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Objective To describe the causes of maternal death in a population-based cohort in six low- and middle-income countries using a standardised, hierarchical, algorithmic cause of death (COD) methodology. Design A population-based, prospective observational study. Setting Seven sites in six low- to middle-income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia. Population All deaths among pregnant women resident in the study sites from 2014 to December 2016. Methods For women who died, we used a standardised questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analysed using a computer-based algorithm to assign cause of maternal death based on the International Classification of Disease-Maternal Mortality system (trauma, termination of pregnancy-related, eclampsia, haemorrhage, pregnancy-related infection and medical conditions). We also compared the COD results to healthcare-provider-assigned maternal COD. Main outcome measures Assigned causes of maternal mortality. Results Among 158 205 women, there were 221 maternal deaths. The most common algorithm-assigned maternal COD were obstetric haemorrhage (38.6%), pregnancy-related infection (26.4%) and pre-eclampsia/eclampsia (18.2%). Agreement between algorithm-assigned COD and COD assigned by healthcare providers ranged from 75% for haemorrhage to 25% for medical causes coincident to pregnancy. Conclusions The major maternal COD in the Global Network sites were haemorrhage, pregnancy-related infection and pre-eclampsia/eclampsia. This system could allow public health programmes in low- and middle-income countries to generate transparent and comparable data for maternal COD across time or regions. Tweetable abstract An algorithmic system for determining maternal cause of death in low-resource settings is described.

Objective To describe the Global Network Near-Miss Maternal Mortality System and its application in seven sites. Methods In a population-based study, pregnant women eligible for enrollment in the Maternal and Newborn Health Registry at seven sites (Democratic Republic of the Congo; Guatemala; Belagavi and Nagpur, India; Kenya; Pakistan; and Zambia) between January 2014 and April 2016 were screened to identify those likely to have a near-miss event. The WHO maternal near-miss criteria were modified for low-resource settings. The ratio of near-miss events to maternal deaths was calculated. Results Among 122 707 women screened, 18 307 (15.0%) had a potential near-miss event, of whom 4866 (26.6%; 4.0% of all women) had a near-miss maternal event. The overall maternal mortality ratio was 155 per 100 000 live births. The ratio of near-miss events to maternal deaths was 26 to 1. The most common factors involved in near-miss cases were the hematologic/coagulation system, infection, and cardiovascular system. Conclusion By using the Global Network Near-Miss Maternal Mortality System, large numbers of women were screened for near-miss events, including those delivering at home or a low-level maternity clinic. The 4.0% incidence of near-miss maternal mortality is similar to previously reported data. The ratio of 26 near-miss cases to 1 maternal death suggests that near miss might evaluate the impact of interventions more efficiently than maternal mortality. This article is protected by copyright. All rights reserved.

Aim This study estimated the causes of neonatal death using an algorithm for low-resource areas, where 98% of the world's neonatal deaths occur. Methods We enrolled women in India, Pakistan, Guatemala, the Democratic Republic of Congo, Kenya and Zambia from 2014 to 2016 and tracked their delivery and newborn outcomes for up to 28 days. Antenatal care and delivery symptoms were collected using a structured questionnaire, clinical observation and/or a physical examination. The Global Network Cause of Death algorithm was used to assign the cause of neonatal death, analysed by country and day of death. Results One-third (33.1%) of the 3068 neonatal deaths were due to suspected infection, 30.8% to prematurity, 21.2% to asphyxia, 9.5% to congenital anomalies and 5.4% did not have a cause of death assigned. Prematurity and asphyxia-related deaths were more common on the first day of life (46.7% and 52.9%, respectively), while most deaths due to infection occurred after the first day of life (86.9%). The distribution of causes was similar to global data reported by other major studies. Conclusion The Global Network algorithm provided a reliable cause of neonatal death in low-resource settings and can be used to inform public health strategies to reduce mortality.

