Translating Research into Practice Series: Improving Birth and Pregnancy Outcomes through Registries in Southern Ethiopia

Originally featured on the Maternal Health Task Force (MHTF) Blog site, this post is part of the Translating Research into Practice Series which features guest posts from authors of the MHTF-PLOS Maternal Health Collections describing the impact of their research since publication.

Post written byBy Yaliso Yaya, PhD candidate, Centre for International Health, University of Bergen, Norway and teaching staff, Arba Minch College of Health Science, Ethiopia

 

Unfortunately, there is still limited information to oversee maternal and newborn mortality interventions in low-income countries. Developing countries lack vital registrations that are present in high-income countries. Because of the shortage of such essential information, translating policy into action and monitoring programmes to reduce maternal and neonatal deaths is difficult.

Image credit: Jack Zalium, Flickr

Image credit: Jack Zalium, Flickr

The new Sustainable Development Goals divide countries into three groups where the maternal mortality ratio (MMR) is greater than 400, between 100 and 400, and less than 100 based on the ratio in 2010. Such a grouping is necessary because different ratios may determine different intervention strategies. Unfortunately, for many countries there is a controversy over the level of the MMR. If we use Ethiopia as an example, a UN estimate of MMR in 2010 is 350 per 100,000 live births, whereas the DHS estimated it to be 676 for the same year.
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Category: General | 1 Comment

Translating Research into Practice Series: Using Research Findings to Influence Maternal Health Action: An Example from Nigeria

Originally featured on the Maternal Health Task Force (MHTF) Blog site, this post is part of the Translating Research into Practice Series which features guest posts from authors of the MHTF-PLOS Maternal Health Collections describing the impact of their research since publication.

Post Written By: Bolaji Fapohunda, Senior Advisor & Nosakhare Orobaton, Chief of Party, TSHIP

 

Image Credit: Jack Zalium, flickr.com

Image Credit: Jack Zalium, flickr.com

Our paper—When Women Deliver with No One Present in Nigeria: Who, what, where and so what, published in the MHTF-PLOS Year 2 Collection—revealed that over one in five births in Nigeria was delivered with no one present (NOP) and 94% of those deliveries occurred in northern Nigeria. A woman’s age, increasing number of pregnancies, Muslim religion, and residence in northern Nigeria increased her risk of delivering alone. However, with greater economic status, decision-making power, and education women were less likely to deliver alone.
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Category: Collections, General, Maternal Newborn and Child Health | 1 Comment

Translating Research into Practice Series: Five ways an Innovative Program increased Facility Birth in Nigeria

Originally featured on the Maternal Health Task Force (MHTF) Blog site, this post is part of the Translating Research into Practice Series which features guest posts from authors of the MHTF-PLOS Maternal Health Collections describing the impact of their research since publication.

Post written bySeye Abimbola, Research Fellow; Nnenna Ihebuzor, Director of Primary Health Care Systems DevelopmentUgo Okoli, Program Director of SURE-P Maternal and Child Health Programme, Nigeria’s National Primary Health Care Development Agency

 

Image Credit: Jack Zalium, flickr.com

Image Credit: Jack Zalium, flickr.com

The Midwives Service Scheme (MSS) was set up as a game changer to reduce maternal and child mortality so Nigeria could achieve the Millennium Development Goals (MDGs) on maternal and child health (MCH). Established by the national government in 2009 to improve the availability of skilled birth attendants in rural communities, the program engages newly graduated, unemployed and retired midwives to work temporarily in rural areas. Four midwives are posted for one year to selected primary health care (PHC) facilities to provide the human resources for health necessary to achieve the MDGs in their states and local government areas.
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Category: Collections, General, Maternal Newborn and Child Health | 1 Comment

A Final Update to the MHTF & PLOS Maternal Health Collection & Reflecting on our 3 Year Collaboration

In November 2011, PLOS and the Maternal Health Task Force (MHTF) embarked on a 3 year partnership aiming to highlight the needs of mothers and infants through the MHTF-PLOS Collection on Maternal Health. Today we announce the final update to the Year 3 Collection & introduce the Translating Research into Practice Series, featuring posts by collection authors describing the influence of their papers.

Image credit: Jack Zalium, Flickr

Image credit: Jack Zalium, Flickr

The collaboration between the MHTF at Harvard School of Public Health and PLOS has been reflected throughout 3 collections, each highlighting a variety of research articles and commentary that tie in with chosen, topical themes.

