Panel presentation for the Global Maternal Health Conference, held in Tanzania in January 2013, organised by Kate Sabot

Presentation Outline

(1) Overview of PMNCH

(2) Overview of Knowledge Summary Process

(3) KS 23 Highlight

Sabot, K

Becker, AJ

Avan, BI

Annales de l Institut Henri Poincaré C Analyse non linéaire

English

arXiv

For a general open set, we characterize the compactness of the embedding for the homogeneous Sobolev space D01,p↪Lq in terms of the summability of its torsion function. In particular, for 1≤

BRASCO, Lorenzo

Ruffini, Berardo

Archivio istituzionale della ricerca - Università di Ferrara

Compact Sobolev embeddings and torsion functions

International audienceFor a general open set, we characterize the compactness of the embedding $W^{1,p}_0\hookrightarrow L^q$ in terms of the summability of its torsion function. In particular, for $1\le q<p$ we obtain that the embedding is continuous if and only if it is compact. The proofs crucially exploit a {\it torsional Hardy inequality} that we investigate in details

Brasco, Lorenzo

Portail HAL Um  (Université de Montpellier)

LSHTM Research Online

Becker, AJ; Schellenberg, JA (2013) Evidence to improve maternaland newborn health: The IDEAS Project. Other. London School ofHygiene Tropical Medicine.Downloaded from: http://researchonline.lshtm.ac.uk/1931307/Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna-tively contact researchonline@lshtm.ac.uk.Available under license: Creative Commons Attribution Non-commercial No Derivativeshttp://creativecommons.org/licenses/by-nc-nd/2.5/ideas.lshtm.ac.ukEvidence to improve maternal and  newborn health: The IDEAS ProjectIDEAS is a measurement and evaluation project aiming to understand which health innovations and programmes improve maternal and newborn health  on a large scale, as well as why and how.Based at the London School of Hygiene & Tropical Medicine, a world-leading centre for research and education in public and global health, the IDEAS team are specialists committed to generating high-quality evidence to inform policy and practice. Measurement and evaluation are vital for local, national and global health planning, so that resources can be used effectively to improve the health of families in Ethiopia, India, Nigeria, where IDEAS is working directly, and beyond. I feel privileged to lead a project that will generate evidence to inform key decisions about maternal and newborn healthDr Joanna Schellenberg  IDEAS Principal Investigator,  The London School of Hygiene & Tropical Medicine Introducing IDEASCover images (l-r) Frontline worker with mother and newborn, Uttar Pradesh, India © Agnes Becker/IDEAS. Auxiliary nurse midwife health records, Uttar Pradesh, India © Dr Bilal Avan. Health records, Ethiopia © Dr Bilal Avan. Mother and newborn, Nigeria © Pep Bonet/Save the Children. Health Extension Worker, Ethiopia © Dr Neil Spicer. Pregnant mother,  Nigeria © istockphoto.Image right: Mother with newborn, Atthasia village,  Bahraich district, Uttar Pradesh. Image courtesy of IntraHealth’s Manthan project © Agnes Becker/IDEAS.2 ideas.lshtm.ac.uk1  UNFPA, et al., Trends in Maternal Mortality: 1990-2010, 2012: WHO 2  Lawn, J., Kinney, M. ‘Stillbirths – An Executive Summary for The Lancet’s Series’ The Lancet, 14 April 20113  WHO, World Health Statistics 2011, 2011: WHO pp154  Countdown to 2015, Building a Future for Women and Children 2012 Report 2012: WHO and UNICEF pp13 Every day 800 women die from pregnancy-related causes1 and more than 7,300 babies are delivered stillborn2. Furthermore, newborn deaths contribute to 40% of all child deaths globally3. Many of these deaths occur in low-income settings, from well understood and preventable causes.IDEAS uses measurement and evaluation to understand which health innovations and programmes deliver the greatest impact on maternal and newborn survival at scale, as well as why and how they work, in Ethiopia, North-Eastern Nigeria and the state of Uttar Pradesh in India. Despite huge efforts and advances –  the number of maternal deaths due  to pregnancy complications dropped by nearly 50% between 1990 and 20104 – the evidence base for what works to improve maternal and newborn health  on a large scale remains relatively weak. Every day800women die  from pregnancy- related causes1ResearchWe contribute to the evidence base by:•  Using standardised approaches to evaluate maternal and newborn health programmes across multiple projects and countries.•  Studying the scale-up of innovations in maternal and newborn health.•  Testing the theory underlying the Bill & Melinda Gates Foundation maternal and newborn health strategy.•  Building capacity in measurement, learning and evaluation.PolicyWe offer local, national and global health decision-makers and programme managers: •  Evidence of which maternal and newborn health innovations work best in specific contexts and why.•  Evidence of which innovations  are likely to be scaled-up successfully from the areas in  which they were introduced to  a larger geographic area.