An analysis of three levels of scaled-up coverage for 28 interventions to avert stillbirths and maternal, newborn and child mortality in 27 countries in Latin America and the Caribbean with the Lives Saved Tool (LiST).

BACKGROUND: Action to avert maternal and child mortality was propelled by the Millennium Development Goals (MDGs) in 2000. The Latin American and Caribbean (LAC) region has shown promise in achieving the MDGs in many countries, but preventable maternal, neonatal and child mortality persist. Furthermore, preventable stillbirths are occurring in large numbers in the region. While an effective set of maternal, newborn and child health (MNCH) interventions have been identified, they have not been brought to scale across LAC. METHODS: Baseline data for select MNCH interventions for 27 LAC countries that are included in the Lives Saved Tool (LiST) were verified and updated with survey data. Three LiST projections were built for each country: baseline, MDG-focused, and All Included, each scaling up a progressively larger set of interventions for 2015 - 2030. Impact was assessed for 2015 - 2035, comparing annual and total lives saved, as projected by LiST. RESULTS: Across the 27 countries 235,532 stillbirths, and 752,588 neonatal, 959,393 under-five, and 60,858 maternal deaths would be averted between 2015 and 2035 by implementing the All-Included intervention package, representing 67 %, 616 %, 807 % and 101 % more lives saved, respectively, than with the MDG-focused interventions. 25 % neonatal deaths averted with the All-Included intervention package would be due to asphyxia, 42 % from prematurity and 24 % from sepsis. CONCLUSIONS: Our modelling suggests a 337 % increase in the number of lives saved, which would have enormous impacts on population health. Further research could help clarify the impacts of a comprehensive scale-up of the full range of essential MNCH interventions we have modelled.

A multi-country, cross-sectional observational study of retinopathy of prematurity in Latin America and the Caribbean.

Objective To consolidate available information from the Latin American and Caribbean (LAC) region on 1) national incidence of retinopathy of prematurity (ROP) and 2) national-level government inputs on ROP (existing national policies, guidelines, programs, and financing for ROP prevention, detection, and treatment, including ROP screening) in 2014. Methods In March and April 2015, a multi-country online survey was distributed to 56 medical and public health experts working on ROP in LAC countries. Respondents were instructed to provide quantitative and qualitative information representative of the national situation in 2014 for ROP incidence and national-level government inputs (existing national policies, guidelines, programs, and financing for ROP prevention, detection, and treatment, including ROP screening) in their country. Results The survey was completed in full by a total of 11 experts from 10 LAC countries (Argentina, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, El Salvador, Mexico, Nicaragua, and Panama). According to the survey results, six countries had a national policy that includes ROP prevention, detection, and treatment, with screening and treatment covered by national/federal funding. Eight countries had national guidelines for ROP. Four countries had legislation mandating eye examination of preterm infants. Most countries had Level 3 and 4 neonatal intensive care units with ROP programs in public sector health care facilities. Five countries had a data collection or monitoring system to track the number of newborn babies screened for ROP within hospital settings. On average, countries with three or four of the above-mentioned ROP elements screened 95% of eligible newborns in 2014, while those with only one or two of the ROP elements screened 35% of eligible newborns. Conclusions National government buy-in and involvement in ROP screening and treatment legislation is related to a higher proportion of eligible premature newborns being screened and treated for ROP. Further research should include more countries and assess national-level engagement with ROP, including ROP screening and treatment.

Gestational syphilis and stillbirth in the Americas: a systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis of reported estimates of the association between gestational syphilis (GS) and stillbirth in the Americas region. METHODS: Cochrane Library, Embase, LILACS, MEDLINE/PubMed, PLOS, and ScienceDirect were searched for original research studies quantifying the relationship between GS and stillbirth in the region. A final sample of eight studies was selected. A cumulative meta-analysis plus four subgroup meta-analyses of study data on the association between maternal syphilis during pregnancy and stillbirth were conducted. The four meta-analyses were based on 1) definition of cases and the control; 2) syphilis treatment (presence or absence, effective or ineffective); 3) definition of stillbirth as "showing no signs of life at birth"; and 4) definition of stillbirth based on low birth weight and gestational age. Random-effects metaanalyses were used to calculate pooled estimates of stillbirth with exposure to GS, and each subgroup analysis was tested for heterogeneity. RESULTS: Women with GS had increased odds of stillbirth (pooled odds ratio (OR): 6.87; 95% confidence interval: 2.93, 16.08). There was considerable heterogeneity across the eight studies (percentage of variance (I²) = 95). The funnel plot was not statistically significant, pointing to a lack of publication bias. Increased odds of stillbirth among pregnant women with syphilis were also seen in all four subgroup meta-analyses. CONCLUSIONS: GS is a major contributing factor for stillbirths in the Americas. Interventions targeting GS are highly cost-effective and, along with high-quality point-of-care testing, should be implemented across the region to help reach the goal of eliminating congenital syphilis.

