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Measuring the mortality impact of health interventions is not straightforward; there is now ample evidence of this. So why bother? Clearly, the utility, sensibility and feasibility of measuring the mortality impact of health interventions depend on many factors, which makes it difficult to offer simple prescriptions. The failure of those demanding measurement to appreciate this has led, on the one hand, to the proliferation of largely unsubstantiated claims on the achievements of health interventions and, on the other hand, to disillusionment about the prospects of demonstrating any impact on mortality. It is not difficult to account for the complexity of this area nor the current state of uncertainty. Progress has largely reflected developments in its three components—mortality measurement, health research and programme evaluation. It is thus not surprising to find the almost exclusive emphasis on measuring impact on infant and child mortality; in developing countries, child health is given a high priority in the allocation of resources by governments and donor agencies, and the techniques for estimating child mortality are generally more advanced.

Background: Arsenic is an odourless, colourless and tasteless carcinogen that can contaminate well-water. Research in Nova Scotia suggests that well-owners misunderstand the issues and risks related to arsenic and do not take necessary precautions. Rationale: Given that no similar study has occurred in Newfoundland, we examined knowledge gaps about arsenic and related water safety issues among well owners in three rural Newfoundland jurisdictions affected by arsenic (Cormack, New World Island, Gander Bay) and one control area unaffected by arsenic (Codroy Valley). Research Methodology & Approach: We mailed 1380 semi-structured surveys to the four regions, aiming to collect 100 surveys. Results: We received 247 responses (17.8% response rate). A very low response rate from Cormack (n=2) meant the community could not be included in most analyses. We conducted descriptive analyses and Chi Squares in SPSS. Discussion: While the majority of respondents in New World Island had previously tested their water for arsenic, most in Gander Bay and the Codroy Valley had not. Some respondents listed ServiceNL as their go-to tester for arsenic despite the fact that the organization can only test for coliforms, and some respondents also mentioned using sensory cues and ineffective purification strategies (e.g. boiling, using a Brita filter). Conclusion & Recommendations: This study revealed encouraging and concerning results that are informative for both the public and policymakers. We recommend the provincial government develop a new online well-water safety resource, devise strategies to clarify the limitations of ServiceNL water testing, and facilitate citizens' access to affordable water tests for arsenic.

This study examines the validity of a survey instrument on near‐miss obstetric complications. Three groups of women–with severe complications, with mild complications, and with a normal delivery–were identified retrospectively in three hospitals in South Benin and interviewed at home. The concept of "near‐miss" was used to identify women with severe episodes of morbidity. The questionnaire was able to detect, with some accuracy, eclamptic fits, abnormal bleeding in the third trimester for a recall period of at least three to four years, and all episodes of bleeding independent of timing within a period of two years. Questions concerning dystocia and infections of the genital tract generated disappointing results except when information on treatment was included. Overall, better results were achieved for antepartum and acute events. Severity made a positive difference only in the case of eclampsia, with an increase in sensitivity. The implications of the results for using women's recall of obstetric complications in surveys are discussed.

AbstractBackgroundHealthcare associated infections (HAIs) are the most frequent adverse outcome in healthcare delivery worldwide. In conflict-affected settings HAIs, in particular surgical site infections, are prevalent. Effective infection prevention and control (IPC) is crucial to ending avoidable HAIs and an integral part of safe, effective, high quality health service delivery. However, armed conflict and widespread violence can negatively affect the quality of health care through workforce shortages, supply chain disruptions and attacks on health facilities and staff. To improve IPC in these settings it is necessary to understand the specific barriers and facilitators experienced locally.MethodsIn January and February of 2020, we conducted semi-structured interviews with hospital staff working for the International Committee of the Red Cross across eight conflict-affected countries (Central African Republic, South Sudan, Democratic Republic of the Congo, Mali, Nigeria, Lebanon, Yemen and Afghanistan). We explored barriers and facilitators to IPC, as well as the direct impact of conflict on the hospital and its' IPC programme. Data was analysed thematically.ResultsWe found that inadequate hospital infrastructure, resource and workforce shortages, education of staff, inadequate in-service IPC training and supervision and large visitor numbers are barriers to IPC in hospitals in this study, similar to barriers seen in other resource-limited settings. High patient numbers, supply chain disruptions, high infection rates and attacks on healthcare infrastructures, all as a direct result of conflict, exacerbated existing challenges and imposed an additional burden on hospitals and their IPC programmes. We also found examples of local strategies for improving IPC in the face of limited resources, including departmental IPC champions and illustrated guidelines for in-service training.ConclusionsHospitals included in this study demonstrated how they overcame certain challenges in the face of limited resources and funding. These strategies present opportunities for learning and knowledge exchange across contexts, particularly in the face of the current global coronavirus pandemic. The findings are increasingly relevant today as they provide evidence of the fragility of IPC programmes in these settings. More research is required on tailoring IPC programmes so that they can be feasible and sustainable in unstable settings.

