Ӧ Tunçalp

Quality of care for pregnant women and newborns—the WHO vision

In 2015, as we review progress towards Millennium Development Goals (MDGs), despite significant progress in reduction of mortality, we still have unacceptably high numbers of maternal and newborn deaths globally. Efforts over the past decade to reduce adverse outcomes for pregnant women and newborns have been directed at increasing skilled birth attendance.1, 2 This has resulted in higher rates of births in health facilities in all regions.3 The proportion of deliveries reportedly attended by skilled health personnel in developing countries rose from 56% in 1990 to 68% in 2012.4 With increasing utilisation of health services, a higher proportion of avoidable maternal and perinatal mortality and morbidity have moved to health facilities. In this context, poor quality of care (QoC) in many facilities becomes a paramount roadblock in our quest to end preventable mortality and morbidity.

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country

To investigate the burden and causes of life‐threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals.

What matters to women: a systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women

Global uptake of antenatal care (ANC) varies widely and is influenced by the value women place on the service they receive. Identifying outcomes that matter to pregnant women could inform service design and improve uptake and effectiveness.

Promoting respect and preventing mistreatment during childbirth

during childbirth JP Vogel, MA Bohren, Ӧ Tunc alp, OT Oladapo, AM G€ ulmezoglu a UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland b Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Correspondence: Dr JP Vogel, Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) World Health Organization, Avenue Appia 20, Geneva, Switzerland. Email vogeljo@who.int

WHO recommendations on antenatal care for a positive pregnancy experience—going beyond survival

Ӧ Tunc alp, JP Pena-Rosas, T Lawrie, M Bucagu, OT Oladapo, A Portela, A Metin G€ ulmezoglu a Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland b Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland c Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland Correspondence: Dr Ӧ Tunc alp, Scientist, Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, Geneva, Switzerland. Email tuncalpo@who.int

Seeking order amidst chaos: A systematic review of classification systems for causes of stillbirth and neonatal death, 2009-2014

BackgroundEach year, about 5.3 million babies die in the perinatal period. Understanding of causes of death is critical for prevention, yet there is no globally acceptable classification system. Instead, many disparate systems have been developed and used. We aimed to identify all systems used or created between 2009 and 2014, with their key features, including extent of alignment with the International Classification of Diseases (ICD) and variation in features by region, to inform the World Health Organization’s development of a new global approach to classifying perinatal deaths.MethodsA systematic literature review (CINAHL, EMBASE, Medline, Global Health, and PubMed) identified published and unpublished studies and national reports describing new classification systems or modifications of existing systems for causes of perinatal death, or that used or tested such systems, between 2009 and 2014. Studies reporting ICD use only were excluded. Data were independently double-extracted (except from non-English publications). Subgroup analyses explored variation by extent and region.ResultsEighty-one systems were identified as new, modifications of existing systems, or having been used between 2009 and 2014, with an average of ten systems created/modified each year. Systems had widely varying characteristics: (i) comprehensiveness (40 systems classified both stillbirths and neonatal deaths); (ii) extent of use (systems were created in 28 countries and used in 40; 17 were created for national use; 27 were widely used); (iii) accessibility (three systems available in e-format); (iv) underlying cause of death (64 systems required a single cause of death); (v) reliability (10 systems tested for reliability, with overall Kappa scores ranging from .35–.93); and (vi) ICD alignment (17 systems used ICD codes). Regional databases were not searched, so system numbers may be underestimated. Some non-differential misclassification of systems was possible.ConclusionsThe plethora of systems in use, and continuing system development, hamper international efforts to improve understanding of causes of death. Recognition of the features of currently used systems, combined with a better understanding of the drivers of continued system creation, may help the development of a truly effective global system.

Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis

What constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable.

Antenatal care for healthy pregnant women: a mapping of interventions from existing guidelines to inform the development of new WHO guidance on antenatal care

The World Health Organization (WHO) is in the process of updating antenatal care (ANC) guidelines.

Giving a voice to millions: developing the WHO application of ICD-10 to deaths during the perinatal period: ICD-PM

application of ICD-10 to deaths during the perinatal period: ICD-PM ER Allanson, Ӧ Tunçalp, J Gardosi, RC Pattinson, JP Vogel, JJHM Erwich, VJ Flenady, JF Frøen, J Neilson, A Quach, A Francis, D Chou, M Mathai, L Say, AM Gülmezoglu a Faculty of Medicine, Dentistry and Health Sciences, School of Women’s and Infants’ Health, University of Western Australia, Crawley, WA, Australia b Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland c Perinatal Institute, Birmingham, UK d Department of Obstetrics and Gynaecology, SAMRC Maternal and Infant Health Care Strategies unit, University of Pretoria, Pretoria, South Africa e Department of Obstetrics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands f Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Qld, Australia g International Stillbirth Alliance, Bristol, UK h Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway i Centre for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway j Centre for Women’s Health Research, University of Liverpool, Liverpool, UK k Pacific Northwest University of Health Sciences, Yakima, WA, USA l Maternal & Perinatal Health, Department of Maternal, Newborn Child & Adolescent Health, World Health Organization, Geneva, Switzerland Correspondence: ER Allanson, Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland. Email allansone@who.int

Application of ICD-PM to preterm-related neonatal deaths in South Africa and United Kingdom

We explore preterm‐related neonatal deaths using the WHO application of the International Classification of Disease (ICD‐10) to deaths during the perinatal period: ICD‐PM as an informative case study, where ICD‐PM can improve data use to guide clinical practice and programmatic decision‐making.