1.  Peer Reviewed Title: ACOG Committee Opinion No. 427: Misoprostol for postabortion care. Author: American College of Obstetricians and Gynecologists Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 1):465-8. Abstract: The World Health Organization estimates that 67,000 women, mostly in developing countries, die each year from untreated or inadequately treated abortion complications. Postabortion care, a term commonly used by the international reproductive health community, refers to a specific set of services for women experiencing problems from all types of spontaneous or induced abortion. There is increasing evidence that misoprostol is a safe, effective, and acceptable method to achieve uterine evacuation for women needing postabortion care. To reduce maternal mortality, availability of postabortion care services must be increased. Misoprostol must be readily available especially for women who do not otherwise have access to postabortion care. Nurses and midwives can safely provide first-line postabortion care services, including in outpatient settings,provided they receive appropriate training and support. Access to contraception and safe abortion services prevents complications from unsafe abortion and decreases the need for postabortion care. It is much less expensive and far better for women's health to prevent the problem of unsafe abortion rather than to treat resulting complications. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | WOMEN | ABORTION | ABORTION, SPONTANEOUS | POSTABORTION CARE | MISOPROSTOL | HEALTH SERVICES | REPRODUCTIVE HEALTH | MATERNAL HEALTH | MATERNAL MORTALITY | PREVENTION AND CONTROL | NEEDS ASSESSMENT | PROGRAM ACCESSIBILITY | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Delivery of Health Care | Health | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Mortality | Population Dynamics | Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 341050 |
2.  Title: Expanding access to injectable contraception. Author: Family Health International [FHI] Source: [Unpublished] [2009]. 12 p. Abstract: A number of technological developments can make injections safer for administration, whether by health personnel, trained community workers or the women themselves: sub-cutaneous injections, which have less complications than intra-muscular injections; non-reusable disposable syringes Distribution by community health workers needs special attention to: the possibility that a woman is already pregnant (or seeking an abortion by using an injectable); the screening of women with pre-existing conditions or on medications; the need for counselling for side-effects (in particular: vaginal bleeding irregularities, amenorrhea, weight gain, delay in return to fertility); the safety of injections to the woman and to the health worker; the possible confusion between different injectables --provided by public and private sectors. To complement pre-service and in-service training, a number of job aids are available to support community workers providing injectables: medical eligibility criteria wheel to screen for eligibility; pregnancy checklist; simplified material for the management of side-effects (bleeding, amenorrhea, weight changes, etc). (Excerpt) Language: English Keywords: GLOBAL | TABLES AND CHARTS | INJECTABLES | DEPO-PROVERA | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE AVAILABILITY | PROGRAM ACCESSIBILITY | COMMUNITY-BASED DISTRIBUTION | CONTRACEPTIVE SAFETY | MATERNAL MORTALITY | CAUSES OF DEATH | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Usage | Program Evaluation | Programs | Organization and Administration | Nonclinical Distribution | Distributional Activities | Program Activities | Safety | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 331838 |
| 3. Title: Time to deliver on maternal health and family planning best practices: White Ribbon Alliances in Asia and the Middle East make it happen. Author: Futures Group International. Health Policy Initiative Source: Washington, D.C., Futures Group International, Health Policy Initiative, 2009 Jul. 12 p. Abstract: White Ribbon Alliances (WRAs) across Asia and the Middle East have become strong advocates for evidence-based strategies to reduce maternal mortality. The USAID | Health Policy Initiative, Task Order 1, has helped to form alliances and support their efforts to scale up family planning (FP) and maternal, neonatal, and child health (MNCH) best practices in the region. This brief highlights the achievements of alliances from Bangladesh, India (Orissa), Indonesia, Pakistan, and Yemen. Language: English Keywords: ASIA | MIDDLE EAST | SUMMARY REPORT | WOMEN | PREGNANCY | POSTPARTUM WOMEN | MOTHERS | ANTENATAL CARE | MATERNAL HEALTH | MATERNAL MORTALITY | AWARENESS | TRAINING ACTIVITIES | HEALTH POLICY | Developing Countries | Demographic Factors | Population | Reproduction | Puerperium | 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 | Mortality | Population Dynamics | Knowledge | Training Programs | Education | Policy | Political Factors Document Number: 331562 |
| 4. Title: Compensation for the brain drain from developing countries [editorial] Author: Agwu K; Llewelyn M Source: Lancet. 2009 May 16;373(9676):1665-6. Abstract: This article examines the consequences and roots of health-worker migration from Sub-Saharan Africa to the developed world, especially to UK, USA and Canada. It explores the results of the major transfer of riches from poor societies to the affluent and discusses a compensation proposal for global justice. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HEALTH PERSONNEL | BRAIN DRAIN | RISK FACTORS | MATERNAL MORTALITY | INFANT MORTALITY | EMPLOYMENT | IMPACT | Delivery of Health Care | Health | International Migration | Migration | Population Dynamics | Demographic Factors | Population | Mortality | Macroeconomic Factors | Economic Factors | Communication Document Number: 341604 |
