646 results
Search Results
2. Pregnancy and neonatal outcomes of <scp>COVID</scp> ‐19: coreporting of common outcomes from <scp>PAN‐COVID</scp> and <scp>AAP‐SONPM</scp> registries
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Susara Blunden, Michelle Vaz, Enrique Gomez-Pomar, Catherine Buck, Jayanta Banerjee, Alexandra Kermack, Mark Chester, Edward Mullins, Nicole Spillane, Stamatina Iliodromiti, Tom Bourne, Christoph Lees, Chidambara Sankara Narayanan, Julia Townson, Aethele Khunda, and Rebecca Playle
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Male ,Perinatal Death ,coronavirus ,SARS‐CoV‐2 ,fetal growth restriction ,0302 clinical medicine ,Pregnancy ,Epidemiology ,Registries ,030212 general & internal medicine ,PAN-COVID investigators and the National Perinatal COVID-19 Registry Study Group ,Pregnancy Complications, Infectious ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Obstetrics ,Pregnancy Outcome ,Obstetrics and Gynecology ,General Medicine ,Stillbirth ,Original Papers ,Vaccination ,Maternal Mortality ,Infant, Small for Gestational Age ,outcome ,Premature Birth ,Gestation ,Female ,Maternal death ,medicine.symptom ,preterm delivery ,Adult ,medicine.medical_specialty ,Context (language use) ,Asymptomatic ,03 medical and health sciences ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Obstetrics & Reproductive Medicine ,Pandemics ,perinatal ,Original Paper ,Fetus ,SARS-CoV-2 ,business.industry ,Infant, Newborn ,COVID-19 ,medicine.disease ,Infectious Disease Transmission, Vertical ,United Kingdom ,United States ,Reproductive Medicine ,1114 Paediatrics and Reproductive Medicine ,business - Abstract
Objective Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID‐19 (PAN‐COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal–Perinatal Medicine (SONPM) National Perinatal COVID‐19 Registry. Methods This was an analysis of data from the PAN‐COVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARS‐CoV‐2 infection at any stage in pregnancy, and the AAP‐SONPM National Perinatal COVID‐19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARS‐CoV‐2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN‐COVID results are presented overall for pregnancies with suspected or confirmed SARS‐CoV‐2 infection and separately in those with confirmed infection. Results We report on 4005 pregnant women with suspected or confirmed SARS‐CoV‐2 infection (1606 from PAN‐COVID and 2399 from AAP‐SONPM). For obstetric outcomes, in PAN‐COVID overall and in those with confirmed infection in PAN‐COVID and AAP‐SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (
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- 2021
3. Tajikistan Country Gender Assessment
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World Bank
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GENDER RELATIONS ,MIGRANT ,EQUAL OPPORTUNITIES ,RURAL DEVELOPMENT ,ELDERLY MEN ,EARLY MARRIAGE ,FEMALE EDUCATION ,EQUAL ACCESS ,EMPLOYMENT ,EARLY MARRIAGES ,EQUALITY OF MEN ,FUTURE GENERATIONS ,GENDER STUDIES ,NATIONAL LEVEL ,INSTITUTIONAL MECHANISMS ,ENTREPRENEURIAL ACTIVITIES ,INFORMAL SECTOR ,ECONOMIC RESOURCES ,SKILL DEVELOPMENT ,INSTITUTIONAL FRAMEWORK ,MOTHER ,FEMALE STUDENTS ,CULTURAL RIGHTS ,BUSINESS DEVELOPMENT ,FERTILITY RATES ,EARNINGS ,INFORMAL SECTOR EMPLOYMENT ,HIV INFECTIONS ,SOCIAL UNREST ,GENDER POLICIES ,PENSIONS ,SHADOW REPORT ,LOW-INCOME COUNTRIES ,INTERNATIONAL FINANCE ,ECONOMIC OPPORTUNITIES ,FERTILITY ,SECONDARY EDUCATION ,IMPORTANT POLICY ,ECONOMIC SITUATION ,ELDERLY ,HEALTH RISKS ,ID ,GENDER AWARENESS ,SOCIAL NORMS ,DELIVERY CARE ,POLICY IMPLICATIONS ,RIGHTS OF WOMEN ,MATERNAL MORTALITY ,WOMEN'S AGENCY ,FINANCIAL CONSTRAINTS ,ELDERLY WOMEN ,LITERACY RATES ,FINANCIAL LITERACY ,FEMALE EMPLOYMENT ,JOINT LIABILITY ,LABOR FORCE PARTICIPATION ,EMPLOYEE ,EMPLOYMENT STATUS ,EDUCATIONAL CHOICES ,INTRAVENOUS DRUG USE ,MALE INVOLVEMENT ,STATE SUPPORT ,YOUNG WOMEN ,LIFE EXPECTANCY ,HUMAN DEVELOPMENT ,NEW BUSINESSES ,ACCESS TO INFORMATION ,PRINCIPLE OF EQUALITY ,DISCRIMINATION AGAINST WOMEN ,ENDOWMENTS ,EQUAL PAY ,SEXUAL INTERCOURSE ,PREGNANCY ,EDUCATION SYSTEM ,HEALTH SYSTEMS ,HOUSEHOLDS ,RESPECT ,CHILDBIRTH ,GENDER-BASED VIOLENCE ,SECONDARY SCHOOL ,BUSINESS WORKSHOPS ,SOCIAL ASSISTANCE ,UNION ,HOUSEHOLD POVERTY ,MIGRANT HOUSEHOLDS ,FINANCIAL RESOURCES ,UNDP ,POLITICAL RIGHTS OF WOMEN ,PUBLIC LIFE ,POLICY RESEARCH WORKING PAPER ,ENROLLMENT ,INTERNATIONAL ORGANIZATION FOR MIGRATION ,TRADITIONAL GENDER ROLES ,VIOLENCE AGAINST WOMEN ,GENDER EQUALITY ,AGRICULTURAL ACTIVITIES ,CORRUPTION ,HIV ,INCLUSION OF WOMEN ,COVID-19 ,FEMALE WORKERS ,MASS MEDIA ,POLITICAL PARTIES ,SECONDARY ENROLMENT ,COUNTRY GENDER ASSESSMENT ,GENDER ROLES ,MARKET ECONOMY ,RURAL WOMEN ,GENDER ,HUSBANDS ,EDUCATED WOMEN ,GENDER GAP ,UNITED NATIONS DEVELOPMENT FUND FOR WOMEN ,STATE POLICY ,NATIONAL DEVELOPMENT ,LEVELS OF EDUCATION ,WOMEN'S VOICE ,ECONOMIC GROWTH ,EMPLOYERS ,GENDER ANALYSES ,CORONAVIRUS ,CHILD HEALTH ,UNICEF ,FAMILIES ,LABOR MIGRATION ,HEALTH SYSTEM ,ROLE OF WOMEN ,UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT ,RURAL HOUSEHOLDS ,GENDER DISPARITIES ,POPULATION GROWTH ,PROMOTING GENDER EQUALITY ,WORKING CONDITIONS ,MIGRANTS ,SEXUAL VIOLENCE ,PANDEMIC IMPACT ,PRODUCTIVITY ,WORLD POPULATION ,CIVIL WAR ,ECONOMIC CRISIS ,LABOUR MARKET ,ENROLMENT RATES ,EQUALITY IN EDUCATION ,DOMESTIC VIOLENCE ,CIVIL SOCIETY ACTORS ,DISEASES ,MICRO-FINANCE ,GENDER DISCRIMINATION ,VICIOUS CYCLE ,PRIMARY EDUCATION ,LIVING STANDARDS ,REPRODUCTIVE ROLES ,ADOLESCENT GIRLS ,GENDER GAPS ,LEGAL ADVICE ,POPULATION STUDY ,SUPPORT FOR WOMEN ,LIVE BIRTHS ,POLITICAL PARTY ,FEMALE ENTREPRENEURSHIP ,PROGRESS ,LACK OF ACCESS ,SAFETY NET ,LABOR MARKET ,LEGAL RIGHTS ,MORTALITY ,EQUAL RIGHTS ,LACK OF FINANCE ,MATERNAL HEALTH ,GENDER WAGE GAP ,GENDER ASSESSMENT ,NUMBER OF WOMEN ,TERTIARY EDUCATION ,HUMAN RIGHTS ,HEALTH SECTOR ,SOCIAL SECURITY ,INFANT ,HUSBAND ,FEMALE ENTREPRENEURS ,ECONOMIC CHARACTERISTICS ,LABOR MIGRANTS ,DEMOGRAPHIC PROFILES ,UNITED NATIONS DEVELOPMENT PROGRAMME ,FEMALE STAFF ,ECONOMIC ACTIVITY ,NATIONAL STRATEGY ,OLD-AGE ,FEMALE POPULATION ,GENDER STEREOTYPES ,WOMAN ,EQUAL WORK ,GENDER SEGREGATION ,REMITTANCES ,LACK OF COLLATERALS ,UNESCO ,HUMAN CAPITAL ,FEMALE LABOR FORCE PARTICIPATION ,SOCIAL DEVELOPMENT ,SEX ,UNITED NATIONS ,POLITICAL DECISION ,AGRICULTURAL SECTOR ,REPRESENTATION OF WOMEN ,MIGRATION ,SOCIAL EXCLUSION ,FORMS OF DISCRIMINATION ,POLICY RESEARCH ,CHILDBEARING ,LIMITED ACCESS ,GENDER ISSUES ,HOUSEHOLD LEVEL ,TERTIARY LEVEL ,JOURNALISTS ,GENDER MAINSTREAMING ,SCHOLARSHIPS ,POLITICAL RIGHTS ,ELIMINATION OF DISCRIMINATION ,INDIVIDUAL ENTREPRENEURS ,LABOR FORCE ,HEALTH SERVICES ,HIV INFECTION ,DISCRIMINATION ,OUTREACH ,DEMOGRAPHIC CHANGES ,RELIGIOUS PRACTICES ,FOCUS GROUP DISCUSSIONS ,EXPENDITURE - Abstract
The aim of this report is to provide a broad overview of the current state of gender equality in Tajikistan. While the Europe and Central Asia (ECA) region traditionally surpassed many other regions in terms of gender equality, this advantage has been eroding in recent decades. Particularly in Tajikistan, concerns have been raised that men and women have unequally born the consequences of economic, political, and social transitions after independence in 1991. The report examines several dimensions of gender equality both quantitatively and qualitatively. Tajikistan has set up a legal framework that enshrines principles of equality and non-discrimination, but better implementation results require continued efforts. Prevailing social norms and patriarchal systems of decision-making limit women s ability to make effective choices be it at home or at work. The paper is structured along the following lines. The first section introduces the idea of agency that will remain an important issue throughout the report. This is followed by an analysis of disparities in human capital endowment, including health and education. Gender gaps in the Tajik labor market and entrepreneurial activities of men and women are discussed in the fourth and fifth section. The final section concludes with some policy recommendations that might be beneficial for discussions among policy-makers, civil society actors, and development partners.
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- 2021
4. Comorbidities, poverty and social vulnerability as risk factors for mortality in pregnant women with confirmed SARS‐CoV ‐2 infection: analysis of 13 062 positive pregnancies including 176 maternal deaths in Mexico
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G Estrada-Gutierrez, José Rafael Villafán-Bernal, Raigam Jafet Martinez-Portilla, J M Solis-Paredes, S. Espino‐y‐Sosa, A. J. Rodriguez-Morales, V. Medina-Jimenez, Liona C. Poon, J. Torres-Torres, and L Rojas-Zepeda
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Adult ,Social Vulnerability ,poverty ,Comorbidity ,Lower risk ,comorbidities ,Cohort Studies ,COVID‐19 ,Pregnancy ,medicine ,Risk of mortality ,Humans ,Radiology, Nuclear Medicine and imaging ,Advanced maternal age ,Social determinants of health ,Prospective Studies ,Pregnancy Complications, Infectious ,Prospective cohort study ,Mexico ,Original Paper ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,COVID-19 ,General Medicine ,vaccines ,medicine.disease ,Original Papers ,Maternal Mortality ,Reproductive Medicine ,maternal death ,Relative risk ,Cohort ,Premature Birth ,Maternal death ,Female ,business ,Demography - Abstract
Mortality in pregnancy due to coronavirus disease 2019 (COVID-19) is a current health priority in developing countries. Identification of clinical and sociodemographic risk factors related to mortality in pregnant women with COVID-19 could guide public policy and encourage such women to accept vaccination. We aimed to evaluate the association of comorbidities and socioeconomic determinants with COVID-19-related mortality and severe disease in pregnant women in Mexico.This is an ongoing nationwide prospective cohort study that includes all pregnant women with a positive reverse-transcription quantitative polymerase chain reaction result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from the Mexican National Registry of Coronavirus. The primary outcome was maternal death due to COVID-19. The association of comorbidities and socioeconomic characteristics with maternal death was explored using a log-binomial regression model adjusted for possible confounders.There were 176 (1.35%) maternal deaths due to COVID-19 among 13 062 consecutive SARS-CoV-2-positive pregnant women. Maternal age, as a continuous (adjusted relative risk (aRR), 1.08 (95% CI, 1.05-1.10)) or categorical variable, was associated with maternal death due to COVID-19; women aged 35-39 years (aRR, 3.16 (95% CI, 2.34-4.26)) or 40 years or older (aRR, 4.07 (95% CI, 2.65-6.25)) had a higher risk for mortality, as compared with those aged 35 years. Other clinical risk factors associated with maternal mortality were pre-existing diabetes (aRR, 2.66 (95% CI, 1.65-4.27)), chronic hypertension (aRR, 1.75 (95% CI, 1.02-3.00)) and obesity (aRR, 2.15 (95% CI, 1.46-3.17)). Very high social vulnerability (aRR, 1.88 (95% CI, 1.26-2.80)) and high social vulnerability (aRR, 1.49 (95% CI, 1.04-2.13)) were associated with an increased risk of maternal mortality, while very low social vulnerability was associated with a reduced risk (aRR, 0.47 (95% CI, 0.30-0.73)). Being poor or extremely poor were also risk factors for maternal mortality (aRR, 1.53 (95% CI, 1.09-2.15) and aRR, 1.83 (95% CI, 1.32-2.53), respectively).This study, which comprises the largest prospective consecutive cohort of pregnant women with COVID-19 to date, has confirmed that advanced maternal age, pre-existing diabetes, chronic hypertension, obesity, high social vulnerability and low socioeconomic status are risk factors for COVID-19-related maternal mortality. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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- 2021
5. A national cohort study and confidential enquiry to investigate ethnic disparities in maternal mortality
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Philippa Cox, Marian Knight, Rohit Kotnis, Judy Shakespeare, Joanna Girling, Nicola Vousden, Jenny J. Kurinczuk, Mandish Dhanjal, Sara Kenyon, Fiona Cross-Sudworth, Meg Wilkinson, Derek Tuffnell, Kathryn J. Bunch, Anita Banerjee, Jenny Douglas, Roshni Patel, and MBRRACE-UK
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Medicine (General) ,Pregnancy ,medicine.medical_specialty ,Research paper ,Ethnic group ,Declaration ,Disease ,General Medicine ,medicine.disease ,R5-920 ,Maternal Mortality ,Family medicine ,General Data Protection Regulation ,Confidential Enquiry ,Ethnic disparity ,medicine ,Cultural bias ,Confidentiality ,Psychology ,Cause of death - Abstract
Background: Ethnic disparities in maternal mortality were first documented in the UK in the early 2000s but are known to be widening. This project aimed to describe the women who died in the UK during or up to a year after the end of pregnancy, to compare the quality of care received by women from different aggregated ethnic groups, and to identify any structural or cultural biases or discrimination affecting their care. Methods: National surveillance data was used to identify all 1894 women who died during or up to a year after the end of pregnancy between 2009-18 in the UK. Their characteristics and causes of death were described. A Confidential Enquiry was undertaken to describe the quality of care women received, and describe any structural or cultural biases or discrimination identified. Findings: There were no major differences in assessed quality of care, nor in causes of death between women from different aggregated ethnic groups, with cardiovascular disease the leading cause of death in all groups. Multiple areas of bias were identified in the care women received, including lack of nuanced care (notable amongst women from Black aggregated ethnic groups who died), microaggressions (most prominent in the care of women from Asian aggregated ethnic groups who died) and clinical, social and cultural complexity (evident across all ethnic groups). Interpretation: This confidential enquiry suggests that multiple structural and other biases exist in UK maternity care. Further research on the role of microaggressions is warranted. Funding: NIHR Policy Research Programme Declaration of Interests: All authors have completed the ICMJE disclosure form and declare: Marian Knight, Sara Kenyon and Jennifer Kurinczuk received grants from the NIHR PRP in relation to the submitted work. Kathryn Bunch, Nicola Vousden, Anita Banerjee, Philippa Cox, Fiona Cross-Sudworth, Mandish K. Dhanjal, Jenny Douglas, Joanna Girling, Rohit Kotnis, Roshni R. Patel, Judy Shakespeare, Derek Tuffnell and Meg Wilkinson have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. No authors have other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: Identifiable MBRRACE-UK data were collected in England and Wales without consent with approval of the Secretary of State for Health and Social Care under Section 251 of the NHS Act 2006 (15/CAG/0119). Data were collected in Scotland without consent with approval from the Public Benefit and Privacy Panel for Health and Social Care (1920-0131). Identifiable information was not provided from Northern Ireland. The legal basis for this activity is Article 6 (1)(e) and Article 9 (2)(i) under the General Data Protection Regulation.
