An assessment of iron status was performed on 112 pregnant women at delivery (and on their newbor... more An assessment of iron status was performed on 112 pregnant women at delivery (and on their newborns in 70 cases) and on 114 menstruating women in N'Djamena, Chad. Anaemia (according to the haematocrit value) was observed in 25.0% of pregnant women and in 23.7% of menstruating women. Iron deficiency was defined as the combination of a low serum ferritin level (less than or equal to 12 micrograms/l), a low transferrin saturation (less than 16%) and/or a high erythrocyte protoporphyrin (greater than 3 micrograms/g Hb). A moderate increase in the serum ferritin level (between 13 and 50 micrograms/l) associated with a low transferrin saturation and/or a high erythrocyte protoporphyrin concentration indicated iron-deficiency in an inflammatory context. Iron deficiency was present in 66.9% of pregnant women and in 30.7% of menstruating women. Anaemia was associated with iron deficiency in 78.6% of cases in anaemic pregnant women and in 44.4% of cases in anaemic menstruating women. A co...
International Journal of Gynecology & Obstetrics, 2006
Introduction: As countries are designing and implementing strategies to address maternal and newb... more Introduction: As countries are designing and implementing strategies to address maternal and newborn mortality and morbidity (Millennium Development Goals 5 and 4), it appears that a large number of evidence-based obstetric practices are not used in many settings, and this is a major obstacle to the improvement of quality obstetric care. Objectives: To remind readers of the existing, relatively easy-toimplement, evidence-based interventions that are currently not being universally applied in obstetric care and, second, to foster research to expand the evidence base further for obstetric care practices and devices, especially those that could be used in resource-poor settings. Methods: We review possible reasons why changes into practices are difficult to obtain, and we list the key evidence-based interventions known to effectively deal with the main obstetric complications, with supporting references and sources of documentation. We also list some promising interventions that require more research before being recommended. Conclusion: Professionals and health services managers have a crucial role in producing the best quality obstetric and neonatal care through implementing the listed evidence-based interventions and make them accessible to all pregnant women and their newborns without delay, even in poor settings. Reasons for which progress is slow should be addressed. One of these reasons being the lack of access
1 1 International Stillbirth Alliance, USA, and Mater Research Institute, University of Queenslan... more 1 1 International Stillbirth Alliance, USA, and Mater Research Institute, University of Queensland, Australia; 2 The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH) and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK, and Saving Newborn Lives, Save the Children, USA; 3 Saving Newborn Lives, Save the Children, South Africa; 4 Every Woman Every Child, USA; 5 UN Population Fund (UNFPA), Switzerland
Un des axes d’amelioration de la qualite des soins pour l’elimination de la mortalite et morbidit... more Un des axes d’amelioration de la qualite des soins pour l’elimination de la mortalite et morbidite maternelle et neonatale evitable est l’amelioration de la formation des professionnels de sante competents dans ce domaine, les sages-femmes en particulier. L’accreditation est un mecanisme de renforcement de la qualite d’un programme d’enseignement ou d’une institution, utilisant une analyse de situation basee sur des criteres preetablis pour une prise de decision. Cet article decrit les efforts deployes dans trois pays francophones africains, la Cote d’Ivoire, le Mali et le Tchad, dans la mise en place d’un tel mecanisme pour leurs ecoles de sages-femmes ainsi que les etapes necessaires pour y parvenir. La volonte politique de soutien et de regulation du secteur, le passage au systeme Licence-Master-Doctorat (LMD), le poids du secteur prive et l’independance d’une Commission nationale d’accreditation sont des composantes essentielles.
This first paper of The Lancet Ending Preventable Stillbirth Series reviews progress in critical ... more This first paper of The Lancet Ending Preventable Stillbirth Series reviews progress in critical areas, identified in the 2011 call to action for stillbirth prevention, to inform the integrated post 2015 maternal and newborn health agenda. Global attention to babies who die in stillbirth is rapidly expanding, from integration within the new Global Strategy for Women's, Children's, and Adolescent's Health, to country policies inspired by the Every Newborn Action Plan. Supportive new guidance and metrics including stillbirth as a core health indicator and measure of quality of care are emerging. Ensuring integration of action for prenatal health the biological foundation of life long health within the continuum of care for maternal and newborn health is becoming a key priority. Still, specific actions for stillbirths remain needed for advocacy, policy formulation, monitoring and research, including remedying the dearth of data on effective coverage of proven interventions for prenatal survival. Stronger leadership is needed globally and in countries, and institutions with a mandate to lead global efforts for mothers and their babies must assert their leadership to reduce stillbirths by promoting healthy and safe pregnancies.