| 5. Title: Reducing maternal mortality in Yemen: challenges and lessons learned from baseline assessment. Author: Al Serouri AW; Al Rabee A; Bin Afif M; Al Rukeimi A Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):86-91. Abstract: OBJECTIVE: The Yemen is a signatory of the Millennium Development Goals (MDGs) and one of 10 countries chosen for the UN Millennium Project. However, recent MDG progress reviews show that it is unlikely that the maternal health goal will be reached by 2015 and Yemen still has an unacceptably high maternal mortality of 365 per 100000 live births. Because 82% of deaths happen intrapartum, the purpose of this needs assessment was to identify and prioritize constraints in delivery of emergency obstetric care (EmOC). METHODS: Four district hospitals and 16 health centers in 8 districts were assessed for functional capacity in terms of infrastructure; availability of essential equipment and drugs; EmOC technical competency and training needs; and Health Management Information System. RESULTS: We found poor obstetric services in terms of structure (staffing pattern, equipment, and supplies) and process (knowledge and management skills). CONCLUSION: The data argue for strengthening the 4 interlinked health system elements-human resources, and access to, use, and quality of services. The Government must address each of these elements to meet the Safe Motherhood MDG. Language: English Keywords: YEMEN | RESEARCH REPORT | MOTHERS | SAFE MOTHERHOOD | MATERNAL HEALTH | MATERNAL MORTALITY | PREVENTION AND CONTROL | EMERGENCY SERVICES | OBSTETRICAL SURGERY | Developing Countries | Middle East | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Health | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Health Services | Delivery of Health Care | Surgery | Treatment | Medical Procedures | Medicine Document Number: 341376 |
| 6. Title: Safe motherhood case studies: learning from South Asia [editorial] Author: Amery J Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):87-8. Abstract: Language: English Keywords: ASIA, SOUTHERN | CRITIQUE | CASE STUDIES | SAFE MOTHERHOOD | MATERNAL HEALTH SERVICES | OBSTETRICS | EMERGENCY SERVICES | DELIVERY OF HEALTH CARE | PROGRAM ACCESSIBILITY | MATERNAL MORTALITY | NEONATAL MORTALITY | Asia | Developing Countries | Studies | Research Methodology | Maternal Health | Health | Maternal-Child Health Services | Primary Health Care | Health Services | Medicine | Program Evaluation | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Infant Mortality Document Number: 341941 |
| 7. Peer Reviewed Title: Neonatal near miss: a measure of the quality of obstetric care. Author: Avenant T Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):369-374. Abstract: Thirty-seven percent of under-five deaths occur in the neonatal period. Identifying and correcting factors that contribute to neonatal and maternal care are of the utmost importance. Evaluation of severe acute maternal morbidity, also known as “near miss”, is used to improve obstetric practice. Neonatal near miss in conjunction with neonatal mortality can be used in a similar fashion to identify deficiencies in care. No accepted definition of neonatal near miss currently exists. None of the neonatal morbidity scoring systems is applicable or appropriate for this purpose. Organ system based criteria are objective and allow for identifying severe morbidities and identifying primary causes. This system can be of use in a variety of settings to identify health system problems and to institute remedial action where necessary. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PREGNANCY | MATERNAL MORTALITY | PERINATAL MORTALITY | MORBIDITY | QUALITY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | MEASUREMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Reproduction | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health | Research Methodology Document Number: 341303 |
| 8. Peer Reviewed Title: Maternal mortality in Syria: causes, contributing factors and preventability. Author: Bashour H; Abdulsalam A; Jabr A; Cheikha S; Tabbaa M; Lahham M; Dihman R; Khadra M; Campbell OM Source: Tropical Medicine and International Health. 2009 Sep;14(9):1122-7. Abstract: OBJECTIVES: To describe the biomedical and other causes of maternal death in Syria and to assess their preventability. METHODS: A reproductive age mortality study (RAMOS) design was used to identify pregnancy related deaths. All deaths among women aged 15-49 reported to the national civil register for 2003 were investigated through home interviews. Verbal autopsies were used to ascertain the cause of death among pregnancy related maternal deaths, and causes and preventability of deaths were assessed by a panel of doctors. RESULTS: A total of 129 maternal deaths were identified and reviewed. Direct medical causes accounted for 88%, and haemorrhage was the main cause of death (65%). Sixty nine deaths (54%) occurred during labour or delivery. Poor clinical skills and lack of clinical competency were behind 54% of maternal deaths. Ninety one percent of maternal deaths were preventable. CONCLUSIONS: The causes of maternal death in Syria and their contributing factors reflect serious defects in the quality of maternal care that need to be urgently rectified. Language: English Keywords: SYRIA | RESEARCH REPORT | RECORDS | MATERNAL MORTALITY | CAUSES OF DEATH | PREGNANCY OUTCOMES | MATERNAL HEALTH SERVICES | QUALITY OF HEALTH CARE | Developing Countries | Middle East | Information Processing | Information | Mortality | Population Dynamics | Demographic Factors | Population | Pregnancy | Reproduction | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 342964 |