The third and final year’s theme, “Integrating Health Care to Meet the Needs of the Mother–Infant Pair”, was chosen with the aim to contribute to a better understanding of how and when to comprehensively integrate maternal and infant health care. This year’s collection has included work on conditions such as HIV, malaria, exposure to environmental risks, and other situations that have a significant impact on both maternal and infant health.
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Category: Collections, General, Maternal Newborn and Child Health | Comments Off on A Final Update to the MHTF & PLOS Maternal Health Collection & Reflecting on our 3 Year Collaboration

How a Tree Helped a Village with Ebola Control

Upon her return from 6 weeks in west Africa working with Partners In Health on the Liberia Ebola response, Farrah Kashfipour reflects on the challenges of responding to an epidemic in a resource-limited setting.

the tree-crop

Image credit: Farrah Kashfipour

The Ebola epidemic continues to ravage west Africa, killing about half of the people who contract the virus.  Those lucky enough to recover face the stigma of having been infected and the subsequent challenge of reintegration into their devastated communities. Many children are left orphans.

In Liberia the number of new cases has fallen in many areas, including cities, while hotspots continue to develop in rural communities. Contrast that with the situation in Sierra Leone where the number of new infections increased rapidly over the past few weeks but may have leveled off more recently.

While in Liberia, I had the privilege of being part of a team- Partners In Health, Last Mile Health and the Ministry of Health county health teams, that hosted 2-day training sessions throughout a rural county in Liberia.  In spite of the difficult conditions, poor roads, lack of cellphone or internet connectivity, and the constant heat and humidity, the trainees showed up every morning, optimistic and enthusiastic as they practiced following the protocols for safely getting into and out of their personal protective equipment.


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Category: Ebola, General, Global Health | 4 Comments

How Will the Ebola Epidemic End?

Upon his return from 6 weeks volunteering with the King’s Sierra Leone Partnership at a number of Ebola isolation facilities in Freetown, Tom Boyles considers the endgame of the Ebola epidemic.

Eneas De Troya, Flickr

Eneas De Troya, Flickr

There are encouraging signs of an overall reduction in confirmed cases of Ebola in west Africa. The graphs below show the epidemic curves for Sierra Leone, Liberia and Guinea as of 14 January 2015 and current data can be found here. Clearly there has been a dramatic reduction in cases in the first 2 countries although in Guinea the epidemic seems to be grumbling on at a lower level. These graphs may signal the beginning of the endgame  but one of the important questions at this point is “How will the Ebola epidemic end?” and no-one is quite sure. Having recently worked on the Ebola response in Sierra Leone my suspicion is that when the end finally approaches we will have a significant ‘last mile problem’; what some others have described as a long and bumpy tail to the epidemic. We will need to ensure that the very last patient either dies or survives without infecting anyone else and this will be easier said than done.

From the beginning it has been vital to avoid losing focus on other interventions such as childhood vaccination programme so that the Ebola crisis is not followed by a measles epidemic, for example. In order to keep healthcare facilities open the model in Freetown has been to put screening services and small isolation units at each one. The over-riding aim is to protect the facility staff from Ebola so they can continue with their everyday work. Patients who screen positive are isolated and tested for Ebola; positive cases are then transferred to dedicated treatment centres and negative cases either discharged home or to the healthcare facility if they need ongoing care. This model has been largely successful in protecting staff at facilities and allowing some normal services to continue.


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Category: Ebola, Global Health | 5 Comments

Introducing the Tripod Statement for Reporting Clinical Prediction Models

tripod

Gary Collins (@GSCollins) of the TRIPOD Steering Group introduces the TRIPOD Statement, which provides guidance for reporting clinical prediction models.

Clinical predictions are routinely made throughout medicine and at all stages in pathways of health care and are the basis for communicating risk or prognosis to patients and therefore inform the clinical decision making process. In the diagnostic setting, predictions are (for example) made as to whether a particular disease is present informing the referral for further testing, initiate treatment or reassure patients that a serious cause for their symptoms is unlikely. In the prognostic setting, predictions can be used for planning lifestyle or therapeutic decisions based on the risk of developing a particular outcome over a time period.

The multifactorial nature of making a clinical prediction makes it difficult for doctors to simultaneously combine and weight multiple risk factors to produce a reliable and accurate estimate of risk. Furthermore, it is unsurprising that numerous studies have shown that doctors are generally poor prognosticators, as they see relatively few cases and are given to cognitive biases.

Increasingly doctors, often based on recommendations in national clinical guidelines, are using multivariable prediction models to support and guide the clinical decision making process.  A clinical prediction model is a mathematical equation that relates multiple predictors for an individual to the probability (or risk) that a particular disease or condition is present or will occur in the future. Well known prediction models include the Framingham Risk score, Apgar Score, Ottawa Ankle Rules, EuroSCORE, Gail Model and the Simplified Acute Physiology Score (SAPS).


