegalSouth AfricaTanzania, U.R.TogoUgandaZambiaZimbabwe
Implementation of IMCI (June 1999)*Implementation of IMCI (June 1999)*
Neonatal Health Interventions I
During Pregnancy
Neonatal Health Interventions I
During Pregnancy● Preparedness and counselling on
safe childbirth;● Treatment of maternal complications; ● Infection control in endemic areas
(malaria, syphilis and hookworm); ● Control of nutritional deficiencies ● Immunizing the mother with tetanus
toxoid; ● Avoiding harmful substances.
● Preparedness and counselling on safe childbirth;
● Treatment of maternal complications; ● Infection control in endemic areas
(malaria, syphilis and hookworm); ● Control of nutritional deficiencies ● Immunizing the mother with tetanus
toxoid; ● Avoiding harmful substances.
Neonatal Health Interventions II During
Childbirth
Neonatal Health Interventions II During
Childbirth● Safe and clean delivery; ● Effectively managed pregnancy
complications, and ● referral for essential obstetric
care;
● Safe and clean delivery; ● Effectively managed pregnancy
complications, and ● referral for essential obstetric
care;
Neonatal Health Interventions III For the
Newborn
Neonatal Health Interventions III For the
Newborn● Routine care and vigilance for all newborns,
during from 6-12 hours after birth; ● Special care for preterm and/or low birth
weight infants, including Kangaroo Care; ● Identification and treatment of infections; ● Support for mothers on providing newborn
care, and on recognizing danger signs and taking appropriate action;
● Immunization, and ● Prevention of vertical HIV/AIDS
transmission
● Routine care and vigilance for all newborns, during from 6-12 hours after birth;
● Special care for preterm and/or low birth weight infants, including Kangaroo Care;
● Identification and treatment of infections; ● Support for mothers on providing newborn
care, and on recognizing danger signs and taking appropriate action;
● Immunization, and ● Prevention of vertical HIV/AIDS
transmission
Bang et al
Community-Based Neonatal Care in India
Community-Based Neonatal Care in India
● Case fatality from sepsis from 18.5% to 2.8%
● Perinatal mortality by 71%● Neonatal mortality by 62%
● Case fatality from sepsis from 18.5% to 2.8%
● Perinatal mortality by 71%● Neonatal mortality by 62%
A study in India which trained community health workers to treat or refer women with pregnancy complications; identify sick or high-risk newborns, treat infections and administer injections, reduced:
A study in India which trained community health workers to treat or refer women with pregnancy complications; identify sick or high-risk newborns, treat infections and administer injections, reduced:
RESEARCH AND PROGRAM PRIORITIES
RESEARCH AND PROGRAM PRIORITIES
Program PrioritiesProgram Priorities
● Before Birth● During Labor and Delivery● The Early Weeks of Life
● Before Birth● During Labor and Delivery● The Early Weeks of Life
Perinatal and Neonatal Program Priorities Before
Birth
Perinatal and Neonatal Program Priorities Before
Birth● Increasing the quality and scope of
syphilis screening;● Improving the diagnosis and
treatment of ascending, reproductive tract infections in pregnant women;
● Expanding maternal immunization with tetanus toxoid and pneumococcus;
● Increasing the quality and scope of syphilis screening;
● Improving the diagnosis and treatment of ascending, reproductive tract infections in pregnant women;
● Expanding maternal immunization with tetanus toxoid and pneumococcus;
Perinatal and Neonatal Program Priorities Before
Birth
Perinatal and Neonatal Program Priorities Before
Birth● Presumptive malaria prophylaxis in
routine antenatal care visits, and● Nutritional support for pregnant
women to improve birth outcomes.
● Presumptive malaria prophylaxis in routine antenatal care visits, and
● Nutritional support for pregnant women to improve birth outcomes.
