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Title: Delivering services and influencing policy: health care professionals join forces to improve maternal, newborn, and child health.
Author: Health Care Professional Association Writing Group
Source: International Journal of Gynaecology and Obstetrics. 2009 Jun;105(3):271-4.
Abstract: This article reviews the major activities of health care professional organizations (HCPAs), and emphasizes the role they can play in advocating for women and children and influencing maternal, newborn, and child health (MNCH) programs and policies. The ICM/FIGO joint effort to prevent postpartum hemorrhage and the 40-year partnership between the American Academy of Pediatrics (AAP) and the Indian Health Service (IHS) are highlighted as examples of how and why HCPAs should assume a leadership role in advocacy work. The action-oriented multicountry HCPA workshops organized by the Partnership for Maternal, Newborn, and Child Health (PMNCH) and the international HCPAs are also described. These capacity building workshops are aimed at strengthening the ability of HCPAs to organize, coordinate activities, and become more involved in program and policy development.
Language: English
Keywords:
INDIA | RESEARCH REPORT | HEALTH PERSONNEL | CAPACITY BUILDING | MATERNAL HEALTH | CHILD HEALTH | ANTENATAL CARE | HEALTH POLICY | Asia, Southern | Asia | Developing Countries | Delivery of Health Care | Health | Program Sustainability | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Policy | Political Factors | Sociocultural Factors
Document Number: 341372

Title: Wealth Index association with gender issues and the reproductive health of Egyptian women.
Author: Afifi M
Source: Nursing and Health Sciences. 2009 Mar;11(1):29-36.
Abstract: This study investigated the association of the Wealth Index of married women in Egypt with a number of gender and reproductive health issues found in the 2005 Egypt Demographic Health Survey. The data from a subsample of 5249 currently married women from a total of 19,474 was examined using logistic regression analysis. The women's lowest wealth quintile predicted the intention to continue female genital cutting for their daughters, exposure to physical and sexual marital violence, not being empowered in household decisions, having a higher number of children, having an unintended last child, mothers' maltreatment of their children, the perception of a lack of health-care providers or drugs as an obstacle to receiving care, and not being covered by health insurance. The association of poverty with the aforementioned adverse health outcomes are discussed. Physicians should understand the effect of poverty on health and endeavour to influence policy-makers to reduce the poverty burden on health.
Language: English
Keywords:
EGYPT | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN | GENDER ISSUES | REPRODUCTIVE HEALTH | POVERTY | ANTENATAL CARE | SOCIOECONOMIC FACTORS | WOMEN'S HEALTH | HEALTH POLICY | Developing Countries | Africa, North | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Sociocultural Factors | Health | Economic Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Policy | Political Factors
Document Number: 342089

5.
Title: Evaluation of transmitted HIV drug resistance among recently-infected antenatal clinic attendees in four Central African countries.
Author: Aghokeng AF; Vergne L; Mpoudi-Ngole E; Mbangue M; Deoudje N; Mokondji E; Nambei WS; Peyou-Ndi MM; Moka JJ; Delaporte E; Peeters M
Source: Antiviral therapy. 2009;14(3):401-11.
Abstract: BACKGROUND: The rapid expansion of antiretroviral treatment in resource-limited settings is raising concerns regarding the emergence and transmission of HIV drug resistance (HIVDR). We evaluated the extent of transmission of drug-resistant HIV strains in four Central African countries: the Republic of Congo, Central African Republic, Chad and Cameroon. METHODS: The World Health Organization (WHO) HIVDR threshold survey was implemented in major treatment areas in each country. Pregnant women who were aged <25 years, who were at first pregnancy and who were HIV type-1-positive were enrolled at each site in 2006-2007 for genotyping. HIVDR prevalence was categorized using the WHO threshold survey binomial sequential sampling method. RESULTS: The prevalence of HIVDR in Brazzaville and Bangui sites could not be classified because the eligible sample number was not reached. HIVDR prevalence was low (<5%) in N'Djamena for all drug classes. In Yaounde, we found one individual with the D67D/N mutation and two with K103N. HIVDR prevalence was categorized as low (<5%) for protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs), and moderate (> or =5-< or =15%) for non-NRTIs (NNRTIs). HIVDR prevalence in Douala was low for PIs and NNRTIs, and moderate for NRTIs as we identified one individual with M184V plus K101E plus G190A mutations and a second with D67D/N. CONCLUSIONS: The moderate HIVDR prevalence found in Yaounde and Douala indicate that efforts should be made in Cameroon to prevent HIVDR; however, additional surveys are needed to confirm this trend. This study highlighted challenges presented by the WHO methodology, such as additional costs, workload, difficulties in acquiring even small sample numbers and the necessity for better quality assurance of HIV testing and record keeping at antenatal clinics.
Language: English
Keywords:
CAMEROON | CENTRAL AFRICAN REPUBLIC | CHAD | REPUBLIC OF THE CONGO | RESEARCH REPORT | SAMPLING STUDIES | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | HIV TRANSMISSION | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | PREVALENCE | ANTENATAL CARE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Africa, Central | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Maternal Health Services | Maternal-Child Health Services | Primary Health Care
Document Number: 342346

