1.  Title: Human resources for health in the low-resource world: collaborative practice and task shifting in maternal and neonatal care. Author: FIGO Safe Motherhood and Newborn Health Committee Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):74-6. Abstract: An important barrier to the attainment of Millennium Development Goals (MDGs) 4 and 5 in many countries is the lack of trained and skilled clinical staff who can provide timely and high-quality care to mothers with pregnancy complications. This article presents guidelines and recommendations on how to better make use of existing health human resources in order to improve maternal and neonatal care. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HEALTH PERSONNEL | MATERNAL-CHILD HEALTH SERVICES | HUMAN RESOURCES | GYNECOLOGY | OBSTETRICS | OBSTETRICAL SURGERY | TRAINING PROGRAMS | Delivery of Health Care | Health | Primary Health Care | Health Services | Economic Factors | Medicine | Surgery | Treatment | Medical Procedures | Education Document Number: 341381 |
2.  Title: Starting with the classroom: updating family planning knowledge in East Africa. Author: IntraHealth International. Capacity Project Source: Chapel Hill, North Carolina, IntraHealth International, Capacity Project, 2009 Feb. [2] p. (Voices No. 28) Abstract: In Kenya, a dedicated midwifery tutor is working hard to train students at Aga Khan University but worries that he isn't teaching them the latest information and techniques. Many of his fellow instructors are in the same situation. "We had our last refresher training ten years ago," he laments. In Tanzania, a midwifery tutor from Tumaini University Faculty of Nursing observes, "Many nurses who are providing service have never been updated on new issues [in family planning]. It will be our responsibility to see how we can help as a training institution because we will send our students to some of these clinics." To build instructors' capacity and address the knowledge gaps, the Capacity Project partnered with East, Central and Southern Africa (ECSA) Health Community and Africa's Health in 2010 to deliver a week-long workshop on Contemporary Issues in Family Planning for midwifery tutors in Kenya, Tanzania and Uganda. Held in Dar es Salaam in April 2008, the workshop updated the knowledge of 22 tutors and enabled them to teach their students more effectively. A quantitative and qualitative evaluation showed the workshop to be highly successful. Average scores climbed from 58% on the pre-test to 81% on the post-test. Additionally, 94% reported that they have used the workshop information and resources to update their colleagues. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | PROGRESS REPORT | EVALUATION | MIDWIVES AND MIDWIFERY | NURSE-MIDWIVES | FAMILY PLANNING EDUCATION | SEX EDUCATION | USAID | CAPACITY BUILDING | WORKSHOPS | CONTRACEPTION | MATERNAL-CHILD HEALTH SERVICES | PERFORMANCE IMPROVEMENT | AUDIOVISUAL AIDS | Africa | Developing Countries | Health Personnel | Delivery of Health Care | Health | Education | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Program Sustainability | Programs | Organization and Administration | Family Planning | Primary Health Care | Health Services | Management | Educational Methods | Educational Activities Document Number: 325236 |
| 3. Title: Expert Group Meeting to Assess the Progress in the Implementation of the Plan of Action on Population and Poverty Adopted at the Fifth Asian and Pacific Population Conference, 3-5 February 2009, Bangkok. Report. Author: United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]; United Nations Population Fund [UNFPA] Source: Bangkok, Thailand, ESCAP, 2009. 38 p. Abstract: The Expert Group Meeting to Assess the Progress in the implementation of the Plan of Action on Population and Poverty adopted at the Fifth Asian and Pacific Population Conference was held at the United Nations Conference Centre, Bangkok from 3 to 5 February 2009. The Expert Group Meeting was organized by the Social Policy and Population Section, Social Development Division, ESCAP in collaboration with the UNFPA Asia and the Pacific Regional Office. The meeting benefited from background papers and country reports prepared by resource persons and representatives of governments. Language: English Keywords: ASIA | OCEANIA | CONFERENCES AND CONGRESSES | ESCAP | POPULATION | SUSTAINABLE DEVELOPMENT | POVERTY | REPRODUCTIVE HEALTH | MATERNAL-CHILD HEALTH SERVICES | GENDER ISSUES | MIGRATION | HIV INFECTIONS | AIDS | IMPLEMENTATION | Developing Countries | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Economic Development | Economic Factors | Socioeconomic Factors | Health | Primary Health Care | Health Services | Delivery of Health Care | Population Dynamics | Demographic Factors | Viral Diseases | Diseases | Programs | Organization and Administration Document Number: 331854 |
| 4. Peer Reviewed Title: PMTCT, HAART, and childbearing in Mozambique: an institutional perspective. Author: Agadjanian V; Hayford SR Source: AIDS and Behavior. 2009 Jun;13(Suppl 1):S103-S112. Abstract: Maternal and Child Health (MCH) units, where VCT/PMTCT/HAART have been integrated with traditional services, play a critical role in the connection between the massive HAART rollout and reproductive behavior. In this article, we use data from semi-structured interviews with MCH workers and ethnographic observations carried out in southern Mozambique to explore this role from the institutional perspective. We find that, along with logistical and workload problems, the de facto segregation of PMTCT/HAART clients within the “integrated” MCH system and the simplistic and uncompromising message discouraging further fertility and stressing condom-based contraception may pose serious challenges to a successful formulation and implementation of reproductive goals among seropositive clients. Although the recency of PMTCT/HAART services may partly explain these challenges, we argue that they are due largely to cultural miscommunication between providers and clients. We show how the cultural gap between the two is bridged by community activists and peer interactions among clients. Language: English Keywords: MOZAMBIQUE | RESEARCH REPORT | HEALTH PERSONNEL | SUPPORT GROUPS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL THERAPY | VOLUNTARY COUNSELING AND TESTING | MATERNAL-CHILD HEALTH SERVICES | INTEGRATED PROGRAMS | HEALTH SERVICES ADMINISTRATION | INTERVIEWS | FERTILITY PREFERENCES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Delivery of Health Care | Health | Social Networks | Friends and Relatives | Family and Household | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Diseases | HIV | HIV Infections | Viral Diseases | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Primary Health Care | Programs | Organization and Administration | Management | Data Collection | Research Methodology | Fertility | Population Dynamics | Demographic Factors | Population Document Number: 341906 |