Gestational syphilis and stillbirth in Latin America and the Caribbean.

OBJECTIVE: To measure the association between gestational syphilis and stillbirth in Latin America and the Caribbean. METHODS: In a retrospective study, data on stillbirth and gestational syphilis extracted from the Sistema Informático Perinatal database were analyzed for deliveries in 11 countries between January 1, 2009, and December 31, 2012. Potential confounders were examined, and binary logistic regression analysis was performed to assess the association between gestational syphilis and stillbirth. RESULTS: Among 368 151 deliveries, 3875 (1.1%) were by women with a positive syphilis test, and 1461 (0.4%) were stillbirths. Among the stillbirths, 29 (2.0%) were delivered by women with a positive syphilis test. After controlling for country, congenital anomalies, gestational age at labor, maternal age, and previous stillbirth, gestational syphilis was significantly associated with stillbirth (odds ratio 1.88, 95% confidence interval 1.25-2.83; P=0.002). CONCLUSION: Gestational syphilis contributes to stillbirth in Latin America and the Caribbean. Interventions targeting gestational syphilis are highly cost-effective and should be implemented across the region.

A multi-country, cross-sectional observational study of retinopathy of prematurity in Latin America and the Caribbean / Estudio de observación, multinacional y transversal de la retinopatía del prematuro en América Latina y el Caribe

Objective. To consolidate available information from the Latin American and Caribbean (LAC) region on 1) national incidence of retinopathy of prematurity (ROP) and 2) national- level government inputs on ROP (existing national policies, guidelines, programs, and financing for ROP prevention, detection, and treatment, including ROP screening) in 2014. Methods. In March and April 2015, a multi-country online survey was distributed to 56 medical and public health experts working on ROP in LAC countries. Respondents were instructed to provide quantitative and qualitative information representative of the national situation in 2014 for ROP incidence and national-level government inputs (existing national policies, guidelines, programs, and financing for ROP prevention, detection, and treatment, including ROP screening) in their country. Results. The survey was completed in full by a total of 11 experts from 10 LAC countries (Argentina, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, El Salvador, Mexico, Nicaragua, and Panama). According to the survey results, six countries had a national policy that includes ROP prevention, detection, and treatment, with screening and treatment covered by national/federal funding. Eight countries had national guidelines for ROP. Four countries had legislation mandating eye examination of preterm infants. Most countries had Level 3 and 4 neonatal intensive care units with ROP programs in public sector health care facilities. Five countries had a data collection or monitoring system to track the number of newborn babies screened for ROP within hospital settings. On average, countries with three or four of the above-mentioned ROP elements screened 95% of eligible newborns in 2014, while those with only one or two of the ROP elements screened 35% of eligible newborns. Conclusions. National government buy-in and involvement in ROP screening and treatment legislation is related to a higher proportion of eligible premature newborns being screened and treated for ROP. Further research should include more countries and assess national-level engagement with ROP, including ROP screening and treatment.

Objetivo. Reunir la información disponible de la región de América Latina y el Caribe sobre: 1) la incidencia nacional de la retinopatía del prematuro (RP); y 2) las aportaciones gubernamentales en materia de RP a nivel nacional (políticas, directrices, programas y financiamiento nacionales para la prevención, la detección y el tratamiento de la RP, incluidas las campañas de tamizaje) en el 2014. Métodos. En marzo y abril del 2015, se distribuyó en línea una encuesta multinacional a 56 expertos en medicina y en salud pública que trabajaban en el área de la RP en una serie de países de América Latina y el Caribe, en la que se pedía información cuantitativa y cualitativa que representase la situación de su país en el 2014, teniendo en cuenta la incidencia de la RP y las aportaciones gubernamentales a nivel nacional (políticas, directrices, programas y financiamiento nacionales para la prevención, la detección y el tratamiento de la RP, así como campañas de tamizaje). Resultados. Contestaron la encuesta íntegramente 11 expertos de 10 países de América Latina y el Caribe (Argentina, Brasil, Colombia, Costa Rica, Cuba, República Dominicana, El Salvador, México, Nicaragua y Panamá). Seis países cuentan con una política nacional de prevención, detección y tratamiento de la RP, con financiamiento nacional/federal para sufragar el tamizaje y el tratamiento. Ocho países cuentan con directrices nacionales sobre RP. En cuatro países, la legislación establece la práctica de exploraciones oftalmológicas a todos los prematuros. La mayoría de los países disponen de unidades de cuidados intensivos neonatales de nivel 3 y 4 con programas de RP en los establecimientos públicos de atención de salud. Cinco países cuentan con una base de datos o sistema de vigilancia para hacer un seguimiento del número de neonatos que pasan el tamizaje de RP en el ámbito hospitalario. En promedio, en el 2014, los países que disponían de tres o cuatro de los citados elementos de RP realizaron el tamizaje al 95% de los neonatos que presentaban los criterios oportunos, mientras que los países que solo contaban con uno o dos elementos de RP lo realizaron al 35%. Conclusiones. La implicación de los gobiernos nacionales y su participación en la legislación relativa al tamizaje y el tratamiento de la RP se relacionan con una proporción mayor de prematuros que pasan el tamizaje y reciben tratamiento por RP. En ulteriores investigaciones, habría que incluir a más países y evaluar el compromiso nacional con la RP, teniendo en cuenta el tamizaje y el tratamiento.

