JournalTOCs

Followed Journals

Journal you Follow: 0

Sign Up to follow journals, search in your chosen journals and, optionally, receive Email Alerts when new issues of your Followed Jurnals are published.
Already have an account? Sign In to see the journals you follow.

Most Followed Journals

Top Publishers

Top Subjects

The Lancet

[478 followers] Follow
Full-text available via subscription

Subscription journal
ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
Published by Elsevier

[2564 journals]

Individualising treatment for older people with diabetes
- Abstract: Publication date: Available online 23 May 2013
  Source:The Lancet
  Author(s): John E Morley , Alan Sinclair
  
  PubDate: 2013-05-23T19:38:44Z
Individualised treatment targets for elderly patients with type 2 diabetes using vildagliptin add-on or lone therapy (INTERVAL): a 24 week, randomised, double-blind, placebo-controlled study
- Abstract: Publication date: Available online 23 May 2013
  Source:The Lancet
  Author(s): W David Strain , Valentina Lukashevich , Wolfgang Kothny , Marie-José Hoellinger , Päivi Maria Paldánius
  Background Guidelines suggest setting individualised targets for glycaemic control in elderly patients with type 2 diabetes, despite no evidence. We aimed to assess the feasibility of setting and achieving individualised targets over 24 weeks along with conventional HbA1c reduction using vildagliptin versus placebo. Methods In this multinational, double-blind, 24 week study, we enrolled drug-naive or inadequately controlled (glycosylated haemoglobin A1c [HbA1c] ≥7·0% to ≤10·0%) patients with type 2 diabetes aged 70 years or older from 45 outpatient centres in Europe. Investigators set individualised treatment targets on the basis of age, baseline HbA1c, comorbidities, and frailty status before a validated automated system randomly assigned patients (1:1) to vildagliptin (50 mg once or twice daily as per label) or placebo. Coprimary efficacy endpoints were proportion of patients reaching their investigator-defined HbA1c target and HbA1c reduction from baseline to study end. The study is registered with ClinicalTrials.gov, number NCT01257451, and European Union Drug Regulating Authorities Clinical Trials database, number 2010-022658-18. Findings Between Dec 22, 2010, and March 14, 2012, we randomly assigned 139 patients each to the vildagliptin and placebo groups. 37 (27%) of 137 patients in the placebo group achieved their individualised targets by education and interactions with the study team alone and 72 (52·6%) of 137 patients achieved their target in the vildagliptin group (adjusted odds ratio 3·16, 96·2% CI 1·81–5·52; p<0·0001). This finding was accompanied by a clinically relevant 0·9% reduction in HbA1c from a baseline of 7·9% with vildagliptin and a between-group difference of −0·6% (98·8% CI −0·81 to −0·33; p<0·0001). The overall safety and tolerability was similar in the vildagliptin and placebo groups, with low incidence of hypoglycaemia and no emergence of new safety signals. Interpretation This study is the first to introduce and show the feasibility of using individualised HbA1c targets as an endpoint in any type 2 diabetes population. Individualised glycaemic target levels are achievable with vildagliptin without any tolerability issues in the elderly type 2 diabetes population. Funding Novartis Pharma AG.
  
