International survey on variations in practice of the management of the third stage of labour

OBJECTIVE: To determine the use of the active management of the third stage of labour in 15 university-based obstetric centres in ten developing and developed countries and to determine whether evidence-based practices were being used. METHODS: From March 1999 to December 1999, the Global Network for Perinatal and Reproductive Health (GNPRH) conducted an observational, cross-sectional survey to assess the use of the practice and its components. Prospective data on patient characteristics and the interventions used in the management of the third stage of labour were collected using standardized methods. Data on approximately 30 consecutive vaginal deliveries in each centre (452 in total) were included. FINDINGS: Significant intracountry and intercountry variation in the practice of the active management of the third stage of labour was found (111/452 deliveries used active management), which confirmed the existence of a large gap between knowledge and practice. CONCLUSION: Areas identified for improvement are the urgent implementation of the evidence-based clinical management practice defined as the active management of the third stage of labour; increased accessibility to systematic reviews in developing countries; and the conduction of clinical trials that assess the impact of this intervention in other settings

Evaluation of UNFPA Support to Adolescents and Youth 2008-2015

The purpose of this evaluation is to assess the performance of UNFPA in its support to adolescents and youth during the period 2008-2015. The evaluation aims to facilitate learning, capture good practices and generate knowledge from UNFPA experience across a range of programmatic interventions in support of adolescents and youth. This is a thematic global evaluation and includes all countries in which UNFPA provided support to adolescents and youth between 2008 and 2015, and addresses the country, regional and global levels. The evaluation results will be used to inform the development of the new UNFPA strategic plan and implementation of adolescents and youth interventions within the framework of the 2030 Agenda for Sustainable Development

Evaluation of UNFPA Support to Adolescents and Youth 2008-2015

The purpose of this evaluation is to assess the performance of UNFPA in its support to adolescents and youth during the period 2008-2015. The evaluation aims to facilitate learning, capture good practices and generate knowledge from UNFPA experience across a range of programmatic interventions in support of adolescents and youth. This is a thematic global evaluation and includes all countries in which UNFPA provided support to adolescents and youth between 2008 and 2015, and addresses the country, regional and global levels. The evaluation results will be used to inform the development of the new UNFPA strategic plan and implementation of adolescents and youth interventions within the framework of the 2030 Agenda for Sustainable Development

Tracking maternal mortality declines in Mongolia between 1992 and 2007: the importance of collaboration

OBJECTIVE: To describe the declining trend in maternal mortality observed in Mongolia from 1992 to 2007 and its acceleration after 2001 following implementation of the Maternal Mortality Reduction Strategy by the Ministry of Health and other partners. METHODS: We performed a descriptive analysis of maternal mortality data collected through Mongolia's vital registration system and provided by the Mongolian Ministry of Health. The observed declining mortality trend was analysed for statistical significance using simple linear regression. We present the maternal mortality ratios from 1992 to 2007 by year and review the basic components of Mongolia's Maternal Mortality Reduction Strategy for 2001-2004 and 2005-2010. FINDINGS: Mongolia achieved a statistically significant annual decrease in its maternal mortality ratio of almost 10 deaths per 100 000 live births over the period 1992-2007. From 2001 to 2007, the maternal mortality ratio in Mongolia decreased approximately 47%, from 169 to 89.6 deaths per 100 000 live births. CONCLUSION: Disparities in maternal mortality represent one of the major persisting health inequities between low- and high-resource countries. Nonetheless, important reductions in low-resource settings are possible through collaborative strategies based on a horizontal approach and the coordinated involvement of key partners, including health ministries, national and international agencies and donors, health-care professionals, the media, nongovernmental organizations and the general public

Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity

<div><p>Background</p><p>Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO’s Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael’s Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (<u>G</u>uideline-driven, <u>R</u>esearch priorities, <u>E</u>vidence synthesis, <u>A</u>pplication of evidence, and <u>T</u>ransfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these.</p><p>Methods</p><p>We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers).</p><p>Results</p><p>Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators.</p><p>Conclusion</p><p>This approach to identifying barriers, facilitators and potential strategies for improving implementation proved feasible in these four lower-income country settings. Further evaluation of the impact of implementing these strategies is needed.</p></div

Summary of indicators and guideline implementation research activities and outcomes in four countries.

<p>Summary of indicators and guideline implementation research activities and outcomes in four countries.</p

Knowledge-to-Action Cycle (Reproduced with permission from[38]).

<p>Reprinted from Straus SE, Tetroe J, Graham I. Knowledge translation in health care: moving from evidence to practice. 2nd ed. BMJ Books, Wiley, 2013. under a CC BY license, with permission from Wiley, original copyright 2013.</p