| 9. Peer Reviewed Title: Maternal healthcare financing: Gujarat's Chiranjeevi Scheme and its beneficiaries. Author: Bhat R; Mavalankar DV; Singh PV; Singh N Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):249-58. 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 3000 (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. Language: English Keywords: INDIA | RESEARCH REPORT | PILOT PROJECTS | LOW INCOME POPULATION | MATERNAL HEALTH SERVICES | FINANCIAL ACTIVITIES | OBSTETRICS | EMERGENCY SERVICES | PROGRAM EVALUATION | MATERNAL MORTALITY | QUALITY OF HEALTH CARE | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Medicine | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Health Services Evaluation Document Number: 341931 |
| 10. Peer Reviewed Title: Effect of human immunodeficiency virus treatment on maternal mortality at a tertiary center in South Africa: a 5-year audit. Author: Black V; Brooke S; Chersich MF Source: Obstetrics and Gynecology. 2009 Aug;114(2 Pt 1):292-9. Abstract: OBJECTIVE:: To review facility-based maternal deaths at a tertiary-level center in Johannesburg, South Africa, during a 5-year period (2003 to 2007) and to investigate the proportion of deaths attributable to human immunodeficiency virus (HIV), the etiology of deaths, and the effects of antiretroviral treatment introduced in late 2004. METHODS:: Patient case files, birth registers, death certificates, and mortality summaries were reviewed. Cause of death was assigned through clinical case discussion. Annual maternal mortality ratios were calculated and disaggregated by HIV status. RESULTS:: During the 5-year period, 106 maternal deaths occurred out of 36,708 births (facility-based maternal mortality ratios 289/100,000 live births, 95% confidence interval [CI] 237-349/100,000). In 72% of cases, HIV status was known (76/106), with the majority being HIV-infected (78%, 59/76). Among HIV-infected women, only two had initiated antiretroviral treatment, and 70% of deaths were HIV-related (41/59), mainly from tuberculosis (21) and pneumonia (12). Direct obstetric causes of death such as hypertension and pregnancy-related sepsis predominated in women who were HIV-negative or of unknown status (48.9%, 23/47). Maternal mortality ratios in HIV-infected women were 776/100,000 (95% CI 591-1,000/100,000), 6.2-fold higher (95% CI 3.6-11.4) than in HIV-negative women (124/100,000, 95% CI 72-199/100,000). Changes in mortality over time were not detected. Although HIV testing increased 1.4-fold each year (95% CI 1.3-1.4) and estimated coverage of antiretroviral treatment for pregnant women reached 59.2% in 2007, levels remain suboptimal. CONCLUSION:: In Johannesburg, HIV remains the major cause of maternal mortality despite integration of antiretroviral treatment into prenatal services. Maternal health services should target barriers to uptake of HIV treatment and care. LEVEL OF EVIDENCE:: III. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PREGNANT WOMEN | HYPERTENSION | MATERNAL-CHILD HEALTH SERVICES | HIV INFECTIONS | AIDS | MATERNAL MORTALITY | CAUSES OF DEATH | HIV/FP INTEGRATION | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Vascular Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Viral Diseases | Mortality | Population Dynamics | Medical Procedures | Medicine Document Number: 342270 |
| 11. Title: Maternal mortality in low-income countries: what interventions have been evaluated and how should the evidence base be developed further? Author: Burchett HE; Mayhew SH Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):78-81. Abstract: OBJECTIVE: This article reviews the evidence for the effectiveness of non-clinical interventions to reduce maternal mortality in low-income settings and identifies the gaps in the evidence base. METHODS: A systematic search was conducted to identify reviews and evaluations of non-clinical interventions to reduce maternal mortality in lower-income countries with high maternal mortality published between 1997 and 2008. Studies were reviewed to identify the topic focus, study design, and outcomes measured. RESULTS: There were 109 intervention evaluations and 30 reviews identified. Studies had been conducted in less than half of the countries and were generally poor quality. More studies focused on tertiary prevention (i.e., preventing death) rather than secondary prevention (i.e., preventing complications). More interventions sought to address quality of care than delays in seeking or accessing care. CONCLUSIONS: While evidence partly reflects difficulties in evaluating complex public health interventions, more robust study designs are possible to evaluate interventions to reduce maternal mortality. In addition, better standardized outcome measures are needed. This overview identifies topic areas neglected by intervention research. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | INTERVENTIONS | LOW INCOME POPULATION | MATERNAL MORTALITY | EVALUATION | RESEARCH METHODOLOGY | Developed Countries | Europe, Western | Europe | Programs | Organization and Administration | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 341377 |
| 12. Peer Reviewed Title: Causes of maternal mortality decline in Matlab, Bangladesh. Author: Chowdhury ME; Ahmed A; Kalim N; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):108-23. 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. Language: English Keywords: BANGLADESH | RURAL AREAS | RESEARCH REPORT | MATERNAL MORTALITY | MORTALITY DECLINE | CAUSES OF DEATH | RISK FACTORS | SAFE MOTHERHOOD | OBSTETRICS | EMERGENCY SERVICES | PROGRAM ACCESSIBILITY | FERTILITY DECLINE | EDUCATIONAL STATUS | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Mortality | Population Dynamics | Demographic Factors | Health | Maternal Health | Medicine | Health Services | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration | Fertility Changes | Fertility | Socioeconomic Status | Socioeconomic Factors | Economic Factors Document Number: 341939 |