6.
Title: Women's perspective in the evaluation of the Program for the Humanization of Antenatal Care and Childbirth.
Author: Almeida CA; Tanaka OY
Source: Revista De Saude Publica. 2009 Feb;43(1):98-104.
Abstract: OBJECTIVE: To analyze the importance of inclusion, from women's perspective, in the evaluation of the Program for the Humanization of Antenatal Care and Childbirth, carried out by the Brazilian Ministry of Health. METHODOLOGICAL PROCEDURES: This qualitative study was based on primary data collected in 2003 in an evaluation of the Program conducted in seven towns spread out among Brazil's five geographic regions. These sites were selected from a Federal Government data base utilized for quantitative analysis. Women attended by the Program were considered key informants when primary data was collected. Sixteen focal groups were performed in the primary care units. The Collective Subject Speech (CSS) method was used for qualitative analysis. The theoretical concepts of accessibility and Paideia Health within the framework of public health were used to interpret the findings. ANALYSIS OF RESULTS: The Program standardizes procedures to be taken in antenatal care and childbirth for all health services in the country, including the flow among these services. However, analysis of women's discourse in the focal groups elucidated the existence of dissonances between their needs and desires and many of the program's recommendations. Pregnant women thus choose among available services and professionals and try to set up their own schedules which, in turn, do not correspond to those set up by the program. This discrepancy damages the bond women establish with the health services and creates obstacles for the control of the activities actually provided by the health services to the women. CONCLUSIONS: Analysis of the Program based on women's perspective identified aspects that might result in more humanized and effective antenatal care, if they are taken into account in the redefinition or correction of the Program schedule Miolo abstract Miolo abstract Miolo abstract.
Language: EnglishPortuguese
Keywords:
BRAZIL | RESEARCH REPORT | FOCUS GROUPS | PREGNANT WOMEN | ANTENATAL CARE | MATERNAL-CHILD HEALTH SERVICES | DELIVERY OF HEALTH CARE | NEEDS | PROGRAM EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Primary Health Care | Health Services | Health | Economic Factors | Programs | Organization and Administration
Document Number: 341988

Title: Inadequate use of prenatal services among brazilian women: the role of maternal characteristics.
Author: Bassani DG; Surkan PJ; Olinto MT
Source: International Perspectives On Sexual and Reproductive Health. 2009 Mar;35(1):15-20.
Abstract: CONTEXT: To improve the uptake of prenatal care, it is important to know how the use of prenatal care varies by maternal attitudes and social and demographic factors. METHODS: Information about social and demographic variables, prenatal care, parity, pregnancy planning, abortion attempts, satisfaction with pregnancy and satisfaction with the relationship with the child's father was collected from 611 postpartum women in Porto Alegre in southern Brazil. Multinomial logistic regression was used to evaluate associations between these variables and whether the women's use of prenatal care was adequate, partially inadequate or inadequate. RESULTS: About 40% of women had inadequate or partially inadequate prenatal care. After adjustment for other covariates, including satisfaction with the pregnancy, women having an unplanned pregnancy were significantly more likely to have had inadequate care than women who had planned their pregnancy (odds ratio, 2.0). Not living with the child's father (2.8) and dissatisfaction with pregnancy (2.1) were also associated with inadequate use of prenatal care. Women having their second or higher order birth were significantly more likely to report inadequate use of prenatal care than women having their first birth (3.9-9.0). Household income was inversely associated with inadequate use of care. CONCLUSIONS: The study suggests that maternal attitudes may be important for adequate prenatal care. Interventions should be created to encourage women with negative maternal attitudes to use prenatal care and to ensure that they have access to the care they need.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | STATISTICAL REGRESSION | POSTPARTUM WOMEN | ANTENATAL CARE | UTILIZATION OF HEALTH CARE | ATTITUDES | SOCIOECONOMIC STATUS | PARITY | LIVING ARRANGEMENTS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Data Analysis | Research Methodology | Puerperium | Reproduction | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Psychological Factors | Behavior | Socioeconomic Factors | Economic Factors | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors
Document Number: 341412

Peer Reviewed

Title: Pregnancy outcome of migrant women and integration policy: a systematic review of the international literature.
Author: Bollini P; Pampallona S; Wanner P; Kupelnick B
Source: Social Science and Medicine. 2009 Feb;68(3):452-61.
Abstract: Immigrant mothers in developed countries often experience worse pregnancy outcomes than native women. Several epidemiological studies have described the pregnancy outcome of immigrant women in European receiving countries, with conflicting results. The present systematic review makes a quantitative synthesis of available evidence on the association between pregnancy outcomes and integration policies. We reviewed all epidemiological studies comparing the pregnancy outcome of native versus immigrant women in European countries from 1966 to 2004 and retained 65 for analysis, from 12 host countries. Overall, as compared to native women, immigrant women showed a clear disadvantage for all the outcomes considered: 43% higher risk of low birth weight, 24% of pre-term delivery, 50% of perinatal mortality, and 61% of congenital malformations. The risks were clearly and significantly reduced in countries with a strong integration policy. This trend was maintained even after adjustment for age at delivery and parity. On the basis of an analysis of naturalisation rates, five countries in our sample could be categorised as having a strong policies promoting the integration of immigrant communities. The mechanisms through which integration policies may be protective include the increased participation of immigrant communities in the life of the receiving society, and the decreased stress and discrimination they may face. The results of this study highlight a serious problem of equity in perinatal health across European countries. Immigrant women clearly need targeted attention to improve the health of their newborn, but a deep societal change is also necessary to integrate and respect immigrant communities in receiving societies.
Language: English
Keywords:
EUROPE | RESEARCH REPORT | LITERATURE REVIEW | PREGNANT WOMEN | FETUS | PREGNANCY | MIGRATION | ANTENATAL CARE | HEALTH POLICY | PREGNANCY OUTCOMES | Developed Countries | Population Characteristics | Demographic Factors | Population | Reproduction | Population Dynamics | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Policy | Political Factors | Sociocultural Factors
Document Number: 331051

