Cyril Engmann - Academia.edu (original) (raw)

Papers by Cyril Engmann

Pediatric Infectious Disease Journal, Sep 1, 2013

Background: In pursuit of innovative approaches for the management of severe infections in young ... more Background: In pursuit of innovative approaches for the management of severe infections in young infants, which is a major cause of mortality, a multipartner research program was conceptualized to provide right care in the right place. The primary objective was to generate evidence and identify a simple, safe and effective treatment regimen for young infants with severe infections that can be provided closer to home by trained health workers where referral is not possible. Research: Published and nonpublished data on community-based approaches for the management of neonatal sepsis were critically reviewed by an independent expert panel convened in 2007 by the World Health Organization in collaboration with the United States Agency for International Development and Save the Children/Saving Newborn Lives. These stakeholders agreed to 1) undertake research to improve the specificity of a diagnostic algorithm and revise World Health Organization/United Nations International Children's Emergency Fund Integrated Management of Childhood Illness guidelines to identify sick young infants for referral, 2) develop research studies with common research designs (1 site in each Bangladesh and Pakistan and a multicentre site in Democratic Republic of Congo, Kenya and Nigeria) and oversight mechanisms to evaluate antibiotic regimens (when referral is not accepted by the family) that are safe and efficacious, appropriate to the severity of infection, and deployable on a large scale and 3) utilize existing program delivery structures incorporating community health workers, skilled health workers to deliver simple antibiotic treatment when referral is not possible. Conclusions: This research program facilitated innovative research in different geographical, cultural and administrative milieus to generate recommendations for policy.

Tropical Medicine & International Health, Dec 1, 2009

objectives To develop a standardized verbal autopsy (VA) training program and evaluate whether it... more objectives To develop a standardized verbal autopsy (VA) training program and evaluate whether its implementation resulted in comparable knowledge required to classify perinatal cause of death (COD) by physicians and non-physicians. methods Training materials, case studies, and written and mock scenarios for this VA program were developed using conventional VA and ICD-10 guidelines. This program was used to instruct physicians and non-physicians in VA methodology using a train-the-trainer model. Written tests of cognitive and applied knowledge required to classify perinatal COD were administered before and after training to evaluate the effect of the VA training program. results Fifty-three physicians and non-physicians (nurse-midwives ⁄ nurses and Community Health Workers [CHW]) from Pakistan, Zambia, the Democratic Republic of Congo, and Guatemala were trained. Cognitive and applied knowledge mean scores among all trainees improved significantly (12.8 and 28.8% respectively, P < 0.001). Cognitive and applied knowledge post-training test scores of nursemidwives ⁄ nurses were comparable to those of physicians. CHW (high-school graduates with 15 months or less formal health ⁄ nursing training) had the largest improvements in post-training applied knowledge with scores comparable to those of physicians and nurse-midwives ⁄ nurses. However, CHW cognitive knowledge post-training scores were significantly lower than those of physicians and nurses. conclusions With appropriate training in VA, cognitive and applied knowledge required to determine perinatal COD is similar for physicians and nurses-midwives ⁄ nurses. This suggests that midwives and nurses may play a useful role in determining COD at the community level, which may be a practical way to improve the accuracy of COD data in rural, remote, geographic areas.

PLOS Medicine, Mar 2, 2016

• Accelerating progress in reproductive, maternal, newborn, and child health (RMNCH) over the pas... more • Accelerating progress in reproductive, maternal, newborn, and child health (RMNCH) over the past 30 years has resulted in significant decreases in mortality, as well as shifts in causes of death. For example, deaths from diarrhea among children under age 5 have significantly declined. This increased survival means an increasing fraction of under-5 deaths occur in the first 4 weeks of life, the neonatal period. • Transformative changes, including advances such as the development of immunizations, wide uptake of contraception, and the availability of medications such as oxytocin, have contributed to an improved morbidity and mortality curve. Such advances are set against a broader backdrop of increasing national wealth, stronger health systems, aligned political agendas, and advocacy systems.

