Title: Perinatal Epidemiology and Maternal Health
Keywords: Vulnerable groups (in general)
International / global
Health systems
Epidemiology
Child health
Country: United Kingdom
Institution: UK - Institute for Global Health, University College London
Course coordinator: Tim Colbourn
Date start: 2018-03-12
Date end: 2018-03-28
About duration and dates: 3 weeks & 2 days: 2 days pre-reading, 2 weeks face-to-face, 1 week essay writing
Classification: advanced optional
Mode of delivery: Face to face
Course location: UCL Institute for Global Health, London
ECTS credit points: 6 ECTS credits
SIT:
150 student Investment Time (33 contact hours, 117 self-study hours).
33 hours seminars, 6 hours student-led critical appraisal of literature, 81 hours private reading, 30 hours essay preparation.
Language: English
Description:
At the end of the module the student should be able to:
• Summarize and discuss key issues in current debates on perinatal and maternal care in developing countries.
• Describe the epidemiology of the main causes of stillbirth, neonatal and maternal mortality.
• Outline major international maternal and perinatal health care strategies, and discuss the controversies around them.
• Analyze the interface between health service provision and community action in perinatal and maternal health.
• Identify the gaps in the evidence base for perinatal and maternal health.
• Distinguish between different operational aspects of interventions.
• Critically evaluate the evidence for new perinatal and maternal interventions.
• Devise and evaluate ideas for perinatal and maternal research.
Assessment Procedures:
100% written essay with synthesis of information from published literature.

Participants are required to produce one essay of 2000 words. Essay topics are selected with two aims: first, to stimulate broad reading, review and synthesis of material; second, to allow students to practise real-world writing for proposals and reports. Examples include:
Critically evaluate an intervention of your choice designed to improve maternal health outcomes
Two things that people often say about newborn survival are, “if we save small babies, there will be more children with disabilities,” and “if we save babies, the population pressure in low-income countries will just get worse.” How would you answer these questions?
How do the causes of perinatal deaths differ within and between countries? Discuss underlying epidemiological and methodological reasons for observed differences and consider how innovation in verbal autopsy might improve understandings of perinatal mortality.
The relationship between the proportion of births attended by skilled birth attendants and the maternal mortality ratio is not clear. Discuss.
You are a district public health officer in a setting of your choice. Your line managers have told you to “do something about babies born too soon”. You have to work within existing public sector human resources, logistic, and budget constraints. Present your plan, and justify it.
What do you understand by “community interventions” to improve maternal and newborn survival? How do approaches differ? Is there a tension between demand-side and supply-side strategies, and is it really possible to fit community interventions within government health programming?
If a student does not successfully pass the assignment they will receive feedback and support to help to improve their performance and will have an opportunity to resubmit an improved version of the assignment at the earliest available opportunity.
Content:
The module has three general emphases:

1. maternal and perinatal health in developing countries
2. the generation and review of evidence: How international estimates of perinatal, neonatal and maternal mortality and morbidity are produced; the difference between the development of interventions from epidemiological data and their effectiveness in the real world; the difference between efficacy and effectiveness at scale, particularly as regards trial and pilot interventions; and the difficulty of ascribing causality to mutually confounded findings.
3. and the potential for pragmatic intervention.

The course aims to equip students with a comprehensive understanding of the complex issues in global perinatal and maternal health and enable students to critically evaluate progress and limitations to progress towards reducing maternal and newborn mortality and morbidity in different contexts, as well as place maternal health issues within a health systems framework. Seminars cover the following topics:

• MDG targets, progress, anomalies
• The role of DFID in maternal and perinatal health and the SDGs
• WHO policy in Maternal and Perinatal Health
• Obstetric Fistula
• Stillbirths, Neonatal and Maternal Mortality (Measurements means and limitations, Maternal and Neonatal Death Surveillance and Response, Example cases from Uganda)
• Labour and Intrapartum asphyxia
• Neonatal sepsis, PMTCT and HIV
• Uterine rupture and near miss
• Maternal psychiatric morbidity
• Mental health consequences in Burkina Faso
• Low birth weight, preterm, growth restriction
• Maternal Micronutrient supplementation
• Caesarean section rates
• Hospital care for mothers and newborns in low-income settings
• Antenatal and postnatal care
• Family planning
• Respectful care and quality of care
Infant and Young Child Feeding

Students should note that due to the availability of some of the external speakers the exact order of the seminar sessions is subject to change.
Methods:
The module makes particular efforts to help students to develop their understanding of research, evidence and appraisal. The seminars include student presentations of published articles on aspects of perinatal and maternal health, the articles having been selected by the facilitator and allocated beforehand. The seminars use the discussion arising from these presentations as a platform for a broader and deeper discussion of the issues. This discussion is augmented by selective presentation of teaching material (slides, articles).

