PH 212A: International Maternal and Child Health
Professor Ndola Prata
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
SCHOOL OF PUBLIC HEALTH
UNIVERSITY OF CALIFORNIA, BERKELEY
PH 212A: International MCH Course
Fall 2013
2 units CCN 76033
Thursdays, 4-6 pm
2011 Valley Life Sciences Building
Instructor of Record:
Ndola Prata, MD, MSc
ndola@berkeley.edu
Office Hours: 4-6pm Tuesday, 229 University Hall
Graduate Student Instructor:
Maggie Crosby
maggie.crosby@berkeley.edu
Office hours: TBD 207 University Hall
Course Objectives:
At the end of this course, you should:
 Understand key health issues for women and children in developing countries.
 Know relevant measures of morbidity, mortality, and reproductive health.
 Know the major international policies shaping the funding and provision of Maternal and
Child Health (MCH) services.
 Recognize the major donors and providers of MCH services in developing countries.
 Understand relevant factors and trends in designing MCH programs.
 Recognize the role of research and evaluation in shaping MCH policies and practices.
 Be aware of the MCH needs of particularly vulnerable and underserved populations.
 Have an appreciation for variations in style and substance in the provision of MCH services
in a sample of countries around the world.
 Be aware of the major challenges to the delivery of MCH services in developing countries
and be able to discuss innovative ways of addressing these challenges.
 Understand approaches for prioritization of health programs.
 Be able to plan an international MCH program and to write a letter of intent on a topic in
international MCH.
Readings:
All readings are available in electronic form at http://bspace.berkeley.edu. There is no course
reader. Additional readings may be given or recommended in preparation for guest speakers.
Course Assessments:
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PH 212A: International Maternal and Child Health
Professor Ndola Prata
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
Class Participation (20%): Participation is a critical component of this course. At each lecture,
the instructor or guest speaker will ask for questions or comments from the group. Students
should participate in the group discussion by asking follow-up questions and making informed
comments that reflect their comprehension of the material. The class participation grade also
includes contribution to priority-setting exercise and overall course attendance. Lack of
participation in class discussions will result in a lower grade.
Take-home Reading Quiz (15%): This quiz will be based on the required class readings and
major points from lectures and discussion. It will be made available through bSpace on October
9th and is due by email to maggie.crosby@berkeley.edu the next week before class starts
(October 16th). Please include IMCH in the subject of the email and include your last name as the
start of the document.
Letter of Intent (LOI) (30%): Students will work together in pairs to design a small-scale
international MCH project using the techniques learned in class. The assignment is to craft a
letter of intent for a grant to fund this project. A Letter of Intent (LOI) is a condensed version of
the grant proposal that allows granting agencies to quickly assess whether or not there is a good
match between the proposed project and the grantor’s mission and goals. Topics should be
approved by the instructor. Students should select a problem in international MCH that is of
interest to them and brainstorm about a potential research project or intervention that will
address this problem. Then identify a granting agency whose mission, goals, or areas of focus
match the selected problem/topic, and craft the LOI as a pitch to this funding agency. The LOI will
be due on December 12th, giving time to incorporate feedback from the class after the
presentation. The LOI should be 12 pages double-spaced, with standard formatting (12 point
font, 1 inch margins). See below for instructions on LOI content.
Group Project Presentation (35%): Students will give an oral presentation of their LOI, followed
feedback and questions from the class. Peer feedback is a very important part of this process.
Letters of intent should include the following:
1. Title: Give the proposed project or scope of work to be done a title that reflects what will
be done, methodology, and population or locale. Example: mMitra: A mobile phone
intervention to improve health behaviors among pregnant women in rural Maharashtra.
2. Summary statement: Succinctly state the nature and purpose of the proposed work.
3. Statement of Need: Describe the problem that the project is trying to address, the people
who are affected by this problem and how it relates to a stated funding agency's program
strategy. Indicate the magnitude of the problem (e.g. for a project to reduce childhood
diarrhea, the number of cases of diarrhea per year in the project region and/or DALYs lost
to diarrhea), as well as outcomes of the problem (e.g. diarrhea can lead to negative
consequences including death). Try to include individual, community and national
outcomes. Be sure to draw from the agency’s statement of purpose, who they fund and
why when writing this section.