Public Health Nutrition, Oct 2, 2017

Objective: Despite numerous global initiatives on breast-feeding, trend data show exclusive breas... more Objective: Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades. The purpose of the present systematic review was to determine barriers to exclusive breast-feeding in twenty-five low-and middle-income countries and discuss implications for programmes. Design: A search of Scopus, MEDLINE, CINAHL and PsychINFO was conducted to retrieve studies from January 2000 to October 2015. Using inclusion criteria, we selected both qualitative and quantitative studies that described barriers to EBF. Setting: Low-and middle-income countries. Subjects: Following application of systematic review criteria, forty-eight articles from fourteen countries were included in the review. Results: Sixteen barriers to EBF were identified in the review. There is moderate evidence of a negative association between maternal employment and EBF practices. Studies that examined EBF barriers at childbirth and the initial 24 h postdelivery found strong evidence that caesarean section can impede EBF. There is moderate evidence for early initiation of breast-feeding and likelihood of practising EBF. Breast-feeding problems were commonly reported from crosssectional or observational studies. Counselling on EBF and the presence of family and/or community support have demonstrated improvements in EBF. Conclusions: Improving the counselling skills of health workers to address breastfeeding problems and increasing community support for breast-feeding are critical components of infant and young child feeding programming, which will aid in attaining the 2025 World Health Assembly EBF targets. Legislation and regulations on marketing of breast-milk substitutes, paid maternity leave and breast-feeding breaks for working mothers require attention in low-and middle-income countries. Keywords Breast-feeding Exclusive breast-feeding Barriers Infant and young child feeding programmes Infant and young child nutrition

PLOS ONE, Jul 14, 2017

Objective To evaluate the cost-effectiveness of a quality improvement intervention aimed at reduc... more Objective To evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal and fetal mortality in Accra, Ghana. Design Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. Methods Data were collected on the cost and outcomes of a 5-year Kybele-Ghana Health Service Quality Improvement (QI) intervention conducted at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana, focused on systems, personnel, and communication. Maternal deaths prevented were estimated comparing observed rates with counterfactual projections of maternal mortality and case-fatality rates for hypertensive disorders of pregnancy and obstetric hemorrhage. Stillbirths prevented were estimated based on counterfactual estimates of stillbirth rates. Cost-effectiveness was then calculated using estimated disability-adjusted life years averted and subjected to Monte Carlo and one-way sensitivity analyses to test the importance of assumptions inherent in the calculations. Main outcome measure Incremental Cost-effectiveness ratio (ICER), which represents the cost per disabilityadjusted life-year (DALY) averted by the intervention compared to a model counterfactual.

Maternal and Child Nutrition, 2019

Integrating maternal-child nutrition into health care services is a desirable but complex task th... more Integrating maternal-child nutrition into health care services is a desirable but complex task that requires implementation research studies. This special supplement, entitled "How to Strengthen Nutrition into the Health Platform: Programmatic Evidence and Experience from Low-and Middle-Income Countries" presents a collection of mixed-methods research and case studies mostly conducted in sub-Saharan Africa that help us gain a better understanding of the barriers and facilitators for this integration to happen. Collectively, the evidence confirms that integrating nutrition services as part of health care systems and other platforms is feasible, but for that to be successful, there is a need to address strong barriers related to all six key health care systems building blocks identified by the World Health Organization. These include financing, health information systems, health workforce, supplies and technology, governance, and service delivery. Moving forward, it is crucial that more robust implementation science research is conducted within the rough and tumble of realworld programming to better understand how to best integrate and scale up nutrition services across health care systems and other platforms based on dynamic complex adaptive systems frameworks. This research can help better understand how the key health care systems building blocks need to interlock and communicate with each other to improve the policymakers' ability to integrate and scale up nutrition services in a more timely and cost-effective way.

