Knowledge Summary 22: Reaching Child Brides

Child marriage affects 10 million girls under the age of 18 every year. The negative health and social impact of child marriage include higher rates of maternal and infant mortality, sexually transmitted infection, social separation, and domestic abuse compared with older married women. The UN defines Child Marriage as a Human Rights violation and is working to end this practice globally, however many girls still fall victim each year. While the importance of ending the practice of child marriage cannot be overlooked, targeted interventions are also needed to mitigate the negative health and development impacts. Health services can serve as an entry point for health and social interventions to decrease the risks associated with pregnancy and improve reproductive and child health. Health services can also facilitate opportunities for multi-sectoral connections such as formal and informal education and income generation to mitigate the negative impact of child marriage

Knowledge Summary 23: Human Rights & Accountability

Progress has been made in reducing maternal and child mortality, yet millions continue to die from preventable causes. These deaths represent an accountability challenge and a major concern shared by both the health and human rights communities. The Millennium Development Goals (MDGs) commit to reducing these deaths. Powerful complementarities exist between MDGs and human rights.1 The MDGs generate attention, mobilise resources and contribute technical health monitoring approaches. Human rights offer a fundamental emphasis on accountability, systematic and sustained attention to inequities and a legal grounding of commitments. This knowledge summary explores human rights accountability systems at community, country, regional and international levels and the potential synergies for achieving both human rights and public health goals including, and beyond, the MDGs

Burden of severe maternal morbidity and association with adverse birth outcomes in sub-Saharan Africa and south Asia: protocol for a prospective cohort study.

OBJECTIVES: The AMANHI morbidity study aims to quantify and describe severe maternal morbidities and assess their associations with adverse maternal, fetal and newborn outcomes in predominantly rural areas of nine sites in eight South Asian and sub-Saharan African countries. METHODS: AMANHI takes advantage of on-going population-based cohort studies covering approximately 2 million women of reproductive age with 1- to 3-monthly pregnancy surveillance to enrol pregnant women. Morbidity information is collected at five follow-up home visits - three during the antenatal period at 24-28 weeks, 32-36 weeks and 37+ weeks of pregnancy and two during the postpartum period at 1-6 days and after 42-60 days after birth. Structured-questionnaires are used to collect self-reported maternal morbidities including hemorrhage, hypertensive disorders, infections, difficulty in labor and obstetric fistula, as well as care-seeking for these morbidities and outcomes for mothers and babies. Additionally, structured questionnaires are used to interview birth attendants who attended women's deliveries. All protocols were harmonised across the sites including training, implementation and operationalising definitions for maternal morbidities. IMPORTANCE OF THE AMANHI MORBIDITY STUDY: Availability of reliable data to synthesize evidence for policy direction, interventions and programmes, remains a crucial step for prioritization and ensuring equitable delivery of maternal health interventions especially in high burden areas. AMANHI is one of the first large harmonized population-based cohort studies being conducted in several rural centres in South Asia and sub-Saharan Africa, and is expected to make substantial contributions to global knowledge on maternal morbidity burden and its implications

Global implications of evidence ‘biased’ practice: management of the third stage of labour

Increasing attention is being paid to the promotion of clinical and cost-effective care informed by the highest level of evidence to ensure health outcomes are optimised and access to health care is equitable. There are obvious advantages to these approaches, including increased awareness of the importance of rigorous methodology when conducting primary and secondary research, utilising methods which are systematic, robust, transparent and explicit. Evidence-based practice was introduced to replace the traditional approach of ‘this is how we have always done it’ as an underpinning for clinical practice. Ironically, however, the transition has not been straightforward and there have been criticisms of the way ‘evidence’ to support some areas of practice is perceived and applied in clinical settings. Anecdotally and based on personal experience, there are two main criticisms: 1. Acceptance of evidence without critique: Too much faith (or blind faith) in the process by which ‘evidence’ (authoritative or systematic) is produced. 2. Lack of holistic insight in the application of evidence: Employing ‘one size fits all’ policies ignoring individual needs for required care in conveyor-like processed care provision. To explore these criticisms, the example of management of the third stage of labour is used.</p

Burden, timing and causes of maternal and neonatal deaths and stillbirths in sub-Saharan Africa and South Asia: protocol for a prospective cohort study.

