Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

Autores
Althabe, Fernando; Espinoza, Marisa Mabel; Pasquale, Julia; Hernández Muñoz, Rosalinda; Carvajal, Javier; Escobar, María Fernanda; Cecatti, José Guilherme; Ribeiro Do Valle, Carolina C.; Mereci, Wilson; Vélez, Paola; Pérez, Aquilino M.; Vitureira, Gerardo; Leroy, Charlotte; Roelens, Kristien; Vandenberghe, Griet; Aguemon, Christiane Tshabu; Cisse, Kadari; Ouedraogo, Henri Gautier; Kannitha, Cheang; Rathavy, Tung; Tebeu, Pierre Marie; Bustillo, Carolina; Bredy, Lara; Herrera Maldonado, Nazarea; Abdosh, Abdulfetah Abdulkadir; Teklu, Alula M.; Kassa, Dawit Worku; Kumar, Vijay; Suri, Vanita; Trikha, Sonia
Año de publicación
2020
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background: Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods: We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings: Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation: The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices.
Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Espinoza, Marisa Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Pasquale, Julia. No especifíca;
Fil: Hernández Muñoz, Rosalinda. No especifíca;
Fil: Carvajal, Javier. No especifíca;
Fil: Escobar, María Fernanda. No especifíca;
Fil: Cecatti, José Guilherme. No especifíca;
Fil: Ribeiro Do Valle, Carolina C.. No especifíca;
Fil: Mereci, Wilson. No especifíca;
Fil: Vélez, Paola. No especifíca;
Fil: Pérez, Aquilino M.. No especifíca;
Fil: Vitureira, Gerardo. No especifíca;
Fil: Leroy, Charlotte. No especifíca;
Fil: Roelens, Kristien. No especifíca;
Fil: Vandenberghe, Griet. No especifíca;
Fil: Aguemon, Christiane Tshabu. No especifíca;
Fil: Cisse, Kadari. No especifíca;
Fil: Ouedraogo, Henri Gautier. No especifíca;
Fil: Kannitha, Cheang. No especifíca;
Fil: Rathavy, Tung. No especifíca;
Fil: Tebeu, Pierre Marie. No especifíca;
Fil: Bustillo, Carolina. No especifíca;
Fil: Bredy, Lara. No especifíca;
Fil: Herrera Maldonado, Nazarea. No especifíca;
Fil: Abdosh, Abdulfetah Abdulkadir. No especifíca;
Fil: Teklu, Alula M.. No especifíca;
Fil: Kassa, Dawit Worku. No especifíca;
Fil: Kumar, Vijay. No especifíca;
Fil: Suri, Vanita. No especifíca;
Fil: Trikha, Sonia. No especifíca;
Materia
Maternal infection
Maternal mortality
Maternal morbidity
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/142687

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network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort studyAlthabe, FernandoEspinoza, Marisa MabelPasquale, JuliaHernández Muñoz, RosalindaCarvajal, JavierEscobar, María FernandaCecatti, José GuilhermeRibeiro Do Valle, Carolina C.Mereci, WilsonVélez, PaolaPérez, Aquilino M.Vitureira, GerardoLeroy, CharlotteRoelens, KristienVandenberghe, GrietAguemon, Christiane TshabuCisse, KadariOuedraogo, Henri GautierKannitha, CheangRathavy, TungTebeu, Pierre MarieBustillo, CarolinaBredy, LaraHerrera Maldonado, NazareaAbdosh, Abdulfetah AbdulkadirTeklu, Alula M.Kassa, Dawit WorkuKumar, VijaySuri, VanitaTrikha, SoniaMaternal infectionMaternal mortalityMaternal morbidityhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods: We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings: Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation: The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices.Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Espinoza, Marisa Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Pasquale, Julia. No especifíca;Fil: Hernández Muñoz, Rosalinda. No especifíca;Fil: Carvajal, Javier. No especifíca;Fil: Escobar, María Fernanda. No especifíca;Fil: Cecatti, José Guilherme. No especifíca;Fil: Ribeiro Do Valle, Carolina C.. No especifíca;Fil: Mereci, Wilson. No especifíca;Fil: Vélez, Paola. No especifíca;Fil: Pérez, Aquilino M.. No especifíca;Fil: Vitureira, Gerardo. No especifíca;Fil: Leroy, Charlotte. No especifíca;Fil: Roelens, Kristien. No especifíca;Fil: Vandenberghe, Griet. No especifíca;Fil: Aguemon, Christiane Tshabu. No especifíca;Fil: Cisse, Kadari. No especifíca;Fil: Ouedraogo, Henri Gautier. No especifíca;Fil: Kannitha, Cheang. No especifíca;Fil: Rathavy, Tung. No especifíca;Fil: Tebeu, Pierre Marie. No especifíca;Fil: Bustillo, Carolina. No especifíca;Fil: Bredy, Lara. No especifíca;Fil: Herrera Maldonado, Nazarea. No especifíca;Fil: Abdosh, Abdulfetah Abdulkadir. No especifíca;Fil: Teklu, Alula M.. No especifíca;Fil: Kassa, Dawit Worku. No especifíca;Fil: Kumar, Vijay. No especifíca;Fil: Suri, Vanita. No especifíca;Fil: Trikha, Sonia. No especifíca;Elsevier2020-05info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/142687Althabe, Fernando; Espinoza, Marisa Mabel; Pasquale, Julia; Hernández Muñoz, Rosalinda; Carvajal, Javier; et al.; Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study; Elsevier; The Lancet Global Health; 8; 5; 5-2020; e661-e6712214-109XCONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30109-1/fulltextinfo:eu-repo/semantics/altIdentifier/doi/10.1016/S2214-109X(20)30109-1info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-03T09:51:57Zoai:ri.conicet.gov.ar:11336/142687instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-03 09:51:58.225CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study
title Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study
spellingShingle Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study
Althabe, Fernando
Maternal infection
Maternal mortality
Maternal morbidity
title_short Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study
title_full Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study
title_fullStr Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study
title_full_unstemmed Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study
title_sort Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study
dc.creator.none.fl_str_mv Althabe, Fernando
Espinoza, Marisa Mabel
Pasquale, Julia
Hernández Muñoz, Rosalinda
Carvajal, Javier
Escobar, María Fernanda
Cecatti, José Guilherme
Ribeiro Do Valle, Carolina C.
Mereci, Wilson
Vélez, Paola
Pérez, Aquilino M.
Vitureira, Gerardo
Leroy, Charlotte
Roelens, Kristien
Vandenberghe, Griet
Aguemon, Christiane Tshabu
Cisse, Kadari
Ouedraogo, Henri Gautier
Kannitha, Cheang
Rathavy, Tung
Tebeu, Pierre Marie
Bustillo, Carolina
Bredy, Lara
Herrera Maldonado, Nazarea
Abdosh, Abdulfetah Abdulkadir
Teklu, Alula M.
Kassa, Dawit Worku
Kumar, Vijay
Suri, Vanita
Trikha, Sonia
author Althabe, Fernando
author_facet Althabe, Fernando
Espinoza, Marisa Mabel
Pasquale, Julia
Hernández Muñoz, Rosalinda
Carvajal, Javier
Escobar, María Fernanda
Cecatti, José Guilherme
Ribeiro Do Valle, Carolina C.
Mereci, Wilson
Vélez, Paola
Pérez, Aquilino M.
Vitureira, Gerardo
Leroy, Charlotte
Roelens, Kristien
Vandenberghe, Griet
Aguemon, Christiane Tshabu
Cisse, Kadari
Ouedraogo, Henri Gautier
Kannitha, Cheang
Rathavy, Tung
Tebeu, Pierre Marie
Bustillo, Carolina
Bredy, Lara
Herrera Maldonado, Nazarea
Abdosh, Abdulfetah Abdulkadir
Teklu, Alula M.