International journal of gynaecology and obstetrics, Jun 26, 2013

Research Square (Research Square), Dec 9, 2019

Background: For every newborn who dies within the first month, as many as eight more suffer lifet... more Background: For every newborn who dies within the first month, as many as eight more suffer lifethreatening complications but survive (termed 'neonatal near-misses' (NNM)). However, there is no universally agreed-upon definition or assessment tool for NNM. This study sought to describe the development of the Neonatal Near-Miss Assessment Tool (NNMAT) for low-resource settings, as well as findings when implemented in Ghana. Methods: This prospective, observational study was conducted at two tertiary care hospitals in southern Ghana from April-July 2015. Newborns with evidence of complications and those admitted to NICUs were screened for inclusion using the NNMAT. Incidence of suspected NNM at enrollment and confirmed near-miss (surviving to 28 days) was determined and compared against institutional neonatal mortality rates. Suspected NNM cases were compared with newborns not classified as a suspected near-miss, and all were followed to 28 days to determine odds of survival. Confirmed nearmisses were those identified as suspected near-misses at enrollment who survived to 28 days. The main outcome measures were incidence of NNM, NNM:mortality ratio, and factors associated with NNM classification. Results: Out of 394 newborns with complications, 341 (86.5%) were initially classified as suspected near-misses at enrollment using the NNMAT, with 53 (13.4%) being classified as a non-near-miss. At 28-day follow-up, 68 (17%) had died, 52 (13%) were classified as a non-near-miss, and 274 were considered confirmed near-misses. Those newborns with complications who were classified as suspected near-misses using the NNMAT at enrollment had 12 times the odds of dying before 28 days than those classified as non-near-misses. While most confirmed near-misses qualified as NNM via intervention-based criteria, nearly two-thirds qualified based on two or more of the four NNMAT categories. When disaggregated, the most predictive elements of the NNMAT were gestational age < 33 weeks, neurologic dysfunction, respiratory dysfunction, and hemoglobin < 10 gd/dl. The ratio of near-misses to deaths was 0.55 : 1, yet this varied across the study sites. Conclusions: This research suggests that the NNMAT is an effective tool for assessing neonatal nearmisses in low-resource settings. We believe this approach has significant systems-level, continuous

Bulletin of The World Health Organization, Mar 1, 2012

Bulletin of The World Health Organization, Dec 1, 2021

Donor human milk is recommended by the World Health Organization both for its advantageous nutrit... more Donor human milk is recommended by the World Health Organization both for its advantageous nutritional and biological properties when mother's own milk is not available and for its recognized support for lactation and breastfeeding when used appropriately. An increasing number of human milk banks are being established around the world, especially in low-and middle-income countries, to facilitate the collection, processing and distribution of donor human milk. In contrast to other medical products of human origin, however, there are no minimum quality, safety and ethical standards for donor human milk and no coordinating global body to inform national policies. We present the key issues impeding progress in human milk banking, including the lack of clear definitions or registries of products; issues around regulation, quality and safety; and ethical concerns about commercialization and potential exploitation of women. Recognizing that progress in human milk banking is limited by a lack of comparable evidence, we recommend further research in this field to fill the knowledge gaps and provide evidence-based guidance. We also highlight the need for optimal support for mothers to provide their own breastmilk and establish breastfeeding as soon as and wherever possible after birth.

Journal of Pregnancy, 2010

This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean ... more This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean section deliveries in China. If so, does the association remain after controlling for clinical factors associated with C-sections? A sample of 227 mostly primiparous women in the third trimester of pregnancy was surveyed in a large tertiary care hospital in Beijing, China. Postdelivery data were collected from medical records. In bivariate analysis, both optimism and pessimism were related to unplanned c-section. However, when optimism and pessimism were entered into a regression model together, optimism was no longer statistically significant. Pessimism remained significant, even when adjusting for clinical factors such as previous abortion, previous miscarriage, pregnancy complications, infant gestational age, infant birthweight, labor duration, birth complications, and selfrated difficulty of the pregnancy. This research suggests that maternal mindset during pregnancy has a role in mode of delivery. However, more research is needed to elucidate potential causal pathways and test potential interventions.