| 5. 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 |
| 6. Title: Philani program: a case study of an integrative approach of empowerment and social and economic development. Author: Austin SA; Mbewu N Source: Social Work In Public Health. 2009 Jan-Apr;24(1-2):148-60. Abstract: This article reports a case study of a South African nongovernmental organization's role in implementing maternal and child health care services for families in Khayelitsha, an informal township in the Western Cape. The township is an extremely poor community with high unemployment and many other social indicators of high need. The case study explores how services were enhanced to respond to the service needs of children and families. The role of economic development as a means of empowering the mothers is examined within the context of nongovernmental organization services. The implications of developing services that integrate social and economic development are discussed as a model for social work practice in the United States. Language: English Keywords: SOUTH AFRICA | SUMMARY REPORT | CASE STUDIES | NONGOVERNMENTAL ORGANIZATIONS | MATERNAL-CHILD HEALTH SERVICES | NEEDS | POVERTY | ECONOMIC DEVELOPMENT | SOCIAL DEVELOPMENT | WOMEN'S EMPOWERMENT | INTEGRATED PROGRAMS | SOCIAL POLICY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Organizations | Political Factors | Sociocultural Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Economic Factors | Socioeconomic Factors | Women's Status | Programs | Organization and Administration | Policy Document Number: 341952 |
| 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. Title: [Newborn babies' health in Rwanda: evolution of factors associated with neonatal mortality trends] La sante des nouveau-nes au Rwanda. Evolution des facteurs associes aux tendances Author: Beck L Source: Sante Publique. 2009 Mar-Apr;21(2):159-72. Abstract: In spite of increasing attention for maternal and child health, neonatal mortality (before the age of one month) represents a significant part of infant mortality in sub-Saharan Africa. Several demographic and health surveys show the lack of any major improvement since the 1980s in Rwanda, and despite some indication of minor improvement, any real progress has been countered by periods of aggravation of the situation. However, a noticeable decrease in neonatal mortality seems to have begun since the year 2000. This study describes the evolution of the determinants of neonatal mortality between 1980 and 2000 and the obstacles that hinder its sustainable decline. Regressive logistical analyses conducted with data on several different generations of newborns showed the persistence of some unfavourable factors and conditions, such as the short period of time between births of babies carried to term and premature births. Nevertheless, although the conditions for pregnancy and delivery are still insufficient, the quality of pre-natal and newborn care seems to be improving. Language: French Keywords: RWANDA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | NEONATAL MORTALITY | DEATH RATE | MORTALITY DETERMINANTS | MATERNAL-CHILD HEALTH SERVICES | NEEDS | QUALITY OF HEALTH CARE | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Infant Mortality | Mortality | Primary Health Care | Health Services | Delivery of Health Care | Health | Economic Factors | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 342436 |
| 9. Title: Task-shifting: exposing the cracks in public health systems [editorial] Author: Berer M Source: Reproductive Health Matters. 2009 May;17(33):4-8. Abstract: This editorial piece discusses the innovative efforts to increase access to skilled reproductive health care especially in resource-poor settings where physicians are in short supply or physicians are not necessary due to trained mid-level providers performing procedures. It also examines the lack of capacity or failure of developing countries to build and strengthen their health systems and develop a strong, well-trained public health workforce. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HEALTH PERSONNEL | PUBLIC HEALTH | PRIMARY HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | HUMAN RESOURCES | TRAINING ACTIVITIES | HEALTH POLICY | DELIVERY OF HEALTH CARE | ANTIRETROVIRAL THERAPY | FINANCIAL ACTIVITIES | QUALITY OF HEALTH CARE | Health | Health Services | Economic Factors | Training Programs | Education | Policy | Political Factors | Sociocultural Factors | HIV | HIV Infections | Viral Diseases | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 342010 |
| 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. Peer Reviewed Title: Incidence and correlates of 'catastrophic' maternal health care expenditure in India. Author: Bonu S; Bhushan I; Rani M; Anderson I Source: Health Policy and Planning. 2009 Aug 17; Abstract: Using data from the 60(th) round of the National Sample Survey of India (2004), the study investigates the incidence and correlates of 'catastrophic' maternal expenditure (ME) in India. Data on ME come from 6879 births that took place during 365 days prior to the survey. The study adapts earlier definitions and methods for catastrophic total health care expenditure to measure 'catastrophic' ME as: (i) maternal health care expenditure more than 10% of the annual normative household consumption expenditure (ME-1), and (ii) maternal health care expenditure more than 40% of the annual 'capacity to pay' (ME-2). The 'capacity to pay' was derived by subtracting state-wise poverty-line household expenditure from household consumption expenditure. The average maternal expenditure varied by place of delivery: US$9.5, US$24.7 and US$104.3 for birth at home, in a public facility and in a private facility, respectively. Sixteen per cent of households incurred ME of more than 10% of total household consumption expenditure (ME-1), while 51% households incurred ME of more than 40% of household 'capacity to pay' (ME-2). While incidence of ME-1 increased with income decile, the reverse was observed for ME-2, reflecting higher non-utilization of institutional maternal care and its non-affordability among poorer households. All the households from the poorest decile and 99% from the second poorest decile paid more than 40% of their capacity to pay. Multivariate regression results indicate that antenatal care and delivery care in private facilities increased the chances of ME-1 and ME-2 (P < 0.001). Measuring maternal expenditure against 'capacity to pay' (ME-2) may be better than measuring it as a proportion of overall household expenditure when assessing financial constraints in the use of maternal services. Improving the performance of the public sector, appropriate regulation of and partnership with the private sector, and effective direct cash transfers to pregnant women in the poorest households may increase utilization of maternal services and reduce the financial distress associated with ME. Language: English Keywords: INDIA | RESEARCH REPORT | EXPENDITURES | INCIDENCE | MATERNAL HEALTH | UTILIZATION OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | FEES | Asia, Southern | Asia | Developing Countries | Financial Activities | Economic Factors | Measurement | Research Methodology | Health | Health Services | Delivery of Health Care | Primary Health Care Document Number: 342553 |
