Measuring maternal mortality : an overview of opportunities and options for developing countries

Background:There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015. Methods: Since the launch of the Safe Motherhood Initiative in 1987, new opportunities for data capture have arisen and new methods have been developed, tested and used. This paper provides a pragmatic overview of these methods and the optimal measurement strategies for different developing country contexts. Results: There are significant recent advances in the measurement of maternal mortality, yet also room for further improvement, particularly in assessing the magnitude and direction of biases and their implications for different data uses. Some of the innovations in measurement provide efficient mechanisms for gathering the requisite primary data at a reasonably low cost. No method, however, has zero costs. Investment is needed in measurement strategies for maternal mortality suited to the needs and resources of a country, and which also strengthen the technical capacity to generate and use credible estimates. Conclusion: Ownership of information is necessary for it to be acted upon: what you count is what you do. Difficulties with measurement must not be allowed to discourage efforts to reduce maternal mortality. Countries must be encouraged and enabled to count maternal deaths and act.WJG is funded partially by the University of Aberdeen. OMRC is partially funded by the London School of Hygiene and Tropical Medicine. CS and SA are partially funded by Johns Hopkins University. CAZ is funded by the Health Metrics Network at the World Health Organization. WJG, OMRC, CS and SA are also partially supported through an international research program, Immpact, funded by the Bill & Melinda Gates Foundation, the Department for International Development, the European Commission and USAID

Establishing a children’s orthopaedic hospital for Malawi: A review after 10 years

BackgroundBEIT CURE International Hospital (BCIH) opened in 2002 providingorthopaedic surgical services to children in Malawi. This study reviews thehospital’s progress 10 years after establishment of operational services. Inaddition we assess the impact of the hospital’s Malawi national clubfootprogramme (MNCP) and influence on orthopaedic training.MethodsAll operative paediatric procedures performed by BCIH services in the10th operative year were included. Data on clubfoot clinic locations andnumber of patients treated were obtained from the MNCP. BCIH recordswere reviewed to identify the number of healthcare professionals whohave received training at the BCIH.Results609 new patients were operated on in the 10th year of hospital service.Patients were treated from all regions; however 60% came fromSouthern regions compared with the 48% in the 5th year. Clubfoot,burn contracture and angular lower limb deformities were the three mostcommon pathologies treated surgically. In total BCIH managed 9,842patients surgically over a 10-year period. BCIH helped to establish andco-ordinate the MNCP since 2007. At present the program has a totalof 29 clinics, which have treated 5748 patients. Furthermore, BCIH hasoverseen the full or partial training of 5 orthopaedic surgeons and 82orthopaedic clinical officers in Malawi.ConclusionThe BCIH has improved the care of paediatric patients in a country thatprior to its establishment had no dedicated paediatric orthopaedic service,treating almost 10,000 patients surgically and 6,000 patients in the MNCP.This service has remained consistent over a 10-year period despite times of global austerity. Whilst the type of training placement offered at BCIH has changed in the last 10 years, the priority placed on training has remained paramount. The strategic impact of long-term training  commitments are now being realised, in particular by the addition of Orthopaedic surgeons serving the nation

Genotypic variation in phosphorus efficiency between wheat cultivars grown under greenhouse and field conditions

Phosphorus (P) efficiency (relative growth), which is described as the ratio of shoot dry matter or grain yield at deficient P supply to that obtained under adequate P supply, was compared in 25 winter wheat cultivars grown under greenhouse and field conditions with low and adequate P levels in a P-deficient calcareous soil. Adequate P supply resulted in significant increases in shoot dry weight and grain yield under both experimental conditions. In the greenhouse experiment, the increases in shoot dry weight under adequate P supply (80 mg kg(-1)) were from 0% (cv: C-1252) to 34% (cv: Dagdas). Under field conditions, the cultivars showed much greater variation in their response to adequate P supply (60 kg ha(-1)): the increases in shoot dry weight and grain yield with adequate P supply were between -2% (cv: Sivas-111/33) and 25% (cv: Kirac-66) for shoot dry matter production at the heading stage and between 0% (cv: Kirkpinar-79) and 76% (cv: Kate A-1) for grain yield at maturity. Almost all cultivars behaved totally different in their response to P deficiency under greenhouse and field conditions. Phosphorus efficiency ratios (relative growth) under greenhouse conditions did not correlate with the P efficiency ratios under field conditions. In general, durum wheat cultivars were found to be more P efficient compared with bread wheat cultivars. The results of this study indicated that there is wide variation in tolerance to P deficiency among wheat cultivars that can be exploited in breeding new wheat cultivars for high P deficiency tolerance. The results also demonstrated that P efficiency was expressed differently among the wheat cultivars when grown under greenhouse and field conditions and, therefore, special attention should be paid to growth conditions in screening wheat for P efficiency