Bulletin of The World Health Organization, Mar 1, 2012

Human Vaccines & Immunotherapeutics, 2021

ABSTRACT Despite significant reduction in childhood mortality, infant – particularly neonatal – m... more ABSTRACT Despite significant reduction in childhood mortality, infant – particularly neonatal – mortality continues to be unacceptably high. A substantial proportion of these deaths could be averted by vaccinating mothers during pregnancy (maternal immunization). However, in order to realize the full life-saving potential of maternal immunization, it is important to develop clear introduction and delivery strategies for maternal vaccines. This will necessitate close collaboration between maternal health and immunization stakeholders. This article examines key considerations and areas for action to support successful and sustainable introduction and scale-up of maternal immunization, from the perspective of maternal, newborn, child, and adolescent health stakeholders.

Resuscitation Plus, 2020

Aim In Ghana, institutional delivery has been emphasized to improve maternal and newborn outcomes... more Aim In Ghana, institutional delivery has been emphasized to improve maternal and newborn outcomes. The Making Every Baby Count Initiative, a large coordinated training effort, aimed to improve newborn outcomes through government engagement and provider training across four regions of Ghana. Two newborn resuscitation training and evaluation approaches are described for front line newborn care providers at five regional hospitals. Methods A modified newborn resuscitation program was taught at the Greater Accra Regional Hospital (GARH) and evaluated with real-time resuscitation observations. A programmatic shift, led to a different approach being utilized in Sunyani, Koforidua, Ho and Kumasi South Regional Hospitals. This included Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) training followed by objective structured clinical examinations (OSCE) with manikins at fixed intervals. Data was collected on training outcomes, fresh stillbirth and institutional newborn ...

Bulletin of The World Health Organization, 2012

International Journal of Clinical Trials, 2020

Background: Approximately 250 million (43%) children under five years in low- and middle-income c... more Background: Approximately 250 million (43%) children under five years in low- and middle-income countries are at risk of sub-optimal development. Of these, 67% are found in sub-Saharan Africa due to exposure to multiple risks, including inadequate stimulation at home. In order to promote early childhood development (ECD), an intervention integrating ECD content into routine facility-based health services and supporting ECD policy and advocacy is currently being implemented in Siaya County. In addition, parental counseling on early stimulation is integrated into home-based visits by community health volunteers. We aim to evaluate the intervention’s operational feasibility, effectiveness and cost-effectiveness.Methods: The study is a cluster-randomized controlled trial using a mixed-methods approach. The study is being conducted in Bondo sub-county in Siaya County. The study has three arms. Arm 1 will receive a health facility-based ECD intervention. Arm 2 will receive the health faci...

The Lancet Global Health, 2019

Panel: Ethical considerations to shape key actions Ethical considerations Vulnerability Consider ... more Panel: Ethical considerations to shape key actions Ethical considerations Vulnerability Consider potential medical, social, and economic vulnerabilities of both donor and recipient mother-infant dyad and mechanisms for reducing vulnerabilities. Equity and fairness Consider which populations carry the risks and burdens of supplying donor human milk; and which receive the benefits of donor human milk. Consider how equity and fairness are addressed through allocation and access to donor milk and develop safeguards to prevent exploitation of women donating and selling milk. Respect for autonomy Consider and respect personal and community decisions regarding donor human milk. Consider the role that sociocultural factors, such as religion and kinship, play in decision-making processes. Human rights Ensure equitable access to donor human milk, without discrimination, for infants in need. Call on governments to meet their commitments to women and children through existing conventions and human rights mechanisms,* which call for maternity protection, gender equality, and rights of women and children to adequate food, nutrition, health, and informed choice.