  PubDate: 2013-05-23T19:38:44Z
Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC)
- Abstract: Publication date: Available online 22 May 2013
  Source:The Lancet
  Author(s): Sarah C Bath , Colin D Steer , Jean Golding , Pauline Emmett , Margaret P Rayman
  Background As a component of thyroid hormones, iodine is essential for fetal brain development. Although the UK has long been considered iodine replete, increasing evidence suggests that it might now be mildly iodine deficient. We assessed whether mild iodine deficiency during early pregnancy was associated with an adverse effect on child cognitive development. Methods We analysed mother–child pairs from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort by measuring urinary iodine concentration (and creatinine to correct for urine volume) in stored samples from 1040 first-trimester pregnant women. We selected women on the basis of a singleton pregnancy and availability of both a urine sample from the first trimester (defined as ≤13 weeks' gestation; median 10 weeks [IQR 9–12]) and a measure of intelligence quotient (IQ) in the offspring at age 8 years. Women's results for iodine-to-creatinine ratio were dichotomised to less than 150 μg/g or 150 μg/g or more on the basis of WHO criteria for iodine deficiency or sufficiency in pregnancy. We assessed the association between maternal iodine status and child IQ at age 8 years and reading ability at age 9 years. We included 21 socioeconomic, parental, and child factors as confounders. Findings The group was classified as having mild-to-moderate iodine deficiency on the basis of a median urinary iodine concentration of 91·1 μg/L (IQR 53·8–143; iodine-to-creatinine ratio 110 μg/g, IQR 74–170). After adjustment for confounders, children of women with an iodine-to-creatinine ratio of less than 150 μg/g were more likely to have scores in the lowest quartile for verbal IQ (odds ratio 1·58, 95% CI 1·09–2·30; p=0·02), reading accuracy (1·69, 1·15–2·49; p=0·007), and reading comprehension (1·54, 1·06–2·23; p=0·02) than were those of mothers with ratios of 150 μg/g or more. When the less than 150 μg/g group was subdivided, scores worsened ongoing from 150 μg/g or more, to 50–150 μg/g, to less than 50 μg/g. Interpretation Our results show the importance of adequate iodine status during early gestation and emphasise the risk that iodine deficiency can pose to the developing infant, even in a country classified as only mildly iodine deficient. Iodine deficiency in pregnant women in the UK should be treated as an important public health issue that needs attention. Funding None.
  
  PubDate: 2013-05-23T19:38:44Z
Iodine and pregnancy: a call to action
- Abstract: Publication date: Available online 22 May 2013
  Source:The Lancet
  Author(s): Alex Stagnaro-Green , Elizabeth N Pearce
  
  PubDate: 2013-05-23T19:38:44Z
Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis
- Abstract: Publication date: Available online 20 May 2013
  Source:The Lancet
  Author(s): Vineet Chopra , Sarah Anand , Andy Hickner , Michael Buist , Mary AM Rogers , Sanjay Saint , Scott A Flanders
  Background Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis to compare the risk of venous thromboembolism associated with PICCs versus that associated with other CVCs. Methods We searched several databases, including Medline, Embase, Biosis, Cochrane Central Register of Controlled Trials, Conference Papers Index, and Scopus. Additional studies were identified through hand searches of bibliographies and internet searches, and we contacted study authors to obtain unpublished data. All human studies published in full text, abstract, or poster form were eligible for inclusion. All studies were of adult patients aged at least 18 years who underwent insertion of a PICC. Studies were assessed with the Newcastle–Ottawa risk of bias scale. In studies without a comparison group, the pooled frequency of venous thromboembolism was calculated for patients receiving PICCs. In studies comparing PICCs with other CVCs, summary odds ratios (ORs) were calculated with a random effects meta-analysis. Findings Of the 533 citations identified, 64 studies (12 with a comparison group and 52 without) including 29 503 patients met the eligibility criteria. In the non-comparison studies, the weighted frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill (13·91%, 95% CI 7·68–20·14) and those with cancer (6·67%, 4·69–8·64). Our meta-analysis of 11 studies comparing the risk of deep vein thrombosis related to PICCs with that related to CVCs showed that PICCs were associated with an increased risk of deep vein thrombosis (OR 2·55, 1·54–4·23, p<0·0001) but not pulmonary embolism (no events). With the baseline PICC-related deep vein thrombosis rate of 2·7% and pooled OR of 2·55, the number needed to harm relative to CVCs was 26 (95% CI 13–71). Interpretation PICCs are associated with a higher risk of deep vein thrombosis than are CVCs, especially in patients who are critically ill or those with a malignancy. The decision to insert PICCs should be guided by weighing of the risk of thrombosis against the benefit provided by these devices. Funding None.
  
