Sub-Saharan Africa's mothers, newborns, and children: how many lives could be saved with targeted health interventions?

Ingrid K Friberg, Mary V Kinney, Joy E Lawn, Kate J Kerber, M Oladoyin Odubanjo, Anne-Marie Bergh, Neff Walker, Eva Weissman, Mickey Chopra, Robert E Black, Science in Action: Saving the lives of Africa's Mothers, Newborns, and Children working group, Henrik Axelson, Barney Cohen, Hoosen Coovadia, Roseanne Diab, Francis Nkrumah, Kate Kerber, Mary Kinney, Joy Lawn, Delali Akati, Reninald Fraser Amonoo, Francis Ankrah, B A Doudou, Hoosen Coovadia, Anna Coutsoudis, Robin Crewe, Roseanne Diab, Samuel Domngang, Oye Ibidapo-Obe, Ousmane Kane, Robert John Leke, Flex Luti, Joseph Malo, David Mbah, Paul E Mugambi, Franklin Muyonjo, Paul Nampala, Souleymane Niang, Francis Nkrumah, Oladoyin Odubanjo, Doh Anderson Sama, Delali Akati, Lauren Augustine, Anne-Marie Bergh, Robert Black, Mickey Chopra, Barney Cohen, Hoosen Coovadia, Anna Coutsoudis, Robin Crewe, Roseanne Diab, Ijeoma Emenanjo, Glenda Gray, Patrick Kelley, Kate Kerber, Mary Kinney, Joy Lawn, Shabir Madhi, Xola Mati, Charles Mwansambo, Phakamile Mngadi, Jack Moodley, Franklin Muyonjo, Francis Nkrumah, Oladoyin Odubanjo, Mark Patrick, Takalani Rambau, Helen Rees, Aranxta Maria Roca-Feltrer, Nthabiseng Taole, Sithembiso Velaphi, Jennifer Bryce, Flavia Bustreo, Andres de Francisco, Natalie Gamache, Elizeus Kahigwa, Linda Waite, Eileen Crimmins, Kuate Defo Barthelemy, Barbara Entwisle, Barbara Torrey, Seth Owusu-Agyei, David Schellenberg, Joanna Schellenberg, S Y Aboubacry, Peter Donaldson, Chales Hirschman, Wolfgang Lutz, Duncan Thomas, Maxine Weinstein, Ingrid K Friberg, Mary V Kinney, Joy E Lawn, Kate J Kerber, M Oladoyin Odubanjo, Anne-Marie Bergh, Neff Walker, Eva Weissman, Mickey Chopra, Robert E Black, Science in Action: Saving the lives of Africa's Mothers, Newborns, and Children working group, Henrik Axelson, Barney Cohen, Hoosen Coovadia, Roseanne Diab, Francis Nkrumah, Kate Kerber, Mary Kinney, Joy Lawn, Delali Akati, Reninald Fraser Amonoo, Francis Ankrah, B A Doudou, Hoosen Coovadia, Anna Coutsoudis, Robin Crewe, Roseanne Diab, Samuel Domngang, Oye Ibidapo-Obe, Ousmane Kane, Robert John Leke, Flex Luti, Joseph Malo, David Mbah, Paul E Mugambi, Franklin Muyonjo, Paul Nampala, Souleymane Niang, Francis Nkrumah, Oladoyin Odubanjo, Doh Anderson Sama, Delali Akati, Lauren Augustine, Anne-Marie Bergh, Robert Black, Mickey Chopra, Barney Cohen, Hoosen Coovadia, Anna Coutsoudis, Robin Crewe, Roseanne Diab, Ijeoma Emenanjo, Glenda Gray, Patrick Kelley, Kate Kerber, Mary Kinney, Joy Lawn, Shabir Madhi, Xola Mati, Charles Mwansambo, Phakamile Mngadi, Jack Moodley, Franklin Muyonjo, Francis Nkrumah, Oladoyin Odubanjo, Mark Patrick, Takalani Rambau, Helen Rees, Aranxta Maria Roca-Feltrer, Nthabiseng Taole, Sithembiso Velaphi, Jennifer Bryce, Flavia Bustreo, Andres de Francisco, Natalie Gamache, Elizeus Kahigwa, Linda Waite, Eileen Crimmins, Kuate Defo Barthelemy, Barbara Entwisle, Barbara Torrey, Seth Owusu-Agyei, David Schellenberg, Joanna Schellenberg, S Y Aboubacry, Peter Donaldson, Chales Hirschman, Wolfgang Lutz, Duncan Thomas, Maxine Weinstein

Abstract

As part of the series on maternal, neonatal, and child health in sub-Saharan Africa, Robert Black and colleagues estimated mortality reduction for 42 countries and conclude that the use of local data is needed to prioritize the most effective mix of interventions.