Additional file 1: Table S1. Health occupations classed as part of the SRMNAH workforce. Table S2... more Additional file 1: Table S1. Health occupations classed as part of the SRMNAH workforce. Table S2. List of WHO Member States by World Bank income group, 2020. Table S3. List of WHO Member States by WHO region, 2020.
RESUMO No presente trabalho é comprovada a presença de Tagetes osteni Hicken para a flora sul-bra... more RESUMO No presente trabalho é comprovada a presença de Tagetes osteni Hicken para a flora sul-brasileira. A espécie é descrita, ilustrada e separada de Tagetes minuta, mediante chave dicotômica.
The designations employed and the presentation of the material in this publication do not imply t... more The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication.
Résumé: L'objectif de cette étude est de préciser l'épidémiologie descriptive et d'... more Résumé: L'objectif de cette étude est de préciser l'épidémiologie descriptive et d'évaluer le pronostic de la grossesse extra-utérine (GEU) au Sénégal à partir d'un recensement de tous les cas diagnostiqués et traités entre le 1er janvier et le 31 décembre 1996. Pour chaque ...
The third global State of the World’s Midwifery report (SoWMy 2021) provides an updated evidence ... more The third global State of the World’s Midwifery report (SoWMy 2021) provides an updated evidence base on the sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce. For the first time, SoWMy includes high-income countries (HICs) as well as low- and middle-income countries. This paper describes the similarities and differences between regions and income groups, and discusses the policy implications of these variations. SoWMy 2021 estimates a global shortage of 900,000 midwives, which is particularly acute in low-income countries (LICs) and in Africa. The shortage is projected to improve only slightly by 2030 unless additional investments are made. The evidence suggests that these investments would yield important returns, including: more positive birth experiences, improved health outcomes, and inclusive and equitable economic growth. Most HICs have sufficient SRMNAH workers to meet the need for essential interventions, and their education and regulatory env...
There were an estimated 2.7 million third trimester stillbirths in 2015 (uncertainty range: 2.5-3... more There were an estimated 2.7 million third trimester stillbirths in 2015 (uncertainty range: 2.5-3.0 million). Stillbirths have reduced more slowly than maternal or child mortality, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan targets ≤12 stillbirths per 1000 births in every country by 2030. Ninety-two mainly high-income countries have already met this target, although with marked disparities. At least 67 countries, particularly in Africa and conflict affected areas will have to double current progress. Most (98%) stillbirths are in low and middle-income countries. Improved care at birth is essential to prevent 1.3 million intrapartum stillbirths, end preventable maternal and neonatal deaths, and also improve child development. Estimates for stillbirth causation are impeded by multiple classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7.4%. Many conditions associated with stillbirths are potentially modifiable, and often co-exist such as maternal infections (population attributable fraction (PAF): malaria 8.2%, syphilis 7.7%), non-communicable diseases, nutrition and lifestyle factors (PAF around 10%) and age>35yrs (PAF: 6.7%). Common causal pathways are through impaired placental function, either leading to fetal growth restriction and/or preterm labour, or secondary to prolonged pregnancy (PAF: 14.2%). Two-thirds of newborns have their birth registered. However, less than 5% of neonatal deaths have death registration, and even fewer stillbirths. Recording and registering all facility births, stillbirths, neonatal, and maternal deaths would substantially increase data availability. Improved data alone will not save lives, but provide a tool for targeting interventions to reach >7500 women every day all over the world who experience the reality of stillbirth. Words 266 CONFIDENTIAL-DO NOT PASS ON OR CITE 3 Key messages What is happening to stillbirth rates? At the end of the Millennium Development Goal (MDG) era there are 2.7 million (uncertainty range: 2.5-3.0 million) third trimester stillbirths annually. Stillbirth rates have declined more slowly since 2000 (Average Annual Rate of Reduction (ARR), 1.8%), than either maternal (ARR=3.4%) or post-neonatal child mortality (ARR=4.5%) which had MDG targets and consequently received more global and country level attention. Better data are essential to accelerate progress towards the target of ≤12 stillbirths per 1000 births in every country by 2030 as outlined in the Every Newborn Action Plan (ENAP), linked to United Nations Secretary General's Every Woman Every Child. Where to focus? 