Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival.
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ABSTRACT:
SUBMITTER: Victora CG
PROVIDER: S-EPMC7613171 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundProgress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.MethodsWe did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 to 2015, using data from nationally representative Demographic Health Surveys done between 1989 and 2014. For comparison, we used modelled mortality estimates from the UN Inter-Agency Groups for Child and Maternal Mortality Estimation. We estimated time trends for key RMNCH indicators, as defined by Countdown to 2015, at both the national and the subnational level, and used linear regression methods to understand the determinants of change in intervention coverage during the past decade. Finally, we used the Lives Saved Tool (LiST) to model the effect of intervention scale-up by 2030.FindingsAfter an increase in mortality between 1990 and 2003, there was a reversal in all mortality trends from 2003 onwards, although progress was not substantial enough for Kenya to achieve Millennium Development Goal targets 4 or 5. Between 1990 and 2015, maternal mortality declined at half the rate of under-5 mortality, and changes in neonatal mortality were even slower. National-level trends in intervention coverage have improved, although some geographical inequities remain, especially for counties comprising the northeastern, eastern, and northern Rift Valley regions. Disaggregation of intervention coverage by wealth quintile also revealed wide inequities for several health-systems-based interventions, such as skilled birth assistance. Multivariable analyses of predictors of change in family planning, skilled birth assistance, and full vaccination suggested that maternal literacy and family size are important drivers of positive change in key interventions across the continuum of care. LiST analyses clearly showed the importance of quality of care around birth for maternal and newborn survival.InterpretationIntensified and focused efforts are needed for Kenya to achieve the RMNCH targets for 2030. Kenya must build on its previous progress to further reduce mortality through the widespread implementation of key preventive and curative interventions, especially those pertaining to labour, delivery, and the first day of life. Deliberate targeting of the poor, least educated, and rural women, through the scale-up of community-level interventions, is needed to improve equity and accelerate progress.FundingUS Fund for UNICEF, Bill & Melinda Gates Foundation.
| S-EPMC5599303 | biostudies-literature
Project description:BackgroundTracking aid flows helps to hold donors accountable and to compare the allocation of resources in relation to health need. With the use of data reported by donors in 2015, we provided estimates of official development assistance and grants from the Bill & Melinda Gates Foundation (collectively termed ODA+) to reproductive, maternal, newborn, and child health for 2013 and complete trends in reproductive, maternal, newborn, and child health support for the period 2003-13.MethodsWe coded and analysed financial disbursements to reproductive, maternal, newborn, and child health to all recipient countries from all donors reporting to the creditor reporting system database for the year 2013. We also revisited disbursement records for the years 2003-08 and coded disbursements relating to reproductive and sexual health activities resulting in the Countdown dataset for 2003-13. We matched this dataset to the 2015 creditor reporting system dataset and coded any unmatched creditor reporting system records. We analysed trends in ODA+ to reproductive, maternal, newborn, and child health for the period 2003-13, trends in donor contributions, disbursements to recipient countries, and targeting to need.FindingsTotal ODA+ to reproductive, maternal, newborn, and child health reached nearly US$14 billion in 2013, of which 48% supported child health ($6·8 billion), 34% supported reproductive and sexual health ($4·7 billion), and 18% maternal and newborn health ($2·5 billion). ODA+ to reproductive, maternal, newborn, and child health increased by 225% in real terms over the period 2003-13. Child health received the most substantial increase in funding since 2003 (286%), followed by reproductive and sexual health (194%), and maternal and newborn health (164%). In 2013, bilateral donors disbursed 59% of all ODA+ to reproductive, maternal, newborn, and child health, followed by global health initiatives (23%), and multilateral agencies (13%). Targeting of ODA+ to reproductive, maternal, newborn, and child health to countries with the greatest health need seems to have improved over time.InterpretationThe increase in reproductive, maternal, newborn, and child health funding over the period 2003-13 is encouraging. Further increases in funding will be needed to accelerate maternal mortality reduction while keeping a high level of investment in sexual and reproductive health and in child health.FundingSubgrant OPP1058954 from the US Fund for UNICEF under their Countdown to 2015 for Maternal, Newborn and Child Survival Grant from the Bill & Melinda Gates Foundation.