Peer Reviewed

Title: [Child health in poor areas: findings from a population-based study in Caracol, Piaui, and Garrafao do Norte, Para, Brazil] Saude infantil em areas pobres: resultados de um estudo de base populacional nos municipios de Caracol, Piaui, e Garrafao do Norte, Para, Brasil.
Author: Cesar JA; Chrestani MA; Fantinel EJ; Goncalves TS; Neumann NA
Source: Cadernos�de Saude Publica. 2009 Apr;25(4):809-818.
Abstract: The aim of this study was to evaluate child health indicators in the municipalities (counties) of Caracol, Piau� State, and Garraf�o do Norte, Par� State, Brazil. Through household visits using systematic sampling, previously trained interviewers applied a standard questionnaire to mothers of under-five children, investigating socioeconomic status, housing and environmental sanitation, demographic characteristics, disease patterns, and prenatal and childbirth care. The analysis used the t-test and chi-square test to compare indicators between the two municipalities. Of the 1,728 children studied, 60% were from families with incomes less than one monthly minimum wage (approximately U$200), 41% had no type of sewage treatment or disposal, 10% of mothers reported zero prenatal visits, 30% of the children were born in the same municipality, and 30% had been taken to a pediatric consultation in the previous 3 months; 20% had a height-for-age deficit > 2 standard deviations. All target indicators were deficient in both the municipalities (especially in Garraf�o do Norte). Expanding health care supply and improving housing and sanitation conditions are priorities in both municipalities.
Language: Portuguese
Keywords:
BRAZIL | RESEARCH REPORT | INTERVIEWS | MOTHERS | CHILD HEALTH | SOCIOECONOMIC STATUS | HOUSEHOLDS | SANITATION | POPULATION CHARACTERISTICS | ANTENATAL CARE | BEHAVIOR | UTILIZATION OF HEALTH CARE | INCOME | South America, Eastern | South America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Health | Socioeconomic Factors | Economic Factors | Public Health | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care
Document Number: 341867

10.
Peer Reviewed

Title: [Child health in poor areas: findings from a population-based study in Caracol, Piaui, and Garrafao do Norte, Para, Brazil] Saude infantil em areas pobres: resultados de um estudo de base populacional nos
Author: Cesar JA; Chrestani MA; Fantinel EJ; Goncalves TS; Neumann NA
Source: Cadernos De Saude Publica. 2009 Apr;25(4):809-18.
Abstract: The aim of this study was to evaluate child health indicators in the municipalities (counties) of Caracol, Piaui State, and Garrafao do Norte, Para State, Brazil. Through household visits using systematic sampling, previously trained interviewers applied a standard questionnaire to mothers of under-five children, investigating socioeconomic status, housing and environmental sanitation, demographic characteristics, disease patterns, and prenatal and childbirth care. The analysis used the t-test and chi-square test to compare indicators between the two municipalities. Of the 1,728 children studied, 60% were from families with incomes less than one monthly minimum wage (approximately U$200), 41% had no type of sewage treatment or disposal, 10% of mothers reported zero prenatal visits, 30% of the children were born in the same municipality, and 30% had been taken to a pediatric consultation in the previous 3 months; 20% had a height-for-age deficit > 2 standard deviations. All target indicators were deficient in both the municipalities (especially in Garrafao do Norte). Expanding health care supply and improving housing and sanitation conditions are priorities in both municipalities.
Language: Portuguese
Keywords:
BRAZIL | RESEARCH REPORT | EVALUATION | HOUSEHOLDS | LOW INCOME POPULATION | CHILD HEALTH | SOCIOECONOMIC STATUS | SANITATION | ANTENATAL CARE | INCOME | SOCIAL WELFARE | NEEDS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Family and Household | Sociocultural Factors | Social Class | Socioeconomic Factors | Economic Factors | Health | Public Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care
Document Number: 342662

11.

Peer Reviewed

Title: Trends in prenatal care settings: Association with medical liability.
Author: Coco AS; Cohen D; Horst MA; Gambler AS
Source: BMC Public Health. 2009 Jul 22;9(1):257.
Abstract: ABSTRACT: BACKGROUND: Medical liability concerns centered around maternity care have widespread public health implications, as restrictions in physician scope of practice may threaten quality of and access to care in the current climate. The purpose of this study was to examine national trends in prenatal care settings based on medical liability climate. METHODS: Analysis of prenatal visits in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1997 to 2004 (N = 21,454). To assess changes in rates of prenatal visits over time, we used the linear trend test. Multivariate logistic regression modeling was developed to determine characteristics associated with visits made to hospital outpatient departments. RESULTS: In regions of the country with high medical liability (N = 11,673), the relative number, or proportion, of all prenatal visits occurring in hospital outpatient departments increased from 11.8% in 1997-1998 to 19.4% in 2003-2004 (p < .001 for trend); the trend for complicated obstetrical visits (N = 3,275) was more pronounced, where the proportion of prenatal visits occurring in hospital outpatient departments almost doubled from 22.7% in 1997-1998 to 41.6% in 2003-2004 (p = .004 for trend). This increase did not occur in regions of the country with low medical liability (N = 9,781) where the proportion of visits occurring in hospital outpatient departments decreased from 13.3% in 1997-1998 to 9.0% in 2003-2004. CONCLUSIONS: There has been a shift in prenatal care from obstetrician's offices to safety net settings in regions of the country with high medical liability. These findings provide strong indirect evidence that the medical liability crisis is affecting patterns of obstetric practice and ultimately patient access to care.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | PHYSICIANS | HIGH RISK WOMEN | ETHNIC GROUPS | ANTENATAL CARE | MEDICAL LIABILITY | OBSTETRICS | PHYSICIAN'S OFFICE | HOSPITALS | PROGRAM ACCESSIBILITY | HEALTH INSURANCE | TITLE 19 MEDICAL ASSISTANCE | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Health Personnel | Delivery of Health Care | Health | Reproduction | Cultural Background | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Medicine | Health Facilities | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Public Assistance | Grants
Document Number: 342287

12.