10 countries account for two-thirds of stillbirths and most neonatal (60%) and maternal (58%) deaths estimated in 2015. Sixty-seven countries need to at least double current progress in reducing stillbirths, many of these in Africa. The highest stillbirth rates (SBR) are in conflict and emergency areas. Over 60% of stillbirths are in rural areas, affecting the poorest families. However, even in the 92 countries with a SBR less than 12 per 1000 marked disparities remain between and within countries. When and where in the health system to focus? Each year there are an estimated 1.3 million intrapartum stillbirths (deaths during labour), despite two-thirds of births worldwide now being in health facilities. High coverage of good quality care during labour and birth is key, and would also reduce maternal and neonatal deaths, prevent disability and improve child development, giving a high return on investment. Improved quality antenatal care is also important to maximise maternal and fetal well-being, to detect and manage underlying conditions, and to promote healthy behaviours and birth planning. Which conditions to focus on? There is a myth that most stillbirths are inevitable due to non-preventable congenital abnormalities, yet for countries with reliable data congenital abnormalities account for a median of only 7.4% of stillbirths. Conditions where population attributable fraction (PAF) could be estimated at global level include: maternal age>35yrs (PAF 6.7%), maternal infections (PAF malaria 8.2%, syphilis 7.7%), non-communicable diseases, nutrition and lifestyle factors, many of which co-exist (PAF each around 10%) and prolonged pregnancy (PAF 14.2%). Stillbirths commonly occur via fetal growth restriction and/or preterm labour. Which data are required for action? Two-thirds of the world's newborns have birth certificate, but death registration coverage is even lower at <5% of neonatal deaths and even fewer stillbirths. Recording and registering all facility births, stillbirths, neonatal deaths, and maternal deaths would substantially increase data availability. Reliable measurement of stillbirths outside facilities using household surveys remains problematic, yet no research is addressing this issue. Little has been invested in improving coverage data for maternal and newborn health interventions including those specific to stillbirths. The ENAP measurement improvement roadmap, includes coverage indicator validation, and development of tools such as a minimum perinatal dataset and perinatal audit, offering opportunities to improve data availability and use.
An assessment of iron status was performed on 112 pregnant women at delivery (and on their newbor... more An assessment of iron status was performed on 112 pregnant women at delivery (and on their newborns in 70 cases) and on 114 menstruating women in N'Djamena, Chad. Anaemia (according to the haematocrit value) was observed in 25.0% of pregnant women and in 23.7% of menstruating women. Iron deficiency was defined as the combination of a low serum ferritin level (less than or equal to 12 micrograms/l), a low transferrin saturation (less than 16%) and/or a high erythrocyte protoporphyrin (greater than 3 micrograms/g Hb). A moderate increase in the serum ferritin level (between 13 and 50 micrograms/l) associated with a low transferrin saturation and/or a high erythrocyte protoporphyrin concentration indicated iron-deficiency in an inflammatory context. Iron deficiency was present in 66.9% of pregnant women and in 30.7% of menstruating women. Anaemia was associated with iron deficiency in 78.6% of cases in anaemic pregnant women and in 44.4% of cases in anaemic menstruating women. A co...