4. Geographic area: Specify the region or location where the project will be set and why.
Some funding agencies have focus countries. It is unlikely that these agencies will fund
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PH 212A: International Maternal and Child Health
Professor Ndola Prata
5.
6.
7.
8.
9.
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
projects outside the focus countries unless a project is unusually compelling can only be
implemented outside these countries.
Project description: Explain how the project will address the need you have identified.
You may want to include a figure showing your theory of change, and should state the
proposed outcomes that you plan to measure. You should give evidence in support your
program design by stating how similar programs have worked in the past and any
evidence of success. The project description will be the longest section in the document.
Credentials and background: Explain how the project relates to you and your team’s
professional background and interests, and why you are qualified to undertake the project
– e.g. education, skills, and background. Do not list your current background as a student
in this class, but the background you would want given the role that you assign yourself for
the project. Include capacities of team members, and any in-country partners you may
work with. The essential question to answer in this section is: What is the evidence that
you and your team can do what you say you will?
Time period for requested funding: Read the agency’s funding guidelines. Do they
generally fund feasibility or demonstration/pilot projects, or long-term projects? Make
your request for funding amount and time appropriate for the project, and include a
timeline.
Communication and dissemination: Indicate the population that you aim to help with
your project, giving specifics such as gender, age ranges or vulnerable groups (e.g. women
of reproductive age, children 3-9 years, girl children 1-5 years). Indicate other agencies,
stakeholders (governments, NGOs,) or communities that may benefit from this research or
project, and the ways in which you will communicate to them (e.g. scientific report,
community meetings, radio). Communication is an important element of project
implementation, so please include the above information as a distinct section of the LOI.
Amount of funding: Include either the total amount for the whole project period or
amount/year. This should be a ballpark figure and should be within the amount given by
the funding agency. Do not include an itemized budget.
Policies
Late work:
Please turn in work on time. Work turned in late will be graded down one third of a grade per day
(e.g. A- to B+).
Absences:
Absences will be factored into the grade as part of class participation. If you must miss class let
Maggie know in advance by email, and give the reason you will be absent. More than a few
absences, even if they are for a valid reason, will still result in a lower grade.
Plagiarism:
Use of others’ work without citation will not be tolerated. Plagiarism is punishable by assigning a
failing grade for the course, with potential for more serious actions.
Disability accommodation:
Please let us know if you are currently listed with Berkeley DSP (Disabled Students’ Program). If
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PH 212A: International Maternal and Child Health
Professor Ndola Prata
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
you are not but believe that you could benefit from their support, you may apply online at
http://dsp.berkeley.edu. Please also feel free to talk with us if you have questions about
accommodation.
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PH 212A: International Maternal and Child Health
Professor Ndola Prata
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
Class schedule and reading list
Date
Class 1: August
28
Class 2:
September 4
Class 3: Sept 11
Title
Introduction to
International
MCH
(Prata, Crosby)
Maternal and
Child Mortality
(Prata)
Millennium
Development
Goals and other
Global MCH
Course content or presenter, assigned reading
CONTENT: Introductions and overview. Review course outline.
READINGS: None
CONTENT: Measurement, trends, global burden of disease, cause specific mortality.
READINGS:
 Khan K et al. WHO analysis of causes of maternal death: a systematic review.
Lancet. 2006;367:1066–74
 Hogan M et al. Maternal mortality for 181 countries, 1980–2008: a systematic
analysis of progress towards Millennium Development Goal 5. Lancet. 2010;
375:1609–23
 Black R et al. Global, regional, and national causes of child mortality in 2008: a
systematic analysis. Lancet 2010;375:1969–87
 UN Inter-agency Group for Child Mortality Estimation. Levels & Trends in Child
Mortality. 2011.
 Obiechina Nj et al. Maternal mortality at Nnamdi Azikiwe University Teaching
Hospital, Southeast Nigeria: a 10-year review (2003-2012). Int J Womens Health.