Peer Reviewed

Title: Prevalence and risk factors for Hepatitis C and HIV-1 infections among pregnant women in Central Brazil.
Author: Costa ZB; Machado GC; Avelino MM; Gomes Filho C; Macedo Filho JV; Minuzzi AL; Turchi MD; Stefani MM; de Souza WV; Martelli CM
Source: BMC Infectious Diseases. 2009;9:116.
Abstract: BACKGROUND: Hepatitis C (HCV) and human immunodeficiency virus (HIV) infections are a major burden to public health worldwide. Routine antenatal HIV-1 screening to prevent maternal-infant transmission is universally recommended. Our objectives were to evaluate the prevalence of and potential risk factors for HCV and HIV infection among pregnant women who attended prenatal care under the coverage of public health in Central Brazil. METHODS: Screening and counselling for HIV and HCV infections was offered free of charge to all pregnant women attending antenatal clinic (ANC) in the public health system, in Goiania city (~1.1 million inhabitants) during 2004-2005. Initial screening was performed on a dried blood spot collected onto standard filter paper; positive or indeterminate results were confirmed by a second blood sample. HCV infection was defined as a positive or indeterminate sample (EIA test) and confirmed HCV-RNA technique. HIV infection was defined according to standard criteria. Factors associated with HIV and HCV infections were identified with logistic regression. The number needed to screen (NNS) to prevent one case of infant HIV infection was calculated using the Monte Carlo simulation method. RESULTS: A total of 28,561 pregnant women were screened for HCV and HIV-1 in ANC. Mean maternal age was 23.9 years (SD = 5.6), with 45% of the women experiencing their first pregnancy. Prevalence of HCV infection was 0.15% (95% CI 0.11%-0.20%), and the risk increased with age (p < 0.01). The prevalence of anti-HIV infection was 0.09% (95% CI 0.06%-0.14%). Black women had a 4.9-fold (95% CI 1.42-16.95) greater risk of HIV-1 infection compared to non-black women. NNS to prevent one case of infant HIV infection ranged from 4,141 to 13,928. CONCLUSION: The prevalence of HIV and HCV infections were low among pregnant women, with high acceptability rates in the opt-in strategy in primary care. Older maternal age was a risk factor for HCV and antenatal HCV testing does not fulfill the requirements for screening recommendation. The finding of higher risk of HIV-1 infection among black women despite being in consonance with the HIV-1 ethnic pattern in some American regions cannot be ruled out to be a surrogate marker of socio-economic condition.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | PREVALENCE | RISK FACTORS | PREGNANT WOMEN | BLACKS | ANTENATAL CARE | HIV TESTING | HIV INFECTIONS | SCREENING | COUNSELING | PRIMARY HEALTH CARE | AGE FACTORS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Measurement | Research Methodology | Health | Population Characteristics | Demographic Factors | Population | Ethnic Groups | Cultural Background | Maternal Health Services | Maternal-Child Health Services | Health Services | Delivery of Health Care | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Viral Diseases | Diseases | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 342683

13.

Peer Reviewed

Title: Factors associated with low early uptake of a national program to prevent mother to child transmission of HIV (PMTCT): results of a survey of mothers and providers, Botswana, 2003.
Author: Creek T; Ntumy R; Mazhani L; Moore J; Smith M; Han G; Shaffer N; Kilmarx PH
Source: AIDS and Behavior. 2009 Apr;13(2):356-364.
Abstract: In Francistown, Botswana, approximately 40% of pregnant women are HIV positive. PMTCT has been available since 1999, antiretroviral (ARV) therapy since 2001, and 95% of women have antenatal care (ANC) and deliver in hospital. However, in 2002, only 33% of ANC clients were tested for HIV, and not all women with HIV received services. In 2003, we conducted a survey of 504 pregnant and postpartum women to explore reasons for poor program uptake, and interviewed 82 health providers about PMTCT. Most women (95%) believed that all pregnant women should be tested for HIV. In multivariate analysis, factors associated with having an HIV test included being interviewed at an urban site, having a high PMTCT knowledge score, knowing someone receiving PMTCT or ARV therapy, and having a partner who had been tested for HIV. Neither fear of stigma nor resistance from partners were frequent reasons for refusing an HIV test. Providers of HIV services reported discomfort with their knowledge and skills, and 84% believed HIV testing should be routine. Ensuring adequate knowledge about HIV and PMTCT, creating systems whereby HIV-positive women receiving care can educate and support other women, and making HIV testing routine for pregnant women may improve the uptake of HIV testing.
Language: English
Keywords:
BOTSWANA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | SEXUAL PARTNERS | POSTPARTUM WOMEN | URBAN POPULATION | HEALTH PERSONNEL | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | GOVERNMENT PROGRAMS | ANTENATAL CARE | KNOWLEDGE | HIV TESTING | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Sex Behavior | Behavior | Puerperium | Reproduction | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Sociocultural Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine
Document Number: 340126

14.

15.

