Networks of Care: An Approach to Improving Maternal and Newborn Health.

The Networks of Care approach has the potential to harmonize existing strategies and optimize health systems functions for maternal and newborn health, thereby strengthening the quality of care and ultimately improving outcomes.

Level of confidence in and endorsement of the health system among internet users in 12 low-income and middle-income countries.

Introduction: People's confidence in and endorsement of the health system are key measures of system performance, yet are undermeasured in low-income and middle-income countries (LMICs). We explored the prevalence and predictors of these measures in 12 countries.

Methods: We conducted an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal and South Africa collecting demographics, ratings of quality, and confidence in and endorsement of the health system.

Preparing to introduce new maternal immunizations in low- and lower-middle-income countries: A report from the Bill & Melinda Gates Foundation convening "Allies in Maternal and Newborn Care"; May 3-4, 2018.

New strategies will be critical to reduce infant mortality and severe morbidity - there are still 5.2 million newborn deaths and stillbirths each year. The decline in newborn mortality has not kept pace with the reduction in under-five deaths and is slowest in low- and lower-middle-income countries (LMICs).

Postpartum hemorrhage care bundles to improve adherence to guidelines: A WHO technical consultation.

Objective: To systematically develop evidence-based bundles for care of postpartum hemorrhage (PPH).

Methods: An international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for PPH taken from the WHO's 2012 and 2017 PPH recommendations and based on the validated "GRADE Evidence-to-Decision" framework. Twenty-three global maternal-health experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences.

The rate and perioperative mortality of caesarean section in Sierra Leone.

Introduction: Sierra Leone has the world's highest maternal mortality, partly due to low access to caesarean section. Limited data are available to guide improvement. In this study, we aimed to analyse the rate and mortality of caesarean sections in the country.

Expectations of healthcare quality: A cross-sectional study of internet users in 12 low- and middle-income countries.

Background: High satisfaction with healthcare is common in low- and middle-income countries (LMICs), despite widespread quality deficits. This may be due to low expectations because people lack knowledge about what constitutes good quality or are resigned about the quality of available services.

Methods And Findings: We fielded an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal, and South Africa in 2017 (N = 17,996).

A multifaceted intervention to improve syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cluster randomised controlled trial.

Background: Despite international recommendations, coverage of syphilis testing in pregnant women and treatment of those found seropositive remains limited in sub-Saharan Africa. We assessed whether combining the provision of supplies with a behavioural intervention was more effective than providing supplies only, to improve syphilis screening and treatment during antenatal care.

Methods: In this 18-month, cluster randomised controlled trial, we randomly assigned (1:1) 26 urban antenatal care clinics in Kinshasa, Democratic Republic of the Congo, and Lusaka, Zambia, to receive a behavioural intervention (opinion leader selection, academic detailing visits, reminders, audits and feedback, and supportive supervision) plus supplies for syphilis testing and treatment (intervention group) or to receive supplies only (control group).

Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries.

Background: Escalation in the global rates of labour interventions, particularly cesarean section and oxytocin augmentation, has renewed interest in a better understanding of natural labour progression. Methodological advancements in statistical and computational techniques addressing the limitations of pioneer studies have led to novel findings and triggered a re-evaluation of current labour practices. As part of the World Health Organization's Better Outcomes in Labour Difficulty (BOLD) project, which aimed to develop a new labour monitoring-to-action tool, we examined the patterns of labour progression as depicted by cervical dilatation over time in a cohort of women in Nigeria and Uganda who gave birth vaginally following a spontaneous labour onset.

An innovative approach to in-service training of maternal health staff in Cambodian hospitals.

Objective: To demonstrate the feasibility of implementing evidence-based continuing medical education (CME) to improve key skills among maternity staff in Cambodia.

Methods: A skills-based CME program was implemented in 33 Cambodian hospitals. Each clinical skills practice (CSP) module consisted of a 1-day practice session, focusing on three maternal and newborn interventions, followed by support visits to participating hospitals.

Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality.

This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care.

Socio-economic improvements and health system strengthening of maternity care are contributing to maternal mortality reduction in Cambodia.

Maternal mortality has been falling significantly in Cambodia since 2005 though it had been stagnant for at least 15 years before that. This paper analyzes the evolution of some major societal and health system factors based on recent national and international reports. The maternal mortality ratio fell from 472 per 100,000 live births in 2000-2005 to 206 in 2006-2010.

Improving African health research capacity.

The issue of strengthening local research capacity in Africa is again high on the health and development agenda. The latest initiative comes from the Wellcome Trust. But when it comes to capacity development, one of the chief obstacles that health sectors in the region must confront is the migration of health professionals to countries that offer more lucrative opportunities, like those in western Europe.

Systematic review of interventions to prevent the spread of sexually transmitted infections, including HIV, among young people in Europe.

Aim: To examine the effectiveness of interventions seeking to prevent the spread of sexually transmitted infections (STIs), including HIV, among young people in the European Union.

Methods: For this systematic review, we examined interventions that aimed at STI risk reduction and health promotion conducted in schools, clinics, and in the community for reported effectiveness (in changing sexual behavior and/or knowledge) between 1995 and 2005. We also reviewed study design and intervention methodology to discover how these factors affected the results, and we compiled a list of characteristics associated with successful and unsuccessful programs.

Does antenatal care facilitate utilization of emergency obstetric care? A case-referent study of near-miss morbidity in Bolivia.

Objective: To determine whether lack of routine antenatal care (ANC) is associated with near-miss morbidity upon arrival at hospital.

Design: Case-referent study.

Setting: Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government subsidized program.

Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia.

Background: Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss) identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia.

Women's groups and professional organizations in advocacy for sexual and reproductive health and rights.

After the International Conference on Population and Development (ICPD) in 1994 and the Fourth World Conference on Women in 1995, sexual and reproductive health and rights (SRHR) have improved in many countries, and been supported by awareness raised by women's health advocates, increasingly by youth groups, and also by organizations of health professionals. In the HIV/AIDS area, involvement of organizations of people living with HIV/AIDS is crucial to improve prevention and care. However, after victories during the 1990s, combating opposition by social and political conservatives has taken up much energy in recent years.

Encouraging innovation: ten research priorities for achieving universal access to HIV/AIDS prevention, treatment and care in Europe by 2010.

When the HIV epidemic officially hit western Europe in the early 1980s, central and eastern Europe were almost completely spared due to the isolation of the Soviet Union. However, in the mid-1990s, reported new cases of HIV in eastern European countries began to increase exponentially. While there have been many declarations and strategies addressing HIV/AIDS, today the goal is universal access to HIV/AIDS prevention, treatment, care and support services by 2010.

Integrating health interventions for women, newborn babies, and children: a framework for action.

For women and children, especially those who are poor and disadvantaged, to benefit from primary health care, they need to access and use cost-effective interventions for maternal, newborn, and child health. The challenge facing weak health systems is how to deliver such packages. Experiences from countries such as Iran, Malaysia, Sri Lanka, and China, and from projects in countries like Tanzania and India, show that outcomes in maternal, newborn, and child health can be improved through integrated packages of cost-effective health-care interventions that are implemented incrementally in accordance with the capacity of health systems.