Sorting live stem cells based on Sox2 mRNA expression.

PMCID: PMC3507951This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.While cell sorting usually relies on cell-surface protein markers, molecular beacons (MBs) offer the potential to sort cells based on the presence of any expressed mRNA and in principle could be extremely useful to sort rare cell populations from primary isolates. We show here how stem cells can be purified from mixed cell populations by sorting based on MBs. Specifically, we designed molecular beacons targeting Sox2, a well-known stem cell marker for murine embryonic (mES) and neural stem cells (NSC). One of our designed molecular beacons displayed an increase in fluorescence compared to a nonspecific molecular beacon both in vitro and in vivo when tested in mES and NSCs. We sorted Sox2-MB(+)SSEA1(+) cells from a mixed population of 4-day retinoic acid-treated mES cells and effectively isolated live undifferentiated stem cells. Additionally, Sox2-MB(+) cells isolated from primary mouse brains were sorted and generated neurospheres with higher efficiency than Sox2-MB(-) cells. These results demonstrate the utility of MBs for stem cell sorting in an mRNA-specific manner

A Call for Responsible Estimation of Global Health

Peer reviewedPublisher PD

A prospective key informant surveillance system to measure maternal mortality – findings from indigenous populations in Jharkhand and Orissa, India

<p>Abstract</p> <p>Background</p> <p>In places with poor vital registration, measurement of maternal mortality and monitoring the impact of interventions on maternal mortality is difficult and seldom undertaken. Mortality ratios are often estimated and policy decisions made without robust evidence. This paper presents a prospective key informant system to measure maternal mortality and the initial findings from the system.</p> <p>Methods</p> <p>In a population of 228 186, key informants identified all births and deaths to women of reproductive age, prospectively, over a period of 110 weeks. After birth verification, interviewers visited households six to eight weeks after delivery to collect information on the ante-partum, intra-partum and post-partum periods, as well as birth outcomes. For all deaths to women of reproductive age they ascertained whether they could be classified as maternal, pregnancy related or late maternal and if so, verbal autopsies were conducted.</p> <p>Results</p> <p>13 602 births were identified, with a crude birth rate of 28.2 per 1000 population (C.I. 27.7–28.6) and a maternal mortality ratio of 722 per 100 000 live births (C.I. 591–882) recorded. Maternal deaths comprised 29% of all deaths to women aged 15–49. Approximately a quarter of maternal deaths occurred ante-partum, a half intra-partum and a quarter post-partum. Haemorrhage was the commonest cause of all maternal deaths (25%), but causation varied between the ante-partum, intra-partum and post-partum periods. The cost of operating the surveillance system was US$386 a month, or US$0.02 per capita per year.</p> <p>Conclusion</p> <p>This low cost key informant surveillance system produced high, but plausible birth and death rates in this remote population in India. This method could be used to monitor trends in maternal mortality and to test the impact of interventions in large populations with poor vital registration and thus assist policy makers in making evidence-based decisions.</p