| 13. Peer Reviewed Title: Estimating the burden of malaria in pregnancy: a case study from rural Madhya Pradesh, India. Author: Diamond-Smith N; Singh N; Gupta RK; Dash A; Thimasarn K; Campbell OM; Chandramohan D Source: Malaria Journal. 2009;8:24. Abstract: BACKGROUND: Malaria in pregnancy (MiP) is inadequately researched in India, and the burden is probably much higher than current estimates suggest. This paper models the burden of MiP and associated foetal losses and maternal deaths, in rural Madhya Pradesh, India. METHODS: Number of pregnancies per year was estimated from the number of births and an estimate of pregnancies that end in foetal loss. The prevalence of MiP, risk of foetal loss attributable to MiP and case fatality rate of MiP were obtained from the literature. The estimated total number of pregnancies was multiplied by the appropriate parameter to estimate the number of MiP cases, and foetal loss and maternal deaths attributable to MiP per year. A Monte Carlo simulation sensitivity analysis was done to assess plausibility of various estimates obtained from the literature. The burden of MiP in tribal women was explored by incorporating the variable prevalence of malaria in tribal and non-tribal populations and in forested and non-forested regions within Madhya Pradesh. RESULTS: Estimates of MiP cases in rural Madhya Pradesh based on the model parameter values found in the literature ranged from 183,000-1.5 million per year, with 73,000-629,000 lost foetuses and 1,500-12,600 maternal deaths attributable to MiP. The Monte Carlo simulation gave a more plausible estimate of 220,000 MiP cases per year (inter-quartile range (IQR): 136,000-305,000), 95,800 lost foetuses (IQR: 56,800-147,600) and 1,000 maternal deaths (IQR: 650-1,600). Tribal women living in forested areas bore 30% of the burden of MiP in Madhya Pradesh, while constituting 18% of the population. CONCLUSION: Although the estimates are uncertain, they suggest MiP is a significant public health problem in rural Madhya Pradesh, affecting many thousands of women and that reducing the MiP burden should be a priority. Language: English Keywords: INDIA | LITERATURE REVIEW | CASE STUDIES | PREVALENCE | RURAL AREAS | PREGNANT WOMEN | MALARIA | MATERNAL MORTALITY | CAUSES OF DEATH | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Measurement | Geographic Factors | Population | Population Characteristics | Demographic Factors | Parasitic Diseases | Diseases | Mortality | Population Dynamics Document Number: 330550 |
| 14. Title: [Czech model for decrease of maternal mortality in Uganda] Cesky model pro snizeni materske umrtnosti v Ugande. Author: Donat J Source: Casopis Lekaru Ceskych. 2009;148(7):338-41. Abstract: High maternal and perinatal mortality is the leading problem of the health care in developing countries of Sub-Saharan Africa, including Uganda. The main condition for decrease of maternal mortality is availability of an emergency obstetrical care in hospital accompanied by skilled team of specialists (gynaecologist, anaesthesiologist, paediatrician), which are able to treat all obstetrical complications and provide an intensive care to risk newborns. The Czech Hospital and School for midwives in Uganda was founded and build with the aim to accomplish a grant project for the decrease of maternal, perinatal and child mortality. Our project to connect emergency obstetrical care in hospital to villages and traditional delivery attendants by mobile phones shows a simple and original model, which can help to decrease maternal mortality in Uganda and in the other countries of Sub-Saharan Africa as well. The Czech-Uganda Hospital started its work on 19th February 2007 with a team of Slovak doctors; however, till now, after 2 years of work, it doesn't fulfil its role of a specialised obstetrical department, which would be able to join its partners in villages and start the grant project for decrease of maternal and perinatal mortality. Language: Czech Keywords: UGANDA | AFRICA, SUB SAHARAN | RESEARCH REPORT | MATERNAL MORTALITY | PERINATAL MORTALITY | EMERGENCY SERVICES | PREGNANCY COMPLICATIONS | MIDWIVES AND MIDWIFERY | PREVENTION AND CONTROL | Africa, Eastern | Africa | Developing Countries | Mortality | Population Dynamics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Diseases | Health Personnel Document Number: 342652 |
| 15. Title: The growing chronic disease burden: implications for reproductive health. Author: Drake JK Source: Outlook. 2009 Jul;26(1):8 p. Abstract: Approximately 80 percent of deaths from chronic disease occur in low- and middle-income countries, where people tend to develop these diseases at younger ages, suffer longer, and die sooner. A recent analysis found that chronic disease is an "important cause of female death, even during childbearing years, and for women with young families." The newsletter provides background on the growing chronic disease burden in developing countries, and explores current and anticipated impacts of cardiovascular conditions, diabetes, and obesity on reproductive health. Examples include hypertension and diabetes in pregnancy and contraceptive choice and access for women with cardiovascular conditions and risk factors. Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | EPIDEMIOLOGY | DISEASES | REPRODUCTIVE HEALTH | MATERNAL MORTALITY | DEATH RATE | HYPERTENSION | DIABETES | SCREENING | FAMILY PLANNING | TREATMENT | PREVENTION AND CONTROL | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population | Vascular Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 341982 |