A multi-country, cross-sectional observational study of retinopathy of prematurity in Latin America and the Caribbean / Estudio de observación, multinacional y transversal de la retinopatía del prematuro en América Latina y el Caribe

ABSTRACT Objective To consolidate available information from the Latin American and Caribbean (LAC) region on 1) national incidence of retinopathy of prematurity (ROP) and 2) national-level government inputs on ROP (existing national policies, guidelines, programs, and financing for ROP prevention, detection, and treatment, including ROP screening) in 2014. Methods In March and April 2015, a multi-country online survey was distributed to 56 medical and public health experts working on ROP in LAC countries. Respondents were instructed to provide quantitative and qualitative information representative of the national situation in 2014 for ROP incidence and national-level government inputs (existing national policies, guidelines, programs, and financing for ROP prevention, detection, and treatment, including ROP screening) in their country. Results The survey was completed in full by a total of 11 experts from 10 LAC countries (Argentina, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, El Salvador, Mexico, Nicaragua, and Panama). According to the survey results, six countries had a national policy that includes ROP prevention, detection, and treatment, with screening and treatment covered by national/federal funding. Eight countries had national guidelines for ROP. Four countries had legislation mandating eye examination of preterm infants. Most countries had Level 3 and 4 neonatal intensive care units with ROP programs in public sector health care facilities. Five countries had a data collection or monitoring system to track the number of newborn babies screened for ROP within hospital settings. On average, countries with three or four of the above-mentioned ROP elements screened 95% of eligible newborns in 2014, while those with only one or two of the ROP elements screened 35% of eligible newborns. Conclusions National government buy-in and involvement in ROP screening and treatment legislation is related to a higher proportion of eligible premature newborns being screened and treated for ROP. Further research should include more countries and assess national-level engagement with ROP, including ROP screening and treatment.

RESUMEN Objetivo Reunir la información disponible de la región de América Latina y el Caribe sobre: 1) la incidencia nacional de la retinopatía del prematuro (RP); y 2) las aportaciones gubernamentales en materia de RP a nivel nacional (políticas, directrices, programas y financiamiento nacionales para la prevención, la detección y el tratamiento de la RP, incluidas las campañas de tamizaje) en el 2014. Métodos En marzo y abril del 2015, se distribuyó en línea una encuesta multinacional a 56 expertos en medicina y en salud pública que trabajaban en el área de la RP en una serie de países de América Latina y el Caribe, en la que se pedía información cuantitativa y cualitativa que representase la situación de su país en el 2014, teniendo en cuenta la incidencia de la RP y las aportaciones gubernamentales a nivel nacional (políticas, directrices, programas y financiamiento nacionales para la prevención, la detección y el tratamiento de la RP, así como campañas de tamizaje). Resultados Contestaron la encuesta íntegramente 11 expertos de 10 países de América Latina y el Caribe (Argentina, Brasil, Colombia, Costa Rica, Cuba, República Dominicana, El Salvador, México, Nicaragua y Panamá). Seis países cuentan con una política nacional de prevención, detección y tratamiento de la RP, con financiamiento nacional/federal para sufragar el tamizaje y el tratamiento. Ocho países cuentan con directrices nacionales sobre RP. En cuatro países, la legislación establece la práctica de exploraciones oftalmológicas a todos los prematuros. La mayoría de los países disponen de unidades de cuidados intensivos neonatales de nivel 3 y 4 con programas de RP en los establecimientos públicos de atención de salud. Cinco países cuentan con una base de datos o sistema de vigilancia para hacer un seguimiento del número de neonatos que pasan el tamizaje de RP en el ámbito hospitalario. En promedio, en el 2014, los países que disponían de tres o cuatro de los citados elementos de RP realizaron el tamizaje al 95% de los neonatos que presentaban los criterios oportunos, mientras que los países que solo contaban con uno o dos elementos de RP lo realizaron al 35%. Conclusiones La implicación de los gobiernos nacionales y su participación en la legislación relativa al tamizaje y el tratamiento de la RP se relacionan con una proporción mayor de prematuros que pasan el tamizaje y reciben tratamiento por RP. En ulteriores investigaciones, habría que incluir a más países y evaluar el compromiso nacional con la RP, teniendo en cuenta el tamizaje y el tratamiento.