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- 2022
6. Obstetric near misses among women with serious mental illness: data linkage cohort study
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Abigail Easter, Jane Sandall, and Louise M. Howard
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Paper ,medicine.medical_specialty ,11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences ,Near Miss, Healthcare ,Information Storage and Retrieval ,Perinatal ,Near miss ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,electronic healthcare records ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,integrated care ,Psychiatry ,Obstetrics ,business.industry ,Mental Disorders ,Odds ratio ,medicine.disease ,Mental illness ,Mental health ,Comorbidity ,women's mental health ,030227 psychiatry ,Pregnancy Complications ,comorbidity ,Psychiatry and Mental health ,Maternal Mortality ,Female ,Perinatal psychiatry ,business ,Historical Cohort ,Cohort study - Abstract
BackgroundInvestigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity.AimsTo investigate the rate and type of obstetric near misses among women with serious mental illness (SMI).MethodWe conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort – all women with a live or still birth in 2007–2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort – all women with a live or still birth in 2007–2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274).ResultsThe rate of obstetric near misses was 884.3/100 000 (95% CI 733.2–1057.4) maternities in the exposed group compared with 575.1/100 000 (95% CI 544.0–607.4) maternities in the unexposed group (adjusted odds ratio 1.6, 95% CI 1.3–2.0, P < 0.001). Highest risks were for acute renal failure (adjusted odds ratio 2.1, 95% CI 1.1–3.8, P = 0.022); cardiac arrest, failure or infarction (adjusted odds ratio 2.3, 95% CI 1.1–4.8, P = 0.028); and obstetric embolism (adjusted odds ratio 3.1, 95% CI 1.6–5.8, P < 0.001).ConclusionsFindings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI.
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- 2021
7. Effect of a maternal and newborn health system quality improvement project on the use of facilities for childbirth: a cluster‐randomised study in rural Tanzania
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Larson, Elysia, Gage, Anna D., Mbaruku, Godfrey M., Mbatia, Redempta, Haneuse, Sebastien, and Kruk, Margaret E.
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Adult ,Rural Population ,Tanzanie ,essai contrôlé randomisé en grappes ,évaluation ,cluster‐randomised controlled trial ,maternal and newborn health ,Tanzania ,Pregnancy ,Infant Mortality ,Humans ,Maternal Health Services ,Home Childbirth ,Quality of Health Care ,evaluation ,qualité ,Infant, Newborn ,Parturition ,Infant ,Prenatal Care ,Patient Acceptance of Health Care ,utilisation ,Delivery, Obstetric ,Quality Improvement ,santé maternelle et néonatale ,Maternal Mortality ,quality ,Original Article ,Female ,Health Facilities ,Original Research Papers ,Delivery of Health Care ,Program Evaluation - Abstract
Reduction in maternal and newborn mortality requires that women deliver in high quality health facilities. However, many facilities provide sub-optimal quality of care, which may be a reason for less than universal facility utilisation. We assessed the impact of a quality improvement project on facility utilisation for childbirth.In this cluster-randomised experiment in four rural districts in Tanzania, 12 primary care clinics and their catchment areas received a quality improvement intervention consisting of in-service training, mentoring and supportive supervision, infrastructure support, and peer outreach, while 12 facilities and their catchment areas functioned as controls. We conducted a census of all deliveries within the catchment area and used difference-in-differences analysis to determine the intervention's effect on facility utilisation for childbirth. We conducted a secondary analysis of utilisation among women whose prior delivery was at home. We further investigated mechanisms for increased facility utilisation.The intervention led to an increase in facility births of 6.7 percentage points from a baseline of 72% (95% Confidence Interval: 0.6, 12.8). The intervention increased facility delivery among women with past home deliveries by 18.3 percentage points (95% CI: 10.1, 26.6). Antenatal quality increased in intervention facilities with providers performing an additional 0.5 actions across the full population and 0.8 actions for the home delivery subgroup.We attribute the increased use of facilities to better antenatal quality. This increased utilisation would lead to lower maternal mortality only in the presence of improvement in care quality.La réduction de la mortalité maternelle et néonatale exige que les femmes accouchent dans des établissements de santé de haute qualité. Cependant, de nombreux établissements offrent une qualité de soins sous-optimale, ce qui peut expliquer l'utilisation moins généralisée des établissements. Nous avons évalué l'impact d'un projet d'amélioration de la qualité sur l'utilisation des établissements pour l'accouchement. MÉTHODES: Dans cet essai randomisé en grappes mené dans quatre districts ruraux de Tanzanie, 12 cliniques de soins primaires et leurs zones de recrutement ont bénéficié d'une intervention d'amélioration de la qualité consistant en une formation au cours du service, une supervision par un encadrement et un accompagnement, un appui en infrastructure et des relations avec les pairs tandis que 12 établissements et leur zone de recrutement ont servi de contrôles. Nous avons procédé à un recensement de tous les accouchements dans la zone de recrutement et utilisé une analyse de la différence des différences pour déterminer l'effet de l'intervention sur l'utilisation des établissements pour l'accouchement. Nous avons effectué une analyse secondaire de l'utilisation chez les femmes dont l'accouchement précédent avait eu lieu à domicile. Nous avons également investigué les mécanismes permettant d'accroître l'utilisation des établissements. RÉSULTATS: L'intervention a entraîné une augmentation du nombre de naissances dans les établissements de 6,7 points de pourcentage par rapport à une de référence base de 72% (intervalle de confiance à 95%: 0.6-12.8). L'intervention a augmenté de 18.3 points de pourcentage l'accouchement dans un établissement pour les femmes ayant accouché à domicile précédemment (IC 95%: 10.1-26.6). La qualité prénatale a augmenté dans les établissements d'intervention, les prestataires effectuant 0.5 action supplémentaire sur l'ensemble de la population et 0.8 action pour le sous-groupe des accouchements à domicile.Nous attribuons l'utilisation accrue des établissements à une meilleure qualité prénatale. Cette utilisation accrue ne ferait baisser la mortalité maternelle que si la qualité des soins s'améliorait.
- Published
- 2019
8. Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho
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Jesper Brix, Hartini Sugianto, Gilles van Cutsem, Sarah Jane Steele, Kristal Duncan, Mit Philips, Aline Aurore Niyibizi, Sandra Sedlimaier, Julia Hill, Quentin Baglione, and Amir Shroufi
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Adult ,neonatal mortality ,retrospective study ,030231 tropical medicine ,mortalité néonatale ,maternal health ,Health Services Accessibility ,User fee ,03 medical and health sciences ,Maternity care ,0302 clinical medicine ,Pregnancy ,District hospital ,Chart review ,Infant Mortality ,Per capita ,Humans ,utilisation des soins obstétricaux ,Medicine ,Maternal Health Services ,obstetric care utilisation ,access to care ,maternal mortality ,business.industry ,Neonatal mortality ,Mortality rate ,Public Health, Environmental and Occupational Health ,Infant ,Retrospective cohort study ,Delivery, Obstetric ,medicine.disease ,Hospital Charges ,Lesotho ,Infectious Diseases ,suppression des frais d'utilisation ,user fee removal ,Female ,Original Article ,étude rétrospective ,Parasitology ,Medical emergency ,business ,Original Research Papers - Abstract
Objective Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co‐payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho. Methods We compared utilisation of delivery services, stillbirths and maternal and neonatal mortality for the periods before (1 July 2012 to 31 December 2013) and after (1 January 2014 to 30 June 2015) user fee removal through a retrospective chart review and estimated additional costs attributed to user fee removal from provider (hospital) and patient perspectives. Results Of 4715 deliveries 3855 were at SJH and 860 at PHC centres. Of women delivering at SJH 684 (18.5%) were ≤19 years and 894 (23.6%) were HIV positive. After user fee removal hospital deliveries increased by 49% — from 1547 to 2308 — and neonatal mortality decreased from 4.8 to 1.3 per 1000 live births (P = 0.033). Extrapolating costs to the entire country, 1 USD per capita per year would allow user fee removal at hospital level, the provision of free transport to/from and accommodation at hospital. Conclusion Removing user fees for hospital delivery care in Lesotho is feasible and affordable, and has the potential to improve maternal and neonatal outcomes by removing financial barriers to skilled birth attendants and increasing coverage of institutional deliveries.
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- 2018
9. Birth preparedness, utilization of skilled birth attendants and delivery outcomes among pregnant women in Ogun State, Nigeria
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Aanuoluwapo Omobolanle Olajubu, Adekemi Eunice Olowokere, Abiola Olubusola Komolafe, and Adeola T. Oyedele
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Response rate (survey) ,lcsh:RT1-120 ,medicine.medical_specialty ,lcsh:Nursing ,business.industry ,maternal mortality ,Obstetrics and Gynecology ,Qualitative property ,lcsh:Gynecology and obstetrics ,Checklist ,delivery outcomes ,Ogun state ,Statistical significance ,Family medicine ,Maternity and Midwifery ,Pediatrics, Perinatology and Child Health ,Health care ,birth preparedness and complication readiness ,Birth attendant ,Birth preparedness ,Medicine ,business ,skilled birth attendants ,lcsh:RG1-991 ,Research Paper - Abstract
Introduction Birth preparedness and complication readiness (BPCR) is an approach initiated to facilitate utilization of skill birth attendants (SBAs) for improved pregnancy outcomes. Despite its usefulness, many women still did not use skilled birth attendants. The purpose of this study is to assess the level of birth preparedness and complication readiness and its association with skilled birth attendants' utilization. Methods A descriptive sequential mixed methods design was used. In all, 350 women in their third trimester were purposively selected from healthcare facilities. Of these, 340 completed the study yielding a 97% response rate. Structured interviewer-administered questionnaire, a checklist and an in-depth interview guide were used to collect data. Data analysis was done in Statistical Package for Social Sciences version 20 using descriptive and inferential statistics at 0.05 level of significance while qualitative data were analyzed through content analysis. Results There was a significant association between level of birth preparedness and complication readiness and use of skilled birth attendants [χ2(2, 340)=19.96; p=0.0001]. Some negative delivery outcomes (complications) were significantly associated with nonutilization of skill birth attendants. Cost, family members' preference, distance, industrial action and irritation from the vaginal examination were factors that prevented women from using a skilled birth attendant. Conclusions The study concluded that BPCR is significantly associated with the use of SBAs and better outcomes were observed in women that used SBAs in Nigeria.
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- 2020
10. Women Deliver: closing the gap for reproductive and maternal health—call for papers
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Pamela Das and Richard Horton
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media_common.quotation_subject ,Closing (real estate) ,General Medicine ,Global Health ,Maternal Mortality ,Reproductive Health ,Nursing ,Political science ,Humans ,Female ,Maternal Health Services ,Maternal health ,Periodicals as Topic ,media_common - Published
- 2012
11. Knowledge of free delivery policy among women who delivered at health facilities in Oudomxay Province, Lao PDR
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Chankham, Tengbriacheu, Yamamoto, Eiko, Reyer, Joshua A., Arafat, Rahman, Khonemany, Innoukham, Panome, Sayamoungkhoun, Hongkham, Dalavong, Bounfeng, Phommalaysith, Anonh, Xeuthvongsa, and Hamajima, Nobuyuki
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Adult ,Original Paper ,knowledge ,Adolescent ,free delivery policy ,health facility ,Young Adult ,Cross-Sectional Studies ,Logistic Models ,Maternal Mortality ,Laos ,Odds Ratio ,maternal care ,Humans ,Female ,Maternal Health Services ,Health Facilities - Abstract
To promote the utilization of maternal health services and reduce financial barriers, the Laos government introduced its “Free Maternal Health Services Policy” in 2012. This policy provides free maternal health services for pregnant women, which includes costs related to treatment, transportation, food fees, referral and an incentive for four antenatal care appointments. This study aims to ascertain the knowledge level regarding this policy among Lao women and determine their level of satisfaction with the maternal service provision. This is a cross-sectional study conducted in Xay district, La district, and Namore district of Oudomxay province, in August 2015. Three hundred and sixty women who delivered their children at the health facilities from July 2014 to June 2015 were randomly selected from the list of mothers who lived in each area. The majority of women had heard about the free delivery policy and knew that the main health services related to delivery and pregnancy were free of charge. Logistic regression analysis showed that education level (P=0.026), length of stay (P
- Published
- 2017
12. A Mobile Health Wallet for Pregnancy-Related Health Care in Madagascar: Mixed-Methods Study on Opportunities and Challenges
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Muller, Nadine, Emmrich, Peter Martin Ferdinand, Rajemison, Elsa Niritiana, De Neve, Jan-Walter, Bärnighausen, Till, Knauss, Samuel, and Emmrich, Julius Valentin
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Original Paper ,cell phone ,maternal mortality ,maternal health services ,Information technology ,developing countries ,T58.5-58.64 ,marketing of health services ,mobile applications ,healthcare financing ,Madagascar ,pregnancy ,telemedicine ,health expenditures ,Public aspects of medicine ,RA1-1270 ,600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit - Abstract
BackgroundMobile savings and payment systems have been widely adopted to store money and pay for a variety of services, including health care. However, the possible implications of these technologies on financing and payment for maternal health care services—which commonly require large 1-time out-of-pocket payments—have not yet been systematically assessed in low-resource settings. ObjectiveThe aim of this study was to determine the structural, contextual, and experiential characteristics of a mobile phone–based savings and payment platform, the Mobile Health Wallet (MHW), for skilled health care during pregnancy among women in Madagascar. MethodsWe used a 2-stage cluster random sampling scheme to select a representative sample of women utilizing either routine antenatal (ANC) or routine postnatal care (PNC) in public sector health facilities in 2 of 8 urban and peri-urban districts of Antananarivo, Madagascar (Atsimondrano and Renivohitra districts). In a quantitative structured survey among 412 randomly selected women attending ANC or PNC, we identified saving habits, mobile phone use, media consumptions, and perception of an MHW with both savings and payment functions. To confirm and explain the quantitative results, we used qualitative data from 6 semistructured focus group discussions (24 participants in total) in the same population. Results59.3% (243/410, 95% CI 54.5-64.1) saved toward the expected costs of delivery and, out of those, 64.4% (159/247, 95% CI 58.6-70.2) used household cash savings for this purpose. A total of 80.3% (331/412, 95% CI 76.5-84.1) had access to a personal or family phone and 35.7% (147/412, 95% CI 31.1-40.3) previously used Mobile Money services. Access to skilled health care during pregnancy was primarily limited because of financial obstacles such as saving difficulties or unpredictability of costs. Another key barrier was the lack of information about health benefits or availability of services. The general concept of an MHW for saving toward and payment of pregnancy-related care, including the restriction of payments, was perceived as beneficial and practicable by the majority of participants. In the discussions, several themes pointed to opportunities for ensuring the success of an MHW through design features: (1) intuitive technical ease of use, (2) clear communication and information about benefits and restrictions, and (3) availability of personal customer support. ConclusionsFinancial obstacles are a major cause of limited access to skilled maternal health care in Madagascar. An MHW for skilled health care during pregnancy was perceived as a useful and desirable tool to reduce financial barriers among women in urban Madagascar. The design of this tool and the communication strategy will likely be the key to success. Particularly important dimensions of design include technical user friendliness and accessible and personal customer service.