•  Lessons about using health data in decision-making to improve maternal and newborn health.Top image: A premature baby lies in hospital © Bill & Melinda Gates Foundation.Bottom image: A mother with her newborn baby sitting outside her house, Nigeria © Bill & Melinda Gates Foundation.Why is IDEAS important?IDEAS aims to improve the health and survival of mothers and babies  through generating evidence to inform policy and practice.ideas.lshtm.ac.uk 3What we doThe IDEAS Technical Resource Centre supports measurement, learning and evaluation by strengthening the capacity of key personnel within the maternal and newborn health projects we collaborate with. The Centre promotes collaboration between projects, and stimulates exchange of expertise. Top image: An Innovation: Village health and sanitation committees use a hand drawn map to plan how to reach every pregnant woman in the village. Courtesy of Sure Start project, Uttar Pradesh  © Agnes Becker/IDEAS.Bottom image: Interactions are enhanced by a mobile phone app innovation to support frontline workers in their work. Courtesy of IntraHealth’s Manthan project, Uttar Pradesh © Agnes Becker/IDEAS.IDEAS is testing the theory of change for improving maternal and newborn health put forward by the Bill & Melinda Gates Foundation. This is the  basis of the foundation’s maternal and newborn funding strategy. IDEAS aims to test the theory by answering four questions. Evidence from IDEAS will inform future investments, policy decisions and strategic plans.IDEAS is collaborating with projects funded by the Bill & Melinda Gates Foundation to improve maternal and newborn health in Ethiopia, North-Eastern Nigeria and Uttar Pradesh, India. These projects deliver innovations that support local health systems, particularly through improving the interactions between families and frontline workers. They aim to improve access, use and provision of care for women and their babies during pregnancy, childbirth and the month after birth. What is an innovation? A community-based approach to enhancing health, which is new to the context.Who are frontline workers? Frontline workers include facility-based staff, shopkeepers who families see regularly, and trained community members who visit families where healthcare facilities are scarce. All give health advice and basic health services. They are often the first point of contact with the health system for rural families in low-income settings.What is an intervention? A life-saving procedure or behaviour that has a proven direct biological benefit for the mother or newborn, e.g. cutting the umbilical cord with a sterilised blade to prevent the baby becoming infected.IDEAS advocates the use of evidence  for effective decision-making and  policy. We promote learning between projects, share findings and tools  with the academic community and  provide evidence to inform future investments, policy decisions and strategic plans.Capacity building Evidence into policy and practice4 ideas.lshtm.ac.ukTheory of change for maternal and newborn health with IDEAS learning questionsThis diagram shows the theory of change for the Bill &  Melinda Gates Foundation maternal and newborn strategy. Innovations enhance the interactions between families and frontline workers. This enables more mothers and babies to access life-saving interventions (increased coverage) leading  to improved maternal and newborn survival. Over time, effective innovations are scaled-up from the areas in which they were introduced to the whole state or country and beyond, and benefit more mothers and newborns. The purple boxes show the four questions IDEAS is asking to test the theory of change.Image left: Mother with children, Ethiopia © Bill & Melinda Gates Foundation.Image right: Life-saving intervention: Initiation of breastfeeding within the first hour of life, Nigeria © Society for Family Health.InteractionsEnhanced interactions between families and frontline workers (more, better, equitable and cost-effective)Scale-upAn innovation is increased in reach to benefit a greater number of people over a wider geographical areaInterventionIncreased coverage  of life-saving  interventionsImproved  maternal  and newborn  survivalInnovationCommunity-based approach to enhancing health, new to  the contextQ1 What are the innovations? Q2 Do innovations enhance interactions and increase life-saving intervention coverage? If so, how?Q3 How and why does scale-up happen?Q4 To what extent do scaled-up innovations  affect coverage of life-saving interventions and survival?ideas.lshtm.ac.uk 5What is the context?When answering our learning questions we consider local social, political, cultural and economic factors which may influence how innovations are implemented. We measure changes in these contextual factors over time.Characterising the innovationsWe are working with Bill & Melinda Gates Foundation funded projects to describe each of their maternal and newborn health innovations using a common framework.Understanding scale-upWe are conducting interviews with a range of stakeholders - including national and regional government, development agencies and civil society - to find out what factors help an innovation get scaled up nationally and what barriers need to be overcome.  