Pediatric Infectious Disease Journal, Sep 1, 2013

Background: In pursuit of innovative approaches for the management of severe infections in young ... more Background: In pursuit of innovative approaches for the management of severe infections in young infants, which is a major cause of mortality, a multipartner research program was conceptualized to provide right care in the right place. The primary objective was to generate evidence and identify a simple, safe and effective treatment regimen for young infants with severe infections that can be provided closer to home by trained health workers where referral is not possible. Research: Published and nonpublished data on community-based approaches for the management of neonatal sepsis were critically reviewed by an independent expert panel convened in 2007 by the World Health Organization in collaboration with the United States Agency for International Development and Save the Children/Saving Newborn Lives. These stakeholders agreed to 1) undertake research to improve the specificity of a diagnostic algorithm and revise World Health Organization/United Nations International Children's Emergency Fund Integrated Management of Childhood Illness guidelines to identify sick young infants for referral, 2) develop research studies with common research designs (1 site in each Bangladesh and Pakistan and a multicentre site in Democratic Republic of Congo, Kenya and Nigeria) and oversight mechanisms to evaluate antibiotic regimens (when referral is not accepted by the family) that are safe and efficacious, appropriate to the severity of infection, and deployable on a large scale and 3) utilize existing program delivery structures incorporating community health workers, skilled health workers to deliver simple antibiotic treatment when referral is not possible. Conclusions: This research program facilitated innovative research in different geographical, cultural and administrative milieus to generate recommendations for policy.

Tropical Medicine & International Health, Dec 1, 2009

objectives To develop a standardized verbal autopsy (VA) training program and evaluate whether it... more objectives To develop a standardized verbal autopsy (VA) training program and evaluate whether its implementation resulted in comparable knowledge required to classify perinatal cause of death (COD) by physicians and non-physicians. methods Training materials, case studies, and written and mock scenarios for this VA program were developed using conventional VA and ICD-10 guidelines. This program was used to instruct physicians and non-physicians in VA methodology using a train-the-trainer model. Written tests of cognitive and applied knowledge required to classify perinatal COD were administered before and after training to evaluate the effect of the VA training program. results Fifty-three physicians and non-physicians (nurse-midwives ⁄ nurses and Community Health Workers [CHW]) from Pakistan, Zambia, the Democratic Republic of Congo, and Guatemala were trained. Cognitive and applied knowledge mean scores among all trainees improved significantly (12.8 and 28.8% respectively, P < 0.001). Cognitive and applied knowledge post-training test scores of nursemidwives ⁄ nurses were comparable to those of physicians. CHW (high-school graduates with 15 months or less formal health ⁄ nursing training) had the largest improvements in post-training applied knowledge with scores comparable to those of physicians and nurse-midwives ⁄ nurses. However, CHW cognitive knowledge post-training scores were significantly lower than those of physicians and nurses. conclusions With appropriate training in VA, cognitive and applied knowledge required to determine perinatal COD is similar for physicians and nurses-midwives ⁄ nurses. This suggests that midwives and nurses may play a useful role in determining COD at the community level, which may be a practical way to improve the accuracy of COD data in rural, remote, geographic areas.

PLOS Medicine, Mar 2, 2016

• Accelerating progress in reproductive, maternal, newborn, and child health (RMNCH) over the pas... more • Accelerating progress in reproductive, maternal, newborn, and child health (RMNCH) over the past 30 years has resulted in significant decreases in mortality, as well as shifts in causes of death. For example, deaths from diarrhea among children under age 5 have significantly declined. This increased survival means an increasing fraction of under-5 deaths occur in the first 4 weeks of life, the neonatal period. • Transformative changes, including advances such as the development of immunizations, wide uptake of contraception, and the availability of medications such as oxytocin, have contributed to an improved morbidity and mortality curve. Such advances are set against a broader backdrop of increasing national wealth, stronger health systems, aligned political agendas, and advocacy systems.