- Published
- 2019
13. Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs
- Author
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Evelyn K. Ansah, Ebenezer Oduro-Mensah, Gbenga A. Kayode, Hannah Brown Amoakoh, Irene Akua Agyepong, Kerstin Klipstein-Grobusch, Diederick E Grobbee, Edith Frimpong, Charity Sarpong, and Mary Amoakoh-Coleman
- Subjects
Unstructured Supplementary Service Data ,Adult ,Short Message Service ,020205 medical informatics ,Health Informatics ,Information needs ,Context (language use) ,02 engineering and technology ,Information technology ,Health informatics ,Ghana ,maternal health ,information retrieval systems ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Pregnancy ,Health care ,Infant Mortality ,Outcome Assessment, Health Care ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,030212 general & internal medicine ,mHealth ,Quality of Health Care ,Original Paper ,business.industry ,Infant ,health care systems ,neonatal health ,developing countries ,decision-making ,medicine.disease ,Decision Support Systems, Clinical ,T58.5-58.64 ,Telemedicine ,Maternal Mortality ,Female ,Medical emergency ,Public aspects of medicine ,RA1-1270 ,business - Abstract
BackgroundDeveloping and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. ObjectiveThis study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). MethodsFor clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. ResultsIn total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P
- Published
- 2019
14. Improving Tanzanian childbirth service quality
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Joanna Schellenberg, Suzanne Penfold, Jennie Jaribu, Fatuma Manzi, and Cathy Green
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Rural Population ,Quality management ,Decision Making ,Collaborative model ,Tanzania ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Health facility delivery ,Nursing ,Health facility ,Pregnancy ,Primary health ,Infant Mortality ,Birth plan ,Humans ,Medicine ,Childbirth ,Maternal Health Services ,030212 general & internal medicine ,Program Development ,Partograph ,Pregnancy danger signs ,Service quality ,biology ,business.industry ,030503 health policy & services ,Health Policy ,Pregnancy Outcome ,Infant ,Rural district ,Delivery, Obstetric ,biology.organism_classification ,Quality Improvement ,General Business, Management and Accounting ,Pregnancy Complications ,Maternal Mortality ,Female ,0305 other medical science ,business ,Program Evaluation ,Research Paper - Abstract
PurposeThe purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania.Design/methodology/approachA QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs.FindingsMedian monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months.Research limitations/implicationsThe time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures.Originality/valueHealthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.
- Published
- 2018
15. Maternal collapse: Challenging the four-minute rule
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Y. Zhou, Alexander Padovano, M.D. Benson, and Ghada Bourjeily
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Maternal mortality ,Resuscitation ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Sensitivity and Specificity ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Cardiopulmonary resuscitation ,Young adult ,Cardiopulmonary resuscitation in pregnancy ,Postmortem cesarean section ,Collapse (medical) ,Survival analysis ,Pregnancy ,030219 obstetrics & reproductive medicine ,Skin incision ,Obstetrics ,business.industry ,General Medicine ,Perimortem cesarean section ,medicine.disease ,Cesarean Birth ,Maternal cardiac arrest ,medicine.symptom ,business ,Research Paper - Abstract
Introduction The current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the “four-minute rule”: If pulses have not returned within 4 min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule. Methods A literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the “four-minute rule.” Maternal and neonatal injury free survival rates as a function of arrest to birth intervals were determined, as well as actual incision to birth intervals. Results Both maternal and neonatal injury free survival rates diminished steadily as the time interval from maternal arrest to birth increased. There was no evidence for any specific survival threshold at 4 min. Skin incision to birth intervals of 1 min occurred in only 10% of women. Conclusion Once a decision to deliver is made, care providers should proceed directly to Cesarean birth during maternal cardiac arrest in the third trimester rather than waiting for 4 min for restoration of the maternal pulse. Birth within 1 min from the start of the incision is uncommon in these circumstances., Graphic abstract Image 1, Highlights • Half of maternal/fetal pairs who are delivered by Cesarean birth within 25 min survive without injury. • The injury free survival rate for both has a roughly linear decrease as the time interval from arrest to birth increases. • Very few babies could be delivered within 1 min of the Cesarean section incision. This information suggests that the current cardio-pulmonary resuscitation guideline in pregnancy, known as the four-minute rule, needs to be changed. Injury free survival for both mother and baby decreases steadily from the moment of cardiac arrest until cesarean birth. Furthermore, in actual practice, the baby usually cannot be delivered within 1 min of the start of surgery. Once a decision for delivery has been made, Cesarean birth should be initiated promptly without waiting for 4 min. In practice, the recommendation to proceed to cesarean birth without delay is also likely to result in less confusion than the current “Four-Minute rule.”
- Published
- 2016
16. Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses
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Ginny Brunton, Angela Reitsma, Eileen K. Hutton, Karyn Kaufman, and Julia Simioni
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Maternal mortality ,Episiotomy ,Research paper ,medicine.medical_treatment ,Psychological intervention ,Home childbirth ,01 natural sciences ,Home birth ,03 medical and health sciences ,0302 clinical medicine ,Obstetrical intervention ,Health care ,Home delivery ,medicine ,Caesarean section ,030212 general & internal medicine ,0101 mathematics ,lcsh:R5-920 ,business.industry ,010102 general mathematics ,General Medicine ,Systematic review ,Home Childbirth ,lcsh:Medicine (General) ,business ,Parity (mathematics) ,Demography - Abstract
Background: We previously concluded that risk of stillbirth, neonatal mortality or morbidity is not different whether birth is intended at home or hospital. Here, we compare the occurrence of birth interventions and maternal outcomes among low-risk women who begin labour intending to birth at home compared to women intending to birth in hospital. Methods: We used our registered protocol (PROSPERO, http://www.crd.york.ac.uk, No.CRD42013004046) and searched five databases from 1990–2018. Using R, we obtained pooled estimates of effect (accounting for study design, study setting and parity). Findings: 16 studies provided data from ~500,000 intended home births for the meta-analyses. There were no reported maternal deaths. When controlling for parity in well-integrated settings we found women intending to give birth at home compared to hospital were less likely to experience: caesarean section OR 0.58(0.44,0.77); operative vaginal birth OR 0.42(0.23,0.76); epidural analgesia OR 0.30(0.24,0.38); episiotomy OR 0.45(0.28,0.73); 3rd or 4th degree tear OR 0.57(0.43,0.75); oxytocin augmentation OR 0.37(0.26,0.51) and maternal infection OR 0.23(0.15,0.35). Pooled results for postpartum haemorrhage showed women intending home births were either less likely or did not differ from those intending hospital birth [OR 0.66(0.54,0.80) and RR 1.30(0.79,2.13) from 2 studies that could not be pooled with the others]. Similar results were found when data were stratified by parity and by degree of integration into health systems. Interpretation: Among low-risk women, those intending to birth at home experienced fewer birth interventions and untoward maternal outcomes. These findings along with earlier work reporting neonatal outcomes inform families, health care providers and policy makers around the safety of intended home births. Funding: Partial funding: Association of Ontario Midwives open peer reviewed grant. Keywords: Home delivery, Home birth, Home childbirth, Maternal mortality, Obstetrical intervention, Systematic review
- Published
- 2020
17. Delivery outcomes and patterns of morbidity and mortality for neonatal admissions in five Kenyan hospitals
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Fred Were, Rachael Nyamai, Jalemba Aluvaala, Newton Isika, Mike English, Lordin Wanjala, Dorothy Okello, A. Wasunna, Leah Wafula, and Gatwiri Murithi
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Male ,medicine.medical_specialty ,Birth weight ,Population ,Asphyxia ,Hospitals, Urban ,Pregnancy ,Cause of Death ,Infant Mortality ,Medicine ,Humans ,education ,reproductive and urinary physiology ,Retrospective Studies ,education.field_of_study ,Neonatal morbidity and mortality ,business.industry ,Obstetrics ,maternal mortality ,Infant, Newborn ,Pregnancy Outcome ,still births ,Infant ,Odds ratio ,developing countries ,Stillbirth ,medicine.disease ,Delivery, Obstetric ,Original Papers ,Kenya ,Infant mortality ,3. Good health ,Hospitalization ,Low birth weight ,Infectious Diseases ,Standardized mortality ratio ,Cross-Sectional Studies ,Logistic Models ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,Morbidity ,business ,Live birth ,hospital care - Abstract
A cross-sectional survey was conducted in neonatal and maternity units of five Kenyan district public hospitals. Data for 1 year were obtained: 3999 maternal and 1836 neonatal records plus tallies of maternal deaths, deliveries and stillbirths. There were 40 maternal deaths [maternal mortality ratio: 276 per 100 000 live births, 95% confidence interval (CI): 197–376]. Fresh stillbirths ranged from 11 to 43 per 1000 births. A fifth (19%, 263 of 1384, 95% CI: 11–30%) of the admitted neonates died. Compared with normal birth weight, odds of death were significantly higher in all of the low birth weight (LBW
- Published
- 2015
18. FACTORS INFLUENCING NON-INSTITUTIONAL DELIVERIES IN AFGHANISTAN: SECONDARY ANALYSIS OF THE AFGHANISTAN MORTALITY SURVEY 2010
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AZIMI, MOHAMMAD DAUD, NAJAFIZADA, SAID AHMAD MAISAM, KHAING, INN KYNN, and HAMAJIMA, NOBUYUKI
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Maternal mortality ,Original Paper ,antenatal care ,Afghanistan ,delivery - Abstract
Home delivery in unhygienic environments is common among Afghan women; only one third of births are delivered at health facilities. Institutional delivery is central to reducing maternal mortality. The factors associated with place of delivery among women in Afghanistan were examined using the Afghanistan Mortality Survey 2010 (AMS 2010), which was open to researchers. The AMS 2010 data were collected through an interviewer-led questionnaire from 18,250 women. Odds ratio (OR) and 95% confidence interval (CI) of non-institutional delivery were estimated by logistic regression analysis. When age at survey, education, parity, residency, antenatal care frequency, remoteness, wealth and regions were adjusted, the OR of non-institutional delivery was 8.37 (95% CI, 7.47–9.39) for no antenatal care relative to four or more antenatal care visits, 4.07 (95% CI, 3.45–4.80) for poorest household relative to women from richest household, 2.02 (95% CI, 1.43–2.84) for no education relative to higher education, 1.78 (95% CI, 1.52–2.09) for six or more deliveries relative to one delivery, and 1.50 (95% CI, 1.36–1.67) for rural relative to urban residency. Since antenatal care was strongly associated with non-institutional delivery after adjustment of the other factors, antenatal care service may promote institutional deliveries, which can reduce maternal mortality ratio in Afghanistan.
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- 2015
19. Factors affecting maternal healthcare utilization in Afghanistan: secondary analysis of Afghanistan Health Survey 2012
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Shahram, Muhammad Shuaib, Hamajima, Nobuyuki, and Reyer, Joshua A.
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Original Paper ,maternal healthcare ,antenatal care ,maternal mortality ,Afghanistan ,skilled birth attendant - Abstract
This study, a secondary analysis of data from Afghanistan Health Survey 2012, aimed to identify factors affecting maternal healthcare utilization in Afghanistan. Subjects were 5,662 women aged 15–49 years who had had one delivery in the two years preceding the survey. Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression analysis. The study found that 54.0% of mothers used antenatal care (ANC) at least one time, and 47.4% of births were assisted by skilled birth attendants (SBA). Adjusted OR of ANC use was 2.74 (95% CI, 2.08–3.60) for urban residency, 1.69 (95% CI, 1.26–2.27) for primary education relative to no education, 3.94 (95% CI, 3.51–4.42) for knowledge on danger signs of pregnancy, and 1.78 (95% CI, 1.47–2.15) for television and radio relative to no exposure. Adjusted OR of SBA utilization was 3.71 (95% CI, 2.65–5.18) for urban residency, 0.67 (95% CI, 0.48–0.91) for age
- Published
- 2015
20. Evidence Acquisition and Evaluation for Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives
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Higgs, Elizabeth S., Stammer, Emily, Roth, Rebecca, and Balster, Robert L.
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Maternal mortality ,Perinatal mortality ,Motivation ,Maternal health services ,Prenatal care ,Original Papers ,Incentive ,Reimbursement - Abstract
Recognizing the need for evidence to inform US Government and governments of the low- and middle-income countries on efficient, effective maternal health policies, strategies, and programmes, the US Government convened the Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives in April 2012 in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used for achieving the goals of the Summit. The goal of the Summit was to obtain multidisciplinary expert review of literature to inform both US Government and governments of the low- and middle-income countries on evidence-informed practice, policies, and strategies for financial incentives. Several steps were undertaken to define the tasks for the Summit and identify the appropriate evidence for review. The process began by identifying focal questions intended to inform governments of the low-and middle-income countries and the US Government about the efficacy of supply- and demand-side financial incentives for enhanced provision and use of quality maternal health services. Experts were selected representing the research and programme communities, academia, relevant non-governmental organizations, and government agencies and were assembled into Evidence Review Teams. This was followed by a systematic process to gather relevant peer-reviewed literature that would inform the focal questions. Members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliography. The Evidence Review Teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. Details of the search processes and methods used for screening and quality reviews are described.
- Published
- 2013
21. The Next Wave of Deaths from Ebola? : The Impact of Health Care Worker Mortality
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Evans, David K., Goldstein, Markus, and Popova, Anna
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CARE SYSTEMS ,INFANT MORTALITY ,MILLENNIUM DEVELOPMENT GOALS ,EPIDEMICS ,CHILDHOOD ,INFANTS ,CHILDREN ,WORLD HEALTH ORGANIZATION ,GLOBAL HEALTH ,DISEASE ,HEALTH CARE WORKERS ,MEASUREMENT ,BURDEN OF DISEASE ,MATERNAL MORTALITY DATA ,HEALTH SYSTEM ,DEVELOPMENT GOALS ,UNDER-FIVE MORTALITY ,LIFE EXPECTANCY ,MIDWIVES ,HEALTH COVERAGE ,HEALTH-SYSTEM ,POPULATION ,RISK ,INCOME ,CATALYST ,HEALTH WORKFORCE ,GENERAL HEALTH SYSTEM ,NATAL CARE ,WOMEN ,SKILLED ATTENDANTS ,WORKERS ,POLICY ,HEALTH WORKERS ,POVERTY ,FEMALE ,DOCTOR ,MORTALITY RATIO ,INFANT DEATHS ,HEALTH CARE ,HEALTH OUTCOMES ,HEALTH SYSTEMS ,VACCINATION ,POPULATIONS ,MORTALITY RATES ,HEALTH ,HEALTH EXPENDITURE ,CHILDBIRTH ,INTERVENTION ,HEALTH ORGANIZATION ,AGED ,NURSING ,BASIC NEEDS ,DEATHS ,VICIOUS CYCLE ,BIRTH ,TRAINING ,MIGRATION ,INFANT MORTALITY RATE ,HEALTH ECONOMICS ,HUMAN RESOURCES ,POLICY DISCUSSIONS ,STUDENTS ,HEALTH SERVICE ,DOCTORS ,MEASLES ,POLICY RESEARCH ,LIVE BIRTHS ,MALARIA ,PEOPLE ,EPIDEMIC ,HEALTH EFFECTS ,POLICY RESEARCH WORKING PAPER ,MATERNAL MORTALITY RATIO ,WORKFORCE ,VACCINE COVERAGE ,PROGRESS ,MORTALITY RATE ,COMMUNITY HEALTH ,PRIMARY HEALTH CARE ,MATERNAL MORTALITY RATES ,MORTALITY ,HEALTH CARE SYSTEMS ,HIV ,POPULATION DATA ,CARE ,DEVELOPMENT POLICY ,DYING ,HOSPITALS ,NURSE ,MATERNAL MORTALITY ,HEALTH SECTOR ,NUMBER OF PEOPLE ,NURSES ,INFANT ,FEMALE LITERACY ,BIRTHS ,HEALTH INTERVENTIONS - Abstract
The ongoing Ebola outbreak in West Africa has put a huge strain on already weak health systems. Ebola deaths have been disproportionately concentrated among health care workers, exacerbating existing skill shortages in Guinea, Liberia, and Sierra Leone in a way that will negatively affect the health of the populations even after Ebola has been eliminated. This paper combines data on cumulative health care worker deaths from Ebola, the stock of health care workers and mortality rates pre-Ebola, and coefficients that summarize the relationship between health care workers in a given country and rates of maternal, infant, and under-five mortality. The paper estimates how the loss of health care workers to Ebola will likely affect non-Ebola mortality even after the disease is eliminated. It then estimates the size of the resource gap that needs to be filled to avoid these deaths, and to reach the minimum thresholds of health coverage described in the Millennium Development Goals. Maternal mortality could increase by 38 percent in Guinea, 74 percent in Sierra Leone, and 111 percent in Liberia due to the reduction in health personnel caused by the epidemic. This translates to an additional 4,022 women dying per year across the three most affected countries. To avoid these deaths, 240 doctors, nurses, and midwives would need to be immediately hired across the three countries. This is a small fraction of the 43,565 doctors, nurses, and midwives that would need to be hired to achieve the adequate health coverage implied by the Millennium Development Goals. Substantial investment in health systems is urgently required not only to improve future epidemic preparedness, but also to limit the secondary health effects of the current epidemic owing to the depletion of the health workforce.