| 12. Peer Reviewed Title: Saving the lives of South Africa's mothers, babies, and children: can the health system deliver? Author: Chopra M; Daviaud E; Pattinson R; Fonn S; Lawn JE Source: Lancet. 2009 Sep 5;374(9692):835-46. Abstract: South Africa is one of only 12 countries in which mortality rates for children have increased since the baseline for the Millennium Development Goals (MDGs) in 1990. Continuing poverty and the HIV/AIDS epidemic are important factors. Additionally, suboptimum implementation of high-impact interventions limits programme effectiveness; between a quarter and half of maternal, neonatal, and child deaths in national audits have an avoidable health-system factor contributing to the death. Using the LiST model, we estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is $220 million per year. Such progress would put South Africa squarely on track to meet MDG 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | ESTIMATION TECHNIQUES | ECONOMIC MODEL | EXCESS MORTALITY | CAUSES OF DEATH | HIV INFECTIONS | INTERVENTIONS | IMPLEMENTATION | HEALTH POLICY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | PRIMARY HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | PERFORMANCE IMPROVEMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Theoretical Models | Mortality | Population Dynamics | Demographic Factors | Population | Viral Diseases | Diseases | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Health Services | Delivery of Health Care | Health | Management Document Number: 342802 |
| 13. Title: Evaluation of the birthweight values of newborns presenting at the Mother-Child Health and Family Planning Center in Yenibosna, Istanbul, Turkey. Author: Dolgun G; Cimen S; Yazici S; Savaser S Source: Nursing and Health Sciences. 2009 Jun;11(2):174-9. Abstract: This study was conducted to examine the effect of a number of variables related to the mother (age, educational level, employment status, cigarette smoking during pregnancy) and to the baby (sex and birth order) on newborns' birthweight. The research was carried out in the province of Istanbul, one of Turkey's large metropolises, at the Mother-Child Health and Family Planning Center in the district of Yenibosna, where 0-1 month old infants had been brought in for phenylketonuria screening and vaccinations. The mean age of the mothers was 26.1 +/- 4.8 years and the mean birthweight of the newborns was 3236.7 +/- 542.2 g. Of the infants, 6.3% were classified as having a low birthweight and 8.3% were large infants. The mean birthweight showed a statistical significance depending upon the infants' sex and birth order. The mean birthweight of the infants of the working mothers, as opposed to the unemployed mothers and the mothers in nuclear families, as opposed to the mothers in extended families, was higher. Language: English Keywords: TURKEY | RESEARCH REPORT | EVALUATION | INFANT | EDUCATION | PREGNANCY | BIRTH WEIGHT | MATERNAL-CHILD HEALTH SERVICES | REPRODUCTIVE AGE | Europe, Southeastern | Europe | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproduction | Body Weight | Physiology | Biology | Primary Health Care | Health Services | Delivery of Health Care | Health Document Number: 341575 |
| 15. Title: Systematic analysis of research underfunding in maternal and perinatal health. Author: Fisk NM; Atun R Source: BJOG. 2009 Feb;116(3):347-56. Abstract: BACKGROUND: Little published evidence supports the widely held contention that research in pregnancy is underfunded compared with other disease areas. OBJECTIVES: To assess absolute and relative government and charitable funding for maternal and perinatal research in the UK and internationally. SEARCH STRATEGY, SELECTION CRITERIA, DATA COLLECTION, AND ANALYSIS: Major research funding bodies and alliances were identified from an Internet search and discussions with opinion leaders/senior investigators. Websites and annual reports were reviewed for details of strategy, research spend, grants awarded, and allocation to maternal and/or perinatal disease using generic and disease-specific search terms. MAIN RESULTS: Within the imprecision in the data sets, < or =1% of health research spend in the UK was on maternal/perinatal health. Other countries fared better with 1-4% investment, although nonexclusive categorisation may render this an overestimate. In low-resource settings, government funders focused on infectious disease but not maternal and perinatal health despite high relative disease burden, while global philanthropy concentrated on service provision rather than research. Although research expenditure has been deemed as appropriate for 'reproductive health' disease burden in the UK, there are no data on the equity of maternal/perinatal research spend against disease burden, which globally may justify a manyfold increase. AUTHOR'S CONCLUSIONS: This systematic review of research expenditure and priorities from national and international funding bodies suggests relative underinvestment in maternal/perinatal health. Contributing factors include the low political priority given to women's health, the challenging nature of clinical research in pregnancy, and research capacity dearth as a consequence of chronic underinvestment. Language: English Keywords: UNITED KINGDOM | LITERATURE REVIEW | EVALUATION | POLICYMAKERS | GOVERNMENT | NONGOVERNMENTAL ORGANIZATIONS | CHILDBIRTH | MATERNAL-CHILD HEALTH SERVICES | FINANCIAL ACTIVITIES | ECONOMIC FACTORS | PREGNANCY | GRANTS | RESEARCH ACTIVITIES | EXPENDITURES | Developed Countries | Europe, Western | Europe | Administrative Personnel | Organization and Administration | Political Factors | Sociocultural Factors | Organizations | Pregnancy Outcomes | Reproduction | Primary Health Care | Health Services | Delivery of Health Care | Health | Research Methodology Document Number: 331089 |
