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Antenatal care data sources and their policy and planning implications: a Palestinian example using the Lives Saved Tool.

ABSTRACT: BACKGROUND:Policy making in healthcare requires reliable and local data. Different sources of coverage data for health interventions can be utilized to populate the Lives Saved Tool (LiST), a commonly used policy-planning tool for women and children's health. We have evaluated four existing sources of antenatal care data in Palestine to discuss the implications of their use in LiST. METHODS:We identified all intervention coverage and health status indicators around the antenatal period that could be used to populate LiST. These indicators were calculated from 1) routine reported data, 2) a Multiple Indicator Cluster Survey (MICS), 3) paper-based antenatal records and 4) the eRegistry (an electronic health information system) for public clinics in the West Bank, Palestine for the most recent year available. We scaled coverage of each indicator to 90%, in public clinics only, and compared this to a no-change scenario for a seven-year period. RESULTS:Eight intervention coverage and health status indicators needed to populate the antenatal section of LiST could be calculated from both paper-based antenatal records and the eRegistry. Only two could be calculated from routine reports and three from a national survey. Maternal lives saved over seven years ranged from 5 to 39, with percent reduction in the maternal mortality ratio (MMR) ranging from 1 to 6%. Pre-eclampsia management accounted for 25 to 100% of these lives saved. CONCLUSIONS:The choice of data source for antenatal indicators will affect policy-based decisions when used to populate LiST. Although all data sources have their purpose, clinical data collected directly in an electronic registry during antenatal contacts may provide the most reliable and complete data to populate currently unavailable but needed indicators around specific antenatal care interventions.

SUBMITTER: Friberg IK

PROVIDER: S-EPMC6354562 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Antenatal care data sources and their policy and planning implications: a Palestinian example using the Lives Saved Tool.

Friberg Ingrid K IK Venkateswaran Mahima M Ghanem Buthaina B Frøen J Frederik JF

BMC public health 20190130 1

<h4>Background</h4>Policy making in healthcare requires reliable and local data. Different sources of coverage data for health interventions can be utilized to populate the Lives Saved Tool (LiST), a commonly used policy-planning tool for women and children's health. We have evaluated four existing sources of antenatal care data in Palestine to discuss the implications of their use in LiST.<h4>Methods</h4>We identified all intervention coverage and health status indicators around the antenatal p ...[more]

PMID: 30700260

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Project description:The worldwide burden of stillbirths is large, with an estimated 2.6 million babies stillborn in 2015 including 1.3 million dying during labour. The Every Newborn Action Plan set a stillbirth target of ?12 per 1000 in all countries by 2030. Planning tools will be essential as countries set policy and plan investment to scale up interventions to meet this target. This paper summarises the approach taken for modelling the impact of scaling-up health interventions on stillbirths in the Lives Saved tool (LiST), and potential future refinements.The specific application to stillbirths of the general method for modelling the impact of interventions in LiST is described. The evidence for the effectiveness of potential interventions to reduce stillbirths are reviewed and the assumptions of the affected fraction of stillbirths who could potentially benefit from these interventions are presented. The current assumptions and their effects on stillbirth reduction are described and potential future improvements discussed.High quality evidence are not available for all parameters in the LiST stillbirth model. Cause-specific mortality data is not available for stillbirths, therefore stillbirths are modelled in LiST using an attributable fraction approach by timing of stillbirths (antepartum/ intrapartum). Of 35 potential interventions to reduce stillbirths identified, eight interventions are currently modelled in LiST. These include childbirth care, induction for prolonged pregnancy, multiple micronutrient and balanced energy supplementation, malaria prevention and detection and management of hypertensive disorders of pregnancy, diabetes and syphilis. For three of the interventions, childbirth care, detection and management of hypertensive disorders of pregnancy, and diabetes the estimate of effectiveness is based on expert opinion through a Delphi process. Only for malaria is coverage information available, with coverage estimated using expert opinion for all other interventions. Going forward, potential improvements identified include improving of effectiveness and coverage estimates for included interventions and addition of further interventions.Known effective interventions have the potential to reduce stillbirths and can be modelled using the LiST tool. Data for stillbirths are improving. Going forward the LiST tool should seek, where possible, to incorporate these improving data, and to continually be refined to provide an increasingly reliable tool for policy and programming purposes.