International Journal of Gynecology & Obstetrics, 2006
Introduction: As countries are designing and implementing strategies to address maternal and newb... more Introduction: As countries are designing and implementing strategies to address maternal and newborn mortality and morbidity (Millennium Development Goals 5 and 4), it appears that a large number of evidence-based obstetric practices are not used in many settings, and this is a major obstacle to the improvement of quality obstetric care. Objectives: To remind readers of the existing, relatively easy-toimplement, evidence-based interventions that are currently not being universally applied in obstetric care and, second, to foster research to expand the evidence base further for obstetric care practices and devices, especially those that could be used in resource-poor settings. Methods: We review possible reasons why changes into practices are difficult to obtain, and we list the key evidence-based interventions known to effectively deal with the main obstetric complications, with supporting references and sources of documentation. We also list some promising interventions that require more research before being recommended. Conclusion: Professionals and health services managers have a crucial role in producing the best quality obstetric and neonatal care through implementing the listed evidence-based interventions and make them accessible to all pregnant women and their newborns without delay, even in poor settings. Reasons for which progress is slow should be addressed. One of these reasons being the lack of access
1 1 International Stillbirth Alliance, USA, and Mater Research Institute, University of Queenslan... more 1 1 International Stillbirth Alliance, USA, and Mater Research Institute, University of Queensland, Australia; 2 The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH) and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK, and Saving Newborn Lives, Save the Children, USA; 3 Saving Newborn Lives, Save the Children, South Africa; 4 Every Woman Every Child, USA; 5 UN Population Fund (UNFPA), Switzerland
Un des axes d’amelioration de la qualite des soins pour l’elimination de la mortalite et morbidit... more Un des axes d’amelioration de la qualite des soins pour l’elimination de la mortalite et morbidite maternelle et neonatale evitable est l’amelioration de la formation des professionnels de sante competents dans ce domaine, les sages-femmes en particulier. L’accreditation est un mecanisme de renforcement de la qualite d’un programme d’enseignement ou d’une institution, utilisant une analyse de situation basee sur des criteres preetablis pour une prise de decision. Cet article decrit les efforts deployes dans trois pays francophones africains, la Cote d’Ivoire, le Mali et le Tchad, dans la mise en place d’un tel mecanisme pour leurs ecoles de sages-femmes ainsi que les etapes necessaires pour y parvenir. La volonte politique de soutien et de regulation du secteur, le passage au systeme Licence-Master-Doctorat (LMD), le poids du secteur prive et l’independance d’une Commission nationale d’accreditation sont des composantes essentielles.
This first paper of The Lancet Ending Preventable Stillbirth Series reviews progress in critical ... more This first paper of The Lancet Ending Preventable Stillbirth Series reviews progress in critical areas, identified in the 2011 call to action for stillbirth prevention, to inform the integrated post 2015 maternal and newborn health agenda. Global attention to babies who die in stillbirth is rapidly expanding, from integration within the new Global Strategy for Women's, Children's, and Adolescent's Health, to country policies inspired by the Every Newborn Action Plan. Supportive new guidance and metrics including stillbirth as a core health indicator and measure of quality of care are emerging. Ensuring integration of action for prenatal health the biological foundation of life long health within the continuum of care for maternal and newborn health is becoming a key priority. Still, specific actions for stillbirths remain needed for advocacy, policy formulation, monitoring and research, including remedying the dearth of data on effective coverage of proven interventions for prenatal survival. Stronger leadership is needed globally and in countries, and institutions with a mandate to lead global efforts for mothers and their babies must assert their leadership to reduce stillbirths by promoting healthy and safe pregnancies.
Additional file 1: Table S1. Health occupations classed as part of the SRMNAH workforce. Table S2... more Additional file 1: Table S1. Health occupations classed as part of the SRMNAH workforce. Table S2. List of WHO Member States by World Bank income group, 2020. Table S3. List of WHO Member States by WHO region, 2020.
RESUMO No presente trabalho é comprovada a presença de Tagetes osteni Hicken para a flora sul-bra... more RESUMO No presente trabalho é comprovada a presença de Tagetes osteni Hicken para a flora sul-brasileira. A espécie é descrita, ilustrada e separada de Tagetes minuta, mediante chave dicotômica.
The designations employed and the presentation of the material in this publication do not imply t... more The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication.
Résumé: L'objectif de cette étude est de préciser l'épidémiologie descriptive et d'... more Résumé: L'objectif de cette étude est de préciser l'épidémiologie descriptive et d'évaluer le pronostic de la grossesse extra-utérine (GEU) au Sénégal à partir d'un recensement de tous les cas diagnostiqués et traités entre le 1er janvier et le 31 décembre 1996. Pour chaque ...
The third global State of the World’s Midwifery report (SoWMy 2021) provides an updated evidence ... more The third global State of the World’s Midwifery report (SoWMy 2021) provides an updated evidence base on the sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce. For the first time, SoWMy includes high-income countries (HICs) as well as low- and middle-income countries. This paper describes the similarities and differences between regions and income groups, and discusses the policy implications of these variations. SoWMy 2021 estimates a global shortage of 900,000 midwives, which is particularly acute in low-income countries (LICs) and in Africa. The shortage is projected to improve only slightly by 2030 unless additional investments are made. The evidence suggests that these investments would yield important returns, including: more positive birth experiences, improved health outcomes, and inclusive and equitable economic growth. Most HICs have sufficient SRMNAH workers to meet the need for essential interventions, and their education and regulatory env...