| 16. Peer Reviewed Title: Evaluation of cluster-randomized trials on maternal and child health research in developing countries. Author: Handlos LN; Chakraborty H; Sen PK Source: Tropical Medicine and International Health. 2009 Aug;14(8):947-56. Abstract: OBJECTIVE: To summarize and evaluate all publications including cluster-randomized trials used for maternal and child health research in developing countries during the last 10 years. METHODS: All cluster-randomized trials published between 1998 and 2008 were reviewed, and those that met our criteria for inclusion were evaluated further. The criteria for inclusion were that the trial should have been conducted in maternal and child health care in a developing country and that the conclusions should have been made on an individual level. Methods of accounting for clustering in design and analysis were evaluated in the eligible trials. RESULTS: Thirty-five eligible trials were identified. The majority of them were conducted in Asia, used community as randomization unit, and had less than 10,000 participants. To minimize confounding, 23 of the 35 trials had stratified, blocked, or paired the clusters before they were randomized, while 17 had adjusted for confounding in the analysis. Ten of the 35 trials did not account for clustering in sample size calculations, and seven did not account for the cluster-randomized design in the analysis. The number of cluster-randomized trials increased over time, and the trials generally improved in quality. CONCLUSIONS: Shortcomings exist in the sample-size calculations and in the analysis of cluster-randomized trials conducted during maternal and child health research in developing countries. Even though there has been improvement over time, further progress in the way that researchers utilize and analyse cluster-randomized trials in this field is needed. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | EVALUATION | DATA ANALYSIS | MATERNAL HEALTH | CHILD HEALTH | MATERNAL-CHILD HEALTH SERVICES | QUALITY OF HEALTH CARE | Research Methodology | Health | Primary Health Care | Health Services | Delivery of Health Care | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 342974 |
| 17. Peer Reviewed Title: Emergency obstetric care and referral: experience of two midwife-led health centres in rural Rajasthan, India. Author: Iyengar K; Iyengar SD Source: Reproductive Health Matters. 2009 May;17(33):9-20. Abstract: This paper documents the experience of two health centres in a primary health service located in interior rural areas of southern Rajasthan, northern India, where trained nurse-midwives are providing skilled maternal and newborn care round the clock daily. The nurse-midwives independently detect and manage complications and decide when to refer women to the nearest hospital for emergency care, in telephonic consultation with a doctor if required. From 2000-2008, 2,771 women in labour and 202 women with maternal emergencies who were not in labour were attended by nurse-midwives. Of women in labour, 21% had a life-threatening complication or its antecedent condition and 16% were advised referral, of which two-thirds complied. Compliance with referral was higher for maternal conditions than fetal conditions. Among the 202 women who came with complications antenatally, post-abortion or post-partum, referral was advised for 70%, of whom 72% complied. The referral system included counselling, arranging transport, accompanying women, facilitating admission and supporting inpatient care, and led to higher referral compliance rates. There was only one maternal death in nine years. We conclude that trained nurse-midwives can significantly improve access to skilled maternal and neonatal care in rural areas, and manage maternal complications with and without the need for referral. Protocols must acknowledge that some families might not comply with referral advice, and also that initial care by nurse-midwives can reverse progression of certain complications and thereby avert the need for referral. Spanish Abstract: Este artículo documenta la experiencia de dos centros de salud de primer nivel situados en zonas rurales del interior de Rajasthan meridional, en la India septentrional, donde enfermeras-parteras profesionales capacitadas brindan atención calificada a madres y recién nacidos las 24 horas del día. Independientemente, ellas detectan y manejan complicaciones y deciden cuándo remitir a las mujeres al hospital más cercano para que reciban atención de urgencia, en consulta telefónica con un médico si es necesario. Desde 2000 a 2008, 2,771 mujeres en trabajo de parto y 202 con urgencias maternas, que no estaban de parto, fueron atendidas por enfermeras-parteras profesionales. De las que estaban de parto, el 21% presentó una complicación que puso en riesgo su vida, o su afección antecedente, y el 16% fueron aconsejadas referencia y, de éstas, dos terceras partes accedieron. El cumplimiento de la referencia fue más alto para las afecciones maternas que para las fetales. Entre las 202 mujeres que llegaron con complicaciones antenatales, se aconsejó referencia postaborto o posparto al 70%, de las cuales el 72% accedieron. El sistema de referencia incluyó consejería, planes de transporte, acompańar a las mujeres, facilitar admisión y atención con apoyo a las pacientes internadas, por lo cual aumentaron las tasas de cumplimiento de referencias. En nueve ańos hubo una sola muerte materna. Concluimos que las enfermeras-parteras profesionales capacitadas pueden mejorar considerablemente el acceso a la atención materna y neonatal calificada en zonas rurales, y manejar las complicaciones maternas con o sin la necesidad de referencias. Los protocolos deben reconocer la posibilidad de que algunas familias no sigan el consejo de referencia, y que la atención inicial brindada por enfermeras-parteras profesionales puede detener la evolución de algunas complicaciones y evitar la necesidad de referencia. French Abstract: Dans deux centres de santé d’un service de soins de santé primaires situé dans des zones rurales de l’intérieur du Rajasthan méridional, en Inde septentrionale, des infirmičres sages-femmes formées assurent des soins de la mčre et du nouveau-né tous les jours, 24 heures sur 24. Les infirmičres sages-femmes décčlent et prennent en charge indépendamment les complications et décident quand transférer les femmes ŕ l’hôpital le plus proche pour des soins d’urgence, si nécessaire en consultation téléphonique avec un médecin. De 2000 ŕ 2008, les infirmičres sages-femmes se sont occupées de 2771 femmes en couches et de 202 femmes avec d’autres urgences maternelles. Sur les femmes en couches, 21% présentaient une complication pouvant entraîner la mort ou son stade précédent ; et 16% se sont vu conseiller un transfert et les trois quarts l’ont accepté. L’acceptation du transfert était plus élevée pour les problčmes maternels que fśtaux. Un transfert a été conseillé ŕ 70% des 202 femmes présentant des complications prénatales, post-avortement ou post-partum, et 72% d’entre elles l’ont accepté. Le systčme de transfert comprenait des conseils, l’organisation du transport, l’accompagnement des patientes, l’aide ŕ l’admission et aux soins hospitaliers ; il a accru les taux d’acceptation du transfert. Un seul décčs maternel a été enregistré en neuf ans. Nous en concluons que, dans les zones rurales, les infirmičres sages-femmes formées peuvent notablement élargir l’accčs ŕ des soins maternels et néonatals compétents, et prendre en charge les complications maternelles nécessitant ou non un transfert. Les protocoles doivent reconnaître qu’il arrive que des familles ne suivent pas les recommandations de transfert et aussi que les soins donnés initialement par des infirmičres sages-femmes peuvent régler certaines complications et éviter la nécessité d’un transfert de la patiente. Language: English Keywords: INDIA | EVALUATION REPORT | NURSE-MIDWIVES | EMERGENCY SERVICES | OBSTETRICS | PRIMARY HEALTH CARE | REFERRAL AND CONSULTATION | RURAL HEALTH CENTERS | MATERNAL-CHILD HEALTH SERVICES | PROGRAM ACCESSIBILITY | PREGNANCY COMPLICATIONS | COUNSELING | Asia, Southern | Asia | Developing Countries | Evaluation | Health Personnel | Delivery of Health Care | Health | Health Services | Medicine | Program Activities | Programs | Organization and Administration | Health Facilities | Program Evaluation | Diseases | Clinic Activities Document Number: 342011 |