Public Health Nutrition, Oct 2, 2017

Objective: Despite numerous global initiatives on breast-feeding, trend data show exclusive breas... more Objective: Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades. The purpose of the present systematic review was to determine barriers to exclusive breast-feeding in twenty-five low-and middle-income countries and discuss implications for programmes. Design: A search of Scopus, MEDLINE, CINAHL and PsychINFO was conducted to retrieve studies from January 2000 to October 2015. Using inclusion criteria, we selected both qualitative and quantitative studies that described barriers to EBF. Setting: Low-and middle-income countries. Subjects: Following application of systematic review criteria, forty-eight articles from fourteen countries were included in the review. Results: Sixteen barriers to EBF were identified in the review. There is moderate evidence of a negative association between maternal employment and EBF practices. Studies that examined EBF barriers at childbirth and the initial 24 h postdelivery found strong evidence that caesarean section can impede EBF. There is moderate evidence for early initiation of breast-feeding and likelihood of practising EBF. Breast-feeding problems were commonly reported from crosssectional or observational studies. Counselling on EBF and the presence of family and/or community support have demonstrated improvements in EBF. Conclusions: Improving the counselling skills of health workers to address breastfeeding problems and increasing community support for breast-feeding are critical components of infant and young child feeding programming, which will aid in attaining the 2025 World Health Assembly EBF targets. Legislation and regulations on marketing of breast-milk substitutes, paid maternity leave and breast-feeding breaks for working mothers require attention in low-and middle-income countries. Keywords Breast-feeding Exclusive breast-feeding Barriers Infant and young child feeding programmes Infant and young child nutrition

PLOS ONE, Jul 14, 2017

Objective To evaluate the cost-effectiveness of a quality improvement intervention aimed at reduc... more Objective To evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal and fetal mortality in Accra, Ghana. Design Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. Methods Data were collected on the cost and outcomes of a 5-year Kybele-Ghana Health Service Quality Improvement (QI) intervention conducted at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana, focused on systems, personnel, and communication. Maternal deaths prevented were estimated comparing observed rates with counterfactual projections of maternal mortality and case-fatality rates for hypertensive disorders of pregnancy and obstetric hemorrhage. Stillbirths prevented were estimated based on counterfactual estimates of stillbirth rates. Cost-effectiveness was then calculated using estimated disability-adjusted life years averted and subjected to Monte Carlo and one-way sensitivity analyses to test the importance of assumptions inherent in the calculations. Main outcome measure Incremental Cost-effectiveness ratio (ICER), which represents the cost per disabilityadjusted life-year (DALY) averted by the intervention compared to a model counterfactual.

Maternal and Child Nutrition, 2019

Integrating maternal-child nutrition into health care services is a desirable but complex task th... more Integrating maternal-child nutrition into health care services is a desirable but complex task that requires implementation research studies. This special supplement, entitled "How to Strengthen Nutrition into the Health Platform: Programmatic Evidence and Experience from Low-and Middle-Income Countries" presents a collection of mixed-methods research and case studies mostly conducted in sub-Saharan Africa that help us gain a better understanding of the barriers and facilitators for this integration to happen. Collectively, the evidence confirms that integrating nutrition services as part of health care systems and other platforms is feasible, but for that to be successful, there is a need to address strong barriers related to all six key health care systems building blocks identified by the World Health Organization. These include financing, health information systems, health workforce, supplies and technology, governance, and service delivery. Moving forward, it is crucial that more robust implementation science research is conducted within the rough and tumble of realworld programming to better understand how to best integrate and scale up nutrition services across health care systems and other platforms based on dynamic complex adaptive systems frameworks. This research can help better understand how the key health care systems building blocks need to interlock and communicate with each other to improve the policymakers' ability to integrate and scale up nutrition services in a more timely and cost-effective way.

