Browsing by Author "Cousens, S."
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Item 3.6 Million Neonatal Deaths-What Is Progressing and What Is Not?(Seminars in Perinatology, 2010-12) Lawn, J.E.; Kerber, K.; Enweronu-Laryea, C.; Cousens, S.Each year 3.6 million infants are estimated to die in the first 4 weeks of life (neonatal period)-but the majority continue to die at home, uncounted. This article reviews progress for newborn health globally, with a focus on the countries in which most deaths occur-what data do we have to guide accelerated efforts? All regions are advancing, but the level of decrease in neonatal mortality differs by region, country, and within countries. Progress also differs by the main causes of neonatal death. Three major causes of neonatal deaths (infections, complications of preterm birth, and intrapartum-related neonatal deaths or "birth asphyxia") account for more than 80% of all neonatal deaths globally. The most rapid reductions have been made in reducing neonatal tetanus, and there has been apparent progress towards reducing neonatal infections. Limited, if any, reduction has been made in reducing global deaths from preterm birth and for intrapartum-related neonatal deaths. High-impact, feasible interventions to address these 3 causes are summarized in this article, along with estimates of potential for lives saved. A major gap is reaching mothers and babies at birth and in the early postnatal period. There are promising community-based service delivery models that have been tested mainly in research studies in Asia that are now being adapted and evaluated at scale and also being tested through a network of African implementation research trials. To meet Millennium Development Goal 4, more can and must be done to address neonatal deaths. A critical step is improving the quantity, quality and use of data to select and implement the most effective interventions and strengthen existing programs, especially at district level. © 2010 Elsevier Inc.Item Antenatal multiple micronutrient supplementation: call to action for change in recommendation(ANNALS OF THE NEW YORK ACADEMY OF SCIENCES, 2019-11-05) Ahmed, S.; Bourassa, M.W.; Osendarp, S.J.M; Adu-Afarwuah, S.; Ajello, C.; Bergeron, G.; Black, R.; Christian, P.; Cousens, S.; de Pee, S.; Dewey, K.G.; Arifeen, S.E.; Engle-Stone, R.; Fleet, A.; Gernand, A.D.; Hoddinott, J.; Klemm, R.; Kraemer, K.; Kupka, R.; McLean, E.; Moore, S.E.; Neufeld, L.M.; Persson, L-A.; Rasmussen, K.M.; Shankar, A.H.; Smith, E.; Sudfeld, C.R.; Udomkesmalee, E.; Vosti, S.A.We appreciate the comments by Devakumar et al .1 and agree that there are still some unanswered questions regarding the long‐term impact of multiple micronutrient supplementation (MMS) during pregnancy. However, in their assessment, Devakumar and colleagues ignore the significant benefits shown in the individual patient data (IPD) meta‐analysis, which strongly influenced our task force's conclusions. Rather, their comments focus only on the birth size data from the Cochrane reviews.2, 3 In the IPD meta‐analysis, which included data from nearly 113,000 pregnancies, the authors found that, in addition to reducing the risk of low birthweight, MMS significantly reduces the risk of preterm birth (RR = 0.93 (0.87–0.98), random effects).2 The Cochrane review also states that MMS “probably led to a slight reduction in preterm births” on the basis of data from 91,425 participants with moderate quality evidence (RR = 0.95 (0.90–1.01)Item Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub Saharan Africa: A population-based prospective cohort study in 8 countries(PLOS, 2021) Aftab, F.; Ahmed, I.; Ahmed, S.; Ali, S.M.; Amenga-Etego, S.; Ariff, S.; Bahl, R.; Baqui, A.H.; Begum, N.; Bhutta, Z.A.; Biemba, G.; Cousens, S.; Das, V.; Deb, S.; Dhingra, U.; Dutta, A.; Edmond, K.; Esamai, F.; Ghosh, A.K.; Gisore, P.; Grogan, C.; Hamer, D.H.; Herlihy, J.; Hurt, L.; Ilyas, M.; Jehan, F.; Juma, M.H.; Kalonji, M.; Khanam, R.; Kirkwood, B.R.; Kumar, A.; Kumar, A.; Kumar, V.; Manu, A.; Marete, I.; Mehmood, U.; Minckas, N.; Mishra, S.; Mitra, D.K.; Moin, M.I.; Muhammad, K.; Newton, S.; Ngaima, S.; Nguwo, A.; Nisar, M.I.; Otomba, J.; Quaiyum, M.A.; Sarrassat, S.; SazawalI, S.; Semrau, K.E.; Shannon, C.; Singh, V.P.; Soofi, S.; Soremekun, S.; Suleiman, A.M.; Sunday, V.; Dilip, T.R.; Tshefu, A.; Wasan, Y.; Yeboah-Antwi, K.; Yoshida, S.; Zaidi, A.K.Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn out comes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman’s self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths.Item Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries(Annals of the New York Academy of Sciences, 2019-05-27) Adu-Afarwuah, S.; Bourassa, M.W.; Osendarp, S.J.M.; Ahmed, S.; Ajello, C.; Bergeron, G.; Black, R.; Christian, P.; Cousens, S.; de Pee, S.; Dewey, K.G.; Arifeen, S.E.; Engle-Stone, R.; Fleet, A.; Gernand, A.D.; Hoddinott, j; Klemm, R.; Kraemer, k; Kupka, R.; McLean, E.; Moore, S.E.; Neufeld, L.M.; Persson, L.A.; Rasmussen, K.M.; Shankar, A.H.; Smith, E.; Sudfeld, C.R.; Udomkesmalee, E.; Vosti, S.A.Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost-effectiveness of MMS compared with IFA. Recent meta-analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost-effective method to reduce the risk of adverse birth outcomes.Item Satisfactory safety and immunogenicity of MSP3 malaria vaccine candidate in tanzanian children aged 12-24 months.(2009-07-17) Lusingu, J.P.; Gesase, S.; Bosomprah, S.; Francis, F.; Lemnge, M.; Seth, M.; Sebuche, S.; Rutta, A.; Minja, D.; Segeja, M.D.; Cousens, S.; Noor, R.; Chilengi, R.; Druilhe, P.Background: Development and deployment of an effective malaria vaccine would complement existing malaria control measures. A blood stage malaria vaccine candidate, Merozoite Surface Protein-3 (MSP3), produced as a long synthetic peptide, has been shown to be safe in non-immune and semi-immune adults. A phase Ib dose-escalating study was conducted to assess the vaccine's safety and immunogenicity in children aged 12 to 24 months in Korogwe, Tanzania (ClinicalTrials.gov number: NCT00469651). Methods: This was a double-blind, randomized, controlled, dose escalation phase Ib trial, in which children were given one of two different doses of the MSP3 antigen (15 g or 30 g) or a control vaccine (Engerix B). Children were randomly allocated either to the MSP3 candidate malaria vaccine or the control vaccine administered at a schedule of 0, 1, and 2 months. Immunization with lower and higher doses was staggered for safety reasons starting with the lower dose. The primary endpoint was safety and reactogenicity within 28 days post-vaccination. Blood samples were obtained at different time points to measure immunological responses. Results are presented up to 84 days post-vaccination. Results: A total of 45 children were enrolled, 15 in each of the two MSP3 dose groups and 15 in the Engerix B group. There were no important differences in reactogenicity between the two MSP3 groups and Engerix B. Grade 3 adverse events were infrequent; only five were detected throughout the study, all of which were transient and resolved without sequelae. No serious adverse event reported was considered to be related to MSP3 vaccine. Both MSP3 dose regimens elicited strong cytophilic IgG responses (subclasses IgG1 and IgG3), the isotypes involved in the monocyte-dependant mechanism of Plasmodium falciparum parasite-killing. The titers reached are similar to those from African adults having reached a state of premunition. Furthermore, vaccination induced seroconversion in all vaccinees. Conclusion: The MSP3 malaria vaccine candidate was safe, well tolerated and immunogenic in children aged 12-24 months living in a malaria endemic community. Given the vaccine's safety and its induction of cytophilic IgG responses, its efficacy against P. falciparum infection and disease needs to be evaluated in Phase 2 studies. © 2009 Lusingu et al.