Background
Rank by highest neonatal mortality rate | Country | Neonatal mortality rate/1,000 live births (UNICEF 2013) | UCDP (2011 and 2012) any conflict* | UNESCO (2010) report definition of conflict
ǂ
| UNHCR (mid-2013) Number refugees from this country | UNHCR (mid-2013) Number of refugees in this country | UNHCR (mid-2013) IDPs in this country |
---|---|---|---|---|---|---|---|
Includes any: war and minor conflict, non-state conflict and one-sided violence | |||||||
1 | Mali | 59 | Yes | 182,780 | 14,425 | 353,455 | |
2 | Sierra Leone | 59 | No | Post conflict | 5734 | 4154 | 0 |
3 | Guinea-Bissau | 58 | No | 1,162 | 7,787 | 0 | |
4 | South Sudan° | 57 | Yes | N/A | 102,651 | 223,636 | 401,433 |
5 | Pakistan | 56 | Yes | Armed Conflict | 46,046 | 1,621,525 | 975,478 |
6 | Ethiopia | 54 | Yes | Armed Conflict | 73,926 | 406,646 | 0 |
7 | Guinea | 54 | Yes | Post conflict | 13,956 | 10,466 | 0 |
8 | Mozambique | 54 | No | 63 | 4,413 | 0 | |
9 | Bangladesh | 54 | No | 9,545 | 231,138 | 0 | |
10 | Nepal | 53 | No | Armed Conflict | 7,323 | 51,232 | 0 |
11 | Nigeria | 52 | Yes | Non-State | 17,735 | 1,849 | 0 |
12 | Angola | 52 | No | Post conflict | 16,229 | 23,718 | 0 |
13 | India | 51 | Yes | Armed Conflict | 11,784 | 187,024 | 0 |
14 | Liberia | 51 | No | Post conflict | 22,488 | 58,852 | 0 |
15 | Malawi | 50 | No | 275 | 6,369 | 0 | |
16 | Somalia | 50 | Yes | Armed Conflict | 1,130,939 | 2,339 | 1,122,559 |
17 | Afghanistan | 50 | Yes | Armed Conflict | 2,552,208 | 16,866 | 5,367 |
18 | Niger | 48 | No | 657 | 50,424 | 0 | |
19 | Côte d’Ivoire | 48 | Yes | Post conflict | 93,738 | 4,025 | 24,000 |
20 | Democratic Republic of Congo | 47 | Yes | Armed Conflict | 490,095 | 183,244 | 2,607,407 |
21 | Equatorial Guinea | 47 | No | 214 | 0 | 0 | |
22 | Timor-Leste | 47 | No | N/A | N/A | N/A | N/A |
23 | Central African Republic | 47 | Yes | Extra definitional | 221,577 | 17,732 | 206,000 |
24 | Chad | 47 | No | Armed Conflict | 39,329 | 418,451 | 90,000 |
25 | Burundi | 46 | No | Armed Conflict | 73,143 | 44.034 | 78,948 |
Neonatal health in complex humanitarian emergencies
Child Health and nutrition research Initiative method
Methods
Defining the research context, questions, and criteria for priority setting
Research context
Research questions
Criterion selection
Enlisting experts to systematically score the research
Data analysis
Funding
Results
Rank | Question | Research type* | Research Priority Score (RPS) | Average Expert Agreement (AEA) | Answerability | Feasibility | Relevance | Equity |
---|---|---|---|---|---|---|---|---|
1 | What strategies are effective in increasing demand for, and use of skilled attendance? | DEL | 0.846 | 0.643 | 0.837 | 0.824 | 0.870 | 0.852 |
2 | What is the feasibility, effectiveness and cost of approaches to increase coverage of clean delivery practices in facilities and in homes? | DEL | 0.841 | 0.616 | 0.820 | 0.774 | 0.863 | 0.908 |
3 | What is the additional burden of neonatal mortality in different emergency situations (e.g. conflict, acute vs. protracted, natural disaster)? | DES | 0.833 | 0.667 | 0.836 | 0.755 | 0.883 | 0.858 |
4 | Can simplified pregnancy surveillance at community level be used to measure neonatal mortality? | DES | 0.830 | 0.616 | 0.799 | 0.857 | 0.797 | 0.867 |
5 | Can simplified verbal autopsy tools be adapted for use in emergency settings to capture the main causes of neonatal mortality? | DES | 0.828 | 0.661 | 0.827 | 0.789 | 0.825 | 0.872 |
