Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Danel I [original query] |
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Rapid reduction of maternal mortality in Uganda and Zambia through the Saving Mothers, Giving Life initiative: results of year 1 evaluation
Serbanescu F , Goldberg HI , Danel I , Wuhib T , Marum L , Obiero W , McAuley J , Aceng J , Chomba E , Stupp PW , Conlon CM . BMC Pregnancy Childbirth 2017 17 (1) 42 BACKGROUND: Achieving maternal mortality reduction as a development goal remains a major challenge in most low-resource countries. Saving Mothers, Giving Life (SMGL) is a multi-partner initiative designed to reduce maternal mortality rapidly in high mortality settings through community and facility evidence-based interventions and district-wide health systems strengthening that could reduce delays to appropriate obstetric care. METHODS: An evaluation employing multiple studies and data collection methods was used to compare baseline maternal outcomes to those during Year 1 in SMGL pilot districts in Uganda and Zambia. Studies include health facility assessments, pregnancy outcome monitoring, enhanced maternal mortality detection in facilities, and population-based investigation of community maternal deaths. Population-based evaluation used standard approaches and comparable indicators to measure outcome and impact, and to allow comparison of the SMGL implementation in unique country contexts. RESULTS: The evaluation found a 30% reduction in the population-based maternal mortality ratio (MMR) in Uganda during Year 1, from 452 to 316 per 100,000 live births. The MMR in health facilities declined by 35% in each country (from 534 to 345 in Uganda and from 310 to 202 in Zambia). The institutional delivery rate increased by 62% in Uganda and 35% in Zambia. The number of facilities providing emergency obstetric and newborn care (EmONC) rose from 10 to 25 in Uganda and from 7 to 11 in Zambia. Partial EmONC care became available in many more low and mid-level facilities. Cesarean section rates for all births increased by 23% in Uganda and 15% in Zambia. The proportion of women with childbirth complications delivered in EmONC facilities rose by 25% in Uganda and 23% in Zambia. Facility case fatality rates fell from 2.6 to 2.0% in Uganda and 3.1 to 2.0% in Zambia. CONCLUSIONS: Maternal mortality ratios fell significantly in one year in Uganda and Zambia following the introduction of the SMGL model. This model employed a comprehensive district system strengthening approach. The lessons learned from SMGL can inform policymakers and program managers in other low and middle income settings where similar approaches could be utilized to rapidly reduce preventable maternal deaths. |
Female genital mutilation/cutting in the United States: Updated estimates of women and girls at risk, 2012
Goldberg H , Stupp P , Okoroh E , Besera G , Goodman D , Danel I . Public Health Rep 2016 131 (2) 340-7 OBJECTIVES: In 1996, the U.S. Congress passed legislation making female genital mutilation/cutting (FGM/C) illegal in the United States. CDC published the first estimates of the number of women and girls at risk for FGM/C in 1997. Since 2012, various constituencies have again raised concerns about the practice in the United States. We updated an earlier estimate of the number of women and girls in the United States who were at risk for FGM/C or its consequences. METHODS: We estimated the number of women and girls who were at risk for undergoing FGM/C or its consequences in 2012 by applying country-specific prevalence of FGM/C to the estimated number of women and girls living in the United States who were born in that country or who lived with a parent born in that country. RESULTS: Approximately 513,000 women and girls in the United States were at risk for FGM/C or its consequences in 2012, which was more than three times higher than the earlier estimate, based on 1990 data. The increase in the number of women and girls younger than 18 years of age at risk for FGM/C was more than four times that of previous estimates. CONCLUSION: The estimated increase was wholly a result of rapid growth in the number of immigrants from FGM/C-practicing countries living in the United States and not from increases in FGM/C prevalence in those countries. Scientifically valid information regarding whether women or their daughters have actually undergone FGM/C and related information that can contribute to efforts to prevent the practice in the United States and provide needed health services to women who have undergone FGM/C are needed. |
Eliminating preventable HIV-related maternal mortality in sub-Saharan Africa: what do we need to know?
