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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

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Peer Reviewed

Title: Community-based skilled birth attendants in Bangladesh: attending deliveries at home.
Author: Ahmed T; Jakaria SM
Source: Reproductive Health Matters. 2009 May;17(33):45-50.
Abstract: Only 15% of births in Bangladesh in 2007 were delivered at health facilities, but the increase over previous years has been significant, and treatment-seeking from a medically trained provider for obstetric complications has also increased. A programme to create a cadre of skilled birth attendants for home births was launched by the Government of Bangladesh in 2004. The training, for community-based health and family planning fieldworkers, covers 74 essential midwifery skills and danger signs for referral. Training of trainers and supervisors for the fieldworkers was also initiated. By the end of 2008 an estimated 4,000 out of a proposed 13,500 skilled birth attendants and 50 of 4,000 proposed supervisors had been trained and were working in 56 districts. There needs to be a full evaluation of the programme and whether it has reduced maternal deaths. Bangladesh now needs to decide how long to invest in this programme and/or whether to train a new cadre of fully qualified midwives, as proposed by the Nursing Council. We believe this programme can only be an interim measure, not a long-term solution, as more women decide to seek institutional delivery and professional midwifery care. For the moment, though, task-shifting seems to have yielded beneficial results and important insights into human resources planning for safe motherhood in Bangladesh.
Spanish Abstract: En 2007, s�lo el 15% de los partos en Bangladesh ocurrieron en establecimientos de salud. En comparaci�n con a�os anteriores, este porcentaje ha aumentado considerablemente, al igual que la b�squeda de tratamiento de complicaciones obst�tricas brindado por un profesional m�dico capacitado. En 2004, el Gobierno de Bangladesh lanz� un programa para crear una categor�a de asistentes de partos calificados que ayudaran con los partos domiciliares. La capacitaci�n de trabajadores comunitarios de la salud y de planificaci�n familiar, abarca 74 habilidades esenciales de parter�a y los signos de alarma para dar referencias. Tambi�n se inici� la capacitaci�n de capacitadores y supervisores de los trabajadores de campo. A finales de 2008, aproximadamente 4,000 de los 13,500 asistentes de partos calificados y 50 de los 4,000 supervisores propuestos hab�an recibido capacitaci�n y estaban trabajando en 56 distritos. Es necesario realizar una evaluaci�n completa del programa y determinar si �ste ha logrado disminuir la tasa de muertes maternas. Bangladesh debe decidir por cu�nto tiempo continuar invirtiendo en este programa y/o si capacitar a un nuevo grupo de parteras profesionales plenamente cualificadas, como propone el Consejo de Enfermer�a. Estimamos que este programa es s�lo una medida provisional, no una soluci�n de largo plazo, ya que cada vez m�s aumenta el n�mero de mujeres que deciden buscar atenci�n institucional y cuidados de parter�a profesionales. No obstante, por ahora la reasignaci�n de tareas parece haber dado buenos resultados e importantes datos sobre los recursos humanos en la planificaci�n de la maternidad sin riesgos en Bangladesh.
French Abstract: Au Bangladesh, en 2007, 15% seulement des naissances avaient eu lieu dans un �tablissement de sant�, mais la hausse par rapport aux pr�c�dentes ann�es �tait sensible et le recours aux services d'un prestataire form� m�dicalement pour les complications obst�tricales avait aussi augment�. En 2004, le Gouvernement a lanc� un programme de cr�ation d'un groupe d'accoucheuses qualifi�s pour les naissances � domicile. La formation des agents de sant� et de planification familiale communautaires couvre 74 comp�tences obst�tricales essentielles et les signes de danger exigeant le transfert de la patiente. La formation des formateurs et des superviseurs des agents de terrain a aussi �t� lanc�e. Fin 2008, environ 4000 des 13 500 accoucheuses qualifi�s envisag�s et 50 des 4000 superviseurs pr�vus avaient �t� form�s et travaillaient dans 56 districts. Il faut mener une �valuation compl�te du programme et d�terminer s'il a diminu� les d�c�s maternels. Le Bangladesh doit maintenant d�cider pendant combien de temps investir dans ce programme et/ou s'il souhaite former un nouveau groupe de sages-femmes pleinement qualifi�es, ainsi que l'a propos� le Conseil des infirmi�res. Nous pensons que ce programme ne peut �tre qu'une mesure provisoire et non une solution � long terme, � mesure que davantage de femmes opteront pour un accouchement institutionnel et des soins de sages-femmes professionnelles. Pour le moment, n�anmoins, la d�l�gation des t�ches semble avoir produit des r�sultats positifs et des connaissances pr�cieuses sur la planification des ressources humaines pour une maternit� � moindre risque au Bangladesh.
Language: English
Keywords:
BANGLADESH | PROGRESS REPORT | PILOT PROJECTS | COMMUNITY WORKERS | MIDWIVES AND MIDWIFERY | CHILDBIRTH | REFERRAL AND CONSULTATION | GOVERNMENT PROGRAMS | TRAINING OF TRAINERS | MEDICAL SUPERVISION | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Program Activities | Programs | Organization and Administration | Training Programs | Education | Supervision | Management
Document Number: 342014