| 17. Peer Reviewed Title: Saving mother's lives: programs that work. Author: Fortney JA; Leong M Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):224-36. Abstract: Maternal mortality is a complex problem requiring complex responses. Nevertheless, every intervention must operate through one of 3 pathways: preventing pregnancy, preventing complications, or preventing death when obstetric complications occur. We describe interventions following each pathway and assess their evidence base. In general, the more specific the intervention (such as procedures) the stronger the evidence. Broad interventions ("programs" for example) have a weaker evidence base although evidence is accumulating. The potential for robust evidence for effective programs is limited by epidemiologic design-the logistic difficulties of randomization, blinding, and single impact variables. Language: English Keywords: GLOBAL | RECOMMENDATIONS | POLICYMAKERS | COMMUNITY | SAFE MOTHERHOOD | MATERNAL MORTALITY | INTERVENTIONS | PREGNANCY COMPLICATIONS | OBSTETRICS | EMERGENCY SERVICES | MATERNAL HEALTH SERVICES | PROGRAM EFFECTIVENESS | FAMILY PLANNING PROGRAMS | Administrative Personnel | Organization and Administration | Residence Characteristics | Population Distribution | Geographic Factors | Population | Maternal Health | Health | Mortality | Population Dynamics | Demographic Factors | Programs | Diseases | Medicine | Health Services | Delivery of Health Care | Maternal-Child Health Services | Primary Health Care | Program Evaluation | Family Planning Document Number: 342175 |
| 18. Peer Reviewed Title: Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali. Author: Fournier P; Dumont A; Tourigny C; Dunkley G; Drame S Source: Bulletin of the World Health Organization. 2009 Jan;87(1):30-8. Abstract: OBJECTIVE: To evaluate the effect of a national referral system that aims to reduce maternal mortality rates through improving access to and the quality of emergency obstetric care in rural Mali (sub-Saharan Africa). METHODS: A maternity referral system that included basic and comprehensive emergency obstetric care, transportation to obstetric health services and community cost-sharing schemes was implemented in six rural health districts in Kayes region between December 2002 and November 2005. In an uncontrolled 'before and after' study, we recorded all obstetric emergencies, major obstetric interventions and maternal deaths during a 4-year observation period (1 January 2003 to 30 November 2006): the year prior to the intervention (P-1); the year of the intervention (P0), and 1 and 2 years after the intervention (P1 and P2, respectively). The primary outcome was the risk of death among obstetric emergency patients, calculated with crude case fatality rates and crude odds ratios. Analyses were adjusted for confounding variables using logistic regression. FINDINGS: The number of women receiving emergency obstetric care doubled between P-1 and P2, and the rate of major obstetric interventions (mainly Caesarean sections) performed for absolute maternal indications increased from 0.13% in P-1 to 0.46% in P2. In women treated for an obstetric emergency, the risk of death 2 years after implementing the intervention was half the risk recorded before the intervention (odds ratio, OR: 0.48; 95% confidence interval, CI: 0.30-0.76). Maternal mortality rates decreased more among women referred for emergency obstetric care than among those who presented to the district health centre without referral. Nearly half (47.5%) of the reduction in deaths was attributable to fewer deaths from haemorrhage. CONCLUSION: The intervention showed rapid effects due to the availability of major obstetric interventions in district health centres, reduced transport time to such centres for treatment, and reduced financial barriers to care. Our results show that national programmes can be implemented in low-income countries without major external funding and that they can rapidly improve the coverage of obstetric services and significantly reduce the risk of death associated with obstetric complications. Language: English Keywords: MALI | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | EMERGENCY SERVICES | PROGRAM ACCESSIBILITY | COMMUNITY HEALTH SERVICES | MATERNAL MORTALITY | HEALTH SERVICES EVALUATION | TRANSPORTATION | OBSTETRICS | PREGNANCY COMPLICATIONS | COMMUNITY FINANCING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Mortality | Population Dynamics | Medicine | Diseases | Financial Activities Document Number: 341163 |
| 19. Title: Birth weight of offspring, maternal pre-pregnancy characteristics, and mortality of mothers: the Jerusalem perinatal study cohort. Author: Friedlander Y; Manor O; Paltiel O; Meiner V; Sharon N; Calderon R; Hochner H; Sagy Y; Avgil M; Harlap S; Siscovick DS Source: Annals of Epidemiology. 2009 Feb;19(2):112-7. Abstract: PURPOSE: To explore the association between birth weight in offspring, a marker of the intrauterine environment, and mortality in their mothers, taking into account maternal pre-pregnancy characteristics, including maternal body mass index (BMI), smoking, and socioeconomic status. Distinguishing the effects of offspring's birth weight and pre-pregnancy characteristics on maternal outcome may provide clues regarding mechanisms underlying the association between birth weight and maternal mortality. METHODS: We studied long-term total mortality (average follow-up period, 29.1 years) in a population-based cohort of 13,185 mothers, aged 15 to 48 years at their offspring's birth, who delivered in West Jerusalem during 1974 through 1976. RESULTS: Univariate and multivariate Cox-proportional hazard models used to estimate the hazard of overall mortality among mothers indicated a nonlinear relationship with birth weight of offspring when introduced into the models as a continuous variable, and a linear positive association with maternal pre-pregnancy BMI. Inclusion of maternal BMI and other pre-pregnancy characteristics in the model did not alter the