Odon device: a promising tool to facilitate vaginal delivery and increase access to emergency care

The last innovation in operative vaginal delivery happened centuries ago with the invention of the forceps and the vacuum extractor. The World Health Organization Odon Device Research Group recently published a protocol for a feasibility and safety study for a new device (Odon device) which aims to revolutionize assisted vaginal delivery. This editorial discusses the device and its pathway to global use. Although preliminary results look promising, the rigorous three-phased WHO protocol needs completion before the device can be determined, based on the evidence, to be safe and effective.Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Harris Requejo, Jennifer. Johns Hopkins Bloomberg School of Public Health. Institute for International Programs; Estados Unido

Implementation Research to Catalyze Advances in Health Systems Strengthening in sub-Saharan Africa: the African Health Initiative (Preface)

The importance of strengthening health systems has gained increased attention in recent years, and there have been renewed calls for a focus on health systems as part and parcel of meeting the health related Millennium Development Goals. Despite the growing focus on health systems, the largest global health initiatives -- suchas PEPFAR, PMI, the Global Fund to Fight AIDS, TB, and Malaria, and GAVI -- continue to have a disease specific focus. The divergence in opinion on what constitutes health systems strengthening and the scarcity of rigorous evaluations of various approaches undermine efforts to focus on health systems as a means of improving population health. In response to this challenge, the Doris DukeCharitable Foundation (DDCF) launched the African Health Initiative (AHI) to catalyze significant advances instrengthening health systems by supporting Population Health and Implementation Training (PHIT) Partnerships in five diverse sub-Saharan African contexts. Each Partnership is implementing and evaluating an innovative project designed to address key health systems constraints and improve service delivery and health outcomes. This article is a preface to a series of reports

Data Resource Profile: Countdown to 2015: Maternal, Newborn and Child Survival

The Countdown to 2015 country profiles present, in one place, comprehensive evidence to enable an assessment of a country's progress in improving reproductive, maternal, newborn and child health. Profiles are available for each of the 75 countries that together account for more than 95% of all maternal and child deaths. The two-page profiles are updated approximately every 2 years with new data and analyses. Profile data include demographics, mortality, nutritional status, coverage of evidence-based interventions, within-countries inequalities in coverage, measures of health system functionality, supportive policies and financing indicators. The main sources of data for the coverage, nutritional status and equity indicators are the US Agency for Internal Development (USAID)-supported demographic and health surveys and the United Nations Children's Fund (UNICEF)-supported multiple indicator cluster surveys. Data on coverage are first summarized and checked for quality by UNICEF, and data on equity in intervention coverage are summarized and checked by the Federal University of Pelotas. The mortality estimates are developed by the Inter-agency Group for Child Mortality Estimation and the Maternal Mortality Estimation Inter-Agency Group. The financing data are abstracted from datasets maintained by the Organization for Economic Co-operation and Development Assistance Committee, and the policies and health systems data are derived from a special compilation prepared by the World Health Organization. Associated country profiles include equity-specific profiles and one-page profiles prepared annually that report on the 11 indicators selected by the Commission on Information and Accountability for Women's and Children's Healt

How much time is available for antenatal care consultations? Assessment of the quality of care in rural Tanzania

BACKGROUND: Many women in Sub-Saharan African countries do not receive key recommended interventions during routine antenatal care (ANC) including information on pregnancy, related complications, and importance of skilled delivery attendance. We undertook a process evaluation of a successful cluster randomized trial testing the effectiveness of birth plans in increasing utilization of skilled delivery and postnatal care in Ngorongoro district, rural Tanzania, to document the time spent by health care providers on providing the recommended components of ANC. METHODS: The study was conducted in 16 health units (eight units in each arm of the trial). We observed, timed, and audio-recorded ANC consultations to assess the total time providers spent with each woman and the time spent for the delivery of each component of care. T-test statistics were used to compare the total time and time spent for the various components of ANC in the two arms of the trial. We also identified the topics discussed during the counselling and health education sessions, and examined the quality of the provider-woman interaction. RESULTS: The mean total duration for initial ANC consultations was 40.1 minutes (range 33-47) in the intervention arm versus 19.9 (range 12-32) in the control arm p < 0.0001. Except for drug administration, which was the same in both arms of the trial, the time spent on each component of care was also greater in the intervention health units. Similar trends were observed for subsequent ANC consultations. Birth plans were always discussed in the intervention health units. Counselling on HIV/AIDS was also prioritized, especially in the control health units. Most other recommended topics (e.g. danger signs during pregnancy) were rarely discussed. CONCLUSION: Although the implementation of birth plans in the intervention health units improved provider-women dialogue on skilled delivery attendance, most recommended topics critical to improving maternal and newborn survival were rarely covered

Improved measurement for mothers, newborns and children in the era of the Sustainable Development Goals.

