Just-in-time postnatal education programees to improve newborn care practices: needs and opportunities in low-resource settings

Worldwide, many newborns die in the first month of life, with most deaths happening in low/middle-income countries (LMICs). Families’ use of evidence-based newborn care practices in the home and timely care-seeking for illness can save newborn lives. Postnatal education is an important investment to improve families’ use of evidence-based newborn care practices, yet there are gaps in the literature on postnatal education programees that have been evaluated to date. Recent findings from a 13 000+ person survey in 3 states in India show opportunities for improvement in postnatal education for mothers and families and their use of newborn care practices in the home. Our survey data and the literature suggest the need to incorporate the following strategies into future postnatal education programming: implement structured predischarge education with postdischarge reinforcement, using a multipronged teaching approach to reach whole families with education on multiple newborn care practices. Researchers need to conduct robust evaluation on postnatal education models incorporating these programee elements in the LMIC context, as well as explore whether this type of education model can work for other health areas that are critical for families to survive and thrive.

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Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Global Health ◽

10.1136/bmjgh-2020-003618 ◽

2021 ◽

Vol 6 (2) ◽

pp. e003618

Author(s):

Mirjam Y Kleinhout ◽

Merel M Stevens ◽

Kwabena Aqyapong Osman ◽

Kwame Adu-Bonsaffoh ◽

Floris Groenendaal ◽

...

Keyword(s):

Low Income ◽

Low Birthweight ◽

Meta Analysis ◽

Neonatal Resuscitation ◽

Newborn Care ◽

Evidence Based ◽

Antenatal Corticosteroids ◽

Essential Newborn Care ◽

Middle Income ◽

Middle Income Countries

BackgroundPreterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations.MethodsSix electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267).Results1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants.ConclusionThe findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.

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An Evidence-Based Approach on Public Health Decisions in Low-Middle Income Countries: Use Case of Senegal at the Verge of COVID-19

10.1109/icdata52997.2021.00046 ◽

2021 ◽

Author(s):

Jesus Ekie ◽

Bassirou Gueye ◽

Tresor Ekie ◽

Ibrahima Niang

Keyword(s):

Public Health ◽

Evidence Based ◽

Use Case ◽

Middle Income ◽

Health Decisions ◽

Middle Income Countries ◽

Low Middle Income Countries

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COVID-19: An opportunity to strengthen Public Health Policy and Advocacy Efforts in LMIC (Low- Middle-Income Countries)

10.31222/osf.io/9mr8h ◽

2021 ◽

Author(s):

Ponn P Mahayosnand ◽

Saman Essa ◽

ZM Sabra

Keyword(s):

Public Health ◽

Cost Effective ◽

World Health ◽

Evidence Based ◽

Middle Income ◽

Policy Problem ◽

Middle Income Countries ◽

Successful Case ◽

Low Middle Income Countries ◽

Public Health Practitioners

Similar to how physicians practice evidence-based medicine to treat individual patients, policymakers should govern the public's health according to evidence-based data. Initiated by the World Health Organization's directive to make COVID-19 research open and freely accessible, (1,2) multidisciplinary studies are still published daily. Collectively, policymakers worldwide have not used available data effectively to make noteworthy reductions in the pandemic that is now over a year old. This brief commentary introduces a policy problem, then shares 3 categories of successful case studies as possible solutions: [1] Low- and Middle-Income Countries (LMIC): Vietnam and Iran, (3,4) [2] public health practitioners: social workers in Africa and pharmacists in Zambia, (5,6) and [3] public health programs: a smoking cessation program and inmate health program. (7,8) Examples from LMIC were selected to demonstrate practical, cost-effective and duplicable methods. A collaborative multidisciplinary approach with community health partners is also proposed. (2,9)

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14 Evidence based medicine in low-middle income countries; online or face-to-face teaching method?