| S-EPMC5565636 | biostudies-literature
Project description:BackgroundChina is one of the few Countdown countries to have achieved Millennium Development Goal 5 (75% reduction in maternal mortality ratio between 1990 and 2015). We aimed to examine the health systems and contextual factors that might have contributed to the substantial decline in maternal mortality between 1997 and 2014. We chose to focus on western China because poverty, ethnic diversity, and geographical access represent particular challenges to ensuring universal access to maternal care in the region.MethodsIn this systematic assessment, we used data from national census reports, National Statistical Yearbooks, the National Maternal and Child Health Routine Reporting System, the China National Health Accounts report, and National Health Statistical Yearbooks to describe changes in policies, health financing, health workforce, health infrastructure, coverage of maternal care, and maternal mortality by region between 1997 and 2014. We used a multivariate linear regression model to examine which contextual and health systems factors contributed to the regional variation in maternal mortality ratio in the same period. Using data from a cross-sectional survey in 2011, we also examined equity in access to maternity care in 42 poor counties in western China.FindingsMaternal mortality declined by 8·9% per year between 1997 and 2014 (geometric mean ratio for each year 0·91, 95% CI 0·91-0·92). After adjusting for GDP per capita, length of highways, female illiteracy, the number of licensed doctors per 1000 population, and the proportion of ethnic minorities, the maternal mortality ratio was 118% higher in the western region (2·18, 1·44-3·28) and 41% higher in the central region (1·41, 0·99-2·01) than in the eastern region. In the rural western region, the proportion of births in health facilities rose from 41·9% in 1997 to 98·4% in 2014. Underpinning such progress was the Government's strong commitment to long-term strategies to ensure access to delivery care in health facilities-eg, professionalisation of maternity care in large hospitals, effective referral systems for women medically or socially at high risk, and financial subsidies for antenatal and delivery care. However, in the poor western counties, substantial disparity by education level of the mother existed in access to health facility births (44% of illiterate women vs 100% of those with college or higher education), antenatal care (17% vs 69%) had at least four visits), and caesarean section (8% vs 44%).InterpretationDespite remarkable progress in maternal survival in China, substantial disparities remain, especially for the poor, less educated, and ethnic minority groups in remote areas in western China. Whether China's highly medicalised model of maternity care will be an answer for these populations is uncertain. A strategy modelled after China's immunisation programme, whereby care is provided close to the women's homes, might need to be explored, with township hospitals taking a more prominent role.FundingGovernment of Canada, UNICEF, and the Bill & Melinda Gates Foundation.
| S-EPMC5387688 | biostudies-literature
Project description:BackgroundLittle is known about the patterns of development assistance (DA) for each component of reproductive, maternal, newborn, child and adolescent health (RMNCAH) in conflict-affected countries nor about the DA allocation in relation to the burden of disease.MethodsWe tracked DA to RMNCAH in general and to each of its four components: reproductive health (RH), maternal and newborn health (MNH), child health (CH) and adolescent health (AH), in 25 conflict-affected countries between 2003 and 2017. We compared DA and disability-adjusted life years (DALYs) for each component. Using keyword searching and funding allocation methods, we produced two sets of estimates: DA primarily targeting RMNCAH (lower bound) and DA both primarily and partially for RMNCAH or DA not explicitly targeting RMNCAH but benefiting it (upper bound).FindingsBetween 2003 and 2017, we identified 46 833 projects among the 25 countries that targeted RMNCAH. During the study period, DA to RMNCAH increased by seven-fold from $0.5 billion to $3.6 billion, with a slowdown since 2013. Cumulatively, RH received the largest proportion of DA to RMNCAH (50%) with 84% of its funding earmarked for HIV/AIDS, which contributed to less than 6% of the total RMNCAH-related DALYs. AH received 3% of the DA-RMNCAH but contributed 15% to the RMNCAH-related DALYs. Non-communicable diseases caused more than one-third of the DALYs among adolescents, but received only 3% of DA to AH. RMNCAH-inclusive estimates showed consistent results.ConclusionWhile there was a substantial increase in funding to RMNCAH in conflict-affected countries over the period of study, some health issues with high disease burden (eg, AH and non-communicable diseases) received a disproportionately small portion of aid for RMNCAH. We recommend that donors increase investment to RMNCAH in conflict-affected countries, particularly in areas where the burden of disease or the potential benefit of investment is likely to be high.