Peer Reviewed

Title: Determinants of nonadherence to a single-dose nevirapine regimen for the prevention of mother-to-child HIV transmission in Rwanda.
Author: Delvaux T; Elul B; Ndagije F; Munyana E; Roberfroid D; Asiimwe A
Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):223-30.
Abstract: OBJECTIVES: To describe experiences, and identify factors associated with nonadherence to a single-dose nevirapine (SD-NVP) regimen for the prevention of mother-to-child transmission (PMTCT) of HIV in Rwanda. METHODS: In April to May 2006, using a case-control design at 12 PMTCT sites, we interviewed HIV-infected women who did not adhere (n = 111) and who adhered (n = 125) to the PMTCT prophylaxis regimen. Nonadherence was defined as mother and/or infant not ingesting SD-NVP at the recommended time or not at all and adherence as mother-infant pairs who ingested it as recommended. RESULTS: Only 61% of nonadherent women had received SD-NVP during pregnancy or delivery. Among nonadherent women who received SD-NVP, 80% ingested it at the recommended time, representing 49% of all nonadherent women. Only 7% of their newborns ingested SD-NVP. Multivariate logistic regression showed that unmarried women, less educated women, women who made 2 or less antenatal care visits, and those offered HIV testing after their first antenatal care visit were more likely to be nonadherent to PMTCT prophylaxis. Not disclosing one's HIV status to someone aside from a partner was also associated with nonadherence in mother-infant pairs. CONCLUSIONS: Sociodemographic factors, health services delivery factors, and a lack of communication and social support contributed to nonadherence to PMTCT prophylaxis in Rwanda.
Language: English
Keywords:
RWANDA | RESEARCH REPORT | KAP SURVEYS | MULTIVARIATE ANALYSIS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | USER COMPLIANCE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | ADMINISTRATION AND DOSAGE | PREVALENCE | EDUCATIONAL STATUS | ANTENATAL CARE | PARTNER COMMUNICATION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Behavior | Disease Transmission Control | Prevention and Control | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Socioeconomic Status | Socioeconomic Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Interpersonal Relations
Document Number: 330370

16.
Peer Reviewed

Title: Prevention of mother-to-child transmission of HIV in Haiti.
Author: Deschamps MM; Noel F; Bonhomme J; Devieux JG; Saint-Jean G; Zhu Y; Wright P; Pape JW; Malow RM
Source: Revista Panamericana de Salud P�blica / Pan American Journal of Public Health. 2009 Jan;25(1):24-30.
Abstract: OBJECTIVES: To describe the effectiveness of a program designed to reduce the rate of mother-to-child transmission (MTCT) of HIV at the primary HIV testing and treatment center in Haiti between 1999 and 2004. METHODS: All pregnant, HIV-positive women who attended the major HIV testing and treatment clinic in Port-au-Prince, Haiti, between March 1999 and December 2004 were asked to participate in an MTCT prevention program. Of the 650 women who participated, 73.3% received zidovudine (AZT), 2.9% received nevirapine (NVP), and 10.1% received triple-drug therapy when it became available in 2003 and if clinical/laboratory indications were met. Approximately 13.8% received no antiretroviral medication. All participants received cotrimoxazole prophylaxis and infant formula for their children. Kaplan-Meier survival analysis and the log rank test were used to evaluate program impact on child survival. RESULTS: Complete data were available for 348 mother-infant pairs who completed the program to prevent MTCT of HIV. The rate of MTCT in the study was 9.2% (95% CI: 6.14-12.24), in contrast to the historical mother-to-child transmission rate of 27% in Haiti. HIV-positive infants were less likely to survive than HIV-negative infants at 18 months of follow-up (chi(2) = 19.06, P < .001, log rank test). Infant survival improved with early pediatric diagnosis and antiretroviral treatment. CONCLUSIONS: The MTCT prevention program described proved to be feasible and effective in reducing vertical HIV transmission in Haiti. The authors emphasize the need to expand testing, extend services to rural areas, and implement early HIV diagnosis to reduce infant mortality.
Language: English
Keywords:
HAITI | RESEARCH REPORT | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTENATAL CARE | HIV TRANSMISSION | HIV INFECTIONS | PROGRAM EFFECTIVENESS | Developing Countries | Caribbean | Americas | Disease Transmission Control | Prevention and Control | Diseases | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Viral Diseases | Program Evaluation | Programs | Organization and Administration
Document Number: 341542

17.

Peer Reviewed

Title: Beneficial effects of offering prenatal HIV counselling and testing on developing a HIV Preventive attitude among couples. Abidjan, 2002-2005.
Author: Desgrees-Du-Lou A; Brou H; Djohan G; Becquet R; Ekouevi DK; Zanou B; Viho I; Allou G; Dabis F; Leroy V
Source: AIDS and Behavior. 2009 Apr;13(2):348-355.
Abstract: Prenatal HIV counselling and testing is mainly an entry-point to the prevention of mother-to-child transmission of HIV, but it may also play an important role in triggering the development of spousal communication about HIV and sexual risks and thus the adoption of a preventive attitude. In Abidjan, Co�te d'Ivoire, we investigated couple communication on STIs and HIV, male partner HIV-testing and condom use at sex resumption after delivery among three groups of pregnant women who were offered prenatal counselling and HIV testing: HIVinfected women, uninfected women, and women who refused HIV-testing. The proportion of women who discussed STIs with their regular partner greatly increased after prenatal HIV counselling and testing in all three groups, irrespective of the women's serostatus and even in the case of test refusal. Spousal communication was related to more frequent male partner HIV-testing and condom use. Prenatal HIV counselling and testing proposal appears to be an efficient tool to sensitize women and their partner to safer sexual practices.
Language: English
Keywords:
COTE D'IVOIRE | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | COUPLES | VOLUNTARY COUNSELING AND TESTING | HIV PREVENTION | ANTENATAL CARE | ATTITUDES | PARTNER COMMUNICATION | SPOUSAL SUPPORT | CONDOM USE | SEXUALLY TRANSMITTED DISEASE PREVENTION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Family Characteristics | Family and Household | Sociocultural Factors | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Psychological Factors | Behavior | Interpersonal Relations | Microeconomic Factors | Risk Reduction Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections
Document Number: 340128

18.