- Published
- 2015
22. Profile of Maternal and Foetal Complications during Labour and Delivery among Women Giving Birth in Hospitals in Matlab and Chandpur, Bangladesh
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Mahbub Elahi Chowdhury, Fauzia Akhter Huda, Jannatul Ferdous, Carine Ronsmans, Anisuddin Ahmed, Marge Koblinsky, Musharrat Jahan, and Sushil Kanta Dasgupta
- Subjects
Maternal mortality ,Male ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,medicine.medical_treatment ,Foetal complications ,Population ,Rural Health ,Abortion ,Maternal complications ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,Pregnancy ,medicine ,Childbirth ,Humans ,Caesarean section ,030212 general & internal medicine ,education ,Perinatal mortality ,education.field_of_study ,Bangladesh ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,medicine.disease ,Original Papers ,Record-keeping ,Infant mortality ,Hospitals ,3. Good health ,Obstetric labor complication ,Obstetric Labor Complications ,Fetal Diseases ,Cross-Sectional Studies ,Fetal Mortality ,Maternal death ,Female ,business ,Delivery ,Food Science - Abstract
Worldwide, for an estimated 358,000 women, pregnancy and childbirth end in death and mourning, and beyond these maternal deaths, 9-10% of pregnant women or about 14 million women per year suffer from acute maternal complications. This paper documents the types and severity of maternal and foetal complications among women who gave birth in hospitals in Matlab and Chandpur, Bangladesh, during 2007-2008. The Community Health Research Workers (CHRWs) of the icddr,b service area in Matlab prospectively collected data for the study from 4,817 women on their places of delivery and pregnancy outcomes. Of them, 3,010 (62.5%) gave birth in different hospitals in Matlab and/or Chandpur and beyond. Review of hospital-records was attempted for 2,102 women who gave birth only in the Matlab Hospital of icddr,b and in other public and private hospitals in the Matlab and Chandpur area. Among those, 1,927 (91.7%) records were found and reviewed by a physician. By reviewing the hospital-records, 7.3% of the women (n=1,927) who gave birth in the local hospitals were diagnosed with a severe maternal complication, and 16.1% with a less-severe maternal complication. Abortion cases--either spontaneous or induced--were excluded from the analysis. Over 12% of all births were delivered by caesarean section (CS). For a substantial proportion (12.5%) of CS, no clear medical indication was recorded in the hospital-register. Twelve maternal deaths occurred during the study period; most (83%) of them had been in contact with a hospital before death. Recommendations include standardization of the hospital record-keeping system, proper monitoring of indications of CS, and introduction of maternal death audit for further improvement of the quality of care in public and private hospitals in rural Bangladesh.
- Published
- 2012
23. Unhappy Development : Dissatisfaction with Life on the Eve of the Arab Spring
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Arampatzi, Efstratia, Burger, Martijn, Ianchovichina, Elena, Röhricht, Tina, and Veenhoven, Ruut
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SOCIAL UPHEAVAL ,MIGRANT ,ECONOMIC GROWTH ,EMPLOYMENT GROWTH ,EMPLOYMENT OPPORTUNITIES ,JOB ,YOUTH UNEMPLOYMENT RATES ,JOB OPPORTUNITIES ,YOUNG PEOPLE ,DRIVERS ,LEVEL OF DEVELOPMENT ,EMPLOYMENT ,POLICY MAKERS ,POPULATION ,HIGH UNEMPLOYMENT ,NATIONAL LEVEL ,UNEMPLOYMENT ,JOB MARKET ,NUMBER OF CHILDREN ,FOREIGN POLICY ,RULE OF LAW ,WOMEN ,WORKERS ,POLITICAL SCIENTISTS ,JOBS ,INFORMAL SECTOR ,DEPRESSION ,PERSISTENT UNEMPLOYMENT ,PUBLIC SECTOR JOBS ,BULLETIN ,OLD AGE ,SOCIAL UNREST ,BASIC NEEDS ,ADULT POPULATION ,LIVING STANDARDS ,PERSONAL HEALTH ,POLITICAL SUPPORT ,POLICY DISCUSSIONS ,STUDENTS ,WORKER ,DEMOCRACY ,PUBLIC SERVICES ,INDIVIDUAL CHOICES ,UNEMPLOYED ,REGULATORY FRAMEWORKS ,SANITATION ,SOCIAL SCIENCES ,PUBLIC EDUCATION ,JOB STATUS ,ECONOMIC OPPORTUNITIES ,HUMAN NEEDS ,DOMESTIC MARKETS ,PROGRESS ,MODERNIZATION ,LABOR MARKET ,NATURAL RESOURCE ,MORTALITY ,LABOR MARKET CONDITIONS ,DRINKING WATER ,WORKSHOP ,EDUCATIONAL QUALIFICATIONS ,DEVELOPMENT POLICY ,EDUCATIONAL ATTAINMENT ,POLICY IMPLICATIONS ,YOUTH UNEMPLOYMENT ,HUMAN RIGHTS ,MATERNAL MORTALITY ,LEVEL OF EDUCATION ,QUALITY SERVICES ,LIVING CONDITIONS ,POLITICAL INSTABILITY ,ECONOMIC JUSTICE ,CROSS-SECTIONAL DATA ,SOCIAL POLICY ,MILLENNIUM DEVELOPMENT GOALS ,GOVERNMENT SUPPORT ,ECONOMIC PROGRESS ,OWNERSHIP STRUCTURES ,PAID MATERNITY ,EMPLOYEE ,EMPLOYMENT STATUS ,JOB INSECURITY ,DEVELOPMENT GOALS ,ELEMENTARY EDUCATION ,CITIZENS ,EARNINGS GROWTH ,HUMAN DEVELOPMENT ,MARRIAGE ,COUNTRY-SPECIFIC FACTORS ,POLICIES ,POLICY ,PUBLIC SECTOR EMPLOYMENT ,HEALTH CARE ,SOCIAL DEVELOPMENT ,EMPLOYEES ,PRIVATE SECTOR ,RESPECT ,FAMILY RELATIONSHIPS ,GOOD GOVERNANCE ,MIGRATION ,SERVICE PROVISION ,HOUSEHOLD INCOME ,POLICY RESEARCH ,DEVELOPING COUNTRIES ,UNEMPLOYMENT RATES ,QUALITY OF LIFE ,SOCIAL CONDITIONS ,LIMITED JOB OPPORTUNITIES ,INEQUITIES ,KNOWLEDGE ,POLICY RESEARCH WORKING PAPER ,LABOR ,LABOR MARKETS ,WORKFORCE ,PERSONAL FREEDOM ,MARITAL STATUS ,PUBLIC EMPLOYMENT ,LIFE ,POLITICAL ACTION ,EXOGENOUS VARIABLES ,CHILD MORTALITY - Abstract
Despite progress in economic and social development in the 2000s, there was an increasing dissatisfaction with life among the population of many developing Arab countries. At the end of the decade, these countries ranked among the least happy economies in the world—a situation that fits the so-called “unhappy development” paradox. The paradox is defined as declining levels of happiness at a time of moderate-to-rapid economic development. This paper empirically tests the strength of association of a range of objective and subjective factors with life evaluation in the Middle East and North Africa region in the years immediately preceding the Arab Spring uprisings (2009–10). The findings suggest a significant, negative association between life satisfaction levels in the region during this period and each of the main perceived reasons for the 2011 uprisings—dissatisfaction with the standard of living, poor labor market conditions, and corruption.
- Published
- 2015
24. Increased Coverage of Maternal Health Services among the Poor in Western Uganda in an Output-Based Aid Voucher Scheme
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Obare, Francis, Okwero, Peter, Villegas, Leslie, Mills, Samuel, and Bellows, Ben
- Subjects
SOCIAL SCIENCE ,ADOLESCENT REPRODUCTIVE HEALTH ,LOCAL POPULATION ,COMMERCIAL SEX ,ACCESS TO FAMILY PLANNING ,SAFE MOTHERHOOD ,IMPROVING HEALTH CARE ,MATERNAL HEALTH SERVICES ,CHILDREN ,CHILD HEALTH ,MEASUREMENT ,CONTRACEPTION ,HEALTH SYSTEM ,SEX WORKERS ,ADOLESCENTS ,IMPLEMENTATION ,SERVICE UTILIZATION ,EMERGENCY OBSTETRIC CARE ,POLICY MAKERS ,EMPOWERMENT OF WOMEN ,POOR MATERNAL HEALTH ,POPULATION ,IMMUNODEFICIENCY ,COMPLICATIONS ,REFERRAL FACILITY ,NUMBER OF CHILDREN ,WOMEN ,ACQUIRED IMMUNODEFICIENCY SYNDROME ,WORKERS ,REDUCING MATERNAL MORTALITY ,STIS ,MORTALITY RATIO ,SERVICE PROVIDERS ,FAMILY PLANNING PROGRAM ,DISEASES ,HEALTH OUTCOMES ,IMPROVEMENTS IN QUALITY OF CARE ,POPULATIONS ,HEALTH ,INTERVENTION ,HEALTH CARE SERVICES ,SEXUALLY TRANSMITTED DISEASES ,VIOLENCE ,BULLETIN ,SERVICE DELIVERY ,POLICY DISCUSSIONS ,NEONATAL MORTALITY ,PATIENT ,PUBLIC SERVICES ,SERVICE QUALITY ,LIVE BIRTHS ,MALARIA ,BABIES ,RURAL AREAS ,PURCHASING POWER ,FERTILITY ,NATIONAL HEALTH SYSTEMS ,HEALTH FACILITIES ,SERVICE PROVIDER ,PROGRESS ,MILLENNIUM DEVELOPMENT GOAL ,HYPERTENSION ,MORTALITY ,HEALTH-SECTOR ,LOW-INCOME COUNTRY ,DELIVERY CARE ,SOCIAL COHESION ,NATIONAL FAMILY PLANNING PROGRAMS ,DEVELOPMENT POLICY ,MATERNAL HEALTH ,RISKS ,INTERVIEW ,RISK GROUPS ,MATERNAL MORTALITY ,HEALTH SECTOR ,LEVEL OF EDUCATION ,QUALITY SERVICES ,DELIVERY COSTS ,HOUSEHOLD SURVEYS ,MARKETING ,PREGNANT WOMEN ,SKILLED HEALTH PERSONNEL ,NEWBORN ,INFORMED CONSENT ,COMMERCIAL SEX WORKERS ,ADOLESCENT HEALTH ,QUALITY OF HEALTH CARE ,WORLD HEALTH ORGANIZATION ,ANTENATAL CARE ,ABORTION ,HOME DELIVERIES ,HOUSEHOLD ASSETS ,LIFE EXPECTANCY ,MIDWIVES ,OBSTETRIC CARE ,HUMAN DEVELOPMENT ,MINISTRY OF HEALTH ,POPULATION COUNCIL ,REPRODUCTIVE HEALTH COMMODITIES ,WOMAN ,HEALTH POLICY ,NATIONAL FAMILY PLANNING ,FAMILY PLANNING PROGRAMS ,FOOD SECURITY ,POLICY ,HEALTH INDICATORS ,FAMILY PLANNING ,HEALTH PROBLEMS ,AIDS ,SEXUALLY TRANSMITTED INFECTIONS ,PREGNANCY ,NORMAL DELIVERIES ,HEALTH CARE ,HEALTH SYSTEMS ,MATERNAL HEALTH CARE ,NUTRITION ,SEX ,PUBLIC HEALTH ,SEXUAL PARTNER ,RESPECT ,CHILDBIRTH ,MATERNAL DEATHS ,EMERGENCY CARE ,NURSING ,REPRODUCTIVE HEALTH SERVICES ,TRAINING ,SERVICE PROVISION ,MATERNAL HEALTH OUTCOMES ,POPULATION STRATEGY ,LOW-INCOME POPULATIONS ,STERILIZATION ,POLICY RESEARCH ,DISEASE SYMPTOMS ,QUALITY OF SERVICES ,MORBIDITY ,DEVELOPING COUNTRIES ,FEMALE STERILIZATION ,CHILDBEARING ,PREGNANCY COMPLICATIONS ,FAMILY PLANNING SERVICES ,PREGNANCIES ,DRUGS ,INEQUITIES ,KNOWLEDGE ,CHILD HEALTH SERVICES ,STRATEGY ,POLICY RESEARCH WORKING PAPER ,MATERNAL MORTALITY RATIO ,REPRODUCTIVE HEALTH INDICATORS ,REPRODUCTIVE HEALTH CARE ,ACCESS TO HEALTH SERVICES ,SKILLED ATTENDANT ,USE OF MATERNAL HEALTH SERVICES ,RADIO ,MARITAL STATUS ,GENDER EQUALITY ,POLICY ANALYSIS ,PHARMACIES ,HIV ,MATERNAL MORBIDITY ,POSTNATAL CARE ,HEALTH SERVICES ,QUALITY OF CARE ,OBSERVATION ,CHILD MORTALITY ,CAESAREAN SECTION ,NEWBORN CARE ,INJURIES ,NURSES ,WEIGHT ,REPRODUCTIVE HEALTH ,PROVISION OF SERVICES ,HOSPITAL ,C-SECTION - Abstract
Vouchers stimulate demand for health care services by giving beneficiaries purchasing power. In turn, health facilities’ claims are reimbursed for providing beneficiaries with improved quality of health care. Efficient strategies to generate demand from new, often poor, users and supply in the form of increased access and expanded scope of services would help move Uganda away from inequity and toward universal health care. A reproductive health voucher program was implemented in 20 western and southwest Ugandan districts from April 2008 to March 2012. Using three years of data, this impact evaluation study employed a quasi-experimental design to examine differences in utilization of health services among women in voucher and nonvoucher villages. Two key findings were a 16-percentage-point net increase in private facility deliveries and a decrease in home deliveries among women who had used the voucher, indicating the project likely made contributions to increase private facility births in villages with voucher clients. No statistically significant difference was seen between respondents from voucher and nonvoucher villages in the use of postnatal care services, or in attending four or more antenatal care visits. A net 33-percentage-point decrease in out-of-pocket expenditure at private facilities in villages with voucher clients was found, and a higher percentage of voucher users came from households in the two poorest quintiles. The greater uptake of facility births by respondents in voucher villages compared with controls indicates that the approach has the potential to accelerate service uptake. A scaled program could help to move the country toward universal coverage of maternal health care.