OBJECTIVE: To determine population-based stillbirth rates and to determine whether the timing and maturity of the stillbirths suggest a high proportion of potentially preventable deaths. DESIGN: Prospective observational study. SETTING: Communities in six low-income countries (Democratic Republic of Congo Kenya Zambia Guatemala India and Pakistan) and one site in a mid-income country (Argentina). POPULATION: Pregnant women residing in the study communities. METHODS: Over a five-year period in selected catchment areas using multiple methodologies trained study staff obtained pregnancy outcomes on each delivery in their area. MAIN OUTCOME MEASURES: Pregnancy outcome stillbirth characteristics. RESULTS: Outcomes of 195400 deliveries were included. Stillbirth rates ranged from 32 per 1000 in Pakistan to 8 per 1000 births in Argentina. Three-fourths (76%) of stillbirth offspring were not macerated 63% were >/= 37 weeks and 48% weighed 2500 g or more. Across all sites women with no education of high and low parity of older age and without access to antenatal care were at significantly greater risk for stillbirth (p /= 37 weeks gestation and almost half weighed at least 2500 g. With access to better medical care especially in the intrapartum period many of these stillbirths could likely be prevented. (c) 2011 Nordic Federation of Societies of Obstetrics and Gynecology No claim to original US government works.

SUMMARY The authors evaluated 89 infants who had had computed tomography of the head and who were followed-up for a minimum of one year. In a large proportion with moderate ventriculomegaly spontaneous stabilization or regression occurred, with normal developmental outcome in a high percentage of cases. However, there was a statistically significant trend toward lower developmental scores as ventricular size increased. Many infants with ventricular enlargement will not develop progressive hydrocephalus, but their cognitive and psychomotor development may be affected. RESUME Devenir des nouveaux-nes a haut risque avec ventriculomegalie 89 nourrissons ayant beneficie d'un scanner de la tete ont ete suivis au moins un an dans un service de suite. Un nombre important d'enfants qui presentaient une ventriculomegalie moderee ont evolue spontanement vers la stabilisation ou la regression de la ventriculo-megalie avec generalement un developpement normal ulterieur. Cependant, il a ete observe une correlation statistiquement significative entre des scores developpement plus bas et le degre de dilatation ventriculaire. Nous en concluons que de nombreux enfants presentant une dilatation ventriculaire n'evoluent pas vers une hydrocephalie progressive mais peuvent avoir un developpement cognitif et psycho-moteur compromis. ZUSAMMENFASSUNG Ergebnis bei Risikoneugeborenen mit Ventrikulomegalie 89 Saulinge, bei denen ein Computertomogramm des Kopfes gemacht worden war, wurden mindestens ein Jahr in einer Nachsorgeklinik kontrolliert. Viele der Sauglinge mit masiger Ventrikulomegalie zeigten eine spontane Stabilisation oder einen Ruckgang der Ventrikulomegalie mit weitgehend normaler Entwicklung. Bei zunehmender Ventrikel-grose jedoch fand ein signifikant schlechteres Ergebnis beim Entwicklungstest zugrunde gelegt wurden. Wir schliesen daraus, das viele Sauglinge mit einer Ventrikelerweiterung keinen progressiven Hydrocephalus entwickeln, eventuell aber eine eingeschrankte kognitive und psychomotorische Entwicklung haben. RESUMEN Curso posterior de recien nacidos con alto riesgo con ventriculomegalia 89 ninos explorados con tomografia computarizada de la cabeza, fueron seguidos durante un minimo de un ano en la Clinica de Seguimiento. Un gran numero de ninos con ventriculomegalia moderada experimento una estabilizacion o regresion espontanea de la ventriculomegalia, con un desarrollo posterior normal en un alto porcentaje. Sin embargo habia una tendencia estadisticamente significativa hacia unos puntajes de desarrollo mas bajos a medida que aumentaba el tamano ventricular. Se concluye que muchos ninos con agrandamiento ventricular, no desarrollaran una hidrocefalia progresiva, pero si pueden tener dificultades en el desarrollo cognitivo y psicomotor.

Interference with Zn absorption is one proposed explanation for adverse effect of Fe supplements in Fe-replete subjects in malaria endemic areas. We determined the effect of Fe on Zn absorption and...