  PubDate: 2013-05-23T19:38:44Z
Peripherally inserted catheters: all that glitters is not gold
- Abstract: Publication date: Available online 20 May 2013
  Source:The Lancet
  Author(s): Paolo Prandoni
  
  PubDate: 2013-05-23T19:38:44Z
Redefining global health-care delivery
- Abstract: Publication date: Available online 20 May 2013
  Source:The Lancet
  Author(s): Jim Yong Kim , Paul Farmer , Michael E Porter
  Initiatives to address the unmet needs of those facing both poverty and serious illness have expanded significantly over the past decade. But many of them are designed in an ad-hoc manner to address one health problem among many; they are too rarely assessed; best practices spread slowly. When assessments of delivery do occur, they are often narrow studies of the cost-effectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families. We propose a framework for global health-care delivery and evaluation by considering efforts to introduce HIV/AIDS care to resource-poor settings. The framework introduces the notion of care delivery value chains that apply a systems-level analysis to the complex processes and interventions that must occur, across a health-care system and over time, to deliver high-value care for patients with HIV/AIDS and cooccurring conditions, from tuberculosis to malnutrition. To deliver value, vertical or stand-alone projects must be integrated into shared delivery infrastructure so that personnel and facilities are used wisely and economies of scale reaped. Two other integrative processes are necessary for delivering and assessing value in global health: one is the alignment of delivery with local context by incorporating knowledge of both barriers to good outcomes (from poor nutrition to a lack of water and sanitation) and broader social and economic determinants of health and wellbeing (jobs, housing, physical infrastructure). The second is the use of effective investments in care delivery to promote equitable economic development, especially for those struggling against poverty and high burdens of disease. We close by reporting our own shared experience of seeking to move towards a science of delivery by harnessing research and training to understand and improve care delivery.
  
  PubDate: 2013-05-23T19:38:44Z
Mapping of available health research and development data: what's there, what's missing, and what role is there for a global observatory?
- Abstract: Publication date: Available online 20 May 2013
  Source:The Lancet
  Author(s): John-Arne Røttingen , Sadie Regmi , Mari Eide , Alison J Young , Roderik F Viergever , Christine Årdal , Javier Guzman , Danny Edwards , Stephen A Matlin , Robert F Terry
  The need to align investments in health research and development (R&D) with public health demands is one of the most pressing global public health challenges. We aim to provide a comprehensive description of available data sources, propose a set of indicators for monitoring the global landscape of health R&D, and present a sample of country indicators on research inputs (investments), processes (clinical trials), and outputs (publications), based on data from international databases. Total global investments in health R&D (both public and private sector) in 2009 reached US$240 billion. Of the US$214 billion invested in high-income countries, 60% of health R&D investments came from the business sector, 30% from the public sector, and about 10% from other sources (including private non-profit organisations). Only about 1% of all health R&D investments were allocated to neglected diseases in 2010. Diseases of relevance to high-income countries were investigated in clinical trials seven-to-eight-times more often than were diseases whose burden lies mainly in low-income and middle-income countries. This report confirms that substantial gaps in the global landscape of health R&D remain, especially for and in low-income and middle-income countries. Too few investments are targeted towards the health needs of these countries. Better data are needed to improve priority setting and coordination for health R&D, ultimately to ensure that resources are allocated to diseases and regions where they are needed the most. The establishment of a global observatory on health R&D, which is being discussed at WHO, could address the absence of a comprehensive and sustainable mechanism for regular global monitoring of health R&D.
  
