Impact of the early COVID-19 pandemic on outcomes in a rural Ugandan neonatal unit: A retrospective cohort study

Background During the early COVID-19 pandemic travel in Uganda was tightly restricted which affected demand for and access to care for pregnant women and small and sick newborns. In this study we describe changes to neonatal outcomes in one rural central Ugandan newborn unit before and during the early phase of the COVID-19 pandemic. Methods We report outcomes from admissions captured in an electronic dataset of a well-established newborn unit before (September 2019 to March 2020) and during the early COVID-19 period (April–September 2020) as well as two seasonally matched periods one year prior. We report excess mortality as the percent change in mortality over what was expected based on seasonal trends. Findings The study included 2,494 patients, 567 of whom were admitted during the early COVID-19 period. During the pandemic admissions decreased by 14%. Patients born outside the facility were older on admission than previously (median 1 day of age vs. admission on the day of birth). There was an increase in admissions with birth asphyxia (22% vs. 15% of patients). Mortality was higher during COVID-19 than previously [16% vs. 11%, p = 0.017]. Patients born outside the facility had a relative increase of 55% above seasonal expected mortality (21% vs. 14%, p = 0.028). During this period patients had decreased antenatal care, restricted transport and difficulty with expenses and support. The hospital had difficulty with maternity staffing and supplies. There was significant community and staff fear of COVID-19. Interpretation Increased newborn mortality during the early COVID-19 pandemic at this facility was likely attributed to disruptions affecting maternal and newborn demand for, access to and quality of perinatal healthcare. Lockdown conditions and restrictions to public transit were significant barriers to maternal and newborn wellbeing, and require further focus by national and regional health officials.

Zooming in and Out: A Holistic Framework for Research on Maternal, Late Fetal, and Newborn Survival and Health

Research is needed to understand why some countries succeed in greater improvements maternal, late fetal and newborn health and reducing mortality than others. Pathways towards these health outcomes operate at many levels, making it difficult to understand which factors contribute most to these health improvements. Conceptual frameworks provide a cognitive means of rendering order to these factors, and how they interrelate to positively influence maternal, late fetal and newborn health. We developed a conceptual framework by integrating theories and frameworks from different disciplines to encapsulate the range of factors that explain reductions in maternal, late fetal and newborn mortality and improvements in health. We developed our framework iteratively, combining our interdisciplinary research team’s knowledge, experience, and review of the literature. We present a framework that includes health policy and systems levers (or intentional actions that policy makers can implement) to improve maternal, late fetal and newborn health; service delivery and coverage of interventions across the continuum of care, and epidemiological and behavioural risk factors. The framework also considers the role of context in influencing for whom and where health and non-health efforts have the most impact, to recognise ‘the causes of the causes’ at play at the individual/household, community, national and transnational levels. Our framework holistically reflects the range of interrelated factors influencing improved maternal, late fetal and newborn health and survival. The framework lends itself to studying how different factors work together to influence these outcomes using an array of methods. Such research should inform future efforts to improve maternal, late fetal and newborn health and survival in different contexts. By re-orienting research in this way, we hope to equip policymakers and practitioners alike with the insight necessary to make the world a safer and fairer place for mothers and their babies.

An analysis of the impact of newborn survival policies in Pakistan using a policy triangle framework

Introduction Pakistan has made slow progress towards reducing the newborn mortality burden; as a result, it has the highest burden of newborn mortality worldwide. This article presents an analysis of the current policies, plans, and strategies aimed at reducing the burden of newborn death in Pakistan for the purpose of identifying current policy gaps and contextual barriers towards proposing policy solutions for improved newborn health. Methods We begin with a content analysis of federal-level policies that address newborn mortality within the context of health system decentralization over the last 20 years. This is then followed by a case study analysis of policy and programme responses in a predominantly rural province of Pakistan, again within the context of broader health system decentralization. Finally, we review successful policies in comparable countries to identify feasible and effective policy choices that hold promise for implementation in Pakistan, considering the policy constraints we have identified. Results The major health policies aimed at reduction of newborn mortality, following Pakistan’s endorsement of global newborn survival goals and targets, lacked time-bound targets. We found confusion around roles and responsibilities of institutions in the implementation process and accountability for the outcomes, which was exacerbated by an incomplete decentralization of healthcare policy-making and health service delivery, particularly for women around birth, and newborns. Such wide gaps in the areas of target-setting, implementation mechanism, and evaluation could be because the policy-making largely ignored international commitments and lessons of successful policy-making in comparable regional counties. Conclusions Inclusion of clear goals and targets in newborn survival policies and plans, completion of the decentralization process of maternal and child healthcare service delivery, and policy-making and implementation by translating complex evidence and using regional but locally applicable case studies will be essential to any effective policy-making on newborn survival in Pakistan.