Project description:Background:As one of several countries that pledged to achieve the Millennium Development Goals (MDGs), Mozambique sought to reduce child, neonatal, and maternal mortality by two thirds by 2015. This study examines the impact of Mozambique's efforts between 1997 and 2015, highlighting the increases in intervention coverage that contributed to saving the most lives. Methods:A retrospective analysis of available household survey data was conducted using the Lives Saved Tool (LiST). Baseline mortality rates, cause-of-death distributions, and coverage of child, neonatal, and maternal interventions were entered as inputs. Changes in mortality rates, causes of death, and additional lives saved were calculated as results. Due to limited coverage data for the year 2015, we reported most results for the period 1997-2011. For 2011-2015 we reported additional lives saved for a subset of interventions. All analyses were performed at national and provincial level. Results:Our modelled estimates show that increases in intervention coverage from 1997 to 2011 saved an additional 422?282 child lives (0-59 months), 85?450 neonatal lives (0-1 month), and 6528 maternal lives beyond those already being saved at baseline coverage levels in 1997. Malaria remained the leading cause of child mortality from 1997 to 2011; prematurity, asphyxia, and sepsis remained the leading causes of neonatal mortality; and hemorrhage remained the leading cause of maternal mortality. Interventions to reduce acute malnutrition and promote artemisinin-based combination therapy (ACT) for malaria were responsible for the largest number of additional child lives saved in the 1997-2011 period. Increases in coverage of delivery management were responsible for most additional newborn and maternal lives saved in both periods in Mozambique. Conclusion:Mozambique has made impressive gains in reducing child mortality since 1997. Additional effort is needed to further reduce maternal and neonatal mortality in all provinces. More lives can be saved by continuing to increase coverage of existing health interventions and exploring new ways to reach underserved populations.

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Project description:BackgroundKwaZulu-Natal province in South Africa has the largest population of children under the age of five and experiences the highest number of child births per annum in the country. Its population has also been ravaged by the dual epidemics of HIV and TB and it has struggled to meet targets for maternal and child mortality. In South Africa's federal system, provinces have decision-making power on the prioritization and allocation of resources within their jurisdiction. As part of strategic planning for 2015-2019, KwaZulu-Natal provincial authorities requested an assessment of current mortality levels in the province and identification and costing of priority interventions for saving additional maternal, newborn and child lives, as well as preventing stillbirths in the province.MethodsThe Lives Saved Tool (LiST) was used to determine the set of interventions, which could save the most additional maternal and child lives and prevent stillbirths from 2015-2019, and the costs of these. The impact of family planning was assessed using two scenarios by increasing baseline coverage of modern contraception by 0.5 percentage points or 1 percentage point per annum.ResultsA total of 7,043 additional child and 297 additional maternal lives could be saved, and 2,000 stillbirths could be prevented over five years. Seventeen interventions account for 75% of additional lives saved. Increasing family planning contributes to a further reduction of up to 137 maternal and 3,168 child deaths. The set of priority interventions scaled up to achievable levels, with no increase in contraception would require an additional US$91 million over five years or US$1.72 per capita population per year. By increasing contraceptive prevalence by one percentage point per year, overall costs to scale up to achievable coverage package, decrease by US$24 million over five years.ConclusionFocused attention on a set of key interventions could have a significant impact on averting stillbirths and maternal and neonatal mortality in KwaZulu-Natal. Concerted effort to prioritize family planning will save more lives overall and has the potential to decrease costs in other areas of maternal and child care.

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Dataset Information

Antenatal care data sources and their policy and planning implications: a Palestinian example using the Lives Saved Tool.

Publications

Antenatal care data sources and their policy and planning implications: a Palestinian example using the Lives Saved Tool.

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