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Category: General | 1 Comment

FDA Voucher for Leishmaniasis Treatment: Can Both Patients and Companies Win?

Bernard Pécoul and Manica Balasegaram discuss whether drug companies have taken advantage of flaws in the FDA Priority Review Voucher program.

It sounded like a pure global health success story.

A company develops a drug for one of the most neglected diseases. As a reward, the company receives a voucher from the U.S. Food and Drug Administration (FDA). The company then sells this voucher, allowing the buyer to “fast-track” FDA approval for another product. A “win-win” in its truest sense: Innovation is rewarded while patients suffering from a deadly illness are given access to the fruits of scientific innovation.

Girl in a leishmaniasis clinic in Muzzaffarpur, India.  Image credit: Anita KHEMKA/DNDi

Leishmaniasis clinic in Muzzaffarpur, India. Image credit: Anita KHEMKA/DNDi

There are problems with this story, though.

What if the company did not actually develop the drug in question? What if patient access to the drug is far from secure?

When it was created in 2007, the FDA Priority Review Voucher (PRV) program came with hopes that it could incentivize research and development (R&D) for neglected diseases. Under the initial legislation, a developer that receives FDA approval for a drug to treat one of 16 diseases is eligible for a PRV, which allows the bearer to speed up approval for a drug application of their choice, or sell the voucher for another company to use. This reduces approval time from ten months on average to six – a crucial window for companies to get drugs on the market earlier than their competitors.


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Category: General | 1 Comment

One Million Deaths by Parasites

The end of 2014 saw the release of the Global Burden of Disease Study 2013 (GBD 2013), in which 240 causes of death were studied through a systematic analysis.  Among the important findings were that globally, parasitic diseases caused more than one million deaths in the year 2013.

To no one’s surprise, malaria was by far the major parasitic disease killer in 2013, causing over 850,000 deaths, with many of those deaths in African children under the age of five infected with Plasmodium falciparum.  However, kinetoplastid infections – leishmaniasis, Chagas disease, and African trypanosomiasis – caused the deaths of over 80,000 people, while two intestinal protozoan infections – cryptosporidiosis and amoebiasis – resulted in over 50,000 deaths.

A breakdown of those deaths is shown in Table 1.

Table 1.  Deaths caused by parasitic diseases in 2013

Parasitic Disease Global Deaths in 2013
Malaria 854,600
Leishmaniasis (Kala-azar) 62,500
Cryptosporidiosis 41,900
Amoebiasis 11,300
Chagas disease 10,600
African Trypanosomiasis   6,900
Schistosomiasis   5,500
Ascariasis   4,500
Cystic Echinococcosis   2,200
Cysticercosis      700
Total Deaths from Parasitic Infections 1,000,700


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Category: General | 3 Comments

Is Margaret Chan Really to Blame for the Delayed Ebola Response?

Sara Gorman (@saragorm) discusses recent criticism of WHO Director-General Margaret Chan and whether the focus should be on failures in preparation rather than response.

A January 6 article in the New York Times suggested that WHO Director-General Margaret Chan’s response to the Ebola crisis was woefully inadequate. The article notes that it took 1,000 Ebola deaths in Africa and the spread of the disease to Nigeria for the Chan to proclaim a global emergency. Citing criticisms of Chan’s response to the SARS epidemic as a public health administrator in Hong Kong, the article accuses the current WHO head of conceding too heavily to local governments. The article claims that she relied too heavily on African regional offices to manage the response when her agency should have stepped in more aggressively earlier. But the history of public responses to infectious disease announcements, as well as tragically underfunded global disease surveillance systems, suggest that, while Chan may not have done everything she could, the story is much more complex than it seems.

Image credit: star5112, Flickr

Image credit: star5112, Flickr

Sounding the alarm bell on an infectious disease threat and taking extreme measures such as quarantine and travel bans is not without risk. American history is littered with examples of harmful infectious disease panic. More often than not, American responses to infectious disease threats tend to tap into embedded racial tensions. We only need to look at vicious attacks on African boys at a Bronx, NY school in October, to the sounds of the nickname “Ebola,” to understand that these dynamics are still very much at play. Chan herself certainly knows the harms of acting perhaps too quickly in response to what seems like a global infectious disease crisis. In 2009, Chan was harshly criticized for supposedly “overreacting” to the H1N1 threat.


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Category: Ebola, Policy, Public, WHO | 1 Comment