| 18. Peer Reviewed Title: Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Author: Jehan I; Harris H; Salat S; Zeb A; Mobeen N; Pasha O; McClure EM; Moore J; Wright LL; Goldenberg RL Source: Bulletin of the World Health Organization. 2009 Feb;87(2):130-8. Abstract: OBJECTIVE: To evaluate the prevalence, sex distribution and causes of neonatal mortality, as well as its risk factors, in an urban Pakistani population with access to obstetric and neonatal care. METHODS: Study area women were enrolled at 20-26 weeks' gestation in a prospective population-based cohort study that was conducted from 2003 to 2005. Physical examinations, antenatal laboratory tests and anthropometric measures were performed, and gestational age was determined by ultrasound to confirm eligibility. Demographic and health data were also collected on pretested study forms by trained female research staff. The women and neonates were seen again within 48 hours postpartum and at day 28 after the birth. All neonatal deaths were reviewed using the Pattinson et al. system to assign obstetric and final causes of death; the circumstances of the death were determined by asking the mother or family and by reviewing hospital records. Frequencies and rates were calculated, and 95% confidence intervals were determined for mortality rates. Relative risks were calculated to evaluate the associations between potential risk factors and neonatal death. Logistic regression models were used to compute adjusted odds ratios. FINDINGS: Birth outcomes were ascertained for 1280 (94%) of the 1369 women enrolled. The 28-day neonatal mortality rate was 47.3 per 1000 live births. Preterm birth, Caesarean section and intrapartum complications were associated with neonatal death. Some 45% of the deaths occurred within 48 hours and 73% within the first week. The primary obstetric causes of death were preterm labour (34%) and intrapartum asphyxia (21%). Final causes were classified as immaturity-related (26%), birth asphyxia or hypoxia (26%) and infection (23%). Neither delivery in a health facility nor by health professionals was associated with fewer neonatal deaths. The Caesarean section rate was 19%. Almost all (88%) neonates who died received treatment and 75% died in the hospital. CONCLUSION: In an urban population with good access to professional care, we found a high neonatal mortality rate, often due to preventable conditions. These results suggest that, to decrease neonatal mortality, improved health service quality is crucial. Language: English Keywords: PAKISTAN | RESEARCH REPORT | PROSPECTIVE STUDIES | URBAN POPULATION | NEONATAL MORTALITY | RISK FACTORS | PREVALENCE | PREMATURE LABOR | CESAREAN SECTION | CAUSES OF DEATH | MATERNAL-CHILD HEALTH SERVICES | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Health | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Primary Health Care Document Number: 341787 |
| 19. Title: On the spatial inequalities of institutional versus home births in Ghana: a multilevel analysis. Author: Johnson FA; Padmadas SS; Brown JJ Source: Journal of Community Health. 2009;34:64-72. Abstract: Spatial inequalities related to the choice of delivery care have not been studied systematically in Sub-Saharan Africa where maternal and perinatal health outcomes continue to worsen despite a range of safe motherhood interventions. Using retrospective data from the 1998 and 2003 Demographic and Health Surveys, this paper investigates the extent of changes in spatial inequalities associated with type of delivery care in Ghana with a focus on rural-urban differentials within and across the three ecological zones (Savannah, Forest and Coastal). More than one-half of births in Ghana continue to occur outside health institutions without any skilled obstetric care. While this is already known, we present evidence from multilevel analyses that there exist considerable and growing inequalities, with regard to birth settings between communities, within rural and urban areas and across the ecological zones. The results show evidence of poor and disproportionate use of institutional care at birth; the inequalities remained high and unchanged in both urban and rural communities within the Savannah zone and widening in urban communities of the Forest and Coastal zones. The key policy challenges in Ghana, therefore, include both increasing the uptake of institutional delivery care and ensuring equity in access to both public and private health institutions. Language: English Keywords: GHANA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | CHILDBIRTH | HOME CARE | HOSPITALS | INEQUALITIES | DELIVERY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Care and Support | Health Services | Health | Health Facilities | Socioeconomic Factors | Economic Factors | Primary Health Care Document Number: 340222 |
| 20. Title: Evidence-based maternal and perinatal healthcare practices in public hospitals in Argentina. Author: Karolinski A; Micone P; Mercer R; Gibbons L; Althabe F; Belizan JM; Messina A; Lapidus A; Correa A; Taddeo C; Lambruschini R; Bertin M; Dibiase L; Montes Varela D; Laterra C Author: AMBA Perinatal Network Research Group Source: International Journal of Gynaecology and Obstetrics. 2009 May;105(2):118-22. Abstract: OBJECTIVE: To investigate the use of beneficial maternal and perinatal healthcare practices in a network of public maternity hospitals in Argentina. METHOD: A multicenter, prospective, descriptive study of 6661 deliveries in 9 hospitals. The use of 5 obstetric care practices that reduce maternal and perinatal morbidity and mortality was evaluated. RESULTS: Median use rates for the selected practices were: continuous support for women during childbirth (17.9%); corticosteroids for preterm birth (35.3%); avoidance of episiotomy in primiparous women (41.2%); iron and folate supplementation (52.5%); active management of third stage of labor (93.5%). CONCLUSION: There is limited use of the selected evidence-based maternal and perinatal practices in public hospitals in Argentina and a large variation in their use among and within hospitals. Efforts should be made to increase the use of these evidence-based practices. Language: English Keywords: ARGENTINA | RESEARCH REPORT | PREVALENCE | INFANT | FETUS | MATERNAL-CHILD HEALTH SERVICES | UTILIZATION OF HEALTH CARE | HOSPITALS | South America, Southern | South America | Latin America | Americas | Developing Countries | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Primary Health Care | Health Services | Delivery of Health Care | Health | Health Facilities Document Number: 341373 |