6 | Develop and validate strategies to identify preterm babies at community level by CHWs and family members | DEV | 0.826 | 0.610 | 0.823 | 0.768 | 0.859 | 0.855 |
7 | Which risk factors for neonatal sepsis can be identified in emergency settings and these mothers and babies given extra support? E.g. low birth weight, short gestational age, unhygienic delivery, skin and umbilical cord care, hypothermia, poor feeding practices. | DES | 0.818 | 0.634 | 0.797 | 0.765 | 0.841 | 0.868 |
8 | Can pregnancy surveillance at community level contribute to increased uptake of facility-based delivery? | DEL | 0.816 | 0.610 | 0.866 | 0.815 | 0.790 | 0.793 |
9 | What is the feasibility, effectiveness and cost of different approaches to increase coverage of syphilis screening in pregnancy, treatment and partner treatment? | DEL | 0.814 | 0.568 | 0.827 | 0.801 | 0.812 | 0.814 |
10 | What is the feasibility, effectiveness and cost of different approaches to promote handwashing of caregivers? | DEL | 0.812 | 0.610 | 0.862 | 0.835 | 0.743 | 0.807 |
11 | What is the incidence of neonatal sepsis in emergency settings? | DES | 0.803 | 0.619 | 0.788 | 0.764 | 0.802 | 0.861 |
12 | What is the relative proportion of death in the neonatal period to other causes of child mortality in emergency settings? | DES | 0.794 | 0.610 | 0.783 | 0.784 | 0.755 | 0.853 |
13 | What is the feasibility, effectiveness and cost of approaches to increase and/or maintain tetanus toxoid coverage? | DEL | 0.791 | 0.557 | 0.828 | 0.773 | 0.679 | 0.885 |
14 | Can use of perinatal audit reduce the incidence of adverse outcomes related in acute intrapartum events? | DEL | 0.785 | 0.500 | 0.805 | 0.795 | 0.801 | 0.740 |
15 | What is the feasibility, effectiveness and cost of different approaches to promote hygienic cord and skin care? | DEV | 0.783 | 0.548 | 0.808 | 0.782 | 0.782 | 0.762 |
16 | Evaluate ways to provide thermal care and feeding for the very preterm baby at or close to home | DEV | 0.780 | 0.512 | 0.798 | 0.766 | 0.744 | 0.812 |
17 | What is the feasibility, effectiveness and cost of a scheme of routine home visits for initiation of supportive practices, detection of illness and newborn survival? | DEL | 0.771 | 0.539 | 0.799 | 0.747 | 0.743 | 0.795 |
18 | What is the feasibility, costs and effectiveness of setting up newborn care corners in mobile clinics, first referral units and district hospitals? | DEL | 0.769 | 0.536 | 0.790 | 0.725 | 0.823 | 0.739 |
19 | Can simpler clinical algorithms (recognition and management) be developed and validated for babies who require resuscitation at birth, and does this increase met need for resuscitation at birth? | DEL | 0.767 | 0.539 | 0.669 | 0.785 | 0.809 | 0.806 |
20 | Safety, feasibility and effectiveness and cost of managing severe neonatal infections at or close to home (e.g. requiring injectable antibiotics) | DEV | 0.763 | 0.530 | 0.807 | 0.590 | 0.836 | 0.820 |
21 | What is the incidence, causes and outcomes of umbilical and skin infections among newborns in emergency settings? | DES | 0.762 | 0.521 | 0.789 | 0.703 | 0.701 | 0.855 |
22 | What is the feasibility and effectiveness of approaches to improve aseptic practices in labour rooms, maternity, paediatric wards and nurseries? | DEL | 0.753 | 0.533 | 0.747 | 0.754 | 0.779 | 0.731 |