- Published
- 2016
25. Maternal and Child Health Inequalities in Ethiopia
- Author
-
Ambel, Alemayehu, Andrews, Colin, Bakilana, Anne, Foster, Elizabeth, Khan, Qaiser, and Wang, Huihui
- Subjects
MODERN CONTRACEPTIVE USE ,LEVELS OF MORTALITY ,MIGRANT ,NUMBER OF DEATHS ,MATERNAL HEALTH SERVICES ,METHOD OF CONTRACEPTION ,CHILDREN ,OWNERSHIP OF LAND ,CHILD HEALTH ,MEASUREMENT ,CONTRACEPTION ,HEALTH SYSTEM ,MORTALITY LEVELS ,IMPLEMENTATION ,SERVICE UTILIZATION ,MODERN CONTRACEPTIVES ,EMERGENCY OBSTETRIC CARE ,POPULATION ,NATIONAL LEVEL ,NUMBER OF CHILDREN ,PLACE OF RESIDENCE ,WOMEN ,WORKERS ,NUTRITIONAL STATUS ,MOTHER ,HEALTH OUTCOMES ,VACCINATION ,HEALTH ,ILL HEALTH ,INTERVENTION ,AGED ,BULLETIN ,FAMILY SIZE ,IMMUNIZATIONS ,MEASLES ,NEONATAL MORTALITY ,LOW-INCOME COUNTRIES ,LIVE BIRTHS ,SANITATION ,ACCESS TO HEALTH CARE ,RURAL AREAS ,SECONDARY EDUCATION ,MARRIED WOMEN ,HEALTH FACILITIES ,NUMBER OF BIRTHS ,PROGRESS ,HEALTH RISKS ,MORTALITY ,DRINKING WATER ,MATERNAL HEALTH ,RISKS ,MATERNAL MORTALITY ,HEALTH SECTOR ,SUSTAINABLE DEVELOPMENT ,INFANT ,INFANT MORTALITY ,MILLENNIUM DEVELOPMENT GOALS ,SANITATION FACILITIES ,WORLD HEALTH ORGANIZATION ,ANTENATAL CARE ,CONTRACEPTIVE PREVALENCE ,GLOBAL HEALTH ,POLIO ,SOCIOECONOMIC INEQUALITIES ,DEVELOPMENT GOALS ,LIFE EXPECTANCY ,OBSTETRIC CARE ,RURAL RESIDENTS ,MINISTRY OF HEALTH ,FOOD SECURITY ,DISSEMINATION ,SKILLED CARE ,CHILD NUTRITION ,POLICY ,IMMUNIZATION ,HEALTH INDICATORS ,FAMILY PLANNING ,PREGNANCY ,INFANT DEATHS ,HEALTH CARE ,NUTRITION ,SEX ,PUBLIC HEALTH ,CHILDBIRTH ,MORALITY ,INFANT MORTALITY RATE ,SKILLED PERSONNEL ,CONTRACEPTIVES ,POLICY RESEARCH ,QUALITY OF SERVICES ,SKILLED BIRTH ATTENDANTS ,DEVELOPING COUNTRIES ,LEGAL STATUS ,HOUSEHOLD SIZE ,PEOPLE ,FAMILY PLANNING SERVICES ,CHILD MORTALITY RATES ,INEQUITIES ,CHILD HEALTH SERVICES ,MEASLES IMMUNIZATION ,POLICY RESEARCH WORKING PAPER ,REPRODUCTIVE HEALTH INDICATORS ,HOUSEHOLD LEVEL ,MORTALITY RATE ,CONTRACEPTIVE USE ,SKILLED PROFESSIONALS ,BIRTH ATTENDANTS ,ANTENATAL VISITS ,LIVE BIRTH ,GLOBAL DEVELOPMENT ,FACT SHEET ,SKILLED BIRTH ATTENDANCE ,HEALTH SERVICES ,SOCIOECONOMIC DIFFERENCES ,OBSERVATION ,URBAN AREAS ,CHILD MORTALITY ,MODERN CONTRACEPTION ,BIRTH ATTENDANT ,RURAL WOMEN ,WEIGHT ,REPRODUCTIVE HEALTH ,HOSPITAL ,HEALTH INTERVENTIONS - Abstract
Recent surveys show considerable progress in maternal and child health in Ethiopia. The improvement has been in health outcomes and health services coverage. The study examines how different groups have fared in this progress. It tracked 11 health outcome indicators and health interventions related to millennium development goals one, four, and five. These are stunting, underweight, wasting, neonatal mortality, infant mortality, under -five mortality, measles vaccination, and full immunization, modern contraceptive use by currently married women, antenatal care visits, and skilled birth attendance. Trends in rate differences and rate ratios are analyzed. The study also investigates the dynamics of inequalities, using concentration curves for different years. In addition, a decomposition analysis is conducted to identify the role of proximate determinants. The study finds substantial improvements in health outcomes and health services. Although there still exists a considerable gap between the rich and the poor, the study finds some reductions in inequalities of health services. However, some of the improvements in selected health outcomes appear to be pro-rich.
- Published
- 2015
26. Maternal Health Situation in India: A Case Study
- Author
-
Dileep Mavalankar, Vikram Gupta, Kranti Vora, Kirti Iyengar, Mudita Upadhyaya, Sharad D. Iyengar, Bharati Sharma, and K. V. Ramani
- Subjects
Program evaluation ,Health indicators ,Maternal mortality ,Economic growth ,Health, Toxicology and Mutagenesis ,media_common.quotation_subject ,Population ,Developing country ,India ,Health Services Accessibility ,Pregnancy ,Cause of Death ,Health care ,Medicine ,Health Status Indicators ,Humans ,education ,Maternal Welfare ,media_common ,education.field_of_study ,business.industry ,Health Policy ,Healthcare ,Public Health, Environmental and Occupational Health ,Health Plan Implementation ,Quarter (United States coin) ,Private sector ,Delivery, Obstetric ,Health indicator ,Socioeconomic Factors ,Papers ,Maternal health services ,Female ,Maternal health ,Public Health ,business ,Delivery ,Food Science ,Diversity (politics) - Abstract
Since the beginning of the Safe Motherhood Initiative, India has accounted for at least a quarter of maternal deaths reported globally. India’s goal is to lower maternal mortality to less than 100 per 100,000 livebirths but that is still far away despite its programmatic efforts and rapid economic progress over the past two decades. Geographical vastness and sociocultural diversity mean that maternal mortality varies across the states, and uniform implementation of health-sector reforms is not possible. The case study analyzes the trends in maternal mortality nationally, the maternal healthcare-delivery system at different levels, and the implementation of national maternal health programmes, including recent innovative strategies. It identifies the causes for limited success in improving maternal health and suggests measures to rectify them. It recommends better reporting of maternal deaths and implementation of evidence-based, focused strategies along with effective monitoring for rapid progress. It also stresses the need for regulation of the private sector and encourages further public-private partnerships and policies, along with a strong political will and improved management capacity for improving maternal health.
- Published
- 2009
27. Maternal Health: A Case Study of Rajasthan
- Author
-
Sharad D. Iyengar, Kirti Iyengar, and Vikram Gupta
- Subjects
Health, Toxicology and Mutagenesis ,Population ,Maternal Welfare ,India ,Janani Suraksha Yojana ,Abortion ,Nursing ,Pregnancy ,Cause of Death ,Health care ,Medicine ,Humans ,Maternal Health Services ,Socioeconomics ,education ,Reproductive health ,education.field_of_study ,business.industry ,Public Health, Environmental and Occupational Health ,Skilled birth attendance ,Abortion, Induced ,Delivery, Obstetric ,Pregnancy Complications ,Contraception ,Maternal Mortality ,Papers ,Health education ,Female ,Maternal health ,Rural area ,business ,Delivery ,Delivery of Health Care ,Food Science - Abstract
This case study has used the results of a review of literature to understand the persistence of poor maternal health in Rajasthan, a large state of north India, and to make some conclusions on reasons for the same. The rate of reduction in Rajasthan’s maternal mortality ratio (MMR) has been slow, and it has remained at 445 per 1000 livebirths in 2003. The government system provides the bulk of maternal health services. Although the service infrastructure has improved in stages, the availability of maternal health services in rural areas remains poor because of low availability of human resources, especially midwives and clinical specialists, and their non-residence in rural areas. Various national programmes, such as the Family Planning, Child Survival and Safe Motherhood and Reproductive and Child Health (phase 1 and 2), have attempted to improve maternal health; however, they have not made the desired impact either because of an earlier emphasis on ineffective strategies, slow implementation as reflected in the poor use of available resources, or lack of effective ground-level governance, as exemplified by the widespread practice of informally charging users for free services. Thirty-two percent of women delivered in institutions in 2005-2006. A 2006 government scheme to give financial incentives for delivering in government institutions has led to substantial increase in the proportion of institutional deliveries. The availability of safe abortion services is limited, resulting in a large number of informal abortion service providers and unsafe abortions, especially in rural areas. The recent scheme of Janani Suraksha Yojana provides an opportunity to improve maternal and neonatal health, provided the quality issues can be adequately addressed.
- Published
- 2009
28. Maternal Deaths in the City of Rio de Janeiro, Brazil, 2000–2003
- Author
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Antonio José Leal Costa and Pauline Lorena Kale
- Subjects
Maternal mortality ,Adult ,Adolescent ,Health, Toxicology and Mutagenesis ,Women's health ,Population ,HIV Infections ,Young Adult ,Pregnancy ,Cause of Death ,medicine ,Humans ,education ,Causes of death ,Cause of death ,education.field_of_study ,Population statistics ,AIDS-Related Opportunistic Infections ,Marital Status ,business.industry ,Incidence (epidemiology) ,Incidence ,Racial Groups ,Public Health, Environmental and Occupational Health ,Hypertensive disorders ,Age Factors ,virus diseases ,HIV ,Hypertension, Pregnancy-Induced ,Middle Aged ,medicine.disease ,Original Papers ,Obstetric labor complication ,Obstetric Labor Complications ,Socioeconomic Factors ,Marital status ,Maternal death ,Female ,Maternal health ,business ,Vital statistics ,Brazil ,Food Science ,Demography - Abstract
The study describes the characteristics of maternal deaths in the city of Rio de Janeiro, Brazil, during 2000-2003. After investigation by public-health services, 217 maternal deaths were identified among predominantly non-white (48.9%), single (57.1%) women aged 29.6 +/- 7.3 years on average. Direct obstetric causes corresponded to 77.4% of the maternal deaths, mainly due to hypertensive disorders. HIV-related diseases accounted for 4% of the maternal deaths. Almost three-fourths of the mothers who died were aged 20-39 years, although the highest risk of maternal death corresponded to the age-group of 40-49 years (248.9 per 100,000 livebirths). The socioeconomic and demographic profiles of maternal deaths in the city of Rio de Janeiro reflected a vulnerable social situation. Appropriate interventions aimed at reducing maternal mortality need to encompass all women of childbearing age, irrespective of the magnitude of the risk of maternal death.
- Published
- 2009
29. Verbal Autopsy of Maternal Deaths in Two Districts of Pakistan—Filling Information Gaps
- Author
-
Nazo Kureshy, Sadiqua N. Jafarey, Marge Koblinsky, and Talat Rizvi
- Subjects
Maternal mortality ,Adult ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Health, Toxicology and Mutagenesis ,Population ,Socioeconomic factors ,Young Adult ,Pregnancy ,Cause of Death ,Surveys and Questionnaires ,Epidemiology ,medicine ,Childbirth ,Humans ,Pakistan ,Maternal Health Services ,Verbal autopsy ,education ,Causes of death ,Cause of death ,education.field_of_study ,business.industry ,Public Health, Environmental and Occupational Health ,Pregnancy Outcome ,Middle Aged ,medicine.disease ,Standardized mortality ratio ,Risk factors ,Papers ,Maternal death ,Female ,Autopsy ,business ,Postpartum period ,Food Science ,Demography - Abstract
In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio are limited. This study was carried out to collect information on maternal deaths from different existing sources during the current year-2007 (prospective) and the past two years-2005 and 2006-(retrospective), identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. The verbal autopsy questionnaire was administered to households where a maternal death had occurred. No single source had complete data on maternal deaths. Risk factors identified among 128 deceased women were low socioeconomic status, illiteracy, low-earning jobs, parity, and bad obstetric history. These were similar to the findings of earlier studies. Half of the women did seek antenatal care, 34% having made more than four visits. Of the 104 women who died during or after delivery, 38% had delivered in a private facility and 18% in a government facility. The quality of services in both private and public sectors was inadequate. Sixty-nine percent of deaths occurred in the postpartum period, and 51% took place within 24 hours of delivery. The study identified gaps in reporting of maternal deaths and also provided profile of the dead women and the causes of death. Key words: Causes of death; Maternal mortality; Risk factors; Socioeconomic factors; Verbal autopsy; Pakistan doi: 10.3329/jhpn.v27i2.3329 J Health Popul Nutr 2009 April;27(2):170-183
- Published
- 2009
30. Emerging lessons from the FIGO LOGIC initiative on maternal death and near-miss reviews
- Author
-
Gwyneth Lewis
- Subjects
medicine.medical_specialty ,education ,Short paper ,Alternative medicine ,Audit ,Near miss ,Obstetrics and gynaecology ,Pregnancy ,medicine ,Humans ,Clinical care ,Maternal Welfare ,Societies, Medical ,Gynecology ,business.industry ,Infant Welfare ,Infant, Newborn ,Obstetrics and Gynecology ,International Agencies ,General Medicine ,medicine.disease ,Obstetrics ,Maternal Mortality ,Family medicine ,Maternal Death ,Severe morbidity ,Maternal death ,Female ,business - Abstract
This short paper describes some early findings from an overview of the maternal death or severe morbidity “near-miss” reviews that have been undertaken to improve clinical care by the eight societies participating in the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health aimed at strengthening the role of professional obstetric associations. While it is expected that each will publish its own report, generalizable lessons emerged and valuable solutions were implemented that will help others planning such reviews and audits in future.
- Published
- 2014
31. New politics, an opportunity for maternal health advancement in eastern myanmar: an integrative review
- Author
-
Adam B, Loyer, Mohammed, Ali, and Diana, Loyer
- Subjects
Maternal mortality ,International aid ,Maternal Health ,Politics ,Myanmar ,Armed Conflicts ,Original Papers ,MMR ,humanities ,Policy ,Pregnancy ,Government ,Ethnicity ,Humans ,Female ,Maternal Health Services ,Human rights violations ,Burma/Myanmar ,Liberalization - Abstract
Myanmar (formerly Burma) is a southeast Asian country, with a long history of military dictatorship, human rights violations, and poor health indicators. The health situation is particularly dire among pregnant women in the ethnic minorities of the eastern provinces (Kachin, Shan, Mon, Karen and Karenni regions). This integrative review investigates the current status of maternal mortality in eastern Myanmar in the context of armed conflict between various separatist groups and the military regime. The review examines the underlying factors contributing to high maternal mortality in eastern Myanmar and assesses gaps in the existing research, suggesting areas for further research and policy response. Uncovered were a number of underlying factors uniquely contributing to maternal mortality in eastern Myanmar. These could be grouped into the following analytical themes: ongoing conflict, health system deficits, and political and socioeconomic influences. Abortion was interestingly not identified as an important contributor to maternal mortality. Recent political liberalization may provide space to act upon identified roles and opportunities for the Myanmar Government, the international community, and non-governmental organizations (NGOs) in a manner that positively impacts on maternal healthcare in the eastern regions of Myanmar. This review makes a number of recommendations to this effect.