2013 Jul 23;5:431-6.
 OPTIONAL:
o Boschi-Pinto C et al. The child health epidemiology reference group reviews
of the effectiveness of interventions to reduce maternal, neonatal and child
mortality. International Journal of Epidemiology 2010;39:i3–i6
o AbouZhar C. New estimates of maternal mortality and how to interpret
them: choice or confusion? Reproductive Health Matters. 2011;19(37):117–
128
CONTENT: International organizations working in MCH. Global MCH workforce,
technology.
READINGS:
 Explore website: www.un.org/millenniumgoals/
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PH 212A: International Maternal and Child Health
Professor Ndola Prata
Date
Title
policies
(Prata)
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
Course content or presenter, assigned reading
 Attaran A. An Immeasurable Crisis? A Criticism of the Millennium Development
Goals and Why They Cannot Be Measured. PLoS Med. 2005;2(10):e318
 Shiffman J. Issue attention in global health: the case of newborn survival. Lancet
2010;375:2045–49
 Hsu J, Berman P, Mills A. Reproductive health priorities: evidence from a resource
tracking analysis of official development assistance in 2009 and 2010. Lancet. 2013
May 18;381(9879):1772-82.
 Patel P, Roberts B. Aid for reproductive health: progress and challenges. Lancet.
2013 May 18;381(9879):1701-2. (commentary on above article by Hsu)
 Health Workforce – providers for MCH:
o Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middleand low-income countries: A literature review of attraction and retention.
BMC Health Services Research. 2008;8:19
o Ogenal Manafa et al. Retention of health workers in Malawi: perspectives of
health workers and district management. Human Resources for Health.
2009;7:65
 OPTIONAL:
o Global policies:
 United Nations Secretary General Ki-Moon, B. Global Strategy for
Women’s and Children’s Health, Executive Summary. 2010.
 UNFPA. State of the World’s Midwifery Report, Executive Summary.
2011.
 UN Global Strategy for Women’s and Children’s Health, FAQ
 UN Commission on Information and Accountability for Women’s and
Children’s Health – Final Report
 McArthur JW, Sachs JD, Schmidt-Traub G. Response to Amir Attaran.
PLoS Med. 2005;2(11):e479
 Attaran A. Author’s reply. PLoS Med. 2(11): e405
o Policy and workforce:
 Record R, Mohiddin A. An economic perspective on Malawi's medical
"brain drain". Globalization and Health. 2006;2:12
 Solberg, K. Running a School of Life. Lancet. 2013 May
6
PH 212A: International Maternal and Child Health
Professor Ndola Prata
Date
Title
Class 4:
September 18
Priority
Interventions for
Maternal Health
I (Prata)
Class 5:
September 25
Priority
Interventions for
Maternal Health
II
(Prata)
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
Course content or presenter, assigned reading
18.(9879):1712-3
o Protocols:
 FIGO: Guideline in brief: Prevention of Post-Partum Haemorrhage
with Misoprostol. 2012
 FIGO: Guideline in brief: Treatment of Post-Partum Haemorrhage
with Misoprostol. 2012
o Resources on Technology and Health:
 U.N. Commission on Life Saving Commodities for Women and
Children: Country Case Studies
 Explore website: http://www.healthunbound.org/ec [a portal for
evidence about mobile health, but not MCH specific]
 Explore website: http://healthunbound.org/mama/ [mobile alliance
for maternal action]
 Explore website: http://www.k4health.org/toolkits/mhealth [a
portal for evidence about mobile health, but not MCH specific]
CONTENT: Discuss a range of interventions to address maternal health issues
READINGS:
 Prata N. et al. Setting priorities for safe motherhood interventions in resourcescarce settings. Health Policy. 2010;94:1–13
 Prata N et al. Maternal mortality in developing countries: challenges in scaling-up
priority interventions. Women's Health. 2010;6(2):311–327
 Explore website: maternalhealthtaskforce.org/
 Recommended: Shiffman J, Smith S. Generation of political priority for global health
initiatives: a framework and case study of maternal mortality. Lancet.
2009;370:1370–79
 OPTIONAL: McGinn T et al. Family planning in conflict: results of cross-sectional
baseline surveys in three African countries. Conflict and Health 2011;5:11
CONTENT: For a given location/region, discuss what is currently being done to address
maternal health and what could be done differently.