| S-EPMC6730579 | biostudies-literature
Project description:ObjectivesTo inform the impacts of health programmes which aimed at preventing women and children from being trapped in or returning to poverty because of illness in Yunnan, the main battlefield against poverty in China.DesignThe longitudinal comparative evaluation design.Data collection and analysisNational and Yunnan policy documents related to maternal and child health programmes for poverty alleviation during 2015-2020 were analysed. The changes in disparities in maternal and child health system inputs, service coverage, and health outcomes between poor and non-poor areas, as well as out-of-pocket payments between poor and non-poor populations were assessed before and after 2017.ResultsIn total 12 policies and 15 programmes related to poverty alleviation for poor women and children in Yunnan were summarised. As a result of health system strengthening in Yunnan, the densities of licensed doctors, nurses, obstetricians, midwives, township health workers and female village doctors had been increased substantially in poor areas, with the annual rates of 14.3%, 22.5%, 21.8%, 23.9%, 14.1% and 7.1% separately. Although disparities existed in some of service coverage between poor and non-poor areas, the health programmes had narrowed the gaps in utilisation of facility birth, caesarean section, prenatal screening and newborn screening across Yunnan (p<0.01). The out-of-pocket payments for inpatient care for serious illnesses among women and children with poverty registration had been considerably decreased to 10.0%. Paralleling the universal coverage, maternal deaths per 100 000 livebirths and child deaths per 1000 livebirths had further declined in both poor and non-poor areas, and the impacts of health programmes on closing the gaps in child survivals across Yunnan were significant (p<0.01).ConclusionsRemarkable progress in equitable maternal and child survival has been achieved in Yunnan. The practices in Yunnan have shown the Chinese model in ending poverty by strengthening health system and implementing universal coverage with firm commitment, determined leadership, detailed blueprint and social participation.
| S-EPMC10583063 | biostudies-literature
Project description:BackgroundFour initiatives have estimated the value of aid for reproductive, maternal, newborn, and child health (RMNCH): Countdown to 2015, the Institute for Health Metrics and Evaluation (IHME), the Muskoka Initiative, and the Organisation for Economic Co-operation and Development (OECD) policy marker. We aimed to compare the estimates, trends, and methodologies of these initiatives and make recommendations for future aid tracking.MethodsWe compared estimates of aid for RMNCH from the four initiatives for all years available at the time of our analysis (1990-2016). We used publicly available datasets for IHME and Countdown. We produced estimates for Muskoka and the OECD policy marker using data in the OECD Creditor Reporting System. We sought to explain differences in estimates by critically comparing the methods used by each approach to identify and analyse aid, and quantifying the effects of these choices on estimates.FindingsAll four approaches indicated substantial increases over time in global aid for RMNCH, but estimates of aid amounts and year-on-year trends differed substantially, especially for individual donors and recipient countries. Muskoka (US$ 13·0 billion in 2013, constant 2015 US$) and Countdown's RMNCH estimates ($13·1 billion in 2013) tended to be the highest and most similar, although they often indicated different year-on-year trends. IHME produced lower estimates ($10·8 billion in 2013), which often indicated different trends from the other approaches. The OECD policy marker produced by far the lowest estimates ($2·0 billion in 2013) because half of bilateral donors did not report on it consistently and those who did tended to apply it narrowly. Estimates differed across approaches primarily because of differences in methods for distinguishing aid for RMNCH from aid for other purposes; adjustments for inflation, exchange rates, and under-reporting; whether donors were credited for their support to multilateral institutions; and the handling of aid to unspecified recipients.InterpretationThe four approaches are likely to lead to different conclusions about whether individual donors and recipient countries have fulfilled their obligations and commitments and whether aid was sufficient, targeted to countries with greater need, or effective. We recommend that efforts to track aid for the Sustainable Development Goals reflect their multisectoral and interconnected nature and make analytical choices that are appropriate to their objectives, recognising the trade-offs between simplicity, timeliness, precision, accuracy, efficiency, flexibility, replicability, and the incentives that different metrics create for donors.FundingSubgrant OPP1058954 from the US Fund for UNICEF under their Countdown to 2015 for Maternal, Newborn and Child Survival Grant from the Bill & Melinda Gates Foundation.