- Published
- 2014
32. Determinants and Consequences of High Fertility : A Synopsis of the Evidence
- Author
-
World Bank
- Subjects
FERTILITY CONTROL ,POPULATION STUDIES ,ECONOMIC CONSEQUENCES OF POPULATION ,ACCESS TO FAMILY PLANNING ,POPULATION GROWTH RATES ,POTENTIAL CONTRIBUTION ,ECONOMIC GROWTH ,GROSS DOMESTIC PRODUCT ,POPULATION DEBATE ,SOCIAL FACTORS ,CHILD HEALTH ,FEWER PREGNANCIES ,NEED FOR FAMILY PLANNING ,YOUNG AGES ,CONTRACEPTION ,SPECIES ,LOW BIRTH WEIGHT ,POPULATION AND DEVELOPMENT ,REPRODUCTIVE BEHAVIOR ,HUMAN POPULATION DENSITY ,UNITED NATIONS POPULATION FUND ,HUMAN SETTLEMENT ,LOW-INCOME SETTINGS ,AGRICULTURAL PRODUCTION ,UNEMPLOYMENT ,RESOURCE CONSTRAINTS ,HUMAN POPULATION GROWTH ,NUMBER OF CHILDREN ,SOCIOECONOMIC FACTORS ,AGE DISTRIBUTION ,ACQUIRED IMMUNODEFICIENCY SYNDROME ,HUMAN IMMUNODEFICIENCY VIRUS ,URBANIZATION ,REDUCING MATERNAL MORTALITY ,INTERNATIONAL FAMILY PLANNING PERSPECTIVES ,MOTHER ,FERTILITY REGULATION ,FOREST COVER ,START OF CHILDBEARING ,FAMILY PLANNING PROGRAM ,FORMULATION OF POPULATION ,FOSSIL FUELS ,CHILD SURVIVAL ,LEVEL OF FERTILITY ,MORTALITY DECLINE ,DEMOGRAPHIC PHENOMENA ,SOCIAL BARRIERS ,HUMAN POPULATION ,LARGE FAMILIES ,OLD AGE ,HUMAN HEALTH ,ECONOMIC PRODUCTIVITY ,FAMILY SIZE ,NEONATAL MORTALITY ,REPRODUCTIVE BEHAVIOUR ,DEMOGRAPHIC TRANSITION ,LIVE BIRTHS ,MANAGEMENT OF POPULATION ,RURAL AREAS ,FERTILITY ,MARRIED WOMEN ,ENVIRONMENTAL REQUIREMENTS ,FERTILITY RATE ,CONTRACEPTIVE PRACTICE ,NUMBER OF BIRTHS ,PROGRESS ,CONTRACEPTIVE METHODS ,CONDOM ,ELDERLY ,HEALTH RISKS ,MILLENNIUM DEVELOPMENT GOAL ,DECLINE IN FERTILITY ,MORTALITY ,BEHAVIOR CHANGE ,MATERNAL CAUSES ,POPULATION EDUCATION ,INTERNATIONAL WOMEN ,FIRST MARRIAGE ,EARLY CHILDHOOD ,LARGE CITIES ,MATERNAL HEALTH ,CHANGES IN FERTILITY ,EDUCATIONAL ATTAINMENT ,POPULATION FACTORS ,INTERNATIONAL FAMILY PLANNING ,SOCIOECONOMIC DEVELOPMENT ,FERTILITY PREFERENCES ,MATERNAL MORTALITY ,BIODIVERSITY ,RATE OF POPULATION GROWTH ,INFANT ,SEXUAL PARTNERS ,POPULATION ACTION INTERNATIONAL ,CONSEQUENCES OF FERTILITY ,LOWER FERTILITY ,INFANT MORTALITY ,NATIONAL POPULATION ,DEVELOPMENT ASSISTANCE ,IMPACT ON FERTILITY ,RECIPIENT COUNTRIES ,INFORMATION CAMPAIGNS ,ACCESS TO REPRODUCTIVE HEALTH SERVICES ,CONTRACEPTIVE PREVALENCE ,POPULATION MATTERS ,SEXUAL BEHAVIOR ,PANDEMIC ,RISK OF DEATH ,ABORTION ,ASSISTANCE FOR POPULATION ,CARBON DIOXIDE ,REPRODUCTIVE DESIRES ,POPULATION INCREASE ,HUMAN DEVELOPMENT ,IMPLICATIONS FOR POPULATION POLICY ,CONDOM USE ,IMPACT OF POPULATION ,POPULATION COUNCIL ,FERTILITY DECLINE ,FERTILITY TRANSITION ,REPRODUCTIVE-AGE COUPLES ,WOMAN ,DEMOGRAPHIC FACTORS ,ABSTINENCE ,EARLY CHILDHOOD MORTALITY ,FAMILY PLANNING ,FIRST BIRTH ,LIFETIME RISK ,AIR POLLUTION ,PREGNANCY ,HUMAN CAPITAL ,DEMOGRAPHIC IMPACT ,NUTRITION ,PUBLIC HEALTH ,RESPECT ,FERTILITY ATTITUDES ,POPULATION ACTION ,SOIL EROSION ,GREENHOUSE GASES ,INFORMED DECISIONS ,PROVISION OF FAMILY PLANNING ,POPULATION POLICY ,INFANT MORTALITY RATE ,GENDER EQUITY ,RAPID POPULATION GROWTH ,DEPENDENCY RATIO ,FEWER CHILDREN ,UNWANTED PREGNANCIES ,POLICY RESEARCH ,DEVELOPING COUNTRIES ,MORTALITY RISK ,POPULATION ASSOCIATION ,CHILDBEARING ,EFFECTS OF POPULATION ,HEALTH COALITION ,FAMILY PLANNING SERVICES ,NATURAL ENVIRONMENT ,REPRODUCTIVE PATTERNS ,IMPACT OF POPULATION GROWTH ,PREGNANCIES ,FERTILITY TRANSITIONS ,POPULATION PRESSURE ,REPRODUCTIVE PREFERENCES ,POLICY RESEARCH WORKING PAPER ,POPULATION GROWTH RATE ,POPULATION CHANGE ,INDIVIDUAL WELFARE ,CONTRACEPTIVE USE ,HIV ,LAM ,LABOR FORCE ,MATERNAL MORBIDITY ,HIV INFECTION ,MATERNAL DEATH ,HUMAN LIFE ,POPULATION DENSITY ,PRACTITIONERS ,CHILD MORTALITY ,MODERN CONTRACEPTION ,SMALL FAMILIES ,URBAN AREAS ,REPRODUCTIVE AGE ,WORKING-AGE POPULATION ,HUSBANDS ,REPRODUCTIVE HEALTH ,STATE UNIVERSITY - Abstract
In the six decades since 1950, fertility has fallen substantially in developing countries. Even so, high fertility, defined as five or more births per woman over the reproductive career, characterizes 33 countries. Twenty-nine of these countries are in Sub-Saharan Africa. High fertility poses health risks for children and their mothers, detracts from human capital investment, slows economic growth, and exacerbates environmental threats. These and other consequences of high fertility are reviewed in the first half of this paper. Recognizing these detrimental consequences motivates two inter-related questions that are addressed in the second half of the paper: Why does high fertility persist? And what can be done about it? The high-fertility countries lag in many development indicators, as reflected for example in their rate of progress toward achievement of the Millennium Development Goals (MDGs). These countries have also received less development assistance for population and reproductive health than countries more advanced in their transitions to lower fertility, and the assistance they did receive increased only marginally from 1995 to 2007, a period during which commitments to both health and HIV/AIDS rose substantially.
- Published
- 2010
33. Public-sector Maternal Health Programmes and Services for Rural Bangladesh
- Author
-
Marge Koblinsky, Malay K Mridha, and Iqbal Anwar
- Subjects
medicine.medical_specialty ,Economic growth ,Health, Toxicology and Mutagenesis ,Population ,Maternal Welfare ,Pregnancy ,Health care ,medicine ,Humans ,education ,Health policy ,Bangladesh ,education.field_of_study ,business.industry ,Health Policy ,Public health ,Public sector ,Health Plan Implementation ,Public Health, Environmental and Occupational Health ,Rural health services ,Obstetrics ,Pregnancy Complications ,Health Planning ,Maternal Mortality ,Papers ,Maternal health services ,Community health ,Female ,Maternal health ,Public Health ,Rural area ,business ,Delivery of Health Care ,Food Science - Abstract
Achieving Millennium Development Goal 5 in Bangladesh calls for an appreciation of the evolution of maternal healthcare within the national health system to date plus a projection of future needs. This paper assesses the development of maternal health services and policies by reviewing policy and strategy documents since the independence in 1971, with primary focus on rural areas where three-fourths of the total population of Bangladesh reside. Projections of need for facilities and human resources are based on the recommended standards of the World Health Organization (WHO) in 1996 and 2005. Although maternal healthcare services are delivered from for-profit and not-for-profit (NGO) subsectors, this paper is focused on maternal healthcare delivery by public subsector. Maternal healthcare services in the public sector of Bangladesh have been guided by global policies (e.g., Health for All by the Year 2000), national policies (e.g., population and health policy), and plans (e.g., five- or three-yearly). The Ministry of Health and Family Welfare (MoHFW), through its two wings-Health Services and Family Planning-sets policies, develops implementation plans, and provides rural public-health services. Since 1971, the health infrastructure has developed though not in a uniform pattern and despite policy shifts over time. Under the Family Planning wing of the MoHFW, the number of Maternal and Child Welfare Centres has not increased but new services, such as caesarean-section surgery, have been integrated. The Health Services wing of the MoHFW has ensured that all district-level public-health facilities, e.g., district hospitals and medical colleges, can provide comprehensive essential obstetric care (EOC) and have targeted to upgrade 132 of 407 rural Upazila Health Complexes to also provide such services. In 2001, they initiated a programme to train the Government's community workers (Family Welfare Assistants and Female Health Assistants) to provide skilled birthing care in the home. However, these plans have been too meagre, and their implementation is too weak to fulfill expectations in terms of the MDG 5 indicator-increased use of skilled birth attendants, especially for poor rural women. The use of skilled birth attendants, institutional deliveries, and use of caesarean section remain low and are increasing only slowly. All these indicators are substantially lower for those in the lower three socioeconomic quintiles. A wide variation exists in the availability of comprehensive EOC facilities in the public sector among the six divisions of the country. Rajshahi division has more facilities than the WHO 1996 standard (1 comprehensive EOC for 500,000 people) whereas Chittagong and Sylhet divisions have only 64% of their need for comprehensive EOC facilities. The WHO 2005 recommendation (1 comprehensive EOC for 3500 births) suggests that there is a need for nearly five times the existing national number of comprehensive EOC facilities. Based on the WHO standard 2005, it is estimated that 9% of existing doctors and 40% of nurses/midwives were needed just for maternal healthcare in both comprehensive EOC and basic EOC facilities in 2007. While the inability to train and retain skilled professionals in rural areas is the major problem in implementation, the bifurcation of the MoHFW (Health Services and Family Planning wings) has led to duplication in management and staff for service-delivery, inefficiencies as a result of these duplications, and difficulties of coordination at all levels. The Government of Bangladesh needs to functionally integrate the Health Services and Family Planning wings, move towards a facility-based approach to delivery, ensure access to key maternal health services for women in the lower socioeconomic quintiles, consider infrastructure development based on the estimation of facilities using the WHO 1996 recommendation, and undertake a human resource-development plan based on the WHO 2005 recommendation.
- Published
- 2009
34. Clinical features, current treatments and outcome of pregnant women with preeclampsaia/eclampsia in northern afghanistan
- Author
-
Sayed Shir Mohammad, Ahadi, Yoshitoku, Yoshida, Mirwais, Rabi, Mohammad Abul Bashar, Sarker, Joshua A, Reyer, and Nobuyuki, Hamajima
- Subjects
Maternal mortality ,Original Paper ,embryonic structures ,Afghanistan ,Eclampsia ,Preeclampsia ,reproductive and urinary physiology ,female genital diseases and pregnancy complications - Abstract
In Afghanistan, preeclampsia/eclampsia is the second leading cause of maternal deaths following maternal hemorrhage. This study aimed to describe clinical features, current treatments, and outcome among preeclampsia and eclampsia patients in the north region of Afghanistan. This was a retrospective study based on medical records of four center hospitals (one regional hospital and three provincial hospitals) in the north region of Afghanistan. Subjects were 322 patients with preeclampsia/eclampsia, admitted from March 2012 to March 2013. Out of 322 cases, 72.7% were diagnosed as preeclampsia and the rest as eclampsia. Those aged 30–39 years were 41.0% among preeclampsia patients and 29 years and younger were 35.2% among eclampsia patients (p= 0.002). The first delivery was significantly higher (p=0.045) among eclampsia patients (51.1%) than among preeclampsia patients (36.8%). While none died among the preeclampsia patients, 12 out of 88 eclampsia patients died in the hospitals. The causes of the 12 deaths were pulmonary edema (6 patients), renal failure (3 patients), cerebrovascular attack (2 patients), and hemorrhage (1 patient). There were no clinical findings at admission significantly associated with the deaths within the eclampsia patient group. Although the sample size was not large enough, patients admitted to the regional/provincial hospitals at the stage of preeclampsia had a low risk of death. Access at the stage of preeclampsia and improvement in treatments for eclampsia would reduce maternal mortality in Afghanistan.
- Published
- 2014
35. Unavailability of essential obstetric care services in a local government area of south-west Nigeria
- Author
-
Kayode T, Ijadunolal, Adesegun O, Fatusi, Ernest O, Orji, Adebanjo B, Adeyemi, Olabimpe O, Owolabi, Ebenezer O, Ojofeitimi, Adekunbi K, Omideyi, and Alfred A, Adewuyi
- Subjects
Maternal mortality ,Nigeria ,Health facilities ,Delivery, Obstetric ,Original Papers ,Health Services Accessibility ,Health services ,Hospitals, Private ,Obstetrics ,Pregnancy ,Humans ,Female ,Maternal Health Services ,Obstetrics and Gynecology Department, Hospital ,Essential obstetric care - Abstract
This paper reports the findings at baseline in a multi-phase project that aimed at reducing maternal mortality in a local government area (LGA) of South-West Nigeria. The objectives were to determine the availability of essential obstetric care (EOC) services in the LGA and to assess the quality of existing services. The first phase of this interventional study, which is the focus of this paper, consisted of a baseline health facility and needs assessment survey using instruments adapted from the United Nations guidelines. Twenty-one of 26 health facilities surveyed were public facilities, and five were privately owned. None of the facilities met the criteria for a basic EOC facility, while only one private facility met the criteria for a comprehensive EOC facility. Three facilities employed a nurse and/or a midwife, while unskilled health attendants manned 46% of the facilities. No health worker in the LGA had ever been trained in lifesaving skills. There was a widespread lack of basic EOC equipment and supplies. The study concluded that there were major deficiencies in the supply side of obstetric care services in the LGA, and EOC was almost non-existent. This result has implications for interventions for the reduction of maternal mortality in the LGA and in Nigeria.
- Published
- 2007
36. Study of Blood-transfusion Services in Maharashtra and Gujarat States, India
- Author
-
Dileep Mavalankar, K. V. Ramani, and Dipti Govil
- Subjects
Blood-storage centres ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,Population ,Maternal Welfare ,India ,Developing country ,Nursing ,Pregnancy ,Health care ,medicine ,Humans ,Blood-banks ,Maternal Health Services ,Socioeconomics ,education ,Government ,education.field_of_study ,business.industry ,Public health ,Blood transfusion ,Public Health, Environmental and Occupational Health ,medicine.disease ,Obstetric Labor Complications ,Maternal Mortality ,Emergency obstetric care ,Papers ,Blood Banks ,Female ,Maternal death ,Rural area ,business ,Food Science - Abstract
Blood-transfusion services are vital to maternal health because haemorrhage and anaemia are major causes of maternal death in South Asia. Unfortunately, due to continued governmental negligence, blood-transfusion services in India are a highly-fragmented mix of competing independent and hospital-based blood-banks, serving the needs of urban populations. This paper aims to understand the existing systems of blood-transfusion services in India focusing on Maharashtra and Gujarat states. A mix of methodologies, including literature review (including government documents), analysis of management information system data, and interviews with key officials was used. Results of analysis showed that there are many managerial challenges in blood-transfusion services, which calls for strengthening the planning and monitoring of these services. Maharashtra provides a good model for improvement. Unless this is done, access to blood in rural areas may remain poor.
- Published
- 2009
37. Impact of Janani Suraksha Yojana on Institutional Delivery Rate and Maternal Morbidity and Mortality: An Observational Study in India
- Author
-
Dinesh Kumar Pal, Rajkumar Patil, Prashant Gupta, Ashish Kumar Shrivastava, Rajesh Garg, Lokesh Agarwal, Chandrakant Lahariya, Radha Sarawagi, Rajesh Tiwari, and Sanjeev Kumar Gupta
- Subjects
Conditional cash transfer ,Maternal mortality ,Adult ,Financing, Government ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,Population ,India ,Developing country ,Institutional deliveries ,Health Promotion ,Janani Suraksha Yojana ,Pregnancy ,medicine ,Maternal survival ,Humans ,Maternal Health Services ,education ,Motivation ,education.field_of_study ,Eclampsia ,Obstetrics ,business.industry ,Antepartum haemorrhage ,Public Health, Environmental and Occupational Health ,Patient Acceptance of Health Care ,Delivery, Obstetric ,medicine.disease ,Original Papers ,Pregnancy Complications ,Standardized mortality ratio ,Female ,Observational study ,business ,Food Science - Abstract
The Government of India initiated a cash incentive scheme--Janani Suraksha Yojana (JSY)--to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India.