Kendall T , Danel I , Cooper D , Dilmitis S , Kaida A , Kourtis AP , Langer A , Lapidos-Salaiz I , Lathrop E , Moran AC , Sebitloane H , Turan JM , Watts DH , Wegner MN . J Acquir Immune Defic Syndr 2014 67 Suppl 4 S250-8 INTRODUCTION: HIV makes a significant contribution to maternal mortality, and women living in sub-Saharan Africa are most affected. International commitments to eliminate preventable maternal mortality and reduce HIV-related deaths among pregnant and postpartum women by 50% will not be achieved without a better understanding of the links between HIV and poor maternal health outcomes and improved health services for the care of women living with HIV (WLWH) during pregnancy, childbirth, and postpartum. METHODS: This article summarizes priorities for research and evaluation identified through consultation with 30 international researchers and policymakers with experience in maternal health and HIV in sub-Saharan Africa and a review of the published literature. RESULTS: Priorities for improving the evidence about effective interventions to reduce maternal mortality and improve maternal health among WLWH include better quality data about causes of maternal death among WLWH, enhanced and harmonized program monitoring, and research and evaluation that contributes to improving: (1) clinical management of pregnant and postpartum WLWH, including assessment of the impact of expanded antiretroviral therapy on maternal mortality and morbidity, (2) integrated service delivery models, and (3) interventions to create an enabling social environment for women to begin and remain in care. CONCLUSIONS: As the global community evaluates progress and prepares for new maternal mortality and HIV targets, addressing the needs of WLWH must be a priority now and after 2015. Research and evaluation on maternal health and HIV can increase collaboration on these 2 global priorities, strengthen political constituencies and communities of practice, and accelerate progress toward achievement of goals in both areas. |
HIV and maternal mortality
Lathrop E , Jamieson DJ , Danel I . Int J Gynaecol Obstet 2014 127 (2) 213-5 The majority of the 17 million women globally that are estimated to be infected with HIV live in Sub-Saharan Africa. Worldwide, HIV-related causes contributed to 19 000-56 000 maternal deaths in 2011 (6%-20% of maternal deaths). HIV-infected pregnant women have two to 10 times the risk of dying during pregnancy and the postpartum period compared with uninfected pregnant women. Many of these deaths can be prevented with the implementation of high-quality obstetric care, prevention and treatment of common co-infections, and treatment of HIV with ART. The paper summarizes what is known about HIV disease progression in pregnancy, specific causes of HIV-related maternal deaths, and the potential impact of treatment with antiretroviral therapy on maternal mortality. Recommendations are proposed for improving maternal health and decreasing maternal mortality among HIV-infected women based on existing evidence. |
Global health. Global indicators and targets for noncommunicable diseases
Angell SY , Danel I , DeCock KM . Science 2012 337 (6101) 1456-7 In September 2011, the United Nations (UN) convened a High Level Meeting (HLM) of member states to address a largely neglected, global reality: Noncommunicable diseases (NCDs)—including heart disease, stroke, cancer, diabetes, and chronic lung diseases—kill more people than other causes, health and non–health related, and the world is ill-prepared to respond. This was only the second such UN meeting of heads of state focused on a health issue, the first having been on HIV/AIDS in 2001. Without more effective and focused action, the growing burden of NCDs threatens to undermine increasingly interdependent development and economic agendas (1–3). The 2011 meeting ushered in the potential for an orchestrated response, facilitated by a mandate that the World Health Organization (WHO), in consultation with member states, develop a global monitoring framework with key indicators and targets to be achieved by 2025. | The task is to be completed by the end of 2012 (1). Only one global voluntary indicator with a target has received formal member-state endorsement thus far: reduce the probability of premature mortality from NCDs by 25% by 2025. Another 10 indicators with targets, and 9 indicators without targets, are proposed and under development (2), with the deadline just months away. |
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