Ornella Lincetto

Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries

OBJECTIVE To report stillbirth and early neonatal mortality and to quantify the relative importance of different primary obstetric causes of perinatal mortality in 171 perinatal deaths from 7993 pregnancies that ended after 28 weeks in nulliparous women. METHODS A review of all stillbirths and early newborn deaths reported in the WHO calcium supplementation trial for the prevention of pre-eclampsia conducted at seven WHO collaborating centres in Argentina, Egypt, India, Peru, South Africa and Viet Nam. We used the Baird-Pattinson system to assign primary obstetric causes of death and classified causes of early neonatal death using the International classification of diseases and related health problems, Tenth revision (ICD-10). FINDINGS Stillbirth rate was 12.5 per 1000 births and early neonatal mortality rate was 9.0 per 1000 live births. Spontaneous preterm delivery and hypertensive disorders were the most common obstetric events leading to perinatal deaths (28.7% and 23.6%, respectively). Prematurity was the main cause of early neonatal deaths (62%). CONCLUSIONS Advancements in the care of premature infants and prevention of spontaneous preterm labour and hypertensive disorders of pregnancy could lead to a substantial decrease in perinatal mortality in hospital settings in developing countries.

The prevention and management of congenital syphilis: an overview and recommendations

The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. More than 1 million infants are born with congenital syphilis each year. Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. The weak organization of services and the costs of screening are the principal obstacles facing programmes. Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant.

Reduction in neonatal mortality in Chile between 1990 and 2000.

OBJECTIVE. Our objective with this article was to describe the declining trend in neonatal mortality in Chile between 1990 and 2000 and examine potential causal factors. METHODS. Descriptive analysis of data that were provided by the Chilean Ministry of Health on all ∼2900000 births occurred in Chile between 1990 and 2000. Total neonatal mortality rates (<28 days), and birth weight–specific and gestational age–specific mortality rates from 1990 to 2000 were analyzed by year. Public health interventions that were implemented during the 1990s were reviewed to assess their potential influence on the observed trends in neonatal mortality. RESULTS. The neonatal mortality rate between 1990 and 2000 decreased from 8.3 to 5.7 per 1000 live births. This decline was not associated with decreases in the proportion of low birth weight and preterm infants but rather with declines in birth weight–specific and gestational age–specific mortality rates. Examination of the trends in birth weight–specific and gestational age–specific mortality rates showed that a marked proportional decrease in mortality rates was achieved among infants who weighed <1500 g and were delivered before 32 weeks. It is plausible, both biologically and temporally, that the observed trends in the reduction in birth weight–specific and gestational age–specific mortality rates are associated with the introduction of specific sector-wide interventions that aim to improve newborn care in very preterm and low birth weight infants. CONCLUSIONS. Important reductions in newborn mortality in developing countries are possible with the implementation of effective neonatal care interventions.

Evaluation of the educational impact of the WHO Essential Newborn Care course in Zambia

Objectives: To evaluate the effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) course in improving knowledge and skills of nurse midwives in low‐risk delivery clinics in a developing country.

Using human rights to improve maternal and neonatal health: history, connections and a proposed practical approach

We describe the historical development of how maternal and neonatal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods to advance maternal and neonatal health. We describe the different contributions of the international community, womens health advocates and human rights activists. We briefly present a recent effort, developed by WHO with the Harvard Program on International Health and Human Rights, that applies a human rights framework to reinforce current efforts to reduce maternal and neonatal mortality.

Maternal health care utilization in Viet Nam: increasing ethnic inequity

OBJECTIVE To investigate changes that took place between 2006 and 2010 in the inequity gap for antenatal care attendance and delivery at health facilities among women in Viet Nam. METHODS Demographic, socioeconomic and obstetric data for women aged 15-49 years were extracted from Viet Nams Multiple Indicator Cluster Survey for 2006 (MICS3) and 2010-2011 (MICS4). Multivariate logistic regression was performed to determine if antenatal care attendance and place of delivery were significantly associated with maternal education, maternal ethnicity (Kinh/Hoa versus other), household wealth and place of residence (urban versus rural). These independent variables correspond to the analytical framework of the Commission on Social Determinants of Health. FINDINGS Large discrepancies between urban and rural populations were found in both MICS3 and MICS4. Although antenatal care attendance and health facility delivery rates improved substantially between surveys (from 86.3 to 92.1% and from 76.2 to 89.7%, respectively), inequities increased, especially along ethnic lines. The risk of not giving birth in a health facility increased significantly among ethnic minority women living in rural areas. In 2006 this risk was nearly five times higher than among women of Kinh/Hoa (majority) ethnicity (odds ratio, OR: 4.67; 95% confidence interval, CI: 2.94-7.43); in 2010-2011 it had become nearly 20 times higher (OR: 18.8; 95% CI: 8.96-39.2). CONCLUSION Inequity in maternal health care utilization has increased progressively in Viet Nam, primarily along ethnic lines, and vulnerable groups in the country are at risk of being left behind. Health-care decision-makers should target these groups through affirmative action and culturally sensitive interventions.

Neonatal resuscitation in Vietnam: a national survey of a middle-income country.

Interventions that improve neonatal resuscitation are critical if we are to reduce perinatal mortality. We evaluated the consistency of resuscitation practices, and adherence to the international guidelines for neonatal resuscitation, in a large representative sample of hospitals in Vietnam.

Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis

In countries that lack prenatal screening and treatment of pregnant women for chlamydia, neonatal chlamydial conjunctivitis is still a common infection. Ours is the first systematic review and meta-analysis of treatment for neonatal chlamydial conjunctivitis.