Building an Open Dissemination System

COPIM's Work package 5 (WP5) is developing technical protocols and infrastructure to better integrate OA books into institutional library, digital learning, and repository systems. This will support wider discovery and dissemination of OA books. Existing print and ebook distribution channels are difficult for new or OA publishers to engage with, requiring submission of metadata in multiple different formats (e.g. MARC, ONIX, KBART), and many platforms requiring multiple different metadata submissions; In addition, existing distribution channels are not well suited to OA content, while entirely new discovery and dissemination platforms are emerging (e.g. Google Books/Scholar). Guided by the perspective of new and emerging not-for-profit OA presses that have not yet been sufficiently integrated into existing discovery systems, knowledge bases, and supply routes, the aim of WP5 is to develop methods and systems to better integrate the catalogues of OA publishers into curated research records. The implementation of “best practices” workflows for OA book publishers will allow their catalogues to be better integrated into the scholarly record (discoverability, reach, persistence), increasing the impact of OA books. WP5 will build an Open Dissemination System (ODS) for OA books and a shared “best practices” digital catalogue. The ODS will be built as a decentralised system, using open source code, open protocols and standards and distributed databases—all under collective control. Doing so will ensure the system cannot be operated for the benefit of a single entity (either commercial or not). The ODS is currently under development under the project name Thoth. It consists of a metadata management system and a suite of exporting functions to allow publication metadata to be exported to all main metadata formats and data transfer with all relevant major platforms in the library and book selling supply chain. This scoping report is a key deliverable of WP5, in order to support the creation of the ODS. The report itself will discuss the distribution of books via the traditional library supply and new forms of digital dissemination before looking at metadata in depth. Metadata creation and types will be investigated in order to form a number of key recommendations for WP5. These recommendations are noted throughout the report before being grouped and discussed further in the recommendation section (see 9.0). Rather than publishing this report at the outset of the work package, it was decided to publish a time-stamped version, while simultaneously continuing to develop the report as the project progressed over time, and to encourage comment from the community. Version 1.0 of this report is available here and on Zenodo as a PDF (https://doi.org/10.5281/zenodo.3961564), and on the COPIM documentation site as a living document

Global Health Estimates: Stronger Collaboration Needed with Low- and Middle-Income Countries

Osman Sankoh argues for much stronger collaboration between generators of global health estimates, and individuals and organizations working at the country level, as part of a PLoS Medicine cluster of articles on global health estimates

An Appraisal of the Maternal Mortality Decline in Nepal

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Mice lacking NF-κB1 exhibit marked DNA damage responses and more severe gastric pathology in response to intraperitoneal tamoxifen administration

Tamoxifen (TAM) has recently been shown to cause acute gastric atrophy and metaplasia in mice. We have previously demonstrated that the outcome of Helicobacter felis infection, which induces similar gastric lesions in mice, is altered by deletion of specific NF-κB subunits. Nfkb1-/- mice developed more severe gastric atrophy than wild-type (WT) mice 6 weeks after H. felis infection. In contrast, Nfkb2-/- mice were protected from this pathology. We therefore hypothesized that gastric lesions induced by TAM may be similarly regulated by signaling via NF-κB subunits. Groups of five female C57BL/6 (WT), Nfkb1-/-, Nfkb2-/- and c-Rel-/- mice were administered 150 mg/kg TAM by IP injection. Seventy-two hours later, gastric corpus tissues were taken for quantitative histological assessment. In addition, groups of six female WT and Nfkb1-/- mice were exposed to 12 Gy γ-irradiation. Gastric epithelial apoptosis was quantified 6 and 48 h after irradiation. TAM induced gastric epithelial lesions in all strains of mice, but this was more severe in Nfkb1-/- mice than in WT mice. Nfkb1-/- mice exhibited more severe parietal cell loss than WT mice, had increased gastric epithelial expression of Ki67 and had an exaggerated gastric epithelial DNA damage response as quantified by γH2AX. To investigate whether the difference in gastric epithelial DNA damage response of Nfkb1-/- mice was unique to TAM-induced DNA damage or a generic consequence of DNA damage, we also assessed gastric epithelial apoptosis following γ-irradiation. Six hours after γ-irradiation, gastric epithelial apoptosis was increased in the gastric corpus and antrum of Nfkb1-/- mice. NF-κB1-mediated signaling regulates the development of gastric mucosal pathology following TAM administration. This is associated with an exaggerated gastric epithelial DNA damage response. This aberrant response appears to reflect a more generic sensitization of the gastric mucosa of Nfkb1-/- mice to DNA damage