Browsing by Author "Lawn, Joy E."

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    Barriers And Enablers To Reporting Pregnancy And Adverse Pregnancy Outcomes In Population-Based Surveys: ENINDEPTH Study
    (Population health metrics, 2021) Kwesiga, Doris; Tawiah, Charlotte; Imam, Ali; Tesega, Adane Kebede; Nareeba, Tryphena; Enuameh, Yeetey A. K.; Biks, Gashaw A.; Manu, Grace; Beedle, Alexandra; Delwa, Nafisa; Fisker, Ane B.; Waiswa, Peter; Lawn, Joy E.; Blencow, Hannah
    Risks of neonatal death, stillbirth and miscarriage are highest in low- and middle-income countries (LMICs), where data has most gaps and estimates rely on household surveys, dependent on women reporting these events. Underreporting of pregnancy and adverse pregnancy outcomes (APOs) is common, but few studies have investigated barriers to reporting these in LMICs. The EN-INDEPTH multi-country study applied qualitative approaches to explore barriers and enablers to reporting pregnancy and APOs in surveys, including individual, community, cultural and interview level factors.
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    Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial
    (Informa UK Limited, 2015-03-31) Waiswa, Peter; Pariyo, George; Kallander, Karin; Akuze, Joseph; Namazzi, Gertrude; Ekirapa-Kiracho, Elizabeth; Kerber, Kate; Sengendo, Hanifah; Aliganyira, Patrick; Lawn, Joy E.; Peterson, Stefan
    Background Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. Objective To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. Design The Uganda Newborn Study (UNEST) was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs) were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth) to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care). Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. Results The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively). Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively). Half (49.6%) of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in the control arm (p<0.001). Dry umbilical cord care was also significantly higher in intervention areas (63.9% vs. 53.1%, p<0.001). There was no difference in care-seeking for newborn illness, which was high (around 95%) in both arms. Skilled attendance at delivery increased in both the intervention (by 21%) and control arms (by 19%) between baseline and endline, but there was no significant difference in coverage across arms at endline (79.6% vs. 78.9%; p=0.717). Home visits were pro-poor, with more women in the poorest quintile visited by a CHW compared to families in the least poor quintile, and more women who delivered at home visited by a CHW after birth (73.6%) compared to those who delivered in a hospital or health facility (59.7%) (p<0.001). CHWs visited 62.8% of women and newborns in the first week after birth, with 40.2% receiving a visit on the critical first day of life. Conclusion Consistent with results from other community newborn care studies, volunteer CHWs can be effective in changing long-standing practices around newborn care. The home visit strategy may provide greater benefit to poorer families. However, CHW strategies require strong linkages with and concurrent improvement of quality through health system strengthening, especially in settings with high and increasing demand for facility-based services.
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    Randomised Comparison Of Two Household Survey Modules For Measuring Stillbirths And Neonatal Deaths In Five Countries: The Every Newborn-INDEPTH Study
    (The Lancet Global Healt, 2020) Akuze, Joseph; Blencowe, Hannah; Waiswa, Peter; Baschieri, Angela; Gordeev, Vladimir S; Kwesiga, Doris; Fisker, Ane B.; Thysen, Sanne M.; Rodrigues, Amabelia; Biks, Gashaw A.; Abebe, Solomon M.; Gelaye, Kassahun A.; Mengistu, Mezgebu Y.; Geremew, Bisrat M.; Delele, Tadesse G.; Tesega, Adane K.; Yitayew, Temesgen A.; Kasasa, Simon; Galiwango, Edward; Natukwatsa, Davis; Kajungu, Dan; Enuameh, Yeetey A.K.; Nettey, Obed E.; Dzabeng, Francis; Amenga-Etego, Seeba; Newton, Sam K.; Tawiah, Charlotte; Asante, Kwaku P.; Owusu-Agyei, Seth; Alam, Nurul; Haider, Moinuddin M.; Imam, Ali; Mahmud, Kaiser; Cousens, Simon; Lawn, Joy E.
    An estimated 5·1 million stillbirths and neonatal deaths occur annually. Household surveys, most notably the Demographic and Health Survey (DHS), run in more than 90 countries and are the main data source from the highest burden regions, but data-quality concerns remain. We aimed to compare two questionnaires: a full birth history module with additional questions on pregnancy losses (FBH+; the current DHS standard) and a full pregnancy history module (FPH), which collects information on all livebirths, stillbirths, miscarriages, and neonatal deaths.
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    Sub-Saharan Africa’s Mothers, Newborns, and Children: Where and Why Do They Die?
    (PLoS medicine, 2010) Kinney, Mary V.; Kerber, Kate J.; Black, Robert E.; Cohen, Barney; Nkrumah, Francis; Coovadia, Hoosen; Nampala, Paul Michael; Lawn, Joy E.
    This paper is part of a PLoS Medicine series on maternal, newborn, and child health in Africa. Nearly 4.7 million mothers, newborns, and children die each year in sub-Saharan Africa: 265,000 mothers die due to complications of pregnancy and childbirth [1]; 1,208,000 babies die before they reach one month of age ; and 3,192,000 children, who survived their first month of life, die before their fifth birthday [1]. This toll of more than 13,000 deaths per day accounts for half of the world’s maternal and child deaths. In addition, an estimated 880,000 babies are stillborn in sub- Saharan Africa and remain invisible on the policy agenda. With only five years left to achieve the United Nation’s Millennium Development Goals (MDGs) for maternal and child health, most African countries in the region are currently unlikely to meet their MDG targets. Since time is short for achieving success, a critical understanding of where and why these deaths occur, and of strategic, data-based prioritization of interventions, are essential to accelerate progress.