Conflict of interest statement

The authors have declared no conflicts of interest.

Figures

Figure 1. Achievable coverage increases of 20%…
Figure 1. Achievable coverage increases of 20% for outreach/community interventions in Uganda.
The figure shows current coverage for some key outreach packages in Uganda with arrows indicating the modeled increase of 20% points within two years. Data from Uganda Demographic Heath Survey, 2006. Some coverages estimated using standard LiST formulas .
Figure 2. Achievable coverage increases by addressing…
Figure 2. Achievable coverage increases by addressing the quality gap for facility births in Uganda.
The figure shows current coverage for some key facility-based MNCH interventions in Uganda with arrows indicating the modeled increase to the current coverage of institutional births within two years. Data from Uganda Demographic Heath Survey, 2006. Some coverages estimated using standard LiST formulas .

References

    1. Kinney MV, Lawn JE, Kerber JE, editors. Science in Action: Savings the lives of Africa's mothers, newborns and children. 2009.
    1. Kinney MV, Kerber KJ, Black R, Cohen B, Okong P. Sub-Saharan Africa's mothers, newborns and children: Where and why do they die? PLoS Med. 2010;7:e294. doi: .
    1. [No authors listed] G8 Leaders Declaration: Responsible Leadership for a Sustainable Future. 2009.
    1. Greco G, Powell-Jackson T, Borghi J, Mills A. Countdown to 2015: assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006. Lancet. 2008;371:1268–1275.
    1. Jamison D, Shahid-Salles S, Jamison J, Lawn JE, Zupan J. Incorporating Deaths near the Time of Birth into Estimates of the Global Burden of Disease. The World Bank and the National Institutes of Health. 2006.
    1. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003;362:65–71.
    1. Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, et al. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet. 2005;365:977–988.
    1. Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol. 2006;35:706–718.
    1. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368:1284–1299.
    1. Graham WJ, Cairns J, Bhattacharya S, Bullough CHW, Quayyum Z. Disease control priotirites in developing countries. New York: Oxford University Press; 2006. Maternal and perinatal conditions. pp. 499–530.
    1. Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, et al. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007;370:1358–1369.
    1. Bryce J, Daelmans B, Dwivedi A, Fauveau V, Lawn JE, et al. Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. Lancet. 2008;371:1247–1258.
    1. UNICEF. State of the World's Children 2010. 2009.
    1. Hofmeyr GJ, Haws RA, Bergstrom S, Lee AC, Okong P, et al. Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet. 2009;107(Suppl 1):S21–S25.
    1. Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done? Int J Gynaecol Obstet. 2009;107(Suppl 1):S19.
    1. World Health Organization. Everybody's business: Strengthening health systems to improve health outcomes: WHO's framework for action. 2010.
    1. Sachs J. Macroeconomics and health: Investing in health for economic development. 2001. Report of hte COmmission of Macroeconomics and Health.
    1. World Health Organization. World Health Report 2000: Health systems: Improving performance. 2000.
    1. Rudan I, Kapiriri L, Tomlinson M, Balliet M, Cohen B. Evidence-based priority setting for health care and research: Tools to support policy in maternal, neonatal, and child health. PLoS Med. 2010 In press.
    1. Rohde J, Cousens S, Chopra M, Tangcharoensathien V, Black R, et al. 30 years after Alma-Ata: has primary health care worked in countries? Lancet. 2008;372:950–961.
    1. Hill K, Thomas K, AbouZahr C, Walker N, Say L, et al. Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. Lancet. 2007;370:1311–1319.
    1. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066–1074.
    1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365:891–900.
    1. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361:2226–2234.