Extensive, categorised reading lists are given out at least a week before the module starts. Research reading will be made available online. Moodle will be used as an information portal for participants and source for course materials, including all lecture contents.
Prerequisites:
English proficiency: Good Level in any of the English language qualifications accepted by UCL for postgraduate studies with 6.5 or equivalent in each subtest.
See: http://www.ucl.ac.uk/prospective-students/graduate/apply/english-language/index
Attendance:
20-30 students
Selection:
The number of available tropEd places on each module in the academic year is normally determined in October. TropEd applicants wishing to secure a place on modules can apply before this period and be placed on a waiting list for the module. Applicants who have paid the course fees will be notified as soon as it is confirmed if places are available on the module(s). Please note that applicants must pay the course fees in order to obtain a confirmed offer of a place on a module, and places are awarded on a first-paid, first-admitted basis. Full course fee refunds will be provided to paid-up applicants if there are no places on the module(s) for which they applied, or if the module is cancelled.
Fees:
850 GBP
Scholarships:
None
Major changes since initial accreditation:
The module has now been revised to include content originally taught on another module (Maternal Health in a Global Context). This content is related and concerns the mother during pregnancy, childbirth and the post-partum period. It is therefore complementary to the previous content on babies during pregnancy and childbirth and the post-partum period. The title has consequently changed from “Perinatal Epidemiology and Newborn Care” to “Perinatal Epidemiology and Maternal Health”. Almost all of the original perinatal and newborn (baby) content has been retained, but it has been condensed to accommodate the maternal content. Subject matter of the module changes in detail from year to year to reflect shifts in international discourse and the development of new knowledge. The objectives are the same except have been expanded to cover maternal as well as perinatal content, and learning methods remain broadly the same. Critical appraisal of published literature remains integral to the module with all students required to present at least two papers over the two-week face-to-face time.
Student evaluation:
Detailed transcripts of a fairly extensive evaluation are produced every year and circulated to teaching administrators and all module facilitators (available on request). They include both general comments and evaluations of each individual contact session. The module continues to be popular and well-received, and of particular note, the Maternal Health in a Global Context module (the content of which feeds into this revised module) received excellent feedback on nearly all sessions last year. Student comments include:

On the positive side: Both the in-house and external speakers and seminar leaders were excellent, as reflected in the student feedback. The students liked the balance of course content and the balance of teaching methods, particularly enjoying the student presentations of papers, which added to the evidence-based nature of the course. There were many interesting class discussions aided by a good mix of experiences from the students and facilitators

On the negative side: A few students felt that too much was packed in to too little time, but this is the nature of ‘short-fat’ modules.

One student also mentioned that the student presentations could be marked as part of the module mark, however this might disrupt the flow of the seminars as well as prevent students from focusing enough on the essay. A couple of students also thought there were too many ‘lectures’. The seminar format was to encourage discussion among students and seminar leaders throughout however, and this was usually successful.
Lessons learned:
Participants often come to the module with limited skills in evaluating evidence. These skills need to be developed through systematic discussion, with considerable repetition and examples. There is no substitute for practice, therefore students are encouraged to present two or more papers during seminars over the two weeks of class time. Participants often take refuge in their fields of experience, and need to be encouraged to develop a broader picture of the international issues.

Writing essays for previous UCL modules and taking previous courses related to research methods and critical appraisal are often beneficial for students, but given support available from the facilitators, not a pre-requisite.

Whilst tropEd students can save money by coming to London for the first two weeks, and (forgoing the use of the physical UCL library facilities) write the essay from home, these students may require more support on essay writing, and this could be provided in London during the third week.
tropEd accreditation:
Accredited 2002 in Lisbon, Re-accredited in London, September 2009, in November 2014 and in October 2016. Accreditation valid until October 2021.
Remarks:
The module begins with a discussion of the nature and importance of perinatal and maternal epidemiology, with particular reference to developing countries. We cover the historical background, important definitions, data collection, statistics and the methods of deriving them, and current trends. We then discuss the key causes of stillbirth, neonatal and maternal mortality, with reference to interventions to address them. We review the history of essential obstetric and newborn care up to and including current practice and future research at community and health facility levels.

The module looks at general interventions from a programme and policy perspective. The final two seminars discuss the main types of community perinatal and maternal care interventions in detail: their history, effectiveness and interface with health systems.
Email Address: a.gilry@ucl.ac.uk
Date Of Record Creation: 2012-01-12 00:35:31 (W3C-DTF)
Date Of Record Release: 2012-01-12 07:20:28 (W3C-DTF)
Date Record Checked: 2017-09-12 (W3C-DTF)
Date Last Modified: 2017-10-10 16:07:00 (W3C-DTF)

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