International journal of gynaecology and obstetrics, Jun 26, 2013

Research Square (Research Square), Dec 9, 2019

Background: For every newborn who dies within the first month, as many as eight more suffer lifet... more Background: For every newborn who dies within the first month, as many as eight more suffer lifethreatening complications but survive (termed 'neonatal near-misses' (NNM)). However, there is no universally agreed-upon definition or assessment tool for NNM. This study sought to describe the development of the Neonatal Near-Miss Assessment Tool (NNMAT) for low-resource settings, as well as findings when implemented in Ghana. Methods: This prospective, observational study was conducted at two tertiary care hospitals in southern Ghana from April-July 2015. Newborns with evidence of complications and those admitted to NICUs were screened for inclusion using the NNMAT. Incidence of suspected NNM at enrollment and confirmed near-miss (surviving to 28 days) was determined and compared against institutional neonatal mortality rates. Suspected NNM cases were compared with newborns not classified as a suspected near-miss, and all were followed to 28 days to determine odds of survival. Confirmed nearmisses were those identified as suspected near-misses at enrollment who survived to 28 days. The main outcome measures were incidence of NNM, NNM:mortality ratio, and factors associated with NNM classification. Results: Out of 394 newborns with complications, 341 (86.5%) were initially classified as suspected near-misses at enrollment using the NNMAT, with 53 (13.4%) being classified as a non-near-miss. At 28-day follow-up, 68 (17%) had died, 52 (13%) were classified as a non-near-miss, and 274 were considered confirmed near-misses. Those newborns with complications who were classified as suspected near-misses using the NNMAT at enrollment had 12 times the odds of dying before 28 days than those classified as non-near-misses. While most confirmed near-misses qualified as NNM via intervention-based criteria, nearly two-thirds qualified based on two or more of the four NNMAT categories. When disaggregated, the most predictive elements of the NNMAT were gestational age < 33 weeks, neurologic dysfunction, respiratory dysfunction, and hemoglobin < 10 gd/dl. The ratio of near-misses to deaths was 0.55 : 1, yet this varied across the study sites. Conclusions: This research suggests that the NNMAT is an effective tool for assessing neonatal nearmisses in low-resource settings. We believe this approach has significant systems-level, continuous

Bulletin of The World Health Organization, Mar 1, 2012

Bulletin of The World Health Organization, Dec 1, 2021

Donor human milk is recommended by the World Health Organization both for its advantageous nutrit... more Donor human milk is recommended by the World Health Organization both for its advantageous nutritional and biological properties when mother's own milk is not available and for its recognized support for lactation and breastfeeding when used appropriately. An increasing number of human milk banks are being established around the world, especially in low-and middle-income countries, to facilitate the collection, processing and distribution of donor human milk. In contrast to other medical products of human origin, however, there are no minimum quality, safety and ethical standards for donor human milk and no coordinating global body to inform national policies. We present the key issues impeding progress in human milk banking, including the lack of clear definitions or registries of products; issues around regulation, quality and safety; and ethical concerns about commercialization and potential exploitation of women. Recognizing that progress in human milk banking is limited by a lack of comparable evidence, we recommend further research in this field to fill the knowledge gaps and provide evidence-based guidance. We also highlight the need for optimal support for mothers to provide their own breastmilk and establish breastfeeding as soon as and wherever possible after birth.

Journal of Pregnancy, 2010

This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean ... more This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean section deliveries in China. If so, does the association remain after controlling for clinical factors associated with C-sections? A sample of 227 mostly primiparous women in the third trimester of pregnancy was surveyed in a large tertiary care hospital in Beijing, China. Postdelivery data were collected from medical records. In bivariate analysis, both optimism and pessimism were related to unplanned c-section. However, when optimism and pessimism were entered into a regression model together, optimism was no longer statistically significant. Pessimism remained significant, even when adjusting for clinical factors such as previous abortion, previous miscarriage, pregnancy complications, infant gestational age, infant birthweight, labor duration, birth complications, and selfrated difficulty of the pregnancy. This research suggests that maternal mindset during pregnancy has a role in mode of delivery. However, more research is needed to elucidate potential causal pathways and test potential interventions.