| 21. Title: Audit for maternal and newborn health services in resource-poor countries. Author: Kongnyuy EJ; van den Broek N Source: BJOG. 2009 Jan;116(1):7-10. Abstract: Each year more than 536 000 women worldwide die from complications of pregnancy and childbirth. Many more survive but will suffer ill health and disability as a result of these complications. In addition, an estimated 4 million neonatal deaths occur each year, accounting for almost 40% of all deaths in children younger than 5 years. The key strategies that have been identified to reduce this global burden are the presence of skilled birth attendants, the availability of essential (or emergency) obstetric care4 and newborn care. To have major effects on maternal outcomes, it is crucial that these elements are not just available but also of high quality. And assessment of quality requires effective clinical audit. However, anyone who has undertaken a clinical audit will realise that the practice is not as simple as the theory, and 'closing the loop' (to achieve the desired endpoint of improvements in clinical care) is often difficult. So the process of clinical audit itself must be critically evaluated. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | INFANT | INFANT HEALTH | QUALITY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | NEEDS ASSESSMENT | PERFORMANCE IMPROVEMENT | COST EFFECTIVENESS | MEASUREMENT | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Child Health | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Evaluation | Management | Evaluation Indexes | Quantitative Evaluation | Research Methodology Document Number: 330471 |
| 22. Peer Reviewed Title: Integrating quality postnatal care into PMTCT in Swaziland. Author: Mazia G; Narayanan I; Warren C; Mahdi M; Chibuye P; Walligo A; Mabuza P; Shongwe R; Hainsworth M Source: Global Public Health. 2009;4(3):253-70. Abstract: Swaziland's prevention of mother-to-child transmission (PMTCT) programme is linked to maternal and newborn health (MNH) services, but is mainly focussed on HIV/AIDS. Existing MNH services are inadequate, especially postnatal care (PNC) of mothers and babies, with delayed postnatal visits occurring at 4-6 weeks after delivery. Fifty-seven percent of staff in seven Swazi health facilities were trained in promoting and providing early PNC. A final evaluation showed a 20-fold increase in the number of visits coming for an early postnatal visit (within the first three days after birth). A direct observation of the client-provider interaction showed a significant increase in the competence of the health workers related to postnatal examinations, and care of mothers and babies (p<0.05- < 0.01). The percentage of women breastfeeding within one hour of delivery increased by 41% in HIV-positive mothers and 52% in HIV-negative mothers. Cotrimoxazole prophylaxis for HIV-exposed infants increased by 24%. Although, health workers were observed providing counselling, maternal recall of messages was deficient, suggesting the need for additional strategies for promoting healthy behaviours. High-quality integrated PMTCT programmes and MNH postnatal services are feasible and acceptable, and can result in promoting early postnatal visits and improved care of both HIV-positive and HIV-negative mothers and their babies. Language: English Keywords: SWAZILAND | RESEARCH REPORT | PILOT PROJECTS | PROVIDERS WITH CLIENTS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | MATERNAL-CHILD HEALTH SERVICES | INTEGRATED PROGRAMS | PROGRAM EFFECTIVENESS | TRAINING ACTIVITIES | KNOWLEDGE | CLINIC VISITS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Health Services | Delivery of Health Care | Health | Disease Transmission Control | Prevention and Control | Diseases | Primary Health Care | Programs | Organization and Administration | Program Evaluation | Training Programs | Education | Sociocultural Factors | Service Statistics | Program Activities Document Number: 341394 |
| 23. Peer Reviewed Title: The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania. Author: Mrisho M; Obrist B; Schellenberg JA; Haws RA; Mushi AK; Mshinda H; Tanner M; Schellenberg D Source: BMC Pregnancy and Childbirth. 2009;9:10. Abstract: BACKGROUND: Although antenatal care coverage in Tanzania is high, worrying gaps exist in terms of its quality and ability to prevent, diagnose or treat complications. Moreover, much less is known about the utilisation of postnatal care, by which we mean the care of mother and baby that begins one hour after the delivery until six weeks after childbirth. We describe the perspectives and experiences of women and health care providers on the use of antenatal and postnatal services. METHODS: From March 2007 to January 2008, we conducted in-depth interviews with health care providers and village based informants in 8 villages of Lindi Rural and Tandahimba districts in southern Tanzania. Eight focus group discussions were also conducted with women who had babies younger than one year and pregnant women. The discussion guide included information about timing of antenatal and postnatal services, perceptions of the rationale and importance of antenatal and postnatal care, barriers to utilisation and suggestions for improvement. RESULTS: Women were generally positive about both antenatal and postnatal care. Among common reasons mentioned for late initiation of antenatal care was to avoid having to make several visits to the clinic. Other concerns included fear of encountering wild animals on the way to the clinic as well as lack of money. Fear of caesarean section was reported as a factor hindering intrapartum care-seeking from hospitals. Despite the perceived benefits of postnatal care for children, there was a total lack of postnatal care for the mothers. Shortages of staff, equipment and supplies were common complaints in the community. CONCLUSION: Efforts to improve antenatal and postnatal care should focus on addressing geographical and economic access while striving to make services more culturally sensitive. Antenatal and postnatal care can offer important opportunities for linking the health system and the community by encouraging women to deliver with a skilled attendant. Addressing staff shortages through expanding training opportunities and incentives to health care providers and developing postnatal care guidelines are key steps to improve maternal and newborn health. Language: English Keywords: TANZANIA | RESEARCH REPORT | KAP SURVEYS | FOCUS GROUPS | RURAL POPULATION | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | HEALTH PERSONNEL | ANTENATAL CARE | MATERNAL-CHILD HEALTH SERVICES | QUALITY OF HEALTH CARE | UTILIZATION OF HEALTH CARE | PERCEPTION | ATTITUDES | FEAR | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Data Collection | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Delivery of Health Care | Health | Maternal Health Services | Primary Health Care | Health Services | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Psychological Factors | Behavior | Emotions Document Number: 331236 |