Perinatal and Neonatal Program Priorities During
Labor and Delivery
Perinatal and Neonatal Program Priorities During
Labor and Delivery
● Regular re-education of health workers and birth attendants and the use of economic incentives to improve the identification and management of malpresentation and prolonged labor;
● Referral of complicated cases to health center or hospital;
● Regular re-education of health workers and birth attendants and the use of economic incentives to improve the identification and management of malpresentation and prolonged labor;
● Referral of complicated cases to health center or hospital;
Perinatal and Neonatal Program Priorities During
Labor and Delivery
Perinatal and Neonatal Program Priorities During
Labor and Delivery
● Combating the barriers to referral compliance, including transportation of mothers and care of other children, and
● Institution of perinatal and neonatal audits at hospitals and health centers
● Combating the barriers to referral compliance, including transportation of mothers and care of other children, and
● Institution of perinatal and neonatal audits at hospitals and health centers
Perinatal and Neonatal Program Priorities In the Early Weeks of
Life
Perinatal and Neonatal Program Priorities In the Early Weeks of
Life● Wider use of resuscitation techniques
for asphyxiated infants;● Proper management of neonatal
sepsis and other infections;● Skin-to-skin Kangaroo Care for
preterm infants, and● Immediate and exclusive
breastfeeding for all newborns.
● Wider use of resuscitation techniques for asphyxiated infants;
● Proper management of neonatal sepsis and other infections;
● Skin-to-skin Kangaroo Care for preterm infants, and
● Immediate and exclusive breastfeeding for all newborns.
.
Crucial to the success of programs is:Crucial to the success of programs is:
● national ownership, and ● public-private partnerships to
ensure long-term funding
● national ownership, and ● public-private partnerships to
ensure long-term funding
A cost-effective, and efficient way
to introduce interventions would be to make additions
to already existing programs.
A cost-effective, and efficient way
to introduce interventions would be to make additions
to already existing programs.
Research PrioritiesResearch Priorities
● Neonatal Infections● IMCI● Community-Based Health
Services● Malaria Reduction● Reduction of Premature and
IUGR Births
● Neonatal Infections● IMCI● Community-Based Health
Services● Malaria Reduction● Reduction of Premature and
IUGR Births
Research Priorities for Neonatal Infections
Research Priorities for Neonatal Infections
● Community-based surveillance to identify the principal bacterial and viral agents of neonatal infections
● Determination of the antimicrobial resistance profiles of the common bacterial agents of serious infections in neonates on a regional basis, in both community and hospital settings;
● Community-based surveillance to identify the principal bacterial and viral agents of neonatal infections
● Determination of the antimicrobial resistance profiles of the common bacterial agents of serious infections in neonates on a regional basis, in both community and hospital settings;
Research Priorities for Neonatal Infections
Research Priorities for Neonatal Infections
● Studies of neonatal care provided in the home by caretakers, traditional birth attendants, and community health workers, and follow cohorts of neonates for infectious outcome, and
● Case-control studies to identify the principal risk factors for neonatal infections. Risk factors to be evaluated include low birth weight; unhygienic delivery, skin and umbilical cord care; birth asphyxia; hypothermia; smoke inhalation; and feeding practices
● Studies of neonatal care provided in the home by caretakers, traditional birth attendants, and community health workers, and follow cohorts of neonates for infectious outcome, and
● Case-control studies to identify the principal risk factors for neonatal infections. Risk factors to be evaluated include low birth weight; unhygienic delivery, skin and umbilical cord care; birth asphyxia; hypothermia; smoke inhalation; and feeding practices
Research Priorities for IMCI
Research Priorities for IMCI
● Identification of historical information and clinical signs and symptoms that are most predictive of the presence of acute neonatal infection;
● Development of an algorithm for use in identifying neonatal infection, and
● Training and testing the abilities of community-health workers to use the algorithm to identify acutely infected neonates
● Identification of historical information and clinical signs and symptoms that are most predictive of the presence of acute neonatal infection;
● Development of an algorithm for use in identifying neonatal infection, and
● Training and testing the abilities of community-health workers to use the algorithm to identify acutely infected neonates
Research Priorities for Community-Based Health
Services
Research Priorities for Community-Based Health
Services● Community-based studies to
determine existing obstetric practices, neonatal care, and health-seeking behavior for neonatal illnesses;
● Training of traditional birth attendants and community health workers to implement the package of basic neonatal care practices;
● Community-based studies to determine existing obstetric practices, neonatal care, and health-seeking behavior for neonatal illnesses;
● Training of traditional birth attendants and community health workers to implement the package of basic neonatal care practices;
Research Priorities for Community-Based Health
Services
Research Priorities for Community-Based Health
Services● Strategies to improve access to
emergency obstetric care, and methods to increase referral rates for complicated pregnancies, and
● Design of a package of simple practices for the routine post-delivery care of neonates born in the community.