READINGS:
 Explore Website: http://www.jhsph.edu/departments/international-
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PH 212A: International Maternal and Child Health
Professor Ndola Prata
Date
Title
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
Course content or presenter, assigned reading
health/IIP/list/
Letter of Intent pairs and topics chosen
Class 6:
October 2
Class 7:
October 9
Childhood
Diseases in
Developing
Countries
Art Reingold, MD
Professor of Epidemiology and Associate Dean for Research School of Public Health, UC
Berkeley
Family Planning
and Abortion
(Prata)
CONTENT: The importance of family planning in the reduction of maternal and child
mortality. Relationship between contraception and abortion. Fertility levels and maternal
and child mortality.
READINGS:
 Darroch JE, Singh S. Trends in contraceptive need and use in developing countries
in 2003, 2008, and 2012: an analysis of national surveys. Lancet. 2013 May
18;381(9879):1756-62.
 Sedgh G, et al. Induced abortion: estimated rates and trends worldwide. Lancet.
2007;370(9595):1338-45.
 Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and Health.
Lancet. 2012;380(9837):149-56
 Rutstein SO. Effects of preceding birth intervals on neonatal, infant and under-five
years mortality and nutritional status in developing countries: evidence from the
demographic and health surveys. Int J Gynaecol Obstet. 2005;89(Suppl 1):S7-24.
 OPTIONAL:
o Prata N. Making family planning accessible in resource-poor settings. Philos
READINGS:
 Bhutta, et al, NEJM, vol 369;23, Dec 5, 2013, pages 2226-35
 Barros, et al, Lancet vol 379, March 31, 2012, pages 1225-33.
 Liu L et al. Global, regional, and national causes of child mortality: an updated
systematic analysis for 2010 with time trends since 2000. Lancet.
2012;379(9832):2151-61.
 Optional: Black RE, Morris SS, Bryce J. Where and why are 10 million children
dying every year? Lancet. 2003;361(9376):2226-34.
8
PH 212A: International Maternal and Child Health
Professor Ndola Prata
Date
Title
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
Course content or presenter, assigned reading
Trans R Soc Lond B Biol Sci. 2009;364(1532):3093-9.
o Fathalla M, Cook RJ. Women, abortion and the new technical and policy
guidance from WHO. Bull World Health Organ. 2012;90:712.
Reading quiz given
Class 8:
October 16
Childhood
Immunizations
Julia Walsh, MD,
MSc
Adjunct Professor School of Public Health, UC Berkeley
READINGS:
 Global and Regional Immunization Coverage (1980-2012) Unicef/WHO
http://www.unicef.org/immunization/files/Global_immunization_coverage.pdf
 Explore website of US vaccine schedule
ttp://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html#printable
 Other readings TBA
Reading quiz due
Class 9:
October 23
Priority
Interventions for
Child Health
(Prata)
CONTENT: Discuss a range of interventions to address child health issues
READINGS:
 Arifeen SE. Effect of the Integrated Management of Childhood Illness strategy on
childhood mortality and nutrition in a rural area in Bangladesh: a cluster
randomized trial. Lancet. 2009; 374(9687),393 – 40.
 Bryce J et al. Reducing child mortality: Can public health deliver? Lancet.
2003;362(9378):159-64.
 Althabe F. Strategies for improving the quality of health care in maternal and child
health in low- and middle-income countries: an overview of systematic reviews.
Paediatric and Perinatal Epidemiology. 2008;22(Suppl. 1):42–60.
 OPTIONAL:
o Bawaskar HS. The world’s forgotten children. Lancet.
2003;361(9364):1224-5.
o Jones G. How many child deaths can we prevent this year? Lancet.
2003;362(9377):65-71.
o Victora CG et al. Applying an equity lens to child health and mortality: More
9
PH 212A: International Maternal and Child Health
Professor Ndola Prata
Date
Title
Class 10:
October 30
Adolescent
Health
Class 11:
November 6
International
Program
Planning and
Research
Methods (Prata)
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
Course content or presenter, assigned reading
of the same is not enough. Lancet. 2003;362(9379):233-41.
Claeson M et al. Knowledge into action for child survival. Lancet. 2003;362(9380):323-7.