Bulletin of The World Health Organization, Mar 1, 2012

Human Vaccines & Immunotherapeutics, 2021

ABSTRACT Despite significant reduction in childhood mortality, infant – particularly neonatal – m... more ABSTRACT Despite significant reduction in childhood mortality, infant – particularly neonatal – mortality continues to be unacceptably high. A substantial proportion of these deaths could be averted by vaccinating mothers during pregnancy (maternal immunization). However, in order to realize the full life-saving potential of maternal immunization, it is important to develop clear introduction and delivery strategies for maternal vaccines. This will necessitate close collaboration between maternal health and immunization stakeholders. This article examines key considerations and areas for action to support successful and sustainable introduction and scale-up of maternal immunization, from the perspective of maternal, newborn, child, and adolescent health stakeholders.

Resuscitation Plus, 2020

Aim In Ghana, institutional delivery has been emphasized to improve maternal and newborn outcomes... more Aim In Ghana, institutional delivery has been emphasized to improve maternal and newborn outcomes. The Making Every Baby Count Initiative, a large coordinated training effort, aimed to improve newborn outcomes through government engagement and provider training across four regions of Ghana. Two newborn resuscitation training and evaluation approaches are described for front line newborn care providers at five regional hospitals. Methods A modified newborn resuscitation program was taught at the Greater Accra Regional Hospital (GARH) and evaluated with real-time resuscitation observations. A programmatic shift, led to a different approach being utilized in Sunyani, Koforidua, Ho and Kumasi South Regional Hospitals. This included Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) training followed by objective structured clinical examinations (OSCE) with manikins at fixed intervals. Data was collected on training outcomes, fresh stillbirth and institutional newborn ...

Bulletin of The World Health Organization, 2012

International Journal of Clinical Trials, 2020

Background: Approximately 250 million (43%) children under five years in low- and middle-income c... more Background: Approximately 250 million (43%) children under five years in low- and middle-income countries are at risk of sub-optimal development. Of these, 67% are found in sub-Saharan Africa due to exposure to multiple risks, including inadequate stimulation at home. In order to promote early childhood development (ECD), an intervention integrating ECD content into routine facility-based health services and supporting ECD policy and advocacy is currently being implemented in Siaya County. In addition, parental counseling on early stimulation is integrated into home-based visits by community health volunteers. We aim to evaluate the intervention’s operational feasibility, effectiveness and cost-effectiveness.Methods: The study is a cluster-randomized controlled trial using a mixed-methods approach. The study is being conducted in Bondo sub-county in Siaya County. The study has three arms. Arm 1 will receive a health facility-based ECD intervention. Arm 2 will receive the health faci...

The Lancet Global Health, 2019

Panel: Ethical considerations to shape key actions Ethical considerations Vulnerability Consider ... more Panel: Ethical considerations to shape key actions Ethical considerations Vulnerability Consider potential medical, social, and economic vulnerabilities of both donor and recipient mother-infant dyad and mechanisms for reducing vulnerabilities. Equity and fairness Consider which populations carry the risks and burdens of supplying donor human milk; and which receive the benefits of donor human milk. Consider how equity and fairness are addressed through allocation and access to donor milk and develop safeguards to prevent exploitation of women donating and selling milk. Respect for autonomy Consider and respect personal and community decisions regarding donor human milk. Consider the role that sociocultural factors, such as religion and kinship, play in decision-making processes. Human rights Ensure equitable access to donor human milk, without discrimination, for infants in need. Call on governments to meet their commitments to women and children through existing conventions and human rights mechanisms,* which call for maternity protection, gender equality, and rights of women and children to adequate food, nutrition, health, and informed choice.