    1. DeCormier-Plosky W, Friberg I, Winfrey B, Stover J. Lives Saved Tool: A Computer Program for Making Childand Maternal Survival Projections. 2009.
    1. Bryce J, Black RE, Walker N, Bhutta ZA, Lawn JE, et al. Can the world afford to save the lives of 6 million children each year? Lancet. 2005;365:2193–2200.
    1. Darmstadt GL, Walker N, Lawn JE, Bhutta ZA, Haws RA, et al. Saving newborn lives in Asia and Africa: cost and impact of phased scale-up of interventions within the continuum of care. Health Policy Plan. 2008;23:101–117.
    1. Bhutta ZA, Ali S, Cousens S, Ali TM, Haider BA, et al. Alma-Ata: Rebirth and Revision 6 Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make? Lancet. 2008;372:972–989.
    1. Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371:417–440.
    1. Lawn JE, Kinney M, Lee AC, Chopra M, Donnay F, et al. Reducing intrapartum-related deaths and disability: can the health system deliver? Int J Gynaecol Obstet. 2009;107(Suppl 1):S123–2.
    1. Lawn JE, Kerber K, Laryea C, Bateman M. Newborn survival in low resource settings - are we delivering? Br J Obstetd Gynecol. 2009 In press.
    1. Chopra M, Daviaud E, Pattinson R, Fonn S, Lawn JE. Saving the lives of South Africa's mothers, babies, and children: can the health system deliver? Lancet. 2009;374:835–846.
    1. Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet. 2006;368:1189–1200.
    1. World Health Organization, UNICEF. WHO/UNICEF Joint Statement: Home visits for the newborn child: a strategy to improve survival. 2009.
    1. Bryce J, Victora CG, Habicht JP, Black RE, Scherpbier RW. Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness. Health Policy Plan. 2005;20(Suppl 1):i5–i17.
    1. Stover J, Johnson P, Zaba B, Zwahlen M, Dabis F, et al. The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds. Sex Transm Infect. 2008;84(Suppl 1):i24–i30.
    1. Stover J, Walker N, Grassly NC, Marston M. Projecting the demographic impact of AIDS and the number of people in need of treatment: updates to the Spectrum projection package. Sex Transm Infect. 2006;82(Suppl 3):iii45–iii50.
    1. Walker N, Fischer-Walker C, Bryce J, Bahl R, Cousens S. Standards for CHERG reviews of intervention effects on child survival. Int J Epidemiol. 2010;39(Suppl 1):i21–i31.
    1. Boschi-Pinto C, Young M, Black RE. The Child Health Epidemiology Reference Group reviews of the effectiveness of interventions to reduce maternal, neonatal and child mortality. Int J Epidemiol. 2010;39(Suppl 1):i3–i6.
    1. Stover J, McKinnon R, Winfrey B. Spectrum: a model platform for linking maternal and child survival interventions with AIDS, family planning and demographic projections. Int J Epidemiol. 2010;39(Suppl 1):i7–10.
    1. Glasier A, Gulmezoglu AM, Schmid GP, Moreno CG, Van Look PF. Sexual and reproductive health: a matter of life and death. Lancet. 2006;368:1595–1607.
    1. Borghi J, Ensor T, Somanathan A, Lissner C, Mills A. Mobilising financial resources for maternal health. Lancet. 2006;368:1457–1465.
    1. Wilkinson D, Sach ME, Abdool Karim SS. Examination of attendance patterns before and after introduction of South Africa's policy of free health care for children aged under 6 years and pregnant women. BMJ. 1997;314:940–941.
    1. Pattinson R, Kerber K, Waiswa P, Day LT, Mussell F, et al. Perinatal mortality audit: counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries. Int J Gynaecol Obstet. 2009;107(Suppl 1):S113–2.
    1. Wall SN, Lee AC, Niermeyer S, English M, Keenan WJ, et al. Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up? Int J Gynaecol Obstet. 2009;107(Suppl 1):S47–4.
    1. Bennett S, Ssengooba F. Closing the gaps: from science to action in maternal, newborn and child health in Africa. PLoS Med. 2010 In press.
    1. Whitworth J, Sewankambo N, Somanathan A, Snewin V. Improving implementation: Building research capacity in maternal, neonatal, and child health in Africa. PLoS Med. 2010 In press.

Source: PubMed

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