  PubDate: 2013-05-23T19:38:44Z
Supplemental parenteral nutrition in critically ill patients
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Michael P Casaer , Alexander Wilmer , Greet Van den Berghe
  
  PubDate: 2013-05-19T22:04:04Z
Supplemental parenteral nutrition in critically ill patients
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Nobuaki Shime , Graeme MacLaren
  
  PubDate: 2013-05-19T22:04:04Z
Supplemental parenteral nutrition in critically ill patients
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Amanda Lopes , Celia Lloret Linares , Jean-François Bergmann
  
  PubDate: 2013-05-19T22:04:04Z
Supplemental parenteral nutrition in critically ill patients
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Paul Marik , Michael Hooper
  
  PubDate: 2013-05-19T22:04:04Z
Supplemental parenteral nutrition in critically ill patients – Authors' reply
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Claudia Paula Heidegger , Mette M Berger , Ronan Thibault , Walter Zingg , Claude Pichard
  
  PubDate: 2013-05-19T22:04:04Z
Films that deliver
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Priya Shetty
  
  PubDate: 2013-05-19T22:04:04Z
Susheela Singh and Jacqueline Darroch: turning research into advocacy for reproductive health
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Carrie Arnold
  
  PubDate: 2013-05-19T22:04:04Z
Running a school of life
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Kristin Solberg
  
  PubDate: 2013-05-19T22:04:04Z
Harry Keen
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Geoff Watts
  
  PubDate: 2013-05-19T22:04:04Z
Supplemental parenteral nutrition in critically ill patients
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Ronald L Koretz
  
  PubDate: 2013-05-19T22:04:04Z
Obstetric fistula: ending the health and human rights tragedy
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Babatunde Osotimehin
  
  PubDate: 2013-05-19T22:04:04Z
Offline: The season of infinite madness
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Richard Horton
  
  PubDate: 2013-05-19T22:04:04Z
Can women's groups reduce maternal and newborn deaths?
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Betty Kirkwood , Rajiv Bahl
  
  PubDate: 2013-05-19T22:04:04Z
Women's health challenges in post-revolutionary Egypt
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Sharmila Devi
  
  PubDate: 2013-05-19T22:04:04Z
Reproductive health on hold in the Philippines
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Yu-Tzu Chiu
  
  PubDate: 2013-05-19T22:04:04Z
Nigeria aims to boost fight against maternal mortality
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Wairagala Wakabi
  
  PubDate: 2013-05-19T22:04:04Z
Maternal health in Malaysia: progress and potential
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Raj Karim , Siti Hasmah Mohamad Ali
  
  PubDate: 2013-05-19T22:04:04Z
Maternal health: a missed opportunity for development
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Karen A Grépin , Jeni Klugman
  
  PubDate: 2013-05-19T22:04:04Z
Participatory women's groups: ready for prime time?
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Cesar G Victora , Fernando C Barros
  
  PubDate: 2013-05-19T22:04:04Z
Care assessment's difficult relation with maternal mortality
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Alexandre Dumont , Marie-Hélène Bouvier-Colle
  
  PubDate: 2013-05-19T22:04:04Z
Meeting the unmet need for family planning: now is the time
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Herbert B Peterson , Gary L Darmstadt , John Bongaarts
  
  PubDate: 2013-05-19T22:04:04Z
Maternal deaths and HIV treatment in sub-Saharan Africa
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Landon Myer
  
  PubDate: 2013-05-19T22:04:04Z
Aid for reproductive health: progress and challenges
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Preeti Patel , Bayard Roberts
  
  PubDate: 2013-05-19T22:04:04Z
May 18–24, 2013
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  
  PubDate: 2013-05-19T22:04:04Z
Women Deliver post–2015
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): The Lancet
  
  PubDate: 2013-05-19T22:04:04Z
GAVI injects new life into HPV vaccine rollout
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): The Lancet
  
  PubDate: 2013-05-19T22:04:04Z
Hepatitis C in the USA and Europe: two problems, one solution
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): The Lancet
  
  PubDate: 2013-05-19T22:04:04Z
Shared commitment to women's health abroad and at home
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Kathleen Sebelius
  
  PubDate: 2013-05-19T22:04:04Z
Maternal health post-2015
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Jim Campbell , Luc de Bernis , Soo Downe , Helga Fogstad , Caroline Homer , Holly Powell Kennedy , Zoe Matthews , Mary Renfrew , Petra ten Hoope-Bender
  