association between offspring's birth weight and mothers' all-cause mortality. When birth weight was introduced as a categorical variable, higher mortality was observed among mothers who gave birth to babies with birth weight less than 2500 g (hazard ratio [HR] = 1.90; 95% confidence interval [95%CI], 1.23-2.94) as compared to mothers whose offspring had birth weight between 3000 and 3499 g. The HR for mothers who gave birth to babies with birth weight 4000 g or more was 1.30 (95%CI, 0.88-1.91). CONCLUSIONS: Independent of pre-pregnancy maternal BMI and other characteristics, birth weight of offspring was associated with mortality in their mothers, suggesting that intrauterine metabolic events reflected by birth weight and not explained by maternal obesity, smoking, and socioeconomic status have remote consequences for maternal health. These findings underline the need to explore specific genetic and/or environmental mechanisms that account for these associations. Language: English Keywords: ISRAEL | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | LONGITUDINAL STUDIES | MULTIVARIATE ANALYSIS | MATHEMATICAL MODEL | INFANT | PREGNANT WOMEN | BIRTH WEIGHT | MATERNAL MORTALITY | PREGNANCY OUTCOMES | MATERNAL HEALTH | Developed Countries | Middle East | Research Methodology | Studies | Data Analysis | Theoretical Models | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Body Weight | Physiology | Biology | Mortality | Population Dynamics | Pregnancy | Reproduction | Health Document Number: 331228 |
| 20. Title: Trends of abortion complications in a transition of abortion law revisions in Ethiopia. Author: Gebrehiwot Y; Liabsuetrakul T Source: Journal of Public Health. 2009 Mar;31(1):81-7. Abstract: BACKGROUND: Evidence from developed countries has shown that abortion-related mortality and morbidity has decreased with the liberalization of the abortion law. This study aimed to assess the trend of hospital-based abortion complications during the transition of legalization in Ethiopia in May 2005. METHODS: Medical records of women with abortion complications from 2003 to 2007 were reviewed (n = 773). Abortion and its complications with regard to legalization were described by rates and ratios, and predictors of fatal outcomes were analyzed by logistic regression. RESULTS: The overall and abortion-related maternal mortality ratios (AMMRs) showed a non-statistically significant downward trend over the 5-year period. However, the case fatality rate of abortion increased from 1.1% in 2003 to 3.6% in 2007. Late gestational age, history of interference and presenting after new abortion legislation passed have been found to be significant predictors of mortality. CONCLUSION: Decreased trends of abortion ratio and the AMMR were identified, but the severity of abortion complications and the case fatality rate increased during the transition of legal revision. Language: English Keywords: ETHIOPIA | RESEARCH REPORT | DATA ANALYSIS | CLIENTS | ABORTION | ABORTION LAW | MATERNAL MORTALITY | MORTALITY CHANGES | ABORTION RATE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 341640 |
| 21. Peer Reviewed Title: Perinatal outcomes in a South Asian setting with high rates of low birth weight. Author: George K; Prasad J; Singh D; Minz S; Albert DS; Muliyil J; Joseph KS; Jayaraman J; Kramer MS Source: BMC Pregnancy and Childbirth. 2009;9:5. Abstract: BACKGROUND: It is unclear whether the high rates of low birth weight in South Asia are due to poor fetal growth or short pregnancy duration. Also, it is not known whether the traditional focus on preventing low birth weight has been successful. We addressed these and related issues by studying births in Kaniyambadi, South India, with births from Nova Scotia, Canada serving as a reference. METHODS: Population-based data for 1986 to 2005 were obtained from the birth database of the Community Health and Development program in Kaniyambadi and from the Nova Scotia Atlee Perinatal Database. Menstrual dates were used to obtain comparable information on gestational age. Small-for-gestational age (SGA) live births were identified using both a recent Canadian and an older Indian fetal growth standard. RESULTS: The low birth weight and preterm birth rates were 17.0% versus 5.5% and 12.3% versus 6.9% in Kaniyambadi and Nova Scotia, respectively. SGA rates were 46.9% in Kaniyambadi and 7.5% in Nova Scotia when the Canadian fetal growth standard was used to define SGA and 6.7% in Kaniyambadi and < 1% in Nova Scotia when the Indian standard was used. In Kaniyambadi, low birth weight, preterm birth and perinatal mortality rates did not decrease between 1990 and 2005. SGA rates in Kaniyambadi declined significantly when SGA was based on the Indian standard but not when it was based on the Canadian standard. Maternal mortality rates fell by 85% (95% confidence interval 57% to 95%) in Kaniyambadi between 1986-90 and 2001-05. Perinatal mortality rates were 11.7 and 2.6 per 1,000 total births and cesarean delivery rates were 6.0% and 20.9% among live births >or= 2,500 g in Kaniyambadi and Nova Scotia, respectively. CONCLUSION: High rates of fetal growth restriction and relatively high rates of preterm birth are responsible for the high rates of low birth weight in South Asia. Increased emphasis is required on health services that address the morbidity and mortality in all birth weight categories. Language: English Keywords: INDIA | CANADA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CROSS-CULTURAL COMPARISONS | LONGITUDINAL STUDIES | INFANT | INFANT, PREMATURE | PREVALENCE | BIRTH WEIGHT | LOW BIRTH WEIGHT | GESTATIONAL AGE | PERINATAL MORTALITY | GROWTH | MATERNAL MORTALITY | Asia, Southern | Asia | Developing Countries | Developed Countries | North America, Northern | Americas | Research Methodology | Comparative Studies | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Body Weight | Physiology | Biology | Fetus | Pregnancy | Reproduction | Mortality | Population Dynamics | Child Development Document Number: 331227 |