| 24. Peer Reviewed Title: Pulmonary tuberculosis among women with cough attending clinics for family planning and maternal and child health in Dar Es Salaam, Tanzania. Author: Ngadaya ES; Mfinanga GS; Wandwalo ER; Morkve O Source: BMC Public Health. 2009 Aug 3;9(1):278. Abstract: ABSTRACT: BACKGROUND: Tuberculosis (TB) case detection in women has remained low in developing world. This study was conducted to determine the proportion of smear positive TB among women with cough regardless of the duration attending family Planning (FP) and Maternal and child health (MCH) clinics in Dar es Salaam. METHODS: We conducted a cross sectional study in all three municipal hospitals of Dar es Salaam, between October 2007 and June 2008. All women with cough attending FP and MCH clinics were screened for TB by smear microscopy. Pearson chi- square was used to compare group difference for categorical variables. Risk factors for smear positive were estimated by logistics regression with 95% confidence intervals (CI) given for odds ratios indicating statistically significant relationship if the CI did not include one. RESULTS: We enrolled a total of 749 TB suspects. Five hundred and twenty nine patients (70.6%) were from MCH clinics. Mean (SD) age was 27.6 (5.2) years. A total of 616 (82.2%) patients were coughing for less than two weeks as compared to 133 (17.8%), who coughed for two or more weeks. Among 616 TB suspects, 14 (2.3%) were smear positive TB patients, and of the 133 who had coughed for two or more weeks, 13 (9.8%) were smear positive TB patients. Risk factors associated with smear positive results were having attended more than one visit to any facility prior to diagnosis (OR=6.8; 95%CI 2.57- 18.0) and having HIV/AIDS (OR= 4.4; 95%CI 1.65-11.96). Long duration of cough was not a risk factor for being smear positive (OR=1.6; 95%CI 0.59-4.49). CONCLUSION: The proportion of smear positive TB patients among women with cough attending MCH and FP was 3.8%. Visits to any health facility prior to Diagnosis and HIV infection were risk for having a smear positive TB. Language: English Keywords: TANZANIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | FAMILY PLANNING CENTERS | FAMILY PLANNING CLINIC ATTENDANCE | MATERNAL-CHILD HEALTH SERVICES | HOSPITALS | TUBERCULOSIS | SIGNS AND SYMPTOMS | LABORATORY EXAMINATIONS AND DIAGNOSES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Family Planning Program Evaluation | Family Planning Programs | Family Planning | Primary Health Care | Health Services | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine Document Number: 342421 |
| 25. Title: Use of traditional and complementary health practices in prenatal, delivery and postnatal care in the context of HIV transmission from mother to child (Pmtct) in the Eastern Cape, South Africa. Author: Peltzer K; Phaswana-Mafuya N; Treger L Source: African Journal of Traditional, Complementary and Alternative Medicines. 2009;6(2):155-162. Abstract: The aim of this study was as part of a baseline assessment in PMTCT in the traditional health sector: a) to determine the views of women who have used the services of traditional practitioners before, during and/or after pregnancy, and b) to conduct formative research with traditional health practitioners (THPs), i.e. herbalists, diviners and traditional birth attendants (TBAs) on HIV, pregnancy care, delivery and infant care. The sample included a) 181 postnatal care clients with a child less than 12 months interviewed at postnatal clinic visits from 20 primary care clinics in the Kouga Local Service Area (LSA), Cacadu district, Eastern Cape, and b) 54 traditional birth attendants (TBAs) and 47 herbalists and/or diviners were interviewed from Kouga LSA. Results showed that THP (in particular TBAs and to a certain extend herbalists/diviners) play a significant role in pregnancy and postnatal care, and also with the assistance of delivery. Certain HIV risk practices were reported on the practice of TBAs. THPs also seem to have some role in infant feeding and family planning. THPs should be trained in optimising their services in pregnancy and postnatal care, and preparation for health facility delivery. In addition, they should be trained on HIV risk practices, HIV/AIDS, HIV prevention including PMTCT, infant feeding and family planning. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PREGNANT WOMEN | MOTHERS | UTILIZATION OF HEALTH CARE | TRADITIONAL HEALTH PRACTICES | TRADITIONAL MEDICINE | ANTENATAL CARE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | CHILDBIRTH | HEALTH SERVICES | HEALTH FACILITIES | MATERNAL-CHILD HEALTH SERVICES | INFANT HEALTH | HIV INFECTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Delivery of Health Care | Health | Culture | Medicine | Maternal Health Services | Primary Health Care | Disease Transmission Control | Prevention and Control | Diseases | Viral Diseases | Pregnancy Outcomes | Pregnancy | Reproduction | Child Health Document Number: 343012 |
| 26. Peer Reviewed Title: Maternal and child health in the occupied Palestinian territory. Author: Rahim HF; Wick L; Halileh S; Hassan-Bitar S; Chekir H; Watt G; Khawaja M Source: Lancet. 2009 Mar 14;373(9667):967-77. Abstract: The Countdown to 2015 intervention coverage indicators in the occupied Palestinian territory are similar to those of other Arab countries, although there are gaps in continuity and quality of services across the continuum of the perinatal period. Since the mid 1990s, however, access to maternity facilities has become increasingly unpredictable. Mortality rates for infants (age Language: English Keywords: MIDDLE EAST | RESEARCH REPORT | INTERVENTIONS | MATERNAL HEALTH | CHILD HEALTH | MATERNAL-CHILD HEALTH SERVICES | QUALITY OF HEALTH CARE | DELIVERY OF HEALTH CARE | QUALITY OF LIFE | STANDARDS | PROGRAM ACCESSIBILITY | Programs | Organization and Administration | Health | Primary Health Care | Health Services | Health Services Evaluation | Program Evaluation | Social Welfare | Economic Factors | Research Methodology Document Number: 330802 |