BACKGROUND: An urgent priority in maternal, newborn and child health is to accelerate the scale-up of cost-effective essential interventions, especially during labor, the immediate postnatal period and for the treatment of serious infectious diseases and acute malnutrition.  Tracking intervention coverage is a key activity to support scale-up and in this paper we examine priorities in coverage measurement, distinguishing between essential interventions that can be measured now and those that require methodological development. METHODS: We conceptualized a typology of indicators related to intervention coverage that distinguishes access to care from receipt of an intervention by the population in need.  We then built on documented evidence on coverage measurement to determine the status of indicators for essential interventions and to identify areas for development. RESULTS: Contact indicators from pregnancy to childhood were identified as current indicators for immediate use, but indicators reflecting the quality of care provided during these contacts need development. At each contact point, some essential interventions can be measured now, but the need for development of indicators predominates around interventions at the time of birth and interventions to treat infections. Addressing this need requires improvements in routine facility based data capture, methods for linking provider and community-based data, and improved guidance for effective coverage measurement that reflects the provision of high-quality care. CONCLUSION: Coverage indicators for some essential interventions can be measured accurately through household surveys and be used to track progress in maternal, newborn and child health.  Other essential interventions currently rely on contact indicators as proxies for coverage but urgent attention is needed to identify new measurement approaches that directly and reliably measure their effective coverage

Regional collaborations as a way forward for maternal, newborn and child health:the South Asian healthcare professional workshop

This article reviews the importance of regional initiatives in the context of global efforts to achieve the Millennium Development Goal 4 and 5 and describes the action-oriented multi-country healthcare professional association (HCPA) workshops organized by the Partnership for Maternal, Newborn and Child Health. The South Asian HCPA workshop served as a catalyst for strengthening the ability of HCPAs in South Asian countries to organize and coordinate their activities effectively, play a larger role in national planning, and collaborate with other key stakeholders in maternal, newborn and child health

The role of robotics in early childhood education: a systematic review for skill development

Cada vez más, la robótica se consolida como un recurso indispensable en la vida cotidiana, y se prevé un empleo continuado en los próximos años. En este contexto, se hace necesario abordar cómo se integra el uso de los robots en el ámbito educativo desde las etapas más tempranas del desarrollo. Para ello, se llevó a cabo una revisión sistemática de la literatura mediante protocolo PRISMA-P para analizar las diversas áreas y los contenidos educativos que se relacionan con la robótica en educación infantil (2013-2022). Se evaluaron las áreas y los contenidos utilizados para la enseñanza de la robótica, las tecnologías empleadas, los desafíos y los obstáculos que se presentan en este contexto, así como el impacto de esta integración en infantil. Los resultados exponen la incorporación más frecuente en áreas de desarrollo cognitivo y del lenguaje, aunque se definen experiencias para el desarrollo motor y socioemocional. En lo relativo a los contenidos educativos trabajados, especialmente destacan los contenidos STEAM como el pensamiento computacional frente a otros como nociones espaciales, la danza, el reciclaje, la identidad propia o la autorregulación, así como su relación con los hallados en el currículo de infantil, comprobando su interdisciplinariedad en el aula, además, del impacto positivo en los estudiantes. En la investigación destaca el uso de robots como el kit de robótica KIBO, LEGO, el software CHERP y Beet-Bot. En conclusión, la robótica permite abordar áreas como la lectoescritura, emociones, educación física, entre otras relacionando los contenidos con la música, la cultura, el juego, la programación, etc. demostrando su capacidad de adaptación en las aulas de educación infantil y la influencia de manera positiva en los procesos de enseñanza-aprendizaje de los infantes, permitiendo el aprendizaje de conceptos STEM y a su vez áreas y contenidos educativos establecidos por la legislación.Robotics is increasingly becoming an indispensable resource in everyday life, and continued use is expected in the coming years. In this context, it is necessary to address how to integrate the use of robots in education from the earliest stages of development. To this end, a systematic review of the literature was carried out using the PRISMA-P protocol to analyse the different areas and educational content related to robotics in early childhood education (2013-2022). The areas and contents used for teaching robotics, the technologies used, the challenges and obstacles that arise in this context, as well as the impact of this integration in early childhood education were evaluated. The results show the most frequent incorporation in areas of cognitive and language development, although experiences are defined for motor and socio-emotional development. Regarding the educational content worked on, STEAM content such as computational thinking stands out in comparison with others such as spatial notions, dance, recycling, self-identity, or self-regulation, as well as its relationship with the content found in the infant curriculum, proving its interdisciplinary nature in the classroom, in addition to the positive impact on the students. The research highlights the use of robots such as the KIBO robotics kit, LEGO, CHERP software and Beet-Bot. In conclusion, robotics allows to address areas such as literacy, emotions, physical education, among others, relating the contents with music, culture, play, programming, etc. demonstrating its adaptability in early childhood education classrooms and the positive influence on the teaching-learning processes of infants, allowing the learning of STEM concepts and in turn areas and educational content established by legislation

Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5?

BACKGROUND: Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress. METHODS: Applying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing). RESULTS: The majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30-40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns -- which require higher-level health workers, more infrastructure, and increased community engagement -- showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers. CONCLUSIONS: These Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts

The role of robotics in early childhood education: a systematic review for skill development

Cada vez más, la robótica se consolida como un recurso indispensable en la vida cotidiana, y se prevé un empleo continuado en los próximos años. En este contexto, se hace necesario abordar cómo se integra el uso de los robots en el ámbito educativo desde las etapas más tempranas del desarrollo. Para ello, se llevó a cabo una revisión sistemática de la literatura mediante protocolo PRISMA-P para analizar las diversas áreas y los contenidos educativos que se relacionan con la robótica en educación infantil (2013-2022). Se evaluaron las áreas y los contenidos utilizados para la enseñanza de la robótica, las tecnologías empleadas, los desafíos y los obstáculos que se presentan en este contexto, así como el impacto de esta integración en infantil. Los resultados exponen la incorporación más frecuente en áreas de desarrollo cognitivo y del lenguaje, aunque se definen experiencias para el desarrollo motor y socioemocional. En lo relativo a los contenidos educativos trabajados, especialmente destacan los contenidos STEAM como el pensamiento computacional frente a otros como nociones espaciales, la danza, el reciclaje, la identidad propia o la autorregulación, así como su relación con los hallados en el currículo de infantil, comprobando su interdisciplinariedad en el aula, además, del impacto positivo en los estudiantes. En la investigación destaca el uso de robots como el kit de robótica KIBO, LEGO, el software CHERP y Beet-Bot. En conclusión, la robótica permite abordar áreas como la lectoescritura, emociones, educación física, entre otras relacionando los contenidos con la música, la cultura, el juego, la programación, etc. demostrando su capacidad de adaptación en las aulas de educación infantil y la influencia de manera positiva en los procesos de enseñanza-aprendizaje de los infantes, permitiendo el aprendizaje de conceptos STEM y a su vez áreas y contenidos educativos establecidos por la legislación.Robotics is increasingly becoming an indispensable resource in everyday life, and continued use is expected in the coming years. In this context, it is necessary to address how to integrate the use of robots in education from the earliest stages of development. To this end, a systematic review of the literature was carried out using the PRISMA-P protocol to analyse the different areas and educational content related to robotics in early childhood education (2013-2022). The areas and contents used for teaching robotics, the technologies used, the challenges and obstacles that arise in this context, as well as the impact of this integration in early childhood education were evaluated. The results show the most frequent incorporation in areas of cognitive and language development, although experiences are defined for motor and socio-emotional development. Regarding the educational content worked on, STEAM content such as computational thinking stands out in comparison with others such as spatial notions, dance, recycling, self-identity, or self-regulation, as well as its relationship with the content found in the infant curriculum, proving its interdisciplinary nature in the classroom, in addition to the positive impact on the students. The research highlights the use of robots such as the KIBO robotics kit, LEGO, CHERP software and Beet-Bot. In conclusion, robotics allows to address areas such as literacy, emotions, physical education, among others, relating the contents with music, culture, play, programming, etc. demonstrating its adaptability in early childhood education classrooms and the positive influence on the teaching-learning processes of infants, allowing the learning of STEM concepts and in turn areas and educational content established by legislatio