The Correlation Between Early Breastfeeding Initiation with The Increase of Newborn’s Body Temperature at Rumah Sehat Cinta Mama Clinic of Tebing Tinggi City in 2017

Newborn mortality in Indonesia at 5 years ago is concern because neonatal mortality (0-28 days) contributes 59% of infant deaths. To address this, early initiation breastfeeding management in field of maternal and child health is increasingly encouraged in order to reduce newborn mortality. Newborns often suffer decrease in body temperature, this due to inability newborn maintain body temperature, for baby's body temperature to remain normal than early breastfeeding initiation is one effort to keep baby's body warm. The purpose of this study to determine the relationship of early breastfeeding initiation with the increase newborns body temperature in Rumah Sehat Cinta Mama Clinic Tebing Tinggi City 2017. The method of this research was quasi eksperiment with one group pretest posttest design, using primary data that direct observation to respondent. The sampling technique is total sampling its all pregnant women who have interpretations of the birth date in April - July 2017 of 30 respondents. The reasult of this research has been showing that of statistic sample pired test which a significant association between early breastfeeding initiation and the increase in body temperature of newborns (? value = 0,000 <0.05). Expected to the Rumah Sehat Cinta Mama Clinic, especially midwife health personnel to improve the quality and quantity of early breastfeeding initiation and involve the husband or family to support implementation of early breastfeeding initiation so as to reduce the newborn mortality rate and the achievement the target of Infant Baby Mortality Rate which the Ministry of Health has established.

Mediation role of low birth weight on the factors associated with newborn mortality and the moderation role of institutional delivery in the association of low birth weight with newborn mortality in a resource-poor setting

ObjectivesTo assess low birth weight’s (LBW) mediation role on the factors associated with newborn mortality (NM), including stillbirth and the role of institutional delivery in the association between LBW and NM.Design and participantsI used the 2011–2015 event histories health demographic data collected by Iganga-Mayuge Health Demographic and Surveillance Site (HDSS). The dataset consisted of 10 758 registered women whose birth occurred at least 22 weeks of the gestation period and records of newborns’ living status 28 days after delivery.SettingThe Iganga-Mayuge HDSS is in Eastern Uganda, which routinely collects health and demographic data from a registered population of at least 100 000 people.Outcome measureThe study’s key outcomes or endogenous factors were perinatal mortality (PM), late NM and LBW (mediating factor).ResultsThe factors that were directly associated with PM were LBW (OR=2.55, 95% CI 1.15 to 5.67)), maternal age of 30+ years (OR=1.68, 95% CI 1.21 to 2.33), rural residence (OR=1.38, 95% CI 1.02 to 1.85), mothers with previous experience of NM (OR=3.95, 95% CI 2.86 to 5.46) and mothers with no education level (OR=1.63, 95% CI 1.21 to 2.18). Multiple births and mother’s prior experience of NM were positively associated with NM at a later age. Institutional delivery had a modest inverse role in the association of LBW with PM. LBW mediated the association of PM with residence status, mothers’ previous NM experience, multiple births, adolescent mothers and mothers’ marital status. Of the total effect attributable to each of these factors, LBW mediated +25%, +22%, +100%, 25% and −38% of rural resident mothers, mothers with previous experience of newborn or pregnancy loss, multiple births, adolescent mothers and mothers with partners, respectively.ConclusionLBW mediated multiple factors in the NM pathways, and the effect of institutional delivery in reducing mortality among LBW newborns was insignificant. The findings demonstrate the need for a holistic life course approach that gears the health systems to tackle NM.

Incidence and Determinants of Newborn Mortality in the First Three Days of Delivery in Northwestern Ethiopia: A Prospective Cohort Study

Background: Addressing the target of sustainable development goals of reducing perinatal mortality was still a global challenge, and it is a concern in Ethiopia. Therefore, this study planned to determine the incidence and determinants of neonatal mortality in the first three days among babies delivered in Amhara Regional State’s referral hospitals. Methods: A hospital-based prospective cohort study design was conducted among 810 neonates in the first three days of delivery between March 1 and August 30, 2018. The neonates were followed, starting from the time of admission to 72 hours. An interviewer-administered questionnaire and medical record review were conducted for data collection. Data were entered into Epi-data manager version 4.4 and analyzed using STATA™ version 16.0 for the analysis. Cox-Proportional hazard model was used to determine the survival time of the newborns. Results: The overall incidence of newborn mortality in this study was 151/1,000 births. Neonatal mortality was significantly high among newborns whose mothers came between 17 and 28 weeks of gestation for the first visit; among those whose mothers labour was not monitored with a partograph, mothers experience postpartum haemorrhage, develop fistula in the first 24 hours, and experience obstructed labour. However, 39% were less risky among newborns whose mothers were directly admitted and whose mothers had visited health facilities in less than 1-hour, both. Conclusions: This study revealed that about 1 in 7 newborns died in the early three days of life. Timing of the first antenatal visit, quality of labour monitoring, maternal complications, and delay in seeking the care were the determinants. Thus, scaling-up of evidence-based interventions and harmonized efforts to improve antenatal care quality, promote institutional deliveries, provide optimal essential and emergency obstetric care, and ensure immediate postnatal care may improve neonatal survival.