- Published
- 2013
38. Consequences of maternal complications in women's lives in the first postpartum year: a prospective cohort study
- Author
-
Swapnaleen Sen, Kirti Iyengar, and Ranjana Yadav
- Subjects
Maternal mortality ,medicine.medical_specialty ,Pediatrics ,Nurse Midwives ,Health, Toxicology and Mutagenesis ,Population ,Maternal-Child Health Centers ,India ,Rural Health ,Cohort Studies ,Cost of Illness ,Pregnancy ,Infant Mortality ,medicine ,Prevalence ,Childbirth ,Humans ,Prospective Studies ,Prospective cohort study ,education ,education.field_of_study ,Delivery complications ,Pregnancy outcomes ,Obstetrics ,business.industry ,Mortality rate ,Postpartum Period ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Infant ,Community Health Centers ,medicine.disease ,Child survival ,Original Papers ,Infant mortality ,Pregnancy Complications ,Impact studies ,Maternal health services ,Female ,business ,Attitude to Health ,Delivery ,Postpartum period ,Food Science ,Cohort study - Abstract
Maternal complications are common during and following childbirth. However, little information is available on the psychological, social and economic consequences of maternal complications on women's lives, especially in a rural setting. A prospective cohort study was conducted in southern Rajasthan, India, among rural women who had a severe or less-severe, or no complication at the time of delivery or in the immediate postpartum period. In total, 1,542 women, representing 93% of all women who delivered in the field area over a 15-month period and were examined in the first week postpartum by nurse-midwives, were followed up to 12 months to record maternal and child survival. Of them, a subset of 430 women was followed up at 6-8 weeks and 12 months to capture data on the physical, psychological, social, or economic consequences. Women with severe maternal complications around the time of delivery and in the immediate postpartum period experienced an increased risk of mortality and morbidity in the first postpartum year: 2.8% of the women with severe complications died within one year compared to none with uncomplicated delivery. Women with severe complications also had higher rates of perinatal mortality [adjusted odds ratio (AOR)=3.98, confidence interval (CI) 1.96-8.1, p=0.000] and mortality of babies aged eight days to 12 months (AOR=3.14, CI 1.4-7.06, p=0.004). Compared to women in the uncomplicated group, women with severe complications were at a higher risk of depression at eight weeks and 12 months with perceived physical symptoms, had a greater difficulty in completing daily household work, and had important financial repercussions. The results suggest that women with severe complications at the time of delivery need to be provided regular follow-up services for their physical and psychological problems till about 12 months after childbirth. They also might benefit from financial support during several months in the postpartum period to prevent severe economic consequences. Further research is needed to identify an effective package of services for women in the first year after delivery.
- Published
- 2012
39. Occurrence and Determinants of Postpartum Maternal Morbidities and Disabilities among Women in Matlab, Bangladesh
- Author
-
Marge Koblinsky, Anisuddin Ahmed, Jannatul Ferdous, Sushil Kanta Dasgupta, Mahbub Elahi Chowdhury, Jahan M, Carine Ronsmans, and Fauzia Akhter Huda
- Subjects
medicine.medical_specialty ,Disabilities ,Health, Toxicology and Mutagenesis ,Population ,Rural Health ,Postpartum morbidities ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,Long-term morbidities ,Pregnancy ,Epidemiology ,Humans ,Medicine ,Childbirth ,Normal uncomplicated births ,Prospective Studies ,030212 general & internal medicine ,Complicated births ,education ,2. Zero hunger ,Bangladesh ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Postpartum Period ,1. No poverty ,Public Health, Environmental and Occupational Health ,Odds ratio ,medicine.disease ,Original Papers ,3. Good health ,Perineum ,Pregnancy Complications ,Maternal Mortality ,medicine.anatomical_structure ,Socioeconomic Factors ,Obstetric complications ,Female ,Perinatal death ,Morbidity ,business ,Postpartum period ,Food Science ,Cohort study - Abstract
The burden of maternal ill-health includes not only the levels of maternal mortality and complications during pregnancy and around the time of delivery but also extends to the standard postpartum period of 42 days with consequences of obstetric complications and poor management at delivery. There is a dearth of reliable data on these postpartum maternal morbidities and disabilities in developing countries, and more research is warranted to investigate these and further strengthen the existing safe motherhood programmes to respond to these conditions. This study aims at identifying the consequences of pregnancy and delivery in the postpartum period, their association with acute obstetric complications, the sociodemographic characteristics of women, mode and place of delivery, nutritional status of the mother, and outcomes of birth. From among women who delivered between 2007 and 2008 in the icddr,b service area in Matlab, we prospectively recruited all women identified with complicated births (n=295); a perinatal mortality (n=182); and caesarean-section delivery without any maternal indication (n=147). A random sample of 538 women with uncomplicated births, who delivered at home or in a facility, was taken as the control. All subjects were clinically examined at 6-9 weeks for postpartum morbidities and disabilities. Postpartum women who had suffered obstetric complications during birth and delivered in a hospital were more likely to suffer from hypertension [adjusted odds ratio (AOR)=3.44; 95% confidence interval (CI)=1.14-10.36], haemorrhoids (AOR=1.73; 95% CI=1.11-3.09), and moderate to severe anaemia (AOR=7.11; 95% CI=2.03-4.88) than women with uncomplicated normal deliveries. Yet, women who had complicated births were less likely to have perineal tears (AOR=0.05; 95% CI=0.02-0.14) and genital prolapse (AOR=0.22; 95% CI=0.06-0.76) than those with uncomplicated normal deliveries. Genital infections were more common amongst women experiencing a perinatal death than those with uncomplicated normal births (AOR=1.92; 95% CI=1.18-3.14). Perineal tears were significantly higher (AOR=3.53; 95% CI=2.32-5.37) among those who had delivery at home than those giving birth in a hospital. Any woman may suffer a postpartum morbidity or disability. The increased likelihood of having hypertension, haemorrhoids, or anaemia among women with obstetric complications at birth needs specific intervention. A higher quality of maternal healthcare services generally might alleviate the suffering from perineal tears and prolapse amongst those with a normal uncomplicated delivery.
- Published
- 2012
40. Kosovo : Gender Gaps in Education, Health, and Economic Opportunities
- Author
-
World Bank
- Subjects
RECREATION ,NEW INFECTIONS ,IUD ,EDUCATIONAL OPPORTUNITIES ,EMPLOYMENT OPPORTUNITIES ,FEMALE EDUCATION ,YOUNG PEOPLE ,ILLITERATE POPULATION ,GENDER STUDIES ,FEMALE PARTICIPANTS ,UNEMPLOYMENT ,URBAN WOMEN ,GENDER IMBALANCE ,FEMALE STUDENTS ,RISK FACTORS ,UNIVERSITY EDUCATION ,WAR ,AGED ,FERTILITY RATES ,REGULATORY REGIME ,VIOLENCE ,BASIC NEEDS ,SKILLED WORKERS ,ADULT POPULATION ,LABOR SUPPLY ,SOCIAL WORKERS ,CAREER DEVELOPMENT ,ETHNIC GROUPS ,INHERITANCE ,PUBLIC SERVICES ,WOMEN IN LEADERSHIP POSITIONS ,WOMEN IN POLITICS ,ECONOMIC OPPORTUNITIES ,FERTILITY ,SECONDARY EDUCATION ,MAJORITY OF CHILDREN ,ADULT WOMEN ,GENDER DISPARITY ,BIRTH CONTROL ,PRIMARY SCHOOL AGE ,MATERNAL MORTALITY RATES ,INFORMATION SYSTEM ,SOCIAL NORMS ,DEVELOPMENT POLICY ,GOVERNMENT OFFICES ,POLICY IMPLICATIONS ,ECONOMIC OPPORTUNITY ,MATERNAL MORTALITY ,MALE CONDOMS ,LITERACY RATES ,POLITICAL INSTABILITY ,PREGNANT WOMEN ,ACCESS TO EMPLOYMENT ,OLDER MEN ,FEMALE EMPLOYMENT ,LABOR FORCE PARTICIPATION ,ANTENATAL CARE ,IMPROVEMENT OF WOMEN ,CITIZENSHIP ,YOUNG WOMEN ,LIFE EXPECTANCY ,HUMAN DEVELOPMENT ,MEDICAL PERSONNEL ,WOMEN IN LEADERSHIP ,EDUCATIONAL SYSTEM ,FEMALE LEADERS ,ABSTINENCE ,GENDER DIFFERENCES ,VITAL STATISTICS ,ADEQUATE HUMAN RESOURCES ,IUDS ,GENDER INEQUALITY ,PREGNANCY ,ADULT MEN ,OUTREACH ACTIVITIES ,PUBLIC HEALTH ,MATERNAL DEATHS ,TRADITIONAL VALUES ,WORKING WOMEN ,LEGISLATORS ,OLD SYSTEM ,INHERITANCE RIGHTS ,FEMALE STERILIZATION ,LEGAL STATUS ,PREGNANCY COMPLICATIONS ,UNEMPLOYMENT RATES ,FEMALE LABOR ,SOCIAL CONDITIONS ,PREGNANCIES ,UNDP ,POLICY RESEARCH WORKING PAPER ,WORKFORCE ,TRADITIONAL PRACTICES ,INTRA-UTERINE DEVICES ,SINGLE WOMEN ,GENDER EQUALITY ,SICK LEAVE ,HIV ,BIRTH RATE ,WATER SUPPLY ,WORK EXPERIENCE ,TRANSPORTATION ,FEMALE MINISTER ,FEMALE LIFE EXPECTANCY ,FLEXIBLE WORK ARRANGEMENTS ,POLITICAL PARTIES ,WAGE GAP ,GENDER ,RURAL WOMEN ,HUSBANDS ,REPRODUCTIVE HEALTH ,EDUCATED WOMEN ,HOSPITAL ,SOCIAL WELFARE ,METHOD OF CONTRACEPTION ,ECONOMIC GROWTH ,UNICEF ,CONTRACEPTION ,HEALTH SYSTEM ,QUALITY OF EDUCATION ,JOB OPPORTUNITIES ,POLITICAL REPRESENTATION OF WOMEN ,RURAL HOUSEHOLDS ,GENDER DISPARITIES ,HEALTH OF WOMEN ,WORKING CONDITIONS ,PRODUCTIVITY ,PUBLIC AWARENESS ,HOUSEHOLD RESPONSIBILITIES ,LABOUR MARKET ,REDUCING MATERNAL MORTALITY ,GENDER ASSESSMENTS ,HEALTH OUTCOMES ,GIRLS ,DRUG ABUSE ,PREVALENCE OF CONTRACEPTION ,JOB-SEEKERS ,WAR RECONSTRUCTION ,CHILDREN PER WOMAN ,GENDER DISCRIMINATION ,COMMITTEE ON HUMAN RIGHTS ,PRIMARY EDUCATION ,LEADING CAUSES ,DEMOCRACY ,EDUCATIONAL INSTITUTIONS ,GENDER GAPS ,BASIC EDUCATION ,ARMED CONFLICT ,DROPOUT ,UNSAFE ABORTIONS ,LIVE BIRTHS ,PATIENTS ,RURAL AREAS ,MARRIED WOMEN ,FERTILITY RATE ,YOUNG MEN ,PROGRESS ,CONDOM ,LABOR MARKET ,FEMALE EMPLOYEES ,CAREER ADVANCEMENT ,MATERNITY LEAVE ,EDUCATIONAL FACILITIES ,MATERNAL HEALTH ,CLINICS ,EDUCATIONAL ATTAINMENT ,HEALTH PROVIDERS ,JOB TRAINING ,NUMBER OF WOMEN ,TERTIARY EDUCATION ,HUMAN RIGHTS ,SOCIAL SECURITY ,OLDER WOMEN ,LEVEL OF EDUCATION ,GOVERNMENT AGENCIES ,HOUSEHOLD SURVEYS ,FEMALE ENTREPRENEURS ,DISCRIMINATORY PRACTICES ,FAMILY RESPONSIBILITIES ,WOMEN IN SOCIETY ,SEXUAL BEHAVIOR ,MASS UNEMPLOYMENT ,ABORTION ,UNFPA ,POOR NUTRITION ,MIDWIVES ,ROLE MODELS ,WOMAN ,REMITTANCES ,POOR FAMILIES ,FAMILY PLANNING ,FORMAL EDUCATION ,HUMAN CAPITAL ,SEX ,UNITED NATIONS ,METHODS OF FAMILY PLANNING ,POLITICAL DECISION ,MIGRATION ,GENDER DISPARITIES IN EDUCATION ,MODERN CONTRACEPTIVE METHODS ,POLICY RESEARCH ,QUALITY OF SERVICES ,CHILD CARE ,SEX INDUSTRY ,GENDER ISSUES ,PRIMARY SCHOOL ,TERTIARY LEVEL ,MARITAL STATUS ,JOB CREATION ,TRADITIONAL SOCIETIES ,HOUSEHOLD BUDGET ,LABOR FORCE ,URBAN POPULATIONS ,HEALTH SERVICES ,SUBSISTENCE AGRICULTURE ,VOCATIONAL TRAINING ,MEDICAL SPECIALISTS ,MODERN CONTRACEPTION ,ILLITERACY ,REPRODUCTIVE AGE ,NURSES ,HUMAN WELFARE - Abstract
Kosovo is one of the poorest countries in Europe (World Bank 2010). In 2009, 35 percent of the population lived below the poverty line. This note was prepared primarily as a key input to the Kosovo country partnership strategy (FY2012 to FY2015) and aims to provide an overview of gender disparities in three major domains: human capital, labor market, and entrepreneurship. The note provides a broad picture of gender disparities in Kosovo in education, health, and access to economic opportunities. Lack of statistical data on Kosovo, and particularly of gender-disaggregated data, limits the depth and scope of this gender diagnostic. Men and women in Kosovo have lower education levels than men and women in the European Union (EU). Women comprise less than 10 percent of all entrepreneurs and 0.3 percent of top management positions. This note is organized as follows: section one highlights gender differences in human capital focusing on education and health outcomes; section two describes men's and women's relative employment patterns; section three focuses on gender disparities in entrepreneurship and career advancement in business and politics; and section four provides concluding observations.
- Published
- 2012
41. Household decision-making about delivery in health facilities: evidence from Tanzania
- Author
-
Sandro Galea, Godfrey Mbaruku, Peter C. Rockers, E. J. Danforth, and Margaret E Kruk
- Subjects
Adult ,Male ,Maternal mortality ,Health, Toxicology and Mutagenesis ,Population ,Developing country ,Midwifery ,Social class ,Tanzania ,Interviews as Topic ,Young Adult ,Professional Competence ,Sex Factors ,Health facility ,Nursing ,Pregnancy ,Physicians ,Health care ,Humans ,Medicine ,Childbirth ,Interpersonal Relations ,Spouses ,education ,Socioeconomic status ,Original Paper ,education.field_of_study ,biology ,business.industry ,Healthcare ,Public Health, Environmental and Occupational Health ,Middle Aged ,Delivery, Obstetric ,biology.organism_classification ,Dissent and Disputes ,Health services ,Neonatal Health ,Maternal Mortality & Morbidity ,Partner's influence ,Female ,Health Facilities ,Service delivery & access ,business ,Attitude to Health ,Delivery ,Food Science - Abstract
This study investigated how partners’ perceptions of the healthcare system influence decisions about delivery-location in low-resource settings. A multistage population-representative sample was used in Kasulu district, Tanzania, to identify women who had given birth in the last five years and their partners. Of 826 couples in analysis, 506 (61.3%) of the women delivered in the home. In multivariate analysis, factors associated with delivery in a health facility were agreement of partners on the importance of delivering in a health facility and agreement that skills of doctors are better than those of traditional birth attendants. When partners disagreed, the opinion of the woman was more influential in determining delivery-location. Agreement of partners regarding perceptions about the healthcare system appeared to be an important driver of decisions about delivery-location. These findings suggest that both partners should be included in the decision-making process regarding delivery to raise rates of delivery at facility.