  PubDate: 2013-05-19T22:04:04Z
Maternal health post-2015
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Harry Strulovici
  
  PubDate: 2013-05-19T22:04:04Z
Maternal health post-2015 – Authors' reply
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Ana Langer , Guerino Chalamilla , Richard Horton
  
  PubDate: 2013-05-19T22:04:04Z
Maternal death reviews
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Vincent De Brouwere , Gwyneth Lewis , Véronique Filippi , Thérèse Delvaux , Jolly Beyeza-Kashesya , Yirgu Gebrehiwot , Cassimo Bique , David Taylor
  
  PubDate: 2013-05-19T22:04:04Z
Counting the dead: properly and promptly
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Sheila M Bird
  
  PubDate: 2013-05-19T22:04:04Z
EU Clinical Trials Regulation
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Bruno Toussaint
  
  PubDate: 2013-05-19T22:04:04Z
Road traffic injuries in Iraq
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Najwan Abu Al Saad , Egbert Sondorp
  
  PubDate: 2013-05-19T22:04:04Z
Department of Error
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  
  PubDate: 2013-05-19T22:04:04Z
Department of Error
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  
  PubDate: 2013-05-19T22:04:04Z
Analyses confirm effect of women's groups on maternal and newborn deaths
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Audrey Prost , Tim Colbourn , Prasanta Tripathy , David Osrin , Anthony Costello
  
  PubDate: 2013-05-19T22:04:04Z
Effect of women's groups and volunteer peer counselling on rates of mortality, morbidity, and health behaviours in mothers and children in rural Malawi (MaiMwana): a factorial, cluster-randomised controlled trial
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Sonia Lewycka , Charles Mwansambo , Mikey Rosato , Peter Kazembe , Tambosi Phiri , Andrew Mganga , Hilda Chapota , Florida Malamba , Esther Kainja , Marie-Louise Newell , Giulia Greco , Anni-Maria Pulkki-Brännström , Jolene Skordis-Worrall , Stefania Vergnano , David Osrin , Anthony Costello
  Background Women's groups and health education by peer counsellors can improve the health of mothers and children. We assessed their effects on mortality and breastfeeding rates in rural Malawi. Methods We did a 2×2 factorial, cluster-randomised trial in 185 888 people in Mchinji district. 48 equal-sized clusters were randomly allocated to four groups with a computer-generated number sequence. 24 facilitators guided groups through a community action cycle to tackle maternal and child health problems. 72 trained volunteer peer counsellors made home visits at five timepoints during pregnancy and after birth to support breastfeeding and infant care. Primary outcomes for the women's group intervention were maternal, perinatal, neonatal, and infant mortality rates (MMR, PMR, NMR, and IMR, respectively); and for the peer counselling were IMR and exclusive breastfeeding (EBF) rates. Analysis was by intention to treat. The trial is registered as ISRCTN06477126. Findings We monitored outcomes of 26 262 births between 2005 and 2009. In a factorial model adjusted only for clustering and the volunteer peer counselling intervention, in women's group areas, for years 2 and 3, we noted non-significant decreases in NMR (odds ratio 0·93, 0·64–1·35) and MMR (0·54, 0·28–1·04). After adjustment for parity, socioeconomic quintile, and baseline measures, effects were larger for NMR (0·85, 0·59–1·22) and MMR (0·48, 0·26–0·91). Because of the interaction between the two interventions, a stratified analysis was done. For women's groups, in adjusted analyses, MMR fell by 74% (0·26, 0·10–0·70), and NMR by 41% (0·59, 0·40–0·86) in areas with no peer counsellors, but there was no effect in areas with counsellors (1·09, 0·40–2·98, and 1·38, 0·75–2·54). Factorial analysis for the peer counselling intervention for years 1–3 showed a fall in IMR of 18% (0·82, 0·67–1·00) and an improvement in EBF rates (2·42, 1·48–3·96). The results of the stratified, adjusted analysis showed a 36% reduction in IMR (0·64, 0·48–0·85) but no effect on EBF (1·18, 0·63–2·25) in areas without women's groups, and in areas with women's groups there was no effect on IMR (1·05, 0·82–1·36) and an increase in EBF (5·02, 2·67–9·44). The cost of women's groups was US$114 per year of life lost (YLL) averted and that of peer counsellors was $33 per YLL averted, using stratified data from single intervention comparisons. Interpretation Community mobilisation through women's groups and volunteer peer counsellor health education are methods to improve maternal and child health outcomes in poor rural populations in Africa. Funding Saving Newborn Lives, UK Department for International Development, and Wellcome Trust.
  