Title: Domestic violence on pregnant women in Turkey.
Author: Ergonen AT; Ozdemir MH; Can IO; Sonmez E; Salacin S; Berberoglu E; Demir N
Source: Journal of Forensic and Legal Medicine. 2009 Apr;16(3):125-9.
Abstract: OBJECTIVE: Domestic violence is accepted worldwide as an important health problem. Besides diagnosis and treatment process, there are difficulties when considering of medico-legal evaluation of pregnant women subjected to domestic violence. As a signatory of the ''Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)'' Turkey has certain commitments regarding domestic violence and made regulations on national law. The purpose of the present study is to demonstrate the prevalence of domestic violence during pregnancy among the women who applied to obstetrics clinics and evaluating of the participants' knowledge level about the legal legislation concerning domestic violence. FINDINGS: Pregnant women attending for antenatal care to department of Gynecology and Obstetrics were interviewed using an anonymous and confidential questionnaire. The questionnaire used was a version of Abuse Assessment Screen with guidance of references. 28 (13.4%) women stated that they had been subjected to violence before pregnancy. Only 10 (4.67%) women had stated experience of violence during pregnancy. 148 (69.2%) of them had stated that they had no knowledge about any legislation concerning domestic violence in our country. CONCLUSION: We believe that society awareness should be increased and the health workers should be informed about their ethical and legal responsibilities concerning domestic violence during pregnancy. The knowledge and sensitivity of health care personnel in Prenatal Clinics and Family Planning Services should be increased and examination protocols should be provided about domestic violence against pregnant women.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | PREGNANT WOMEN | DOMESTIC VIOLENCE | PREVALENCE | LEGISLATION | KNOWLEDGE | EDUCATIONAL STATUS | QUESTIONNAIRES | TREATIES | ANTENATAL CARE | Europe, Southeastern | Europe | Developing Countries | Population Characteristics | Demographic Factors | Population | Crime | Social Problems | Sociocultural Factors | Measurement | Research Methodology | Political Factors | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health
Document Number: 342189

19.

Peer Reviewed

Title: What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya.
Author: Fotso J; Ezeh A; Madise N; Ziraba A; Ogollah R
Source: Maternal and Child Health Journal. 2009 Jan;13(1):130-7.
Abstract: Objectives: The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and "appropriate" health facilities. Methods: The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either "inappropriate" or "appropriate". Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Results: Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy "wantedness", and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Conclusion: Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.
Language: English
Keywords:
KENYA | RESEARCH REPORT | KAP SURVEYS | SLUMS | URBAN POPULATION | WOMEN IN DEVELOPMENT | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | PROGRAM ACCESSIBILITY | QUALITY OF HEALTH CARE | CHILDBIRTH | EDUCATIONAL STATUS | PROMOTION | ANTENATAL CARE | MULTIPARITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Population Characteristics | Demographic Factors | Economic Development | Economic Factors | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Health Services Evaluation | Pregnancy Outcomes | Pregnancy | Reproduction | Socioeconomic Status | Socioeconomic Factors | Marketing | Parity | Fertility Measurements | Fertility | Population Dynamics
Document Number: 308031

20.

Peer Reviewed

Title: Do women increase their use of reproductive health care when it becomes more available? Evidence from Indonesia.
Author: Frankenberg E; Buttenheim A; Sikoki B; Suriastini W
Source: Studies in Family Planning. 2009 Mar;40(1):27-38.
Abstract: Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health-care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery-changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use.
Language: English
Keywords:
INDONESIA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | COMMUNITY WORKERS | UTILIZATION OF HEALTH CARE | CHILDBIRTH | WOMEN'S HEALTH | PROGRAM ACCESSIBILITY | DECISION MAKING | COMMUNITY HEALTH SERVICES | ANTENATAL CARE | TRADITIONAL BIRTH ATTENDANTS | Developing Countries | Asia, Southeastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Health Services | Pregnancy Outcomes | Pregnancy | Reproduction | Program Evaluation | Programs | Organization and Administration | Behavior | Primary Health Care | Maternal Health Services | Maternal-Child Health Services
Document Number: 341081

21.
Peer Reviewed

Title: Do women increase their use of reproductive health care when it becomes more available? Evidence from Indonesia.
Author: Frankenberg E; Buttenheim A; Sikoki B; Suriastini W
Source: Studies In Family Planning. 2009 Mar;40(1):27-38.
Abstract: Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health-care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery--changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use.
Language: English
Keywords:
INDONESIA | RESEARCH REPORT | FAMILY LIFE SURVEYS | WOMEN | MIDWIVES AND MIDWIFERY | ANTENATAL CARE | REPRODUCTIVE HEALTH | UTILIZATION OF HEALTH CARE | HEALTH SERVICES | PROGRAM ACCESSIBILITY | Developing Countries | Asia, Southeastern | Asia | Family Research | Family and Household | Sociocultural Factors | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Program Evaluation | Programs | Organization and Administration
Document Number: 341338

