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Table 1 Five-pronged framework for understanding and preventing Maternal-Neonatal morbidity and mortality in low income countries

From: ‘Tweaking’ the model for understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries: “inserting new ideas into a timeless wine skin”

Foetal-Maternal strategies Original component of the three-delay model advanced in 1994 Post-discharge follow up and rehabilitation
(Primary Prevention) (Secondary Prevention) (Tertiary Prevention)
Prong 1 Prong 2 Prong 3 Prong 4 Prong 5
• Prevention of vertical transmission of infections
• Prediction and Preventing intra-partum related neonatal morbidity and mortality
• Vaccines against causes of early neonatal sepsis especially Group B
Streptococcus and other diseases including HIV|AIDS
• Chemoprophylaxis against GBS
• Effective prevention of mother to child transmission of congenital infections including HIV|AIDS
• Barrier preventions e.g provisions of LLITNSa
• Family planning, education and economic empowerment of women
• Specific focus on adolescent girls
Addressing delays in decision to seek care
• Education on danger signs during pregnancy and early neonatal life
• Community engagement through behavioral change and communication strategies
• Demand of care creation
Addressing delays in reaching point of care once decision is made
• financial incentives e.g. transport refunds
• facility output-based financing approaches
• referral systems that can help minimize delays that contribute to HIEb
• use of community cadres
Addressing delays in provision of quality services at point of care
• point of care quality improvement approaches
• continuous investment in in-service skills development
• operational research on how to best offer care at point of service delivery
• More research on the role of facility improvement teams
• Continuous direct investments in health systems building blocks
• Exploring adjunct treatment options for infections and HIE
Post-discharge follow up and rehabilitation
• expanding of human resource for health cadres with rehabilitation skills (occupational, physiotherapy,& psyscho-social support) in LICS
• surveillance systems for post-discharge complications and or sequelea
• specific follow up and treatment of obstetrics complications including obstetric fistulas
• Ongoing support where long-term impairments are anticipated
  1. aLLITN-Long Lasting Insecticide treated mosquito nets
  2. bHIE-Hypoxic ischemic Encephalopathy