● Strategies to improve access to emergency obstetric care, and methods to increase referral rates for complicated pregnancies, and
● Design of a package of simple practices for the routine post-delivery care of neonates born in the community.
Research Priorities to Reduce Malaria
Research Priorities to Reduce Malaria
● Efficacy studies of presumptive, intermittent treatment to prevent malaria as part of routine antenatal care in areas of high transmission;
● Design of methods for treatment of malaria during pregnancy using safe, effective and simple regimens in areas of high, medium, and low transmission;
● Efficacy studies of presumptive, intermittent treatment to prevent malaria as part of routine antenatal care in areas of high transmission;
● Design of methods for treatment of malaria during pregnancy using safe, effective and simple regimens in areas of high, medium, and low transmission;
Research Priorities to Reduce Malaria
Research Priorities to Reduce Malaria
● Evaluation of the safety and efficacy of newly available antimalarial drugs (alone or in combinations) for treatment and prevention in pregnancy, and
● Reduction of malaria exposure during pregnancy using methods such as insecticide-permeated bed nets.
● Evaluation of the safety and efficacy of newly available antimalarial drugs (alone or in combinations) for treatment and prevention in pregnancy, and
● Reduction of malaria exposure during pregnancy using methods such as insecticide-permeated bed nets.
Research Priorities to Reduce
Premature and IUGR Births
Research Priorities to Reduce
Premature and IUGR Births● Evaluation of simple methods for
detection of bacterial vaginosis, and appropriate treatment, such as comparing a once versus three-times daily treatment with metronidazole;
● Development of strategies to improve knowledge and practice of methods to prevent sexually-transmitted diseases;
● Evaluation of simple methods for detection of bacterial vaginosis, and appropriate treatment, such as comparing a once versus three-times daily treatment with metronidazole;
● Development of strategies to improve knowledge and practice of methods to prevent sexually-transmitted diseases;
Research Priorities to Reduce
Premature and IUGR Births
Research Priorities to Reduce
Premature and IUGR Births● Evaluation of the safety and efficacy
of maternal caloric supplementation for reducing low birth weight, and methods to reduce maternal anemia through the use of iron supplements, antihelminths and antimalarials, and
● Evaluation of micronutrient supplementation for the reduction of LBW, and improved neonatal health.
● Evaluation of the safety and efficacy of maternal caloric supplementation for reducing low birth weight, and methods to reduce maternal anemia through the use of iron supplements, antihelminths and antimalarials, and
● Evaluation of micronutrient supplementation for the reduction of LBW, and improved neonatal health.
● An ongoing dialogue must be established between governments and researchers to combat perinatal and neonatal mortality
● Governments must be able to call upon researchers to help them solve health problems, and research results must be used to formulate national programs and policies.
● An ongoing dialogue must be established between governments and researchers to combat perinatal and neonatal mortality
● Governments must be able to call upon researchers to help them solve health problems, and research results must be used to formulate national programs and policies.
We must create sustainable interventions
in countries where the needs are greatest
We must create sustainable interventions
in countries where the needs are greatest
More than nine million children will continue to die
before or just after birth each year, unless the international
health community finds solutions for and implements
programs to reduce their numbers.
More than nine million children will continue to die
before or just after birth each year, unless the international
health community finds solutions for and implements
programs to reduce their numbers.Duff Gillespie, Ph.D.,
Deputy Assistant AdministratorUSAID Population Health and Nutrition/Global Programs
Duff Gillespie, Ph.D., Deputy Assistant Administrator
USAID Population Health and Nutrition/Global Programs
THANK YOUFOR THINKING OF US
THANK YOUFOR THINKING OF US