There were an estimated 2.7 million third trimester stillbirths in 2015 (uncertainty range: 2.5-3... more There were an estimated 2.7 million third trimester stillbirths in 2015 (uncertainty range: 2.5-3.0 million). Stillbirths have reduced more slowly than maternal or child mortality, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan targets ≤12 stillbirths per 1000 births in every country by 2030. Ninety-two mainly high-income countries have already met this target, although with marked disparities. At least 67 countries, particularly in Africa and conflict affected areas will have to double current progress. Most (98%) stillbirths are in low and middle-income countries. Improved care at birth is essential to prevent 1.3 million intrapartum stillbirths, end preventable maternal and neonatal deaths, and also improve child development. Estimates for stillbirth causation are impeded by multiple classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7.4%. Many conditions associated with stillbirths are potentially modifiable, and often co-exist such as maternal infections (population attributable fraction (PAF): malaria 8.2%, syphilis 7.7%), non-communicable diseases, nutrition and lifestyle factors (PAF around 10%) and age>35yrs (PAF: 6.7%). Common causal pathways are through impaired placental function, either leading to fetal growth restriction and/or preterm labour, or secondary to prolonged pregnancy (PAF: 14.2%). Two-thirds of newborns have their birth registered. However, less than 5% of neonatal deaths have death registration, and even fewer stillbirths. Recording and registering all facility births, stillbirths, neonatal, and maternal deaths would substantially increase data availability. Improved data alone will not save lives, but provide a tool for targeting interventions to reach >7500 women every day all over the world who experience the reality of stillbirth. Words 266 CONFIDENTIAL-DO NOT PASS ON OR CITE 3 Key messages What is happening to stillbirth rates? At the end of the Millennium Development Goal (MDG) era there are 2.7 million (uncertainty range: 2.5-3.0 million) third trimester stillbirths annually. Stillbirth rates have declined more slowly since 2000 (Average Annual Rate of Reduction (ARR), 1.8%), than either maternal (ARR=3.4%) or post-neonatal child mortality (ARR=4.5%) which had MDG targets and consequently received more global and country level attention. Better data are essential to accelerate progress towards the target of ≤12 stillbirths per 1000 births in every country by 2030 as outlined in the Every Newborn Action Plan (ENAP), linked to United Nations Secretary General's Every Woman Every Child. Where to focus? 10 countries account for two-thirds of stillbirths and most neonatal (60%) and maternal (58%) deaths estimated in 2015. Sixty-seven countries need to at least double current progress in reducing stillbirths, many of these in Africa. The highest stillbirth rates (SBR) are in conflict and emergency areas. Over 60% of stillbirths are in rural areas, affecting the poorest families. However, even in the 92 countries with a SBR less than 12 per 1000 marked disparities remain between and within countries. When and where in the health system to focus? Each year there are an estimated 1.3 million intrapartum stillbirths (deaths during labour), despite two-thirds of births worldwide now being in health facilities. High coverage of good quality care during labour and birth is key, and would also reduce maternal and neonatal deaths, prevent disability and improve child development, giving a high return on investment. Improved quality antenatal care is also important to maximise maternal and fetal well-being, to detect and manage underlying conditions, and to promote healthy behaviours and birth planning. Which conditions to focus on? There is a myth that most stillbirths are inevitable due to non-preventable congenital abnormalities, yet for countries with reliable data congenital abnormalities account for a median of only 7.4% of stillbirths. Conditions where population attributable fraction (PAF) could be estimated at global level include: maternal age>35yrs (PAF 6.7%), maternal infections (PAF malaria 8.2%, syphilis 7.7%), non-communicable diseases, nutrition and lifestyle factors, many of which co-exist (PAF each around 10%) and prolonged pregnancy (PAF 14.2%). Stillbirths commonly occur via fetal growth restriction and/or preterm labour. Which data are required for action? Two-thirds of the world's newborns have birth certificate, but death registration coverage is even lower at <5% of neonatal deaths and even fewer stillbirths. Recording and registering all facility births, stillbirths, neonatal deaths, and maternal deaths would substantially increase data availability. Reliable measurement of stillbirths outside facilities using household surveys remains problematic, yet no research is addressing this issue. Little has been invested in improving coverage data for maternal and newborn health interventions including those specific to stillbirths. The ENAP measurement improvement roadmap, includes coverage indicator validation, and development of tools such as a minimum perinatal dataset and perinatal audit, offering opportunities to improve data availability and use.
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