| S-EPMC6057137 | biostudies-literature
Project description:Worldwide, 250,000-280,000 women die during pregnancy and childbirth every year and an estimated 6.55 million children die under the age of five. The majority of maternal deaths occur during or immediately after childbirth, while 43% of child death occurs during the first 28 days of life. However, the progress in limiting these has been slow and sporadic. In this supplement of five papers, we aim to systematically assess and summarize essential interventions for reproductive, maternal, newborn and child health from relevant systematic reviews. This paper is an introductory paper detailing the background and methodology used for grading interventions. The following three papers summarize the evidence on essential interventions for pre-pregnancy, pregnancy, childbirth, postnatal (mother and neonatal) and child heath while the last paper describes the essential interventions as per the level of health care delivery and their proposed packages of care.
| S-EPMC4145855 | biostudies-other
Project description:Despite numerous international and national efforts, only 12 countries in the World Health Organization's African Region met the Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across sub-Saharan Africa, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia and Zambia were chosen to represent countries making substantial progress towards MDG#4, while Kenya and Zimbabwe represented countries making less progress. Our individual case studies suggested that strong health governance and leadership (HGL) was a significant driver of the greater success in Liberia and Zambia compared with Kenya and Zimbabwe. To elucidate specific components of national HGL that may have substantially influenced the pace of reductions in child mortality, we conducted a cross-country analysis of national policies and strategies pertaining to maternal, neonatal and child health (MNCH) and qualitative interviews with individuals working in MNCH in each of the four study countries. The three aspects of HGL identified in this study which most consistently contributed to the different progress towards MDG#4 among the four study countries were (1) establishing child survival as a top national priority backed by a comprehensive policy and strategy framework and sufficient human, financial and material resources; (2) bringing together donors, strategic partners, health and non-health stakeholders and beneficiaries to collaborate in strategic planning, decision-making, resource-allocation and coordination of services; and (3) maintaining accountability through a 'monitor-review-act' approach to improve MNCH. Although child mortality in sub-Saharan Africa remains high, this comparative study suggests key health leadership and governance factors that can facilitate reduction of child mortality and may prove useful in tackling current Sustainable Development Goals.
| S-EPMC6479825 | biostudies-literature
Project description:BackgroundAchievement of Millennium Development Goal (MDG) 4 for child survival requires acceleration of gains in newborn survival, and current trends in improving maternal health will also fall short of reaching MDG 5 without more strategic actions. We present a Maternal Newborn and Child Health (MNCH) strategy for accelerating progress on MDGs 4 and 5, sustaining the gains beyond 2015, and further bringing down maternal and child mortality by two thirds by 2030.DiscussionThe strategy takes into account current trends in coverage and cause-specific mortality, builds on lessons learned about what works in large-scale implementation programs, and charts a course to reach those who do not yet access services. A central hypothesis of this strategy is that enhancing interactions between frontline workers and mothers and families is critical for increasing the effective coverage of life-saving interventions. We describe a framework for measuring and evaluating progress which enables continuous course correction and improvement in program performance and impact.SummaryEvidence for the hypothesis and impact of this strategy is being gathered and will be synthesized and disseminated in order to advance global learning and to maximise the potential to improve maternal and neonatal survival.
| S-EPMC3866510 | biostudies-literature
Project description:The objective of this review is to assess and synthesize the role of the maternal and child health (MCH) handbook on improving healthcare service utilization, behavior change, and health outcomes for women and children. A systematic search of all relevant existing reports was conducted on 14 January 2021, using the following online bibliographic databases: PubMed, EMBASE, MEDLINE, The Cochrane Library, Academic Search Premier, Emcare, APA PsycINFO, and Web of Science. Two reviewers independently performed study selection, data extraction, and quality assessment. We included 7 trials from 1430 articles, and a total of 2643 women. As overall risk of bias assessment, most domains of the Cochrane risk-of-bias assessment tool showed a high or unclear risk of bias. The risk of ≥6 antenatal care (ANC) visits was 19% higher (RR 1.19, 95% CI 1.09 to 1.30, I2 = 47%, 2 studies, 955 women, moderate certainty of evidence) and skilled birth attendants during delivery was 13% higher (RR 1.13, 95% CI 1.04 to 1.24, I2 = 0%, 2 studies, 1094 women, low certainty of the evidence) in the intervention group than in the control group. The MCH handbook can increase maternal health service utilization and early breastfeeding practice. It also leads to a sense of autonomy during ANC, better communication with healthcare providers, and support from family members.
| S-EPMC10046926 | biostudies-literature