| 27. Title: Management capacity assessment for national health programs: a study of RCH program in India. Author: Ramani KV; Mavalankar D Source: Journal of Health Organization and Management. 2009;23(1):133-42. Abstract: PURPOSE: This paper aims to focus on the management capacity assessment of the Reproductive and Child Health (RCH) program at the state level. DESIGN/METHODOLOGY/APPROACH: Based on an extensive literature survey, and discussions with senior officers in charge of RCH program at the central and state level, the authors have developed a conceptual framework for management capacity assessment. Central to their framework are a few determinants of management capacity, a set of indicators to estimate these determinants, and a management capacity assessment tool to be administered by each state. A pilot survey of the management tool in a few states helped the authors to refine each instrument and finalize the same. A suitable management structure is suggested for effective management of the RCH program based on the population in each state. FINDINGS: The assessment brought out the need to strengthen the planning and monitoring of RCH activities, HR management practices, and inter-departmental coordination. PRACTICAL IMPLICATIONS: The Ministry of Health and Family Welfare, Government of India has accepted the management tool and asked each state to administer it. The recommended management structure is used as a guideline by each state to identify the capacity gaps and take necessary steps to augment its management capacity. ORIGINALITY/VALUE: The authors' framework to assess the management capacity of RCH program is very comprehensive, the management tool is easy to administer, and assessment of capacity gaps can be made quickly. Language: English Keywords: INDIA | EVALUATION REPORT | MATERNAL-CHILD HEALTH SERVICES | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | HEALTH SERVICES ADMINISTRATION | CAPACITY BUILDING | MONITORING | PLANNING | IMPLEMENTATION | Asia, Southern | Asia | Developing Countries | Evaluation | Primary Health Care | Health Services | Delivery of Health Care | Health | Family Planning | Programs | Organization and Administration | Management | Program Sustainability Document Number: 341808 |
| 28. Peer Reviewed Title: Reasons for non-adherence to vaccination at mother and child care clinics (MCCs) in Lambarene, Gabon. Author: Schwarz NG; Gysels M; Pell C; Gabor J; Schlie M; Issifou S; Lell B; Kremsner PG; Grobusch MP; Pool R Source: Vaccine. 2009 Jul 16; Abstract: The aim of this paper is to explore attitudes of mothers towards childhood vaccinations and reasons for non-attendance and non-adherence to mother-child clinics (MCCs). Forty in-depth interviews with mothers of children under 5 years of age revealed positive attitudes towards vaccination that seem at odds with the region's observed low vaccination coverage. Important reasons for MCC non-attendance included distance to the MCC, transport costs, negative experiences at MCCs (such as interactions with unfriendly staff) and mothers' feeling of shame provoked by different, often poverty-associated reasons such as attending the clinic with a dirty or poorly clothed child. Language: English Keywords: GABON | RESEARCH REPORT | MOTHERS | MATERNAL-CHILD HEALTH SERVICES | VACCINATION | USER COMPLIANCE | ATTITUDES | QUESTIONNAIRES | INTERVIEWS | CLINIC VISITS | DISTANCE | TRANSPORTATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Immunization | Behavior | Psychological Factors | Data Collection | Research Methodology | Service Statistics | Program Activities | Programs | Organization and Administration | Geographic Factors | Population | Economic Factors Document Number: 342280 |
| 29. Title: Assessment of quality of midwifery care in labour and delivery wards of selected Kordestan Medical Science University hospitals. Author: Simbar M; Ghafari F; Zahrani ST; Majd HA Source: International Journal of Health Care Quality Assurance. 2009;22(3):266-77. Abstract: PURPOSE: Quality improvement of reproductive health care has been announced as one of five global strategies to accelerate progress toward reproductive health goals. The World Health Organization emphasises the evaluation of structure, procedure and outcome of health services to improve quality of care. This study aims to assess the quality of provided care in labour and delivery units in two selected Kordestan Medical Science University hospitals. DESIGN/METHODOLOGY/APPROACH: A descriptive study methodology was utilised to assess the quality of care provided to 96 women with normal pregnancies. Two checklists were used to observe procedures of care and structure together with a questionnaire utilised to assess satisfaction ratings of patients. Data were analysed by SPSS 11.5. FINDINGS: Midwifery care was provided in different stages of labour, with the following mean percentages of compatibility with desirable situation: first stage of labour (71.4 per cent), second stage of labour (63.03 per cent), third stage of labour (80.63 per cent) and first 2 hours after labour (70.50 per cent). The lowest scores were related to the domains of "emotional support", "hand wash" and "assessment of vital signs". ORIGINALITY/VALUE: The paper develops instructions for care provision or promotion of partograph use for continuous monitoring and evaluation of quality of care by managers. Increasing midwifery personnel and providing facilities for accompanied people to improve quality of emotional care can lead to quality improvement, and finally the women's health and satisfaction. Language: English Keywords: IRAN | RESEARCH REPORT | SAMPLING STUDIES | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | HOSPITALS | MATERNAL-CHILD HEALTH SERVICES | MEDICAL PROCEDURES | QUALITY OF HEALTH CARE | CHILDBIRTH | QUESTIONNAIRES | SATISFACTION | Middle East | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Health Facilities | Primary Health Care | Health Services | Medicine | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Pregnancy Outcomes | Pregnancy | Reproduction | Psychological Factors | Behavior Document Number: 341990 |
| 30. Title: How to mobilize communities for improved maternal and newborn health. Author: Storti C Source: [Baltimore, Maryland], JHPIEGO, Access to Clinical and Community Maternal, Neonatal and Women’s Health Services Program [ACCESS], 2009 Apr. [90] p. Abstract: This guide is intended for individuals who will work with communities as they mobilize to improve maternal and newborn health. It has two parts: Chapter one is a general overview of maternal and newborn health. Chapters two through seven take the readers step by step through the mobilization process, following the phases of the community action cycle. This part contains all of the essential instructions for carrying out a community mobilization initiative to improve the health of pregnant women and newborns. Language: English Keywords: DEVELOPING COUNTRIES | TEACHING MATERIALS | QUESTIONNAIRES | MOTHERS | PREGNANT WOMEN | INFANT | MATERNAL HEALTH | INFANT HEALTH | MATERNAL-CHILD HEALTH SERVICES | ANTENATAL CARE | POSTPARTUM PROGRAMS | INFECTION PREVENTION | PREVENTIVE MEDICINE | DELIVERY OF HEALTH CARE | COMMUNITY PARTICIPATION | COMMUNITY-BASED DISTRIBUTION WORKERS | PLANNING METHODOLOGY | EVALUATION METHODOLOGY | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Health | Child Health | Primary Health Care | Health Services | Maternal Health Services | Family Planning Programs | Family Planning | Infections | Diseases | Medicine | Organization and Administration | Community Workers | Health Personnel | Planning | Evaluation Document Number: 331789 |
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