  PubDate: 2013-05-19T22:04:04Z
Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Audrey Prost , Tim Colbourn , Nadine Seward , Kishwar Azad , Arri Coomarasamy , Andrew Copas , Tanja A J Houweling , Edward Fottrell , Abdul Kuddus , Sonia Lewycka , Christine MacArthur , Dharma Manandhar , Joanna Morrison , Charles Mwansambo , Nirmala Nair , Bejoy Nambiar , David Osrin , Christina Pagel , Tambosi Phiri , Anni-Maria Pulkki-Brännström , Mikey Rosato , Jolene Skordis-Worrall , Naomi Saville , Neena Shah More , Bhim Shrestha , Prasanta Tripathy , Amie Wilson , Anthony Costello
  Background Maternal and neonatal mortality rates remain high in many low-income and middle-income countries. Different approaches for the improvement of birth outcomes have been used in community-based interventions, with heterogeneous effects on survival. We assessed the effects of women's groups practising participatory learning and action, compared with usual care, on birth outcomes in low-resource settings. Methods We did a systematic review and meta-analysis of randomised controlled trials undertaken in Bangladesh, India, Malawi, and Nepal in which the effects of women's groups practising participatory learning and action were assessed to identify population-level predictors of effect on maternal mortality, neonatal mortality, and stillbirths. We also reviewed the cost-effectiveness of the women's group intervention and estimated its potential effect at scale in Countdown countries. Findings Seven trials (119 428 births) met the inclusion criteria. Meta-analyses of all trials showed that exposure to women's groups was associated with a 37% reduction in maternal mortality (odds ratio 0·63, 95% CI 0·32–0·94), a 23% reduction in neonatal mortality (0·77, 0·65–0·90), and a 9% non-significant reduction in stillbirths (0·91, 0·79–1·03), with high heterogeneity for maternal (I 2=58·8%, p=0·024) and neonatal results (I 2=64·7%, p=0·009). In the meta-regression analyses, the proportion of pregnant women in groups was linearly associated with reduction in both maternal and neonatal mortality (p=0·026 and p=0·011, respectively). A subgroup analysis of the four studies in which at least 30% of pregnant women participated in groups showed a 55% reduction in maternal mortality (0·45, 0·17–0·73) and a 33% reduction in neonatal mortality (0·67, 0·59–0·74). The intervention was cost effective by WHO standards and could save an estimated 283 000 newborn infants and 41 100 mothers per year if implemented in rural areas of 74 Countdown countries. Interpretation With the participation of at least a third of pregnant women and adequate population coverage, women's groups practising participatory learning and action are a cost-effective strategy to improve maternal and neonatal survival in low-resource settings. Funding Wellcome Trust, Ammalife, and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Birmingham and the Black Country programme.
  