22.
Peer Reviewed

Title: Community-based promotional campaign to improve uptake of intermittent preventive antimalarial treatment in pregnancy in Burkina Faso.
Author: Gies S; Coulibaly SO; Ky C; Ouattara FT; Brabin BJ; D'Alessandro U
Source: American Journal of Tropical Medicine and Hygiene. 2009 Mar;80(3):460-9.
Abstract: Malaria preventive strategies in pregnancy were assessed in a health center randomized trial comparing intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) with and without community based promotional activities in rural Burkina Faso. The study involved 2,240 secundigravidae and secundigravidae and evaluated factors associated with antenatal clinic (ANC) attendance and uptake of IPTp-SP. With promotion, 64.2% completed > or = 3 ANC visits compared with 44.7% without (P = 0.05). Complete uptake of IPTp-SP was 71.8% with and 49.1% without promotion (P = 0.008). The IPTp-SP uptake was lowest in adolescents delivering during high malaria transmission with (29%) or without promotion (30%). Uptake of SP was higher during the low transmission season than in the high transmission season (adjusted odds ratio = 2.17, 95% confidence interval = 1.59-3.03). Community sensitization increased ANC attendance and IPTp-SP uptake. Adolescents were the most difficult to reach, particularly during the high malaria transmission period. The impact of IPTp-SP will be limited unless this high risk group is protected.
Language: English
Keywords:
BURKINA FASO | RESEARCH REPORT | CASE CONTROL STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | COMMUNITY | ANTIMALARIAL DRUGS | PROMOTION | CAMPAIGNS | COMMUNITY HEALTH SERVICES | ANTENATAL CARE | PREVENTIVE MEDICINE | UTILIZATION OF HEALTH CARE | AGE FACTORS | SEASONAL VARIATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Residence Characteristics | Population Distribution | Geographic Factors | Malaria | Parasitic Diseases | Diseases | Marketing | Communication Programs | Communication | Primary Health Care | Health Services | Delivery of Health Care | Health | Maternal Health Services | Maternal-Child Health Services | Medicine | Population Dynamics
Document Number: 331127

23.

Peer Reviewed

Title: Recent increase in sex ratio at birth in Viet Nam.
Author: Guilmoto CZ; Hoang X; Van TN
Source: PLoS One. 2009;4(2):e4624.
Abstract: INTRODUCTION: Since the 1980s, sex ratio at birth (male births per 100 female births) has increased in many Asian countries as a result of selective abortions, but to date there has been no such evidence for Viet Nam. Our aim in this paper is to ascertain the situation with respect to sex ratio at birth in Viet Nam over the past five years. MATERIALS AND METHODS: Original data were obtained from sample population surveys in Viet Nam recording annual birth rates since 2000 of about 450,000 women, as well as from two successive birth surveys conducted for the first time in 2007 (1.1 million births). The annual population surveys include specific information on birth history and mothers' characteristics to be used for the analysis of trends and differentials in sex ratio at birth. RESULTS AND DISCUSSION: Birth history statistics indicate that the SRB in Viet Nam has recorded a steady growth since 2001. Starting from a level probably close to the biological standard of 105, the SRB reached 108 in 2005 and 112 in 2006, a value significantly above the normal level. An independent confirmation of these results comes from the surveys of births in health facilities which yielded a SRB of 110 in 2006-07. High SRB is linked to various factors such as access to modern health care, number of prenatal visits, level of higher education and employment status, young age, province of residence and prenatal sex determination. These results suggest that prenatal sex determination followed by selective abortion has recently become more common in Viet Nam. This recent trend is a consequence of various factors such as preference for sons, declining fertility, easy access to abortion, economic development as well as the increased availability of ultrasonography facilities.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | DATA ANALYSIS | SONS | SEX RATIO | MATERNAL HEALTH SERVICES | EMPLOYMENT STATUS | SOCIOECONOMIC STATUS | ABORTION | EDUCATIONAL STATUS | ANTENATAL CARE | SEX PREFERENCE | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Sex Distribution | Sex Factors | Population Characteristics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Socioeconomic Factors | Economic Factors | Fertility Control, Postconception | Family Planning | Value Orientation | Psychological Factors | Behavior
Document Number: 331220 Notification

24.

Title: Domestic violence against women during pregnancy: the case of Palestinian refugees attending an antenatal clinic in Lebanon.
Author: Hammoury N; Khawaja M; Mahfoud Z; Afifi RA; Madi H
Source: Journal of Women's Health. 2009 Mar;18(3):337-45.
Abstract: OBJECTIVES: To determine the factors associated with domestic violence against pregnant Palestinian refugee women residing in Lebanon and currently using the United Nation Relief and Work Agency's (UNRWA) primary healthcare services. METHODS: This was a cross-sectional study conducted at a polyclinic of primary healthcare of the UNRWA in South Lebanon during the years 2005-2006. The sample was 351 pregnant women who were 15-42 years of age and not accompanied by their husbands or relatives. All women were invited by the midwife to participate in the study during their visit to the clinic for their first checkup or during a follow-up visit. The Abuse Assessment Screen instrument was used to screen for past and recent history of physical and emotional abuse among the participants. RESULTS: Domestic violence was significantly associated with education, gestational age, fear of husband or someone else in the house, and unintended pregnancy. The odds of abuse for women with an elementary or lower education were 6.86 (95% CI 1.2-38.1) and for women with an intermediate or secondary education 6.84 (95% CI 1.4-33.3) compared with women with a university education. The odds of abuse during pregnancy for women whose husbands did not desire their pregnancy were 3.80 (95% CI 1.5-9.7) compared with other women. CONCLUSIONS: Domestic violence against women in Lebanon was associated with educational level, gestational age, fear of husband or someone else in the house, and unintended pregnancy.
Language: English
Keywords:
LEBANON | RESEARCH REPORT | PREVALENCE | PREGNANT WOMEN | REFUGEES | ANTENATAL CARE | VIOLENCE AGAINST WOMEN | PHYSICAL ABUSE | SIGNS AND SYMPTOMS | EDUCATIONAL STATUS | FEAR | PREGNANCY, UNPLANNED | Middle East | Developing Countries | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Migrants | Migration | Population Dynamics | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Domestic Violence | Crime | Social Problems | Sociocultural Factors | Violence | Behavior | Diseases | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Emotions | Psychological Factors | Reproductive Behavior | Fertility
Document Number: 341353

25.