Gestational syphilis and stillbirth in the Americas: a systematic review and meta-analysis / Sífilis gestacional y mortinatalidad en la Región de las Américas: una revisión sistemática y metanálisis

OBJECTIVE: To perform a systematic review and meta-analysis of reported estimates of the association between gestational syphilis (GS) and stillbirth in the Americas region. METHODS: Cochrane Library, Embase, LILACS, MEDLINE/PubMed, PLOS, and ScienceDirect were searched for original research studies quantifying the relationship between GS and stillbirth in the region. A final sample of eight studies was selected. A cumulative meta-analysis plus four subgroup meta-analyses of study data on the association between maternal syphilis during pregnancy and stillbirth were conducted. The four meta-analyses were based on 1) definition of cases and the control; 2) syphilis treatment (presence or absence, effective or ineffective); 3) definition of stillbirth as "showing no signs of life at birth"; and 4) definition of stillbirth based on low birth weight and gestational age. Random-effects metaanalyses were used to calculate pooled estimates of stillbirth with exposure to GS, and each subgroup analysis was tested for heterogeneity. RESULTS: Women with GS had increased odds of stillbirth (pooled odds ratio (OR): 6.87; 95% confidence interval: 2.93, 16.08). There was considerable heterogeneity across the eight studies (percentage of variance (I²) = 95). The funnel plot was not statistically significant, pointing to a lack of publication bias. Increased odds of stillbirth among pregnant women with syphilis were also seen in all four subgroup meta-analyses. CONCLUSIONS: GS is a major contributing factor for stillbirths in the Americas. Interventions targeting GS are highly cost-effective and, along with high-quality point-of-care testing, should be implemented across the region to help reach the goal of eliminating congenital syphilis.

OBJETIVO: Llevar a cabo una revisión sistemática y metanálisis de los cálculos notificados de la asociación entre sífilis gestacional (SG) y mortinatalidad en la Región de las Américas. MÉTODOS: Se realizó una búsqueda en Cochrane Library, Embase, LILACS, MEDLINE/PubMed, PLOS y ScienceDirect de estudios de investigación originales que cuantificaran la relación entre la SG y la mortinatalidad en la Región de las Américas. Se seleccionó una muestra final de ocho estudios. Se efectuaron un meta-nálisis acumulativo y cuatro metanálisis de subgrupo de los datos de estudio sobre la asociación entre sífilis materna durante el embarazo y mortinatalidad. Los cuatro metanálisis se basaron en 1) la definición de casos y del control; 2) el tratamiento de la sífilis (presencia o ausencia, eficaz o ineficaz); 3) la definición de mortinatalidad como "ausencia de signos de vida al nacer"; y 4) la definición de mortinatalidad basada en el bajo peso al nacer y la edad gestacional. Se emplearon metanálisis de efectos aleatorios para calcular las estimaciones acumuladas de mortinatalidad con exposición a la SG, y se comprobó la heterogeneidad de cada uno de los análisis de subgrupo. RESULTADOS: Las mujeres con SG presentaron mayores probabilidades de mortinatalidad (razón de posibilidades [OR] acumulada: 6,87; IC de 95%: 2,93-16,08). Se observó una heterogeneidad considerable en los ocho estudios (porcentaje de variación [I2] = 95). El gráfico en embudo no fue estadísticamente significativo, lo que indica una ausencia de sesgo de publicación. En los cuatro metanálisis de subgrupo, también se observaron mayores probabilidades de mortinatalidad en las mujeres embarazadas con sífilis. CONCLUSIONES: La SG es un importante factor contribuyente a la mortinatalidad en la Región de las Américas. Las intervenciones dirigidas a la SG son altamente eficaces en función de los costos y deben ejecutarse en toda la región, junto con las pruebas diagnósticas de alta calidad en el lugar de asistencia, para ayudar a alcanzar la meta de eliminación de la sífilis congénita.