23 | What is the feasibility, effectiveness and cost of approaches to increase coverage of antibiotics for prolonged rupture of membranes? | DEL | 0.752 | 0.494 | 0.779 | 0.716 | 0.738 | 0.776 |
24 | What is the relative proportion of neonatal infections that are pneumonia, sepsis, meningitis and are there reliable clinical markers/combination of markers to distinguish these conditions? | DES | 0.739 | 0.521 | 0.686 | 0.720 | 0.734 | 0.815 |
25 | What is the feasibility and effectiveness of approaches to improve quality of care in hospitals? | DEL | 0.739 | 0.479 | 0.706 | 0.729 | 0.752 | 0.768 |
26 | Can introduction of Doppler increase the use of partograph to monitor labor? | DEL | 0.724 | 0.461 | 0.829 | 0.736 | 0.655 | 0.675 |
27 | What is the attribute of clean delivery kit distribution in decision making process for home or facility based delivery? | DEL | 0.713 | 0.429 | 0.729 | 0.695 | 0.677 | 0.751 |
28 | What is the additional burden of stillbirth in different emergency situations (e.g. conflict, acute vs protracted, natural disaster)? | DES | 0.706 | 0.515 | 0.725 | 0.604 | 0.785 | 0.709 |
29 | Can low-cost, robust, simple fetal heart monitors be developed and tested that are more user-friendly than the Pinard? Does use of such a device improve fetal heart rate monitoring and reduce intrapartum stillbirth and asphyxia-related outcomes? | DEV | 0.700 | 0.443 | 0.718 | 0.689 | 0.770 | 0.622 |
30 | Can UTI screening in pregnancy be reduced in cost and made more feasible so can be used in lower levels of care? | DEV | 0.698 | 0.438 | 0.726 | 0.653 | 0.663 | 0.751 |
31 | Can simpler, cheaper technology be developed to improve supportive care of neonates who require oxygen (such as robust pulse oximeter, oxygen condensers, low cost CPAP etc.) and does this reduce deaths, improve outcomes? | DEV | 0.696 | 0.458 | 0.734 | 0.617 | 0.760 | 0.675 |
32 | How can diagnostic facilities in health facilities for identification of neonatal sepsis be improved? | DEL | 0.696 | 0.461 | 0.662 | 0.682 | 0.758 | 0.684 |
33 | What is the feasibility, effectiveness and cost of different approaches to promote prompt care seeking for illness from an appropriate provider? | DEL | 0.691 | 0.426 | 0.699 | 0.614 | 0.705 | 0.744 |
34 | Identification of new interventions to prevent transmission of infections during childbirth, e.g. chlorhexidine vaginal douche, immune modulators like zinc to mothers. | DEV | 0.679 | 0.440 | 0.678 | 0.674 | 0.692 | 0.672 |
35 | Evaluate different methods of behavior change that overcome harmful practices and promote positive cultural and social norms | DEL | 0.679 | 0.411 | 0.751 | 0.585 | 0.681 | 0.699 |
Discussion
Conclusions
Appendix 1
STAGE 1: Defining the context and criteria for priority setting
-
The space: complex humanitarian emergencies, defined as acute or chronic situations of conflict, war or civil disturbance, natural disasters, food insecurity or other crises that affect large civilian populations result in significant excess mortality, and are beyond the capacity of the local government to cope;
-
Time: from present day to the year 2020;
-
The population of interest: internally displaced persons (IDP), refugees, and communities affected by complex humanitarian emergencies in low and middle income countries;
-
The burden of disease was all cause mortality and disability during the neonatal period.