title: '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".
abstract: BACKGROUND
  Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care.
  
  
  CONCLUSIONS
  The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries
  
  
  CONCLUSIONS
  In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in LICS.
authors.affiliation: University Research Co., LLC (URC) 7200 Wisconsin Avenue, Ste. 600, Bethesda, MD, 20814, USA. michael.kivkiv@gmail.com.|Afya Research Africa, P.O. Box 20880, 00202, Nairobi, Kenya. michael.kivkiv@gmail.com.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Mwaniki
authors.affiliation: Afya Research Africa, P.O. Box 20880, 00202, Nairobi, Kenya.|Nairobi University, College of Health sciences, Kenyatta National Hospital, P. O. Box 19676-00202, Nairobi, Kenya.
authors.forename: Evaline J
authors.initials: EJ
authors.lastname: Baya
authors.affiliation: University Research Co., LLC (URC) 7200 Wisconsin Avenue, Ste. 600, Bethesda, MD, 20814, USA.
authors.forename: Faith
authors.initials: F
authors.lastname: Mwangi-Powell
authors.affiliation: Mental Health & Wellbeing, University of Warwick, Medical school Building, Gibbet Hill Campus, Coventry, CV4 7AL, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Sidebotham
mesh_terms: D017954:Africa South of the Sahara; D005260:Female; D006801:Humans; D007223:Infant; D000068104:Infant Health; D007226:Infant Mortality; D007231:Infant, Newborn; D000068097:Maternal Health; D008428:Maternal Mortality; D008962:Models, Theoretical; D009017:Morbidity; D011159:Population Surveillance / Q000379:methods*; D011203:Poverty; D011247:Pregnancy
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