OBJECTIVES: The AMANHI mortality study aims to use harmonized methods, across eleven sites in eight countries in South Asia and sub-Saharan Africa, to estimate the burden, timing and causes of maternal, fetal and neonatal deaths. It will generate data to help advance the science of cause of death (COD) assignment in developing country settings. METHODS: This population-based, cohort study is being conducted in the eleven sites where approximately 2 million women of reproductive age are under surveillance to identify and follow-up pregnancies through to six weeks postpartum. All sites are implementing uniform protocols. Verbal autopsies (VAs) are conducted for deaths of pregnant women, newborns or stillbirths to confirm deaths, ascertain timing and collect data on the circumstances around the death to help assign causes. Physicians from the sites are selected and trained to use International Classification of Diseases (ICD) principles to assign CODs from a limited list of programmatically-relevant causes. Where the cause cannot be determined from the VA, physicians assign that option. Every physician who is trained to assign causes of deaths from any of the study countries is tested and accredited before they start COD assignment in AMANHI. IMPORTANCE OF THE AMANHI MORTALITY STUDY: It is one of the first to generate improved estimates of burden, timing and causes of maternal, fetal and neonatal deaths from empirical data systematically collected in a large prospective cohort of women of reproductive age. AMANHI makes a substantial contribution to global knowledge to inform policies, interventions and investment decisions to reduce these deaths

Nutrient Analysis and Shelf Life Study of Watermelon Rind Sports Drink

Sports drinks are the most common and by far the most efficient in replenishing electrolytes lost during exercise or heavy physical activity. Although there are a number of commercial sports drinks available, the electrolytes in these products are intentionally added. Watermelon contains natural vitamins and minerals both in its flesh and rind. Watermelon rind also contains citrulline, a compound that helps fight free radicals, may boost libido, and aid in weight loss. Although watermelons are abundant in the Philippines, the rinds are often discarded. This study developed a sports drink from watermelon rind (WRSD) and compared its nutrient content with two commercial brands. Nutrients studied were vitamins C and B6 and the minerals potassium and sodium. Shelf life study was done to determine the minimum number of days of refrigeration storage prior to fermentation. Methods of analysis used were the following: vitamin C – iodometric titration, vitamin B6 – high performance liquid chromatography (HPLC), potassium and sodium – atomic absorption spectrophotometry (AAS); and shelf life study – pH analysis. Compared to commercial brands, WRSD has the highest amount of potassium at 34.8 mg/100 g and significant amount of sodium at 45 mg/100 g. It is an excellent source of vitamin C at 192 mg/100 g. However, it is an insignificant source of vitamin B6 at &lt;10 mg/100 g. As a natural drink, it is shown to be stable for at least 12 days. Study concludes that watermelon rind is a viable source of electrolytes and substrate for sport drink production. A value-added product from underutilized waste rinds may be developed where electrolytes are naturally available

The way to move beyond the numbers: the lesson learnt from the Italian Obstetric Surveillance System

Objective.To describe the Italian Obstetric Surveillance System (ItOSS) investigating maternal death through incident case reporting and confidential enquiries.Methods. All maternal deaths occurred in any public and private health facility in 8 Italian regions covering 73% of national births have been notified to the ItOSS. Every incident case is confidentially reviewed to assess quality of care and establish the cause and avoidability of the death.Findings. A total of 106 maternal deaths among 1.455.545 new-borns have been notified to the surveillance system in 2013-17. Haemorrhage, sepsis and hypertensive disorders of pregnancy are the leading causes of direct maternal deaths due to obstetric causes.Conclusions. A maternal mortality surveillance system, including incidence reporting and confidential enquiries along with a retrospective analysis of administrative data sources, emerged as the best option for case ascertainment and for promoting avoidable maternal deaths.