CONTENT: Perspectives from a young public health professional
READINGS:
 WHO Report: Health For the World’s Adolescents (executive summary)
 Save the Children Report: A Global Village - What Do Menstruating Girls Need in
Schools?
 IRIN Article: Uganda teen pregnancies’ plan under fire
 OPTIONAL:
o Young people and the law in Asia and the Pacific: A review of laws and
policies affecting young people's reproductive access to sexual and
reproductive health and HIV services. (executive summary)
CONTENT: Discussion of Letter of Intent (Final Project)
READINGS:
 Heffron et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a
prospective cohort study. The Lancet Infectious Diseases, 2011;12(1)19 – 26
 Watch Video: http://abcnews.go.com/Health/video/oral-contraception-hiv14693133
 World Health Organization. Hormonal contraception and HIV: Technical
statement.16 February 2012. WHO/RHR/12.08
 Monitoring and evaluation
o Arnold B et al. Causal inference methods to study nonrandomized,
preexisting development interventions. PNAS. 2010:107(52);22605-22610
o Bryce J et al. The Multi-Country Evaluation of the Integrated Management of
Childhood Illness Strategy: Lessons for the Evaluation of Public Health
Interventions. Am J Public Health. 2004; 94(3): 406–415.
o Explore Website:
http://www.who.int/maternal_child_adolescent/documents/monitoring/e
n/index.html
 REQUIRED, FOUND IN LOI RESOURCES FOLDER:
o Grant Writing Guidelines
10
PH 212A: International Maternal and Child Health
Professor Ndola Prata
Date
Title
Class 12:
November 13
Maternal and
Child Oral
Disease: A
Neglected
Pandemic
(Karen SokalGutierrez)
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
Course content or presenter, assigned reading
o Gates Foundation Letter of Intent Instructions
o Explore Website:
http://foundationcenter.org/getstarted/faqs/html/loi.html [general
resource explaining letters of intent]
o Explore Website: http://www.macfound.org/info-grantseekers/submitletter-inquiry/ [MacArthur Foundation’s LOI webpage]
 OPTIONAL:
o WHO Monitoring and Evaluation of Maternal and Newborn Health and
Services at the District Level Technical Consultation Meeting Report 5-8
December 2006
o Pradhan, Jalandhar. Challenges of Monitoring and Evaluating Maternal and
Child Health Programme in Developing Countries.
o WHO Department of Making Pregnancy Safer. Reproductive Health
Indicators: Guidelines for their generation, interpretation and analysis for
global monitoring. 2006
o UNICEF: Countdown to 2015 Tracking Progress In Maternal, Newborn &
Child Survival: The 2008 Report
READINGS:
 BAGRAMIAN R, GARCIA-GODOY F, VOLPE A. The global increase in dental caries. A
pending public health crisis.
American Journal of Dentistry, Vol. 21, No. 1, February, 2009
http://www.amjdent.com/Archive/2009/Bagramian%20%20February%202009.pdf
 Fisher-Owens S, et al. Influences on Children's Oral Health: A Conceptual
Model. PEDIATRICS Vol. 120 No. 3. September 1, 2007 pp. e510 -e520 (doi:
10.1542/peds.2006-3084)
http://pediatrics.aappublications.org/content/120/3/e510.full.pdf+html?nfstatus
=200&nftoken=098ffb68-e9c8-4120-9dac3b7890a7e2bc&nfstatusdescription=SUCCESS%3a+Login+worked
 Shanthi, V., Vanka, A., Bhambal, A., Saxena, V., Saxena, S., & Kumar, S. S.
(2012). Association of pregnant women periodontal status to preterm and lowbirth weight babies: A systematic and evidence-based review.Dental Research
11
PH 212A: International Maternal and Child Health
Professor Ndola Prata
Fall 2014, Thursdays 4-6
GSI Maggie Crosby
Date
Title
Course content or presenter, assigned reading
Journal, 9(4), 368–380.
Class 13:
November 20
No class
November 27
LOI presentations
CONTENT: Half of the student pairs present Letter of Intent
Class 14:
December 4
LOI presentations,
course
evaluations
Thanksgiving
CONTENT: Half of the student pairs present Letter of Intent
Letter of Intent is due Tuesday, December 16 at 5pm
12