Active Management of Third Stage of Labour Saves Facility Costs in Guatemala and Zambia

This study calculated the net benefit of using active management of the third stage of labour (AMTSL) rather than expectant management of the third stage of labour (EMTSL) for mothers in Guatemala and Zambia. Probabilities of events were derived from opinions of experts, publicly available data, and published literature. Costs of clinical events were calculated based on national price lists, observation of resources used in AMTSL and EMTSL, and expert estimates of resources used in managing postpartum haemorrhage and its complications, including transfusion. A decision tree was used for modelling expected costs associated with AMTSL or EMTSL. The base case analysis suggested a positive net benefit from AMTSL, with a net cost-saving of US$18,000 in Guatemala (with 100 lives saved) and US$ 145,000 in Zambia (with 467 lives saved) for 100,000 births. Facilities have strong economic incentives to adopt AMTSL if uterotonics are available

Active Management of Third Stage of Labour Saves Facility Costs in Guatemala and Zambia

This study calculated the net benefit of using active management of the third stage of labour (AMTSL) rather than expectant management of the third stage of labour (EMTSL) for mothers in Guatemala and Zambia. Probabilities of events were derived from opinions of experts, publicly available data, and published literature. Costs of clinical events were calculated based on national price lists, observation of resources used in AMTSL and EMTSL, and expert estimates of resources used in managing postpar\uadtum haemorrhage and its complications, including transfusion. A decision tree was used for modelling expected costs associated with AMTSL or EMTSL. The base case analysis suggested a positive net benefit from AMTSL, with a net cost-saving of US$18,000 in Guatemala (with 100 lives saved) and US$ 145,000 in Zambia (with 467 lives saved) for 100,000 births. Facilities have strong economic incentives to adopt AMTSL if uterotonics are available

Measuring coverage in MNCH: indicators for global tracking of newborn care.

Neonatal mortality accounts for 43% of under-five mortality. Consequently, improving newborn survival is a global priority. However, although there is increasing consensus on the packages and specific interventions that need to be scaled up to reduce neonatal mortality, there is a lack of clarity on the indicators needed to measure progress. In 2008, in an effort to improve newborn survival, the Newborn Indicators Technical Working Group (TWG) was convened by the Saving Newborn Lives program at Save the Children to provide a forum to develop the indicators and standard measurement tools that are needed to measure coverage of key newborn interventions. The TWG, which included evaluation and measurement experts, researchers, individuals from United Nations agencies and non-governmental organizations, and donors, prioritized improved consistency of measurement of postnatal care for women and newborns and of immediate care behaviors and practices for newborns. In addition, the TWG promoted increased data availability through inclusion of additional questions in nationally representative surveys, such as the United States Agency for International Development-supported Demographic and Health Surveys and the United Nations Children's Fund-supported Multiple Indicator Cluster Surveys. Several studies have been undertaken that have informed revisions of indicators and survey tools, and global postnatal care coverage indicators have been finalized. Consensus has been achieved on three additional indicators for care of the newborn after birth (drying, delayed bathing, and cutting the cord with a clean instrument), and on testing two further indicators (immediate skin-to-skin care and applications to the umbilical cord). Finally, important measurement gaps have been identified regarding coverage data for evidence-based interventions, such as Kangaroo Mother Care and care seeking for newborn infection

Standard questionnaire for measuring coverage of immediate newborn care.

<p>Standard questionnaire for measuring coverage of immediate newborn care.</p

Proportion of women who received postnatal care within two days of delivery by time of first visit, DHS survey data 2005–2011 [<b>18</b>].

<p>Proportion of women who received postnatal care within two days of delivery by time of first visit, DHS survey data 2005–2011 <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001415#pmed.1001415-MEASURE1" target="_blank">[<b>18</b>]</a>.</p

Proportion of home births for which women and babies received postnatal care within two days of delivery, DHS survey data 2005–2011 [<b>18</b>].

<p>Proportion of home births for which women and babies received postnatal care within two days of delivery, DHS survey data 2005–2011 <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001415#pmed.1001415-MEASURE1" target="_blank">[<b>18</b>]</a>.</p

Postnatal care indicator: measurement issues and advances.

<p>Postnatal care indicator: measurement issues and advances.</p

Recommended indicators for care behaviors and practices for newborns.

<p>Surveys will vary in period of recall. Typically, DHS surveys use a recall period of five years, while MICS surveys use a two-year period. Interviewer records all substances put on the cord from cutting until it falls off. Harmful substances are determined locally and split out during analysis.</p