| 22. Peer Reviewed Title: Tackling health inequities in Chile: maternal, newborn, infant, and child mortality between 1990 and 2004. Author: Gonzalez R; Requejo JH; Nien JK; Merialdi M; Bustreo F; Betran AP Author: Chile Maternal, Newborn, and Child Health Writing Group Source: American Journal of Public Health. 2009 Jul;99(7):1220-6. Abstract: OBJECTIVES: We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. METHODS: Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4,000,000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged > 28 days and < 1 year), and children aged 1 to 4 years. We also calculated these statistics by 5-year intervals for Chile's poorest to richest district quintiles. RESULTS: During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100,000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. CONCLUSIONS: During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. Language: English Keywords: CHILE | RESEARCH REPORT | DATA ANALYSIS | INFANT | CHILDREN | CHILD MORTALITY | MATERNAL MORTALITY | DEATH RATE | PARITY SPECIFIC BIRTH RATE | INEQUALITIES | PREVENTION AND CONTROL | Developing Countries | South America, Southern | South America | Latin America | Americas | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Fertility Rate | Birth Rate | Fertility Measurements | Fertility | Socioeconomic Factors | Economic Factors | Diseases Document Number: 342239 |
| 23. Title: Maternal mortality due to cardiac disease in Sri Lanka. Author: Haththotuwa HR; Attygalle D; Jayatilleka AC; Karunaratna V; Thorne SA Source: International Journal of Gynaecology and Obstetrics. 2009 Mar;104(3):194-8. Abstract: OBJECTIVE: To investigate Sri Lankan maternal deaths due to heart disease and to consider low-cost interventions to reduce these deaths. METHODS: A qualitative study based on retrospective audit of all maternal deaths and late maternal deaths in Sri Lanka caused by cardiac disease in 2004. RESULTS: A total of 145 maternal deaths were recorded in 2004, for a maternal mortality rate of 38 per 100,000. There were 42 indirect deaths, 25 of which were due to cardiac disease; 23 deaths had a specific cardiac cause listed. Standard care was identified in prepregnancy counseling, contraception, and prenatal community and specialist care. CONCLUSION: Cardiac disease is a major cause of maternal mortality in Sri Lanka, second only to postpartum hemorrhage. Rheumatic mitral valve disease is responsible for more than a third of maternal deaths from cardiac disease. Substandard care was identified in all cases; strategies to improve care could allow a reduction in maternal cardiac deaths. Language: English Keywords: SRI LANKA | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | MATERNAL MORTALITY | HEART DISEASES | QUALITY OF HEALTH CARE | EXAMINATIONS AND DIAGNOSES | CAUSES OF DEATH | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341384 |
| 24. Title: Confidential inquiries into maternal deaths: Modifications and adaptations in Ghana and Indonesia. Author: Hussein J; D'Ambruoso L; Armar-Klemesu M; Achadi E; Arhinful D; Izati Y; Ansong-Tornui J Source: International Journal of Gynaecology and Obstetrics. 2009 May 8; Abstract: OBJECTIVE: Factors contributing to the limited use of confidential inquiries into maternal deaths include the negative focus and demotivating effect of such inquiries, perceptions of unavailability of sufficient documentation of events, and lack of time and resources. To ascertain whether these problems can be overcome, variations to confidential inquiries into maternal deaths were introduced in Ghana and Indonesia. METHODS: Clinical review panels were set up as part of the usual process of confidential inquiries, and modifications to the confidential inquiries were introduced. In Ghana, the traditional confidential inquiry process focusing on health facility care was modified to introduce the assessment of positive factors. In addition to the assessment of positive factors, adaptations in Indonesia consisted of including cases of obstetric complications, as well as deaths, and the use of interview testimonials as data sources. Information about resource and time needs for conducting confidential inquiries was collected. RESULTS: The introduction of positive aspects to the process provided a balanced and more motivating setting for the inquiry. The data obtained from case notes in district hospitals and interview testimonials provided sufficient information to assess why maternal deaths and severe complications occurred. The costs of conducting the inquiries ranged from US $4000 to US $11000 (per study), and the estimated time required for a panel member to review each case was more than 3 hours. CONCLUSION: This study introduced practical ways to encourage the implementation of maternal death reviews, inquiries, and audits that are context specific and, therefore, acceptable to local practitioners. Language: English Keywords: GHANA | INDONESIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | CONFIDENTIAL INFORMATION | MATERNAL MORTALITY | PERCEPTION | MOTIVATION | TIME FACTORS | PREGNANCY COMPLICATIONS | ECONOMIC FACTORS | AUTOPSY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Asia, Southeastern | Asia | Research Methodology | Economic Development | Population Characteristics | Demographic Factors | Population | Ethics | Sociocultural Factors | Mortality | Population Dynamics | Psychological Factors | Behavior | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341454 |