  PubDate: 2013-05-19T22:04:04Z
Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): João Paulo Souza , Ahmet Metin Gülmezoglu , Joshua Vogel , Guillermo Carroli , Pisake Lumbiganon , Zahida Qureshi , Maria José Costa , Bukola Fawole , Yvonne Mugerwa , Idi Nafiou , Isilda Neves , Jean-José Wolomby-Molondo , Hoang Thi Bang , Kannitha Cheang , Kang Chuyun , Kapila Jayaratne , Chandani Anoma Jayathilaka , Syeda Batool Mazhar , Rintaro Mori , Mir Lais Mustafa , Laxmi Raj Pathak , Deepthi Perera , Tung Rathavy , Zenaida Recidoro , Malabika Roy , Pang Ruyan , Naveen Shrestha , Surasak Taneepanichsku , Nguyen Viet Tien , Togoobaatar Ganchimeg , Mira Wehbe , Buyanjargal Yadamsuren , Wang Yan , Khalid Yunis , Vicente Bataglia , José Guilherme Cecatti , Bernardo Hernandez-Prado , Juan Manuel Nardin , Alberto Narváez , Eduardo Ortiz-Panozo , Ricardo Pérez-Cuevas , Eliette Valladares , Nelly Zavaleta , Anthony Armson , Caroline Crowther , Carol Hogue , Gunilla Lindmark , Suneeta Mittal , Robert Pattinson , Mary Ellen Stanton , Liana Campodonico , Cristina Cuesta , Daniel Giordano , Nirun Intarut , Malinee Laopaiboon , Rajiv Bahl , Jose Martines , Matthews Mathai , Mario Merialdi , Lale Say
  Background We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities. Methods In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios. Results From May 1, 2010, to Dec 31, 2011, we included 314 623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23 015 (7·3%) women had potentially life-threatening disorders and 3024 (1·0%) developed an SMO. 808 (26·7%) women with an SMO had post-partum haemorrhage and 784 (25·9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0·826 [95% CI 0·802–0·851]). Interpretation High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy. Funding UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Tr...
  PubDate: 2013-05-19T22:04:04Z
Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys
- Abstract: Publication date: 18–24 May 2013
  Source:The Lancet, Volume 381, Issue 9879
  Author(s): Jacqueline E Darroch , Susheela Singh
  Background Data for trends in contraceptive use and need are necessary to guide programme and policy decisions and to monitor progress towards Millennium Development Goal 5, which calls for universal access to contraceptive services. We therefore aimed to estimate trends in contraceptive use and unmet need in developing countries in 2003, 2008, and 2012 . Methods We obtained data from national surveys for married and unmarried women aged 15–49 years in regions and subregions of developing countries. We estimated trends in the numbers and proportions of women wanting to avoid pregnancy, according to whether they were using modern contraceptives, or had unmet need for modern methods (ie, using no methods or a traditional method). We used comparable data sources and methods for three reference years (2003, 2008, and 2012). National survey data were available for 81–98% of married women using and with unmet need for modern methods. Findings The number of women wanting to avoid pregnancy and therefore needing effective contraception increased substantially, from 716 million (54%) of 1321 million in 2003, to 827 million (57%) of 1448 million in 2008, to 867 million (57%) of 1520 million in 2012. Most of this increase (108 million) was attributable to population growth. Use of modern contraceptive methods also increased, and the overall proportion of women with unmet need for modern methods among those wanting to avoid pregnancy decreased from 29% (210 million) in 2003, to 26% (222 million) in 2012. However, unmet need for modern contraceptives was still very high in 2012, especially in sub-Saharan Africa (53 million [60%] of 89 million), south Asia (83 million [34%] of 246 million), and western Asia (14 million [50%] of 27 million). Moreover, a shift in the past decade away from sterilisation, the most effective method, towards injectable drugs and barrier methods, might have led to increases in unintended pregnancies in women using modern methods. Interpretation Achievement of the desired number and healthy timing of births has important benefits for women, families, and societies. To meet the unmet need for modern contraception, countries need to increase resources, improve access to contraceptive services and supplies, and provide high-quality services and large-scale public education interventions to reduce social barriers. Our findings confirm a substantial and unfinished agenda towards meeting of couples' reproductive needs. Funding UK Department for International Development, the Bill & Melinda Gates Foundation, and the UN Population Fund (UNFPA).
  
  PubDate: 2013-05-19T22:04:04Z