Title: Education, prenatal care, and poor perinatal outcome in Khartoum, Sudan.
Author: Hassan AA; Abubaker MS; Radi EA; Adam I
Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):66-7.
Abstract: Perinatal outcome is an important indicator of obstetric care and health status. Reducing the incidence of low birth weight neonates by at least one third between 2000 and 2010 is one of the major goals of the United Nations resolution "A World Fit for Children" and is an important contribution toward Millennium Development Goal (MDG) 4 which is to reduce child mortality by two thirds by 2015. Local surveillance and basic epidemiology can more accurately assess perinatal outcome and identify areas to which interventions should be targeted. The aims of the present study were to identify and quantify the risk factors for low birth weight neonates and perinatal mortality in Sudan, and to assess the role of sociodemographic factors.
Language: English
Keywords:
SUDAN | RESEARCH REPORT | STATISTICAL STUDIES | MOTHERS | ANTENATAL CARE | LOW BIRTH WEIGHT | RISK FACTORS | EDUCATIONAL STATUS | ANTHROPOMETRY | PREGNANCY OUTCOMES | Developing Countries | Africa, North | Africa | Studies | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Birth Weight | Body Weight | Physiology | Biology | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Measurement | Pregnancy | Reproduction
Document Number: 341386

27.

Peer Reviewed

Title: Systematic review of effect of community-level interventions to reduce maternal mortality.
Author: Kidney E; Winter HR; Khan KS; Gulmezoglu AM; Meads CA; Deeks JJ; Macarthur C
Source: BMC Pregnancy and Childbirth. 2009;9:2.
Abstract: BACKGROUND: The objective was to provide a systematic review of the effectiveness of community-level interventions to reduce maternal mortality. METHODS: We searched published papers using Medline, Embase, Cochrane library, CINAHL, BNI, CAB ABSTRACTS, IBSS, Web of Science, LILACS and African Index Medicus from inception or at least 1982 to June 2006; searched unpublished works using National Research Register website, metaRegister and the WHO International Trial Registry portal. We hand searched major references.Selection criteria were maternity or childbearing age women, comparative study designs with concurrent controls, community-level interventions and maternal death as an outcome. We carried out study selection, data abstraction and quality assessment independently in duplicate. RESULTS: We found five cluster randomised controlled trials (RCT) and eight cohort studies of community-level interventions. We summarised results as odds ratios (OR) and confidence intervals (CI), combined using the Peto method for meta-analysis. Two high quality cluster RCTs, aimed at improving perinatal care practices, showed a reduction in maternal mortality reaching statistical significance (OR 0.62, 95% CI 0.39 to 0.98). Three equivalence RCTs of minimal goal-oriented versus usual antenatal care showed no difference in maternal mortality (1.09, 95% CI 0.53 to 2.25). The cohort studies were of low quality and did not contribute further evidence. CONCLUSION: Community-level interventions of improved perinatal care practices can bring about a reduction in maternal mortality. This challenges the view that investment in such interventions is not worthwhile. Programmes to improve maternal mortality should be evaluated using randomised controlled techniques to generate further evidence.
Language: English
Keywords:
GLOBAL | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | REPRODUCTIVE AGE | MATERNAL MORTALITY | ANTENATAL CARE | INTERVENTIONS | NEEDS | PROGRAM EVALUATION | Demographic Factors | Population | Reproduction | Mortality | Population Dynamics | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Economic Factors
Document Number: 331219

28.

Peer Reviewed

Title: Fourteen years of surveillance of HIV-1 prevalence among pregnant women attending antenatal care clinics in western Uganda.
Author: Kipp W; Chapman E; Jhangri GS; Veugelers P; Kilian A; Rubaale T; Kabagambe G
Source: International Journal of STD and AIDS. 2009 Jul;20(7):499-502.
Abstract: This study monitored long-term temporal trends in HIV-1 prevalence in antenatal clinic attendees living in western Uganda. Semi-annual data collection was done from 1991 to 2004. For each woman the following data were recorded: HIV-1 status, age, educational status, marital status, occupation and parity. The results show that the overall HIV-1 prevalence was 15.3% during the entire time period (urban 21.3%, semi-urban 12.7% and rural 7.1%). Between 1991 and 2004, we observed a gradual decline in the HIV-1 prevalence. The decline was most pronounced in urban women aged 15-19 years old and least pronounced in rural women aged 20-24 years. Women above 25 years of age did not show any decline in HIV-1 prevalence over time. The declining HIV-1 prevalence in the younger age groups (15-24 years) likely represents a declining risk for acquiring HIV infection as we have previously shown in the urban sub-sample of this data set.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | SAMPLING STUDIES | DATA ANALYSIS | PREGNANT WOMEN | HIV INFECTIONS | PREVALENCE | ANTENATAL CARE | MONITORING | AGE FACTORS | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa |