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Lancet (London, England) May 2023A package of care for all pregnant women within eight scheduled antenatal care contacts is recommended by WHO. Some interventions for reducing and managing the outcomes... (Review)
Review
A package of care for all pregnant women within eight scheduled antenatal care contacts is recommended by WHO. Some interventions for reducing and managing the outcomes for small vulnerable newborns (SVNs) exist within the WHO package and need to be more fully implemented, but additional effective measures are needed. We summarise evidence-based antenatal and intrapartum interventions (up to and including clamping the umbilical cord) to prevent vulnerable births or improve outcomes, informed by systematic reviews. We estimate, using the Lives Saved Tool, that eight proven preventive interventions (multiple micronutrient supplementation, balanced protein and energy supplementation, low-dose aspirin, progesterone provided vaginally, education for smoking cessation, malaria prevention, treatment of asymptomatic bacteriuria, and treatment of syphilis), if fully implemented in 81 low-income and middle-income countries, could prevent 5·202 million SVN births (sensitivity bounds 2·398-7·903) and 0·566 million stillbirths (0·208-0·754) per year. These interventions, along with two that can reduce the complications of preterm (<37 weeks' gestation) births (antenatal corticosteroids and delayed cord clamping), could avert 0·476 million neonatal deaths (0·181-0·676) per year. If further research substantiates the preventive effect of three additional interventions (supplementation with omega-3 fatty acids, calcium, and zinc) on SVN births, about 8·369 million SVN births (2·398-13·857) and 0·652 million neonatal deaths (0·181-0·917) could be avoided per year. Scaling up the eight proven interventions and two intrapartum interventions would cost about US$1·1 billion in 2030 and the potential interventions would cost an additional $3·0 billion. Implementation of antenatal care recommendations is urgent and should include all interventions that have proven effects on SVN babies, within the context of access to family planning services and addressing social determinants of health. Attaining high effective coverage with these interventions will be necessary to achieve global targets for the reduction of low birthweight births and neonatal mortality, and long-term benefits on growth and human capital.
Topics: Infant; Pregnancy; Infant, Newborn; Female; Humans; Perinatal Death; Incidence; Prenatal Care; Stillbirth; Parturition
PubMed: 37167988
DOI: 10.1016/S0140-6736(23)00355-0 -
JAMA Network Open Oct 2022Although child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to...
IMPORTANCE
Although child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to sub-Saharan Africa and Southern Asia. Tailored and innovative approaches are needed to increase access, coverage, and quality of child health care services to reduce mortality, but an understanding of health system deficiencies that may have the greatest impact on mortality among children younger than 5 years is lacking.
OBJECTIVE
To investigate which health care and public health improvements could have prevented the most stillbirths and deaths in children younger than 5 years using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used longitudinal, population-based, and mortality surveillance data collected by CHAMPS to understand preventable causes of death. Overall, 3390 eligible deaths across all 7 CHAMPS sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) between December 9, 2016, and December 31, 2021 (1190 stillbirths, 1340 neonatal deaths, 860 infant and child deaths), were included. Deaths were investigated using minimally invasive tissue sampling (MITS), a postmortem approach using biopsy needles for sampling key organs and fluids.
MAIN OUTCOMES AND MEASURES
For each death, an expert multidisciplinary panel reviewed case data to determine the plausible pathway and causes of death. If the death was deemed preventable, the panel identified which of 10 predetermined health system gaps could have prevented the death. The health system improvements that could have prevented the most deaths were evaluated for each age group: stillbirths, neonatal deaths (aged <28 days), and infant and child deaths (aged 1 month to <5 years).
RESULTS
Of 3390 deaths, 1505 (44.4%) were female and 1880 (55.5%) were male; sex was not recorded for 5 deaths. Of all deaths, 3045 (89.8%) occurred in a healthcare facility and 344 (11.9%) in the community. Overall, 2607 (76.9%) were deemed potentially preventable: 883 of 1190 stillbirths (74.2%), 1010 of 1340 neonatal deaths (75.4%), and 714 of 860 infant and child deaths (83.0%). Recommended measures to prevent deaths were improvements in antenatal and obstetric care (recommended for 588 of 1190 stillbirths [49.4%], 496 of 1340 neonatal deaths [37.0%]), clinical management and quality of care (stillbirths, 280 [23.5%]; neonates, 498 [37.2%]; infants and children, 393 of 860 [45.7%]), health-seeking behavior (infants and children, 237 [27.6%]), and health education (infants and children, 262 [30.5%]).
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, interventions prioritizing antenatal, intrapartum, and postnatal care could have prevented the most deaths among children younger than 5 years because 75% of deaths among children younger than 5 were stillbirths and neonatal deaths. Measures to reduce mortality in this population should prioritize improving existing systems, such as better access to antenatal care, implementation of standardized clinical protocols, and public education campaigns.
Topics: Infant; Infant, Newborn; Female; Child; Male; Humans; Pregnancy; Child, Preschool; Child Mortality; Stillbirth; Perinatal Death; Cause of Death; Cross-Sectional Studies; Delivery of Health Care
PubMed: 36269354
DOI: 10.1001/jamanetworkopen.2022.37689 -
International Journal of Gynaecology... Aug 2022To analyze implementation of the maternal and neonatal death surveillance and response (MNDSR) strategy in Burundi.
OBJECTIVE
To analyze implementation of the maternal and neonatal death surveillance and response (MNDSR) strategy in Burundi.
METHODS
Secondary data analysis using a qualitative approach and document review. The qualitative approach consisted of semistructured interviews with decision-makers at central, regional, and district levels, health providers, and technical and financial partners using four interview guides and a data extraction tool. Document review utilized maternal death review reports and policy documents. Interviews and hospital visits took place from July 16-26, 2017, in Bujumbura and Gitega, Burundi.
RESULTS
Notification of maternal deaths is incorporated into the Integrated Disease Surveillance and Response (IDSR) system. Maternal death review committees existed in the five visited hospitals (Prince Regent Charles Hospital and Kamenge University Hospital in Bujumbura, Gitega Regional Hospital, Kibimba District Hospital, and Kibuye District Hospital) but not at subnational level (provincial or district levels). Since the beginning of 2017, maternal death review has been effective and regular in some district and regional hospitals due to integration of quality-of-care criteria for the performance-based financing strategy; review has been less effective at national hospital level. Implementation of review recommendations is heterogeneous and varies from one health facility to another. No formal follow-up mechanism on review recommendations was identified. Notification and review of neonatal deaths does not occur, nor does notification of maternal or neonatal deaths at community level.
CONCLUSION
Despite integration of notification of maternal deaths into IDSR, efforts must be undertaken to scale up MNDSR to include neonatal deaths and maternal and neonatal deaths at community level.
Topics: Burundi; Female; Health Facilities; Humans; Infant, Newborn; Maternal Death; Maternal Mortality; Perinatal Death
PubMed: 35322418
DOI: 10.1002/ijgo.14151 -
Europace : European Pacing,... Nov 2022Most patients who receive implantable cardioverter defibrillators (ICDs) for primary prevention do not receive therapy during the lifespan of the ICD, whilst up to 50%...
AIMS
Most patients who receive implantable cardioverter defibrillators (ICDs) for primary prevention do not receive therapy during the lifespan of the ICD, whilst up to 50% of sudden cardiac death (SCD) occur in individuals who are considered low risk by conventional criteria. Machine learning offers a novel approach to risk stratification for ICD assignment.
METHODS AND RESULTS
Systematic search was performed in MEDLINE, Embase, Emcare, CINAHL, Cochrane Library, OpenGrey, MedrXiv, arXiv, Scopus, and Web of Science. Studies modelling SCD risk prediction within days to years using machine learning were eligible for inclusion. Transparency and quality of reporting (TRIPOD) and risk of bias (PROBAST) were assessed. A total of 4356 studies were screened with 11 meeting the inclusion criteria with heterogeneous populations, methods, and outcome measures preventing meta-analysis. The study size ranged from 122 to 124 097 participants. Input data sources included demographic, clinical, electrocardiogram, electrophysiological, imaging, and genetic data ranging from 4 to 72 variables per model. The most common outcome metric reported was the area under the receiver operator characteristic (n = 7) ranging between 0.71 and 0.96. In six studies comparing machine learning models and regression, machine learning improved performance in five. No studies adhered to a reporting standard. Five of the papers were at high risk of bias.
CONCLUSION
Machine learning for SCD prediction has been under-applied and incorrectly implemented but is ripe for future investigation. It may have some incremental utility in predicting SCD over traditional models. The development of reporting standards for machine learning is required to improve the quality of evidence reporting in the field.
Topics: Humans; Death, Sudden, Cardiac; Defibrillators, Implantable; Electrocardiography; Machine Learning
PubMed: 36201237
DOI: 10.1093/europace/euac135 -
South Dakota Medicine : the Journal of... Jan 2021Between 2015 and 2019, the total number of births in South Dakota declined by 7 percent. As infant mortality rates are calculated per 1,000 live births, slight increases...