Kebijakan Partisipatif Pemerintah dalam Rangka memenuhi Visi Terwujudnya Kabupaten Pasuruan yang Sejahtera, Maslahat dan Berdaya Saing

One of the objectives of the state being established is to protect life and advance the welfare of the nation, so the government is obliged to help fulfill the basic rights of society. The high mortality rate for mothers and newborns is not just a matter of fate, but something that is done by humans. The maternal and newborn mortality rate in Indonesia is the highest compared to other countries in ASEAN. In response to this, the Pasuruan Regency Government responded by making a policy in the form of the establishment of the Penakib Forum which has a vision to make Pasuruan district a safe, safe and pleasant place for every pregnant woman. and newborns. This forum consists of all cross-sectoral components, namely consisting of the health office, referral hospitals, puskesmas, village midwives, health cadres, and community organizations in Pasuruan Regency. This vision is in accordance with the regional medium-term development plan (RPJMD) for 2018 - 2023 which carries the vision "The realization of a Prosperous, Maslahat and competitive Pasuruan Regency". ______________________________________________________________________ Negara didirikan salah satu tujuannya adalah untuk melindungi kehidupan dan memajukan kesejahteraan bangsa, maka pemerintah berkewajiban membantu memenuhi hak-hak dasar dasar masyarakat. Tingginya angka kematian ibu dan bayi baru lahir bukan sekedar bicara takdir, namun ada suatu kesalahan yang dilakukan oleh manusia. Angka kematian ibu dan bayi baru lahir di Indonesia tertinggi dibandingkan dengan negaralain di ASEAN.menganggapi hal tersebut Pemerintah Kabupaten Pasuruan merespon dengan membuat kebijakan dalam bentuk pendirian Forum penakib yang memiliki visi untuk mewujudkan Kabupaten Pasuruan menjadi tempat yang aman, selamat dan menyenangkan bagi setiap ibu hamil dan bayi baru lahir. Forum ini terdiri dari seluruh komponen lintas sektoral, yaitu terdiri dari dinas kesehatan, rumah sakit rujukan, puskesmas, bidan desa, kader kesehatan, serta organisasi masyarakat yang ada di Kabupaten Pasuruan. Visi ini sesuai dengan rencana pembangunan jangka menengah daerah (RPJMD) tahun 2018 - 2023 yang mengusung Visi “ Terwujudnya Kabupaten Pasuruan yang Sejahtera, Maslahat dan berdaya saing”.

271 Maternal transfer of phytogenic compounds supplemented during gestation and/or lactation of hyperprolific sows: effects on reproductive performance and colostrum-milk features

Improvement on litter size in hyperprolific sows has decreased piglet’s birthweight and increased newborn mortality. Besides, no significant changes have been reported on the sow colostrum-milk composition. Phytogenic compounds (PC) are phytochemicals that may promote swine health and performance. This study aims to evaluate the effects of PC maternal transfer on reproductive and litter performance, and sows colostrum-milk features. Eighty-one hyperprolific sows were assigned to 3 treatments. Control sows were unsupplemented, whereas treated sows were offered supplemented diets with 1 g/kg of a blend of PC (BPC) during gestation and lactation (GL), or only lactation (L). Maternal transfer of PC into the amniotic fluid and milk were determined by using gas chromatography and mass spectrometry. Farrowing and litter performance were monitored. Moreover, the colostrum and milk composition, and milk inhibitory activity against Bacillus subtilis, Escherichia coli, Staphylococcus aureus, Lactobacillus plantarum, and Candida albicans were determined. Data were analyzed with ANOVA by using the MIXED procedure of SAS, while, Fisher test for milk bacteriostatic activity was performed. Thymol, anethole, linalool, and eucalyptol were transferred via amniotic liquid, whereas, p-cymene, thymol, and anethole were also transferred into the milk (P &lt; 0.05). No differences (P &gt; 0.05) were observed on number of total born piglets (C 17.14, L 17.75, and GL 19.16). However, BPC supplementation increased (P = 0.007) the piglets born alive (C 14.53, L 15.33, and GL 17.60), while reduced (P = 0.031) the newborn piglets BW. Colostrum protein in GL and milk fat contents in L and GL (Table 1) were increased (P &lt; 0.05). Milk of GL showed inhibitory activity (P &lt; 0.05) against Bacillus subtilis and Staphylococcus aureus. In conclusion, dietary BPC supplementation during gestation and/or lactation increased the number of piglets born alive, enhanced both the colostrum-milk composition, and the milk inhibitory activity against well-known pathogens.