Kassa, Dawit Worku
Kumar, Vijay
Suri, Vanita
Trikha, Sonia
author_role author
author2 Espinoza, Marisa Mabel
Pasquale, Julia
Hernández Muñoz, Rosalinda
Carvajal, Javier
Escobar, María Fernanda
Cecatti, José Guilherme
Ribeiro Do Valle, Carolina C.
Mereci, Wilson
Vélez, Paola
Pérez, Aquilino M.
Vitureira, Gerardo
Leroy, Charlotte
Roelens, Kristien
Vandenberghe, Griet
Aguemon, Christiane Tshabu
Cisse, Kadari
Ouedraogo, Henri Gautier
Kannitha, Cheang
Rathavy, Tung
Tebeu, Pierre Marie
Bustillo, Carolina
Bredy, Lara
Herrera Maldonado, Nazarea
Abdosh, Abdulfetah Abdulkadir
Teklu, Alula M.
Kassa, Dawit Worku
Kumar, Vijay
Suri, Vanita
Trikha, Sonia
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Maternal infection
Maternal mortality
Maternal morbidity
topic Maternal infection
Maternal mortality
Maternal morbidity
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Background: Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods: We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings: Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation: The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices.
Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Espinoza, Marisa Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Pasquale, Julia. No especifíca;
Fil: Hernández Muñoz, Rosalinda. No especifíca;
Fil: Carvajal, Javier. No especifíca;
Fil: Escobar, María Fernanda. No especifíca;
Fil: Cecatti, José Guilherme. No especifíca;
Fil: Ribeiro Do Valle, Carolina C.. No especifíca;
Fil: Mereci, Wilson. No especifíca;
Fil: Vélez, Paola. No especifíca;
Fil: Pérez, Aquilino M.. No especifíca;
Fil: Vitureira, Gerardo. No especifíca;
Fil: Leroy, Charlotte. No especifíca;
Fil: Roelens, Kristien. No especifíca;
Fil: Vandenberghe, Griet. No especifíca;
Fil: Aguemon, Christiane Tshabu. No especifíca;
Fil: Cisse, Kadari. No especifíca;
Fil: Ouedraogo, Henri Gautier. No especifíca;
Fil: Kannitha, Cheang. No especifíca;
Fil: Rathavy, Tung. No especifíca;
Fil: Tebeu, Pierre Marie. No especifíca;
Fil: Bustillo, Carolina. No especifíca;
Fil: Bredy, Lara. No especifíca;
Fil: Herrera Maldonado, Nazarea. No especifíca;
Fil: Abdosh, Abdulfetah Abdulkadir. No especifíca;
Fil: Teklu, Alula M.. No especifíca;
Fil: Kassa, Dawit Worku. No especifíca;
Fil: Kumar, Vijay. No especifíca;
Fil: Suri, Vanita. No especifíca;
Fil: Trikha, Sonia. No especifíca;
description Background: Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods: We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings: Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation: The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices.
publishDate 2020
dc.date.none.fl_str_mv 2020-05
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/142687
Althabe, Fernando; Espinoza, Marisa Mabel; Pasquale, Julia; Hernández Muñoz, Rosalinda; Carvajal, Javier; et al.; Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study; Elsevier; The Lancet Global Health; 8; 5; 5-2020; e661-e671
2214-109X
CONICET Digital
CONICET
url http://hdl.handle.net/11336/142687
identifier_str_mv Althabe, Fernando; Espinoza, Marisa Mabel; Pasquale, Julia; Hernández Muñoz, Rosalinda; Carvajal, Javier; et al.; Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study; Elsevier; The Lancet Global Health; 8; 5; 5-2020; e661-e671
2214-109X
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
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info:eu-repo/semantics/altIdentifier/doi/10.1016/S2214-109X(20)30109-1
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by/2.5/ar/
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dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
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repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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