10.1136/bmjebm-2018-111024.14 ◽

2018 ◽

Author(s):

Iman El Sayed ◽

Sherif Abdelmonem

Keyword(s):

Evidence Based Medicine ◽

Teaching Method ◽

Evidence Based ◽

Middle Income ◽

Face To Face ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Based Medicine

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Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review

Health Policy and Planning ◽

10.1093/heapol/czaa122 ◽

2020 ◽

Vol 35 (Supplement_2) ◽

pp. ii47-ii65

Author(s):

Kimberly Peven ◽

Debra Bick ◽

Edward Purssell ◽

Torill Alise Rotevatn ◽

Jane Hyldgaard Nielsen ◽

...

Keyword(s):

Systematic Review ◽

Implementation Research ◽

Newborn Care ◽

Implementation Strategies ◽

Community Based ◽

Essential Newborn Care ◽

Middle Income ◽

Middle Income Countries ◽

Implementation Outcomes ◽

Low Middle Income Countries

Abstract Neonatal mortality remains a significant health problem in low-income settings. Low-cost essential newborn care (ENC) interventions with proven efficacy and cost-effectiveness exist but have not reached high coverage (≥90%). Little is known about the strategies used to implement these interventions or how they relate to improved coverage. We conducted a systematic review of implementation strategies and implementation outcomes for ENC in low- and low middle-income countries capturing evidence from five medical and global health databases from 1990 to 2018. We included studies of implementation of delayed cord clamping, immediate drying, skin-to-skin contact (SSC) and/or early initiation of breastfeeding implemented in the first hour (facility-based studies) or the 1st day (community-based studies) of life. Implementation strategies and outcomes were categorized according to published frameworks: Expert Recommendations for Implementing Change and Outcomes for Implementation Research. The relationship between implementation strategies and outcomes was evaluated using standardized mean differences and correlation coefficients. Forty-three papers met inclusion criteria. Interventions included community-based care/health promotion and facility-based support and health care provider training. Included studies used 3–31 implementation strategies, though the consistency with which strategies were applied was variable. Conduct educational meetings was the most frequently used strategy. Included studies reported 1–4 implementation outcomes with coverage reported most frequently. Heterogeneity was high and no statistically significant association was found between the number of implementation strategies used and coverage of ENC. This review highlights several challenges in learning from implementation of ENC in low- and low middle-income countries, particularly poor description of interventions and implementation outcomes. We recommend use of UK Medical Research Council guidelines (2015) for process evaluations and checklists for reporting implementation studies. Improved reporting of implementation research in this setting is necessary to learn how to improve service delivery and outcomes and thereby reduce neonatal mortality.

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Service transformation plans in the Eastern Cape informed by a needs-based gap analysis

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v21i2.823 ◽

2015 ◽

Vol 21 (2) ◽

pp. 5

Author(s):

Kiran Sukeri ◽

Orlando Alonso-Betancourt ◽

Robin Emsley

Keyword(s):

Mental Health ◽

Health Services ◽

Human Resource ◽

Gap Analysis ◽

Evidence Based ◽

Eastern Cape ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

The World

Objectives. Part I of this research paper presented a needs and gap analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape Province, South Africa. It identified deficits and inequitable distribution of human resources and beds in the province. In this article, Part II, the authors propose a plan for public sector mental health services to address the human resource needs in the poorer eastern regions of the province. The plan focuses on human resource training and development. Methods. Evidence-based data on staff development in mental health from low-middle income countries were utilised to develop strategies to increase staff capacity to address unmet need. A financing model with a poverty index was developed to sustain a needs-based plan. Databases searched included Pubmed, Medline, Google and Google Scholar. The key words used included: mental health, mental health training, mental health resources, mental health in low-middle-income countries, mental health policy and plans, mental health needs- based planning, primary healthcare, primary mental healthcare, mental health financing. In addition the websites of the World Health Organization and the World Psychiatric Association were searched for similar resources.Conclusions. It is feasible, with careful attention to planning and implementation of evidence-based tools, to improve public mental health service delivery in this province. Sustained political will and professional commitment will ensure successful delivery of mental health services in a resource-limited province.

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