| 25. Peer Reviewed Title: Pregnancy-related deaths in rural Rajasthan, India: exploring causes, context, and care-seeking through verbal autopsy. Author: Iyengar K; Iyengar SD; Suhalka V; Dashora K Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):293-302. Abstract: In 2002-2003, all deaths (n=156) of women aged 15-49 years in a block of southern Rajasthan were investigated to determine the cause of death and care-seeking behaviour. Family members of 156 (98%) of 160 deceased women were interviewed following the comprehensive listing of all deaths among women of reproductive age. Of the 156 deaths, 31 (20%) were pregnancy-related; 77% of these women died during the postpartum period, and 74% of the deaths occurred in the home. Direct and indirect obstetric causes were responsible for 58% and 29% of the deaths respectively; 12% were injury-related deaths. Medical care was sought for 65% of the women, and 29% were hospitalized. Family perception of not being able to afford treatment at distant hospitals was a major barrier to seeking care, and 60% of those who sought care had to borrow money for treatment. Lack of skilled attendance and immediate postpartum care were major factors contributing to deaths. Improved access to emergency obstetric care facilities in rural areas and steps to eliminate costs at public hospitals would be crucial to prevent pregnancy-related deaths. Language: English Keywords: INDIA | RURAL AREAS | RESEARCH REPORT | CASE HISTORIES | LOW LITERATES | MATERNAL MORTALITY | PREGNANCY COMPLICATIONS | AUTOPSY | CAUSES OF DEATH | RURAL HEALTH SERVICES | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | OBSTACLES | Asia, Southern | Asia | Developing Countries | Geographic Factors | Population | Data Collection | Research Methodology | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Maternal-Child Health Services | Primary Health Care | Organization and Administration Document Number: 341928 |
| 26. Peer Reviewed Title: Maternal health: a case study of Rajasthan. Author: Iyengar SD; Iyengar K; Gupta V Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):271-92. 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. Language: English Keywords: INDIA | LITERATURE REVIEW | MATERNAL HEALTH | REPRODUCTIVE HEALTH | WOMEN'S STATUS | MATERNAL MORTALITY | MATERNAL HEALTH SERVICES | UTILIZATION OF HEALTH CARE | QUALITY OF HEALTH CARE | SAFE MOTHERHOOD | PERFORMANCE IMPROVEMENT | HUMAN RESOURCES | CONTRACEPTION | ABORTION | Asia, Southern | Asia | Developing Countries | Health | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Management | Family Planning | Fertility Control, Postconception Document Number: 341929 Notification |
| 27. Peer Reviewed Title: Verbal autopsy of maternal deaths in two districts of Pakistan--filling information gaps. Author: Jafarey SN; Rizvi T; Koblinsky M; Kureshy N Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):170-83. 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. Language: English Keywords: PAKISTAN | RESEARCH REPORT | MATERNAL MORTALITY | CAUSES OF DEATH | RISK FACTORS | AUTOPSY | DEATH RECORDS | SOCIOECONOMIC STATUS | PREGNANCY COMPLICATIONS | PREGNANCY OUTCOMES | UTILIZATION OF HEALTH CARE | Developing Countries | Asia, Southern | Asia | Mortality | Population Dynamics | Demographic Factors | Population | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Vital Statistics | Population Statistics | Research Methodology | Socioeconomic Factors | Economic Factors | Diseases | Pregnancy | Reproduction Document Number: 341936 |
| 28. Peer Reviewed Title: Postpartum haemorrhage and eclampsia: differences in knowledge and care-seeking behaviour in two districts of Bangladesh. Author: Kalim N; Anwar I; Khan J; Blum LS; Moran AC; Botlero R; Koblinsky M Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):156-69. 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. Language: English Keywords: BANGLADESH | RESEARCH REPORT | SAMPLING STUDIES | WOMEN | POSTPARTUM | BLEEDING | ECLAMPSIA | KNOWLEDGE | UTILIZATION OF HEALTH CARE | MATERNAL MORTALITY | PREGNANCY COMPLICATIONS | PERCEPTION | SOCIOCULTURAL FACTORS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Demographic Factors | Population | Puerperium | Reproduction | Signs and Symptoms | Diseases | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Psychological Factors | Behavior Document Number: 341993 |
| 29. Peer Reviewed Title: Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan. Author: Kandasamy T; Merialdi M; Guidotti RJ; Betran AP; Harris-Requejo J Source: International Journal of Gynecology and Obstetrics. 2009;104:14-17. Abstract: Objective: To use an active facility-based maternal and newborn surveillance system to describe cesarean delivery practices and outcomes in a resource-poor setting. Methods: Using data from operating room logbooks, 392 cesarean deliveries were evaluated between April 1 and June 30 2006 at a large public maternity hospital in Kabul, Afghanistan. Results: The perinatal mortality rate was 89 per 1000 births: 57% antepartum and 37% intrapartum stillbirths. Fetuses with normal birth weight comprised 85% of intrapartum stillbirths. Obstructed labor, uterine rupture, and malpresentation accounted for more than 50% of perinatal deaths. The cesarean delivery rate was 10.2% and there were 2 maternal deaths. Conclusion: The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives. Language: English Keywords: AFGHANISTAN | RESEARCH REPORT | DATA COLLECTION | CESAREAN SECTION | HOSPITALS | MONITORING | OBSTETRICS | ANESTHESIA | QUALITY OF HEALTH CARE | PERINATAL MORTALITY | MATERNAL MORTALITY | FETAL DEATH | BIRTH WEIGHT | Asia, Southern | Asia | Developing Countries | Research Methodology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Evaluation | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Body Weight | Physiology | Biology Document Number: 340226 |
| 30. 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 |
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