Between 2015 and 2019, the total number of births in South Dakota declined by 7 percent. As infant mortality rates are calculated per 1,000 live births, slight increases or decreases in total deaths and deaths due to specific causes manifest in notable shifts in yearly infant mortality rates (IMR). In 2019, 10 more infants died than in 2018 (80 vs. 70). With the decline in the state's births, the IMR increased from 5.9 to 6.7, which is significantly higher than the U.S. rate of 5.7 for 2018. South Dakota's 2019 increase in births of very low birth weight infants and deaths due to congenital anomalies contributed to this increase in mortality. In South Dakota, between 2015-19, 62 percent of all infant deaths occurred during the first 27 days of life. Though the rate of death for the state's minority infants remains significantly higher than that of its white infants, a decline in the ratio of the minority to white IMR is noted. Further, the rate of death due to sudden unexpected infant death (SUID) remained stable between 2018-19 but there is evidence that increasingly these deaths are caused by accidental suffocation or strangulation in bed which is typically preventable with safe sleeping environments for infants. The interactions between birth weight, incidence, cause, and timing of death are explored in this annual review of infant mortality.
Topics: Birth Rate; Cause of Death; Child; Female; Humans; Infant; Infant Mortality; Pregnancy; South Dakota; Sudden Infant Death
PubMed: 33691050
DOI: No ID Found -
Anatomical Sciences Education Sep 2020The importance of patient-centered decisions is embedded throughout clinical practice. The principle that the patient is at the center of all decisions has helped form...
The importance of patient-centered decisions is embedded throughout clinical practice. The principle that the patient is at the center of all decisions has helped form the contemporary approach to death and dying. The concept of a "good death" will naturally mean different things to different individuals, but is based on the foundation of being pain free, comfortable, and able to make informed decisions. Potential donors are faced with many personal, ethical, and often spiritual considerations when they come to think about their wishes after death. One consideration is that of a "good death." This article explores how the concept of a "good death" may be applied to anatomy. Where first-person consent is in place, the motivating factors frequently include the wish for others to learn from the donation, and this notion may form part of the "good death" for the donor. Such motivations may impact positively on how students feel about dissecting and may provide comfort, assuaging feelings of discomfort, and allowing students to focus on anatomical learning. For donors where second-person consent is in place, the concept of a "good death" must depend on whether the individual wanted to donate their body in the first instance. The notion of a "bad death" may also be considered with body donation where no consent for donation is in place. This article proposes that there is ultimately a place for the concept that a "good death" may involve an individual donating their body to medical education.
Topics: Advance Directives; Anatomy; Cadaver; Death; Humans; Tissue Donors
PubMed: 32364328
DOI: 10.1002/ase.1969 -
European Heart Journal Mar 2022Sudden cardiac death (SCD) is a tragic incident accountable for up to 50% of deaths from cardiovascular disease. Sports-related SCD (SrSCD) is a phenomenon which has... (Review)
Review
Sudden cardiac death (SCD) is a tragic incident accountable for up to 50% of deaths from cardiovascular disease. Sports-related SCD (SrSCD) is a phenomenon which has previously been associated with both competitive and recreational sport activities. SrSCD has been found to occur 5-33-fold less frequently in women than in men, and the sex difference persists despite a rapid increase in female participation in sports. Establishing the reasons behind this difference could pinpoint targets for improved prevention of SrSCD. Therefore, this review summarizes existing knowledge on epidemiology, characteristics, and causes of SrSCD in females, and elaborates on proposed mechanisms behind the sex differences. Although literature concerning the aetiology of SrSCD in females is limited, proposed mechanisms include sex-specific variations in hormones, blood pressure, autonomic tone, and the presentation of acute coronary syndromes. Consequently, these biological differences impact the degree of cardiac hypertrophy, dilation, right ventricular remodelling, myocardial fibrosis, and coronary atherosclerosis, and thereby the occurrence of ventricular arrhythmias in male and female athletes associated with short- and long-term exercise. Finally, cardiac examinations such as electrocardiograms and echocardiography are useful tools allowing easy differentiation between physiological and pathological cardiac adaptations following exercise in women. However, as a significant proportion of SrSCD causes in women are non-structural or unexplained after autopsy, channelopathies may play an important role, encouraging attention to prodromal symptoms and family history. These findings will aid in the identification of females at high risk of SrSCD and development of targeted prevention for female sport participants.
Topics: Adaptation, Physiological; Athletes; Death, Sudden, Cardiac; Female; Humans; Incidence; Male; Sports
PubMed: 34894223
DOI: 10.1093/eurheartj/ehab833 -
Autonomic Neuroscience : Basic &... Jul 2022
Topics: Death, Sudden; Humans; Risk Factors; Sudden Unexpected Death in Epilepsy
PubMed: 35390578
DOI: 10.1016/j.autneu.2022.102982 -
Seminars in Neurology Oct 2022Sudden unexpected death in epilepsy (SUDEP) is a tragic and unexpected cause of death in patients with a known diagnosis of epilepsy. It occurs in up to 6.3 to 9.3/1,000...
Sudden unexpected death in epilepsy (SUDEP) is a tragic and unexpected cause of death in patients with a known diagnosis of epilepsy. It occurs in up to 6.3 to 9.3/1,000 patients with drug-resistant epilepsy. The main three risk factors associated with SUDEP are the presence of generalized tonic-clonic seizures, the presence of a seizure in the past year, and an intellectual disability. There are several mechanisms that can result in SUDEP. The most likely sequence of events appears to be a convulsive seizure, overactivation of the autonomic nervous system, cardiorespiratory dysfunction, and death. While the risk of SUDEP is relatively high in patients with drug-resistant epilepsy, studies indicate that more than 50% of patients and caregivers are unaware of the diagnosis. Counseling about the diagnosis and preventative measures at the time of diagnosis is important. There are numerous interventions that may reduce the risk of SUDEP, including conservative measures such as nocturnal surveillance with a bed partner (where applicable) and automated devices. Optimizing seizure control with antiseizure medications and surgical interventions can result in a reduced risk of SUDEP.
Topics: Humans; Sudden Unexpected Death in Epilepsy; Death, Sudden; Epilepsy; Seizures; Risk Factors; Drug Resistant Epilepsy
PubMed: 36223819
DOI: 10.1055/a-1960-1355 -
Obstetrics and Gynecology Jun 2023To describe the clinical profile, management, and potential preventability of maternal cardiovascular deaths.
OBJECTIVE
To describe the clinical profile, management, and potential preventability of maternal cardiovascular deaths.
METHODS
We conducted a retrospective, descriptive study of all maternal deaths resulting from a cardiovascular disease during pregnancy or up to 1 year after the end of pregnancy in France from 2007 to 2015. Deaths were identified through the nationwide permanent enhanced maternal mortality surveillance system (ENCMM [Enquête Nationale Confidentielle sur les Morts Maternelles]). Women were classified into four groups based on the assessment of the national experts committee: those who died of a cardiac condition and those who died of a vascular condition and, within these two groups, whether the condition was known before the acute event. Maternal characteristics, clinical features and components of suboptimal care, and preventability factors, which were assessed with a standard evaluation form, were described among those four groups.
RESULTS
During the 9-year period, 103 women died of cardiac or vascular disease, which corresponds to a maternal mortality ratio from these conditions of 1.4 per 100,000 live births (95% CI 1.1-1.7). Analyses were conducted on 93 maternal deaths resulting from cardiac (n=70) and vascular (n=23) disease with available data from confidential inquiry. More than two thirds of these deaths occurred in women with no known pre-existing cardiac or vascular condition. Among the 70 deaths resulting from a cardiac condition, 60.7% were preventable, and the main preventability factor was a lack of multidisciplinary prepregnancy and prenatal care for women with a known cardiac disease. For those with no known pre-existing cardiac condition, preventability factors were related mostly to inadequate prehospital care of the acute event, in particular an underestimation of the severity and inadequate investigation of the dyspnea. Among the 23 women who died of a vascular disease, three had previously known conditions. For women with no previously known vascular condition, 47.4% of deaths were preventable, and preventability factors were related mostly to wrong or delayed diagnosis and management of acute intense chest or abdominal pain in a pregnant woman.
CONCLUSION
Most maternal deaths attributable to cardiac or vascular diseases were potentially preventable. The preventability factors varied according to the cardiac or vascular site and whether the condition was known before pregnancy. A more granular understanding of the cause and related risk factors for maternal mortality is crucial to identify relevant opportunities for improving care and training health care professionals.
Topics: Pregnancy; Female; Humans; Maternal Death; Maternal Mortality; Retrospective Studies; Prenatal Care; Vascular Diseases; Cause of Death; Pregnancy Complications
PubMed: 37141627
DOI: 10.1097/AOG.0000000000005176