Our analysis provides recommendations on what different stakeholders can do to improve scalability of innovations to improve maternal and newborn survival.How we are answering our learning questions© Dr Bilal Avan InteractionsEnhanced interactions between families and frontline workers (more, better, equitable and cost-effective)Scale-upAn innovation is increased in reach to benefit a greater number of people over a wider geographical areaInterventionIncreased coverage  of life-saving  interventionsImproved  maternal  and newborn  survivalInnovationCommunity-based approach to enhancing health, new to  the contextQ1 What are the innovations? Q2 Do innovations enhance interactions and increase life-saving intervention coverage? If so, how?Q3 How and why does scale-up happen? Q4 To what extent do scaled-up innovations  affect coverage of life-saving interventions and survival?6 ideas.lshtm.ac.ukMeasuring interactions between families and frontline workersWe are undertaking large-scale surveys in Ethiopia, North-Eastern Nigeria and Uttar Pradesh, India, by interviewing families, frontline workers and health facility staff. The surveys will show whether:•	 Interactions between families and frontline workers have been enhanced,  i.e. increased in number, and become better in quality and more equitable.•  The coverage of life-saving interventions and behaviours has increased  as a result of the maternal and newborn health innovations.Understanding the link between enhanced interactions and coverage of critical interventions We are conducting in-depth interviews to find out how and why the interactions between frontline workers and families have changed and how they affect the coverage of life-saving interventions.Cost effectiveness analysisWe are developing an economic model to synthesise evidence on the cost-effectiveness of a range of maternal and newborn health innovations.Measuring scale-up: Pathway analysis of innovations and implementation strengthFor innovations that are most likely to be scaled up, we are developing an in-depth understanding of each innovation’s pathway from its implementation through to  the life-saving interventions intended to improve as a result. Implementation strength is a score showing the intensity of effort put into operationalising an innovation: through regular data collection over time, this measure shows the  extent to which implementation efforts result in the scale-up of an innovation  to a wider geographic area. Measuring scale-up: Coverage of life-saving interventions surveys, analysing lives saved and cost-effectivenessIn areas where innovations are being scaled up, we are conducting surveys to estimate the change in the coverage of life-saving interventions. The surveys will also assess the relationship between implementation strength (‘dose’) and change in the coverage of critical life-saving interventions (‘response’), i.e. if more effort is put in to implementing an innovation, does it result in more life-saving interventions reaching women and newborns? We will use mathematical modelling to estimate the number of maternal and newborn lives saved when an innovation is scaled up, and its cost effectiveness.Top image: Nigerian children playing © Bill & Melinda Gates Foundation.Middle image: Newborn baby having anthropometric measures taken during a post-natal check © Dr Tanya Marchant.Bottom image: Mother with newborn and the local ASHA, a frontline worker, at a rural Primary Health Centre, Uttar Pradesh © Dr Meenakshi Gautha.ideas.lshtm.ac.uk 7COLOMBIA SLOVAKIAWhere we workIDEAS works in Ethiopia, North-Eastern Nigeria and Uttar Pradesh in India. All three areas have high death rates for women and babies and many of these deaths could be prevented with improved access to effective health care5.IDEAS teamOur UK-based team and staff in Ethiopia, Nigeria and India work closely with Bill  & Melinda Gates Foundation funded maternal and newborn health projects and  our in-country research partners – JaRco Consulting (Ethiopia), Sambodhi Research  & Communications Pvt. (India) and Health Hub (Nigeria).Contact usLondon School of Hygiene  & Tropical MedicineKeppel StreetLondon WC1E 7HTUnited KingdomEmailideas@lshtm.ac.uk Websitelshtm.ac.uk twitter @LSHTM_IDEASIDEAS is funded by the Bill & Melinda Gates Foundation © London School of Hygiene & Tropical Medicine June 20135  Countdown to 2015, Building a Future for Women and Children 2012 Report 2012: WHO and UNICEFhigher than that of  a woman in a high-income country.100 timesAn African  woman’s risk of  dying from pregnancy-related causes is Image left: Mother and newborn, Uttar Pradesh, India © Bill and Melinda Gates Foundation.Image right: The size of a newborn babies foot can be used to determine whether it is putting on enough weight © Bill and Melinda Gates Foundation.Countries IDEAS is working in

PMNCH Knowledge Summary 23: Human Rights & Accountability

For a general open set, we characterize the compactness of the embedding W 1,p 0 → L q in terms of the summability of its torsion function. In particular, for 1 ≤ q < p we obtain that the embedding is continuous if and only if it is compact. The proofs crucially exploit a torsional Hardy inequality that we investigate in details

HAL-Polytechnique

27 pagesFor a general open set, we characterize the compactness of the embedding $W^{1,p}_0\hookrightarrow L^q$ in terms of the summability of its torsion function. In particular, for $1\le q<p$ we obtain that the embedding is continuous if and only if it is compact. The proofs crucially exploit a {\it torsional Hardy inequality} that we investigate in details

HAL AMU

http://www.numdam.org/item/10.1016/j.anihpc.2016.05.005.pdf

PMNCH Knowledge Summary 23: Human Rights & Accountability

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Archivio istituzionale della ricerca - Università di Ferrara

Portail HAL Um (Université de Montpellier)

LSHTM Research Online

Archivio istituzionale della ricerca - Università di Ferrara

HAL-Polytechnique

HAL AMU

HAL AMU

HAL AMU