- Published
- 2009
42. Maternal Mortality-reduction Programme in Andhra Pradesh
- Author
-
M. Prakasamma
- Subjects
Maternal mortality ,medicine.medical_specialty ,Referral ,Health, Toxicology and Mutagenesis ,Population ,India ,Developing country ,Midwifery ,Nursing ,Pregnancy ,Environmental health ,Epidemiology ,Humans ,Medicine ,Childbirth ,Safe motherhood ,Maternal Health Services ,Health Workforce ,education ,Maternal Welfare ,education.field_of_study ,Primary Health Care ,business.industry ,Public Health, Environmental and Occupational Health ,Health facilities ,Health indicator ,Obstetric Labor Complications ,Standardized mortality ratio ,Family planning ,Family Planning Services ,Papers ,Women's Rights ,Female ,Maternal health ,business ,Food Science - Abstract
Andhra Pradesh, a large state in southern India, has a high maternal mortality ratio of 195 per 100,000 livebirths despite the improvements in social, demographic and health indicators over the last two decades. This contrary situation has been analyzed using findings of different studies on maternal mortality, and four factors have been presented for consistently-high maternal mortality in the state. First, the disproportionately-high focus on family planning towards population stabilization reduced the emphasis on maternal health in the peripheral hospitals, resulting in low use of these facilities for childbirths. Second, the growth of services in Primary Health Centres was not given adequate emphasis, resulting in the weakening of the peripheral health system. Third, there was little emphasis on developing a cadre of midwives who would have primarily focused on maternal health. Lastly, the low status of women in the state has hampered timely referral and access to services.
- Published
- 2009
43. Causes of Maternal Mortality Decline in Matlab, Bangladesh
- Author
-
Mahbub Elahi Chowdhury, Marge Koblinsky, Anisuddin Ahmed, and Nahid Kalim
- Subjects
Maternal mortality ,Emergency Medical Services ,Health Knowledge, Attitudes, Practice ,Health, Toxicology and Mutagenesis ,media_common.quotation_subject ,Total fertility rate ,Population ,Maternal Welfare ,Fertility ,Midwifery ,Health Services Accessibility ,Pregnancy ,Cause of Death ,Environmental health ,Health care ,Odds Ratio ,Humans ,Medicine ,Maternal Health Services ,Obstetric care ,education ,Causes of death ,media_common ,Reproductive health ,Bangladesh ,education.field_of_study ,business.industry ,Healthcare ,Public Health, Environmental and Occupational Health ,Health facilities ,Abortion, Induced ,Health services ,Pregnancy Complications ,Contraception ,Standardized mortality ratio ,Risk factors ,Socioeconomic Factors ,Family Planning Services ,Papers ,Educational Status ,Female ,Maternal health ,Clinical Competence ,Rural area ,business ,Delivery ,Food Science - Abstract
Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality--86.7% and 78.3%--in the ICDDR,B and government service areas respectively. Education of women was a strong predictor of the maternal mortality decline in both the areas. Possible explanations for the maternal mortality decline in Matlab are: better access to comprehensive EmOC services, reduction in the total fertility rate, and improved education of women. To achieve the Millenium Development Goal 5 targets, policies that bring further improved comprehensive EmOC, strengthened family-planning services, and expanded education of females are essential.
- Published
- 2009
44. Maternal Healthcare Financing: Gujarat’s Chiranjeevi Scheme and Its Beneficiaries
- Author
-
Ramesh Bhat, Dileep Mavalankar, Neelu Singh, and Prabal V. Singh
- Subjects
Maternal mortality ,Program evaluation ,Emergency Medical Services ,Economic growth ,Health, Toxicology and Mutagenesis ,Population ,Maternal Welfare ,India ,Developing country ,Public-Private Sector Partnerships ,Chiranjeevi scheme ,Cost Savings ,Pregnancy ,Health care ,Humans ,Medicine ,Maternal Health Services ,Obstetric care ,education ,education.field_of_study ,Poverty ,business.industry ,Public sector ,Public Health, Environmental and Occupational Health ,Delivery, Obstetric ,Private sector ,Socioeconomic Factors ,Emergency obstetric care ,Papers ,Female ,business ,Delivery ,Private-public relationship ,Food Science - Abstract
Maternal mortality is an important public-health issue in India, specifically in Gujarat. Contributing factors are the Government's inability to operationalize the First Referral Units and to provide an adequate level of skilled birth attendants, especially to the poor. In response, the Gujarat state has developed a unique public-private partnership called the Chiranjeevi Scheme. This scheme focuses on institutional delivery, specifically emergency obstetric care for the poor. The objective of the study was to explore the targeting of the scheme, its coverage, and socioeconomic profile of the beneficiaries and to assess financial protection offered by the scheme, if any, in Dahod, one of the initial pilot districts of Gujarat. A household-level survey of beneficiaries (n=262) and non-users (n=394) indicated that the scheme is well-targeted to the poor but many poor people do not use the services. The beneficiaries saved more than Rs 3,000 (US$ 75) in delivery-related expenses and were generally satisfied with the scheme. The study provided insights on how to improve the scheme further. Such a financing scheme could be replicated in other states and countries to address the cost barrier, especially in areas where high numbers of private specialists are available.
- Published
- 2009
45. Improving Maternal Survival in South Asia - What Can We Learn from Case Studies?
- Author
-
Barbara McPake and Marge Koblinsky
- Subjects
Maternal mortality ,Economic growth ,Health, Toxicology and Mutagenesis ,Population ,Maternal Welfare ,Psychological intervention ,India ,Context (language use) ,Prenatal care ,Pregnancy ,Health care ,Humans ,Medicine ,Maternal Health Services ,Pakistan ,Marketing ,education ,Health policy ,Bangladesh ,education.field_of_study ,business.industry ,Health Policy ,Health Plan Implementation ,Parturition ,Public Health, Environmental and Occupational Health ,Prenatal Care ,Pregnancy Complications ,Incentive ,Papers ,Female ,Maternal health ,Case studies ,Asia, South ,business ,Food Science - Abstract
Technical interventions for maternal healthcare are implemented through a dynamic social process. Peoples' behaviours--whether they be planners, managers, providers, or potential users--influence the outcomes. Given the complexity and unpredictability inherent in such dynamic processes, the proposed cause-and-effect relationships in any one context cannot be directly transferred to another. While this is true of all health services, its importance is magnified in maternal healthcare because of the need to involve multiple levels of the health system, multiple types of care providers from the highly skilled specialist to community-level volunteers, and multiple technical interventions, without the ability to measure significant change in the outcome, the maternal mortality ratio. Patterns can be followed however, in terms of outcomes in response to interventions. From these case studies of implementation of maternal health programmes across five states of India, Pakistan, and Bangladesh, some patterns stand out and seem to apply virtually everywhere (e.g., failure of systems to post staff in difficult areas) while others require more data to understand the observed patterns (e.g., response to financial incentives for improving maternal health systems; instituting available accessible safe blood). The patterns formed can provide guidance to programme managers as to what aspects of the process to track and micro-manage, to policy-makers as to what features of a context may particularly influence impacts of alternative maternal health strategies, and to governments more broadly as to the factors shaping dynamic responses that might themselves warrant intervention.
- Published
- 2009
46. Quality of Obstetric Care in Public-sector Facilities and Constraints to Implementing Emergency Obstetric Care Services: Evidence from High- and Low-performing Districts of Bangladesh
- Author
-
Iqbal Anwar, Nahid Kalim, and Marge Koblinsky
- Subjects
Program evaluation ,Emergency Medical Services ,Health, Toxicology and Mutagenesis ,Population ,Context (language use) ,Regional Medical Programs ,Regional Health Planning ,Nursing ,Pregnancy ,Health care ,medicine ,Emergency medical services ,Humans ,Obstetric care ,education ,Quality of Health Care ,Bangladesh ,education.field_of_study ,Public Sector ,business.industry ,Public sector ,Quality of care ,Health Plan Implementation ,Public Health, Environmental and Occupational Health ,Health facilities ,Rural health services ,Service provider ,Delivery, Obstetric ,medicine.disease ,Health services ,Obstetric Labor Complications ,Obstetrics ,Maternal Mortality ,Emergency obstetric care ,Papers ,Maternal health services ,Female ,Maternal health ,Medical emergency ,Rural area ,business ,Food Science - Abstract
This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in rural areas of Khulna and Sylhet divisions, relatively high- and low-performing areas of Bangladesh respectively. Quality was explored by physically inspecting all public-sector EOC facilities and the constraints through in-depth interviews with public-sector programme managers and service providers. Distribution of the functional EOC facilities satisfied the United Nation's minimum criteria of at least one comprehensive EOC and four basic EOC facilities for every 500,000 people in Khulna but not in Sylhet region. Human-resource constraints were the major barrier for maternal health. Sanctioned posts for nurses were inadequate in rural areas of both the divisions; however, deployment and retention of trained human resources were more problematic in rural areas of Sylhet. Other problems also plagued care, including unavailability of blood in rural settings and lack of use of evidence-based techniques. The overall quality of care was better in the EOC facilities of Khulna division than in Sylhet. 'Context' of care was also different in these two areas: the population in Sylhet is less literate, more conservative, and faces more geographical and sociocultural barriers in accessing services. As a consequence of both care delivered and the context, more normal vaginal and caesarian-section deliveries were carried out in the public-sector EOC facilities in the Khulna region, with the exception of the medical college hospitals. To improve maternal healthcare, there is a need for a human-resource plan that increases the number of posts in rural areas and ensures availability. All categories of maternal healthcare providers also need training on evidence-based techniques. While the centralized push system of management has its strengths, special strategies for improving the response in the low-performing areas is urgently warranted.
- Published
- 2009
47. Postpartum Haemorrhage and Eclampsia: Differences in Knowledge and Care-seeking Behaviour in Two Districts of Bangladesh
- Author
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Allisyn C. Moran, Marge Koblinsky, Roslin Botlero, Nahid Kalim, Lauren S. Blum, Jasmin Khan, and Iqbal Anwar
- Subjects
Maternal mortality ,Adult ,Postnatal Care ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Beliefs ,Adolescent ,Health, Toxicology and Mutagenesis ,Population ,Postpartum haemorrhage ,Care-seeking behaviour ,Young Adult ,Pregnancy ,Qualitative research ,Environmental health ,medicine ,Humans ,Eclampsia ,education ,Socioeconomic status ,Aged ,Bangladesh ,education.field_of_study ,postpartum bleeding ,Obstetrics ,business.industry ,Postpartum Hemorrhage ,Public Health, Environmental and Occupational Health ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Obstetric Labor Complications ,Obstetric labor complication ,Socioeconomic Factors ,Papers ,Female ,business ,Postpartum period ,Food Science - Abstract
In high- and low-performing districts of Bangladesh, the study explored the demand-side of maternal healthcare by looking at differences in perceived knowledge and care-seeking behaviours of women in relation to postpartum haemorrhage or eclampsia. Haemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. The study was conducted during July 2006-December 2007. Both postpartum bleeding and eclampsia were recognized by women of different age-groups as severe and life-threatening obstetric complications. However, a gap existed between perception and actual care-seeking behaviours which could contribute to the high rate of maternal deaths associated with these conditions. There were differences in care-seeking practices among women in the two different areas of Bangladesh, which may reflect sociocultural differences, disparities in economic and educational opportunities, and a discrimination in the availability of care.
- Published
- 2009
48. Maternal Health in Gujarat, India: A Case Study
- Author
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Parvathy Sankara Raman, Mudita Upadhyaya, Dileep Mavalankar, Bharati Sharma, K. V. Ramani, and Kranti Suresh Vora
- Subjects
Maternal mortality ,Emergency Medical Services ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,Population ,Maternal Welfare ,India ,Midwifery ,Nursing ,Pregnancy ,Health care ,medicine ,Emergency medical services ,Humans ,Maternal Health Services ,education ,Government ,education.field_of_study ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Health indicator ,Health services ,Obstetric Labor Complications ,Obstetrics ,Management capacity ,Papers ,Blood Banks ,Female ,Public Health ,Maternal health ,Morbidity ,Rural area ,business ,Food Science - Abstract
Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness.
- Published
- 2009
49. Cultural theories of postpartum bleeding in Matlab, Bangladesh: implications for community health intervention
- Author
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Moni Paul, Nahid Kalim, Daniel J. Hruschka, Joyce K. Edmonds, Jasmin Khan, Marjorie Koblinsky, and Lynn M. Sibley
- Subjects
Adult ,Rural Population ,Maternal mortality ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Adolescent ,Health, Toxicology and Mutagenesis ,Population ,Culture ,Developing country ,Midwifery ,Postpartum haemorrhage ,Interviews as Topic ,Young Adult ,Nursing ,Medicine ,Humans ,Community Health Services ,Young adult ,education ,Home Childbirth ,Anthropometry, Cultural ,education.field_of_study ,Bangladesh ,postpartum bleeding ,business.industry ,Postpartum Hemorrhage ,Public Health, Environmental and Occupational Health ,Anthropometry ,Middle Aged ,medicine.disease ,Original Papers ,Family medicine ,Structured interview ,Community health ,Female ,Morbidity ,business ,Postpartum period ,Food Science - Abstract
Early recognition can reduce maternal disability and deaths due to postpartum haemorrhage. This study identified cultural theories of postpartum bleeding that may lead to inappropriate recognition and delayed care-seeking. Qualitative and quantitative data obtained through structured interviews with 149 participants living in Matlab, Bangladesh, including women aged 18-49 years, women aged 50+ years, traditional birth attendants (TBAs), and skilled birth attendants (SBAs), were subjected to cultural domain. General consensus existed among the TBAs and lay women regarding signs, causes, and treatments of postpartum bleeding (eigenvalue ratio 5.9, mean competence 0.59, and standard deviation 0.15). Excessive bleeding appeared to be distinguished by flow characteristics, not colour or quantity. Yet, the TBAs and lay women differed significantly from the SBAs in beliefs about normalcy of blood loss, causal role of the retained placenta and malevolent spirits, and care practices critical to survival. Cultural domain analysis captures variation in theories with specificity and representativeness necessary to inform community health intervention.
- Published
- 2009
50. Causes of death among women aged 10-50 years in Bangladesh, 1996-1997
- Author
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Hussain R, Yusuf, Halida H, Akhter, Mahbub Elahi, Chowdhury, and Roger W, Rochat
- Subjects
Adult ,Maternal mortality ,Bangladesh ,Adolescent ,Middle Aged ,Original Papers ,Pregnancy Complications ,Suicide ,Age Distribution ,Pregnancy ,Accidents ,Cause of Death ,Humans ,Women's Health ,Wounds and Injuries ,Female ,Child ,Homicide ,Causes of death - Abstract
Limited information is available at the national and district levels on causes of death among women of reproductive age in Bangladesh. During 1996-1997, health-service functionaries in facilities providing obstetric and maternal and child-heath services were interviewed on their knowledge of deaths of women aged 10-50 years in the past 12 months. In addition, case reports were abstracted from medical records in facilities with in-patient services. The study covered 4,751 health facilities in Bangladesh. Of 28,998 deaths reported, 13,502 (46.6%) occurred due to medical causes, 8,562 (29.5%) due to pregnancy-related causes, 6,168 (21.3%) due to injuries, and 425 (1.5%) and 259 (0.9%) due to injuries and medical causes during pregnancy respectively. Cardiac problems (11.7%), infectious diseases (11.3%), and system disorders (9.1%) were the major medical causes of deaths. Pregnancy-associated causes included direct maternal deaths (20.1%), abortion (5.1%), and indirect maternal deaths (4.3%). The highest proportion of deaths among women aged 10-19 years was due to injuries (39.3%) with suicides accounting for 21.7%. The largest proportion of direct obstetric deaths occurred among women aged 20-29 years (30.5%). At least one quarter (24.3%) of women (n = 28,998) did not receive any treatment prior to death, and 47.8% received treatment either from a registered physician or in a facility. More focus is needed on all causes of deaths among women of reproductive age in Bangladesh.
- Published
- 2008
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