BACKGROUND: Healthcare associated infections (HAIs) are the most frequent adverse outcome in healthcare delivery worldwide. In conflict-affected settings HAIs, in particular surgical site infections, are prevalent. Effective infection prevention and control (IPC) is crucial to ending avoidable HAIs and an integral part of safe, effective, high quality health service delivery. However, armed conflict and widespread violence can negatively affect the quality of health care through workforce shortages, supply chain disruptions and attacks on health facilities and staff. To improve IPC in these settings it is necessary to understand the specific barriers and facilitators experienced locally. METHODS: In January and February of 2020, we conducted semi-structured interviews with hospital staff working for the International Committee of the Red Cross across eight conflict-affected countries (Central African Republic, South Sudan, Democratic Republic of the Congo, Mali, Nigeria, Lebanon, Yemen and Afghanistan). We explored barriers and facilitators to IPC, as well as the direct impact of conflict on the hospital and its' IPC programme. Data was analysed thematically. RESULTS: We found that inadequate hospital infrastructure, resource and workforce shortages, education of staff, inadequate in-service IPC training and supervision and large visitor numbers are barriers to IPC in hospitals in this study, similar to barriers seen in other resource-limited settings. High patient numbers, supply chain disruptions, high infection rates and attacks on healthcare infrastructures, all as a direct result of conflict, exacerbated existing challenges and imposed an additional burden on hospitals and their IPC programmes. We also found examples of local strategies for improving IPC in the face of limited resources, including departmental IPC champions and illustrated guidelines for in-service training. CONCLUSIONS: Hospitals included in this study demonstrated how they overcame certain challenges in the face of limited resources and funding. These strategies present opportunities for learning and knowledge exchange across contexts, particularly in the face of the current global coronavirus pandemic. The findings are increasingly relevant today as they provide evidence of the fragility of IPC programmes in these settings. More research is required on tailoring IPC programmes so that they can be feasible and sustainable in unstable settings.

BACKGROUND: Healthcare associated infections (HAIs) are the most frequent adverse outcome in healthcare delivery worldwide. In conflict-affected settings HAIs, in particular surgical site infections, are prevalent. Effective infection prevention and control (IPC) is crucial to ending avoidable HAIs and an integral part of safe, effective, high quality health service delivery. However, armed conflict and widespread violence can negatively affect the quality of health care through workforce shortages, supply chain disruptions and attacks on health facilities and staff. To improve IPC in these settings it is necessary to understand the specific barriers and facilitators experienced locally. METHODS: In January and February of 2020, we conducted semi-structured interviews with hospital staff working for the International Committee of the Red Cross across eight conflict-affected countries (Central African Republic, South Sudan, Democratic Republic of the Congo, Mali, Nigeria, Lebanon, Yemen and Afghanistan). We explored barriers and facilitators to IPC, as well as the direct impact of conflict on the hospital and its' IPC programme. Data was analysed thematically. RESULTS: We found that inadequate hospital infrastructure, resource and workforce shortages, education of staff, inadequate in-service IPC training and supervision and large visitor numbers are barriers to IPC in hospitals in this study, similar to barriers seen in other resource-limited settings. High patient numbers, supply chain disruptions, high infection rates and attacks on healthcare infrastructures, all as a direct result of conflict, exacerbated existing challenges and imposed an additional burden on hospitals and their IPC programmes. We also found examples of local strategies for improving IPC in the face of limited resources, including departmental IPC champions and illustrated guidelines for in-service training. CONCLUSIONS: Hospitals included in this study demonstrated how they overcame certain challenges in the face of limited resources and ...

Despite the impressive progress gains for maternal and child health during the Millennium Development Goals era, over 5.6 million women and babies died in 2015 due to complications during pregnancy, birth and in the first month of life. In order to achieve the new mortality targets set out in the Sustainable Development Goals, there needs to be intentional efforts to maintain and accelerate action to end preventable maternal and newborn deaths and stillbirths. This paper outlines what progress is required to meet these new 2030 targets based on patterns of progress in the recent past; where the burden is the greatest; when to focus attention along the continuum of care; and what causes of death require concerted efforts. Priority actions include intentional and intensified political attention and investment in maternal-newborn health with particular focus on improving quality and experience of care around the time of birth with implementation at scale of integrated maternal-newborn health interventions across the continuum of care with commensurate investment targeted at the most vulnerable populations. Looking forward, improved data for decision making and accountability will be required. The health and survival of babies and their mothers are inextricably linked, and calls for coordinated efforts and innovation before and during pregnancy, in childbirth, and postnatally, in order to end preventable maternal, neonatal deaths and stillbirths.