JAMA Pediatrics
April 2015, Vol 169, No. 4
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint | April 2015
Program Science—A Framework for Improving Global Maternal, Newborn, and Child Health
Maryanne Crockett, MD, MPH, FRCPC, DTM&H1; Lisa Avery, MD, MIH, FRCPC2; James Blanchard, MD, MPH, PhD3
Author Affiliations
JAMA Pediatr. 2015;169(4):305-306. doi:10.1001/jamapediatrics.2015.9.
Extract
In 2000, leaders from 189 countries set forth Millennium Development Goals, 2 of which focused on significant reductions in child mortality and maternal mortality by 2015. Despite substantial progress toward these goals, many countries are lagging, with increasing disparity among countries with differing resources. There is a strong consensus that much of this mortality could be prevented through the effective implementation of known evidence-based interventions.1- 3 In particular, there is evidence that the greatest effect on mortality occurs when efforts are initially focused on the most vulnerable individuals.4 Therefore, the main challenges in reducing mortality relate to how best to improve the availability, quality, and use of these critical interventions, especially for those who most need them. Meeting this challenge will require a better understanding of the distribution and configuration of health services, factors that are associated with enhancing and maintaining the quality of services, and the factors that promote and prevent use of these services along the continuum of care.5 In this regard, academic institutions can and should contribute much more effectively to generate and translate scientific knowledge that will result in better programs to improve maternal, newborn, and child health (MNCH). To fulfill this important academic mission, “science must leave the ivory tower and enter the agora,” as Gibbons urged 17 years ago.

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Editorial | April 2015
The Know, Do, and Quality Gaps in International Maternal and Child Health Care Interventions
James M. Tielsch, PhD1
Author Affiliations
JAMA Pediatr. 2015;169(4):313-314. doi:10.1001/jamapediatrics.2014.3741.
Extract
Tremendous progress has been made in reducing the mortality rates for young children, especially in low- and middle-income countries, with annual deaths down from 12.6 million in 1990 to 6.3 million in 2013.1 Although it is unlikely that number 4 (reduce child mortality) of the Millennium Development Goals set by the United Nations in 20012 will be achieved by the deadline this year, an even more ambitious goal for the elimination of preventable deaths among newborns and children younger than 5 years by 2030 is likely to be set by the United Nations General Assembly in the fall of 2015.3 Discussions about these laudable goals often center on claims such as, “we know what works, we just need to do it.” In fact, estimates of coverage of proven interventions for child survival are significantly lower than needed to maximize the effects, with the most important coverage gaps seen in the areas of family planning, interventions for newborns, and case management of childhood diseases, such as diarrhea, pneumonia, and malaria.4 This is often referred to as the know-do gap. In this issue, Mohanan et al5 provide a distressing description of this gap related to the diagnosis and treatment of diarrhea and pneumonia by health care practitioners in Bihar, India.

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The Know-Do Gap in Quality of Health Care for Childhood Diarrhea and Pneumonia in Rural India
Manoj Mohanan, PhD; Marcos Vera-Hernández, PhD; Veena Das, PhD; Soledad Giardili, MA; Jeremy D. Goldhaber-Fiebert, PhD; Tracy L. Rabin, MD; Sunil S. Raj, MD; Jeremy I. Schwartz, MD; Aparna Seth, MBA
Includes: Supplemental Content
Editorial: International Maternal and Child Health Care Gaps; James M. Tielsch, PhD