Title: Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births.
Author: de Jonge A; van der Goes BY; Ravelli AC; Amelink-Verburg MP; Mol BW; Nijhuis JG; Bennebroek Gravenhorst J; Buitendijk SE
Source: BJOG. 2009 Aug;116(9):1177-84.
Abstract: OBJECTIVE: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. DESIGN: A nationwide cohort study. SETTING: The entire Netherlands. POPULATION: A total of 529,688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321,307 (60.7%) intended to give birth at home, 163,261 (30.8%) planned to give birth in hospital and for 45,120 (8.5%), the intended place of birth was unknown. METHODS: Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics. MAIN OUTCOME MEASURES: Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit. RESULTS: No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16). CONCLUSIONS: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.
Language: English
Keywords:
NETHERLANDS | RESEARCH REPORT | COHORT ANALYSIS | RETROSPECTIVE STUDIES | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | PERINATAL MORTALITY | CHILDBIRTH | PREGNANCY OUTCOMES | RISK FACTORS | MATERNAL AGE | Europe, Western | Europe | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Mortality | Population Dynamics | Pregnancy | Reproduction | Parental Age | Age Factors
Document Number: 342276

4.
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

Peer Reviewed

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

6.
Peer Reviewed

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

Title: Midwives in China: 'jie sheng po' to 'zhu chan shi'.
Author: Harris A; Belton S; Barclay L; Fenwick J
Source: Midwifery. 2009 Apr;25(2):203-12.
Abstract: We explore the position of midwifery in contemporary China, and draw on fieldwork conducted in Shanxi and Sichuan Provinces during 2005 and 2006, the available literature in English and to a lesser extent in Mandarin. We also explore the historical antecedents to the present-day professional status, practices and position within the health-care system of midwifery in China. We consider the effect on midwifery of the place of biomedicine in the modernising project of the post-reform State, the shift of birth from the private to the public domain, the rise of the medical profession, the medicalisation of birth and the increasing use of technology, and trace changes in the nature of relations between midwives, doctors and the State from Imperial China to the present day. In particular, we examine the changes that have occurred as midwifery has moved from the arena of the lay practitioner ('jie sheng po') to the professional ('zhu chan shi'). We draw out and critique some ways that midwives act to differentiate themselves and lay claim to a variant body of practice-based knowledge, yet question the capacity of midwifery in China today to assert, in any substantial way, a professional identity that distinguishes it from medical obstetric practice.
Language: English
Keywords:
CHINA | RESEARCH REPORT | MIDWIVES AND MIDWIFERY | HEALTH PERSONNEL | PUBLIC SECTOR | CHANGES | Asia, Eastern | Asia | Developing Countries | Delivery of Health Care | Health | Macroeconomic Factors | Economic Factors | Social Change | Sociocultural Factors
Document Number: 341368

10.

11.

Title: Influence of provider training on quality of emergency obstetric care in Kenya. January 2009. Based on further analysis of the 2004 Kenya Service Provision Assessment Survey.
Author: Olenja J; Godia P; Kibaru J; Egondi T
Source: Calverton, Maryland, Macro International, MEASURE DHS, 2009 Jan. [33] p. (USAID Contract No. GPO-C-00-03-00002-00Kenya Working Papers No. 3)
Abstract: In addition to infectious diseases, maternal and neonatal conditions account for a substantial part of the health gap between rich and poor countries. For example, more than 99 percent of maternal deaths occur in the developing world. The majority of the deaths are caused by direct obstetric complications, including haemorrhage, sepsis, eclampsia, obstructed labour, and unsafe abortion practices. In Kenya, complications related to pregnancy and childbirth are leading causes of morbidity and mortality, translating to 414 maternal deaths per 100,000 live births. Although 88 percent of Kenyan women attend antenatal care, only 40 percent deliver in the health facilities, and only 42 percent of all deliveries have skilled attendance at delivery. In the Kenyan context, access to and use of quality emergency obstetric care (EmOC) are essential to efforts aimed at reducing maternal morbidity and mortality. We examine data from the 2004 Kenya Service Provision Assessment (KSPA) to assess the availability of EmOC services in Kenya, and to demonstrate the importance of health worker training in the delivery of these life-saving services. We find that less than 20 percent of maternal health workers interviewed had received training in focused antenatal or postnatal care in the last three years. Among caregivers providing delivery services, only 18 percent had received training in lifesaving skills, and only 37 percent had received training in the prevention of mother-to-child transmission of HIV during the last three years. Our analysis also demonstrates that training is a critical element in the detection and management of complications. Recent training in relevant subject matter was found to be significantly and positively associated with the ability to provide quality care in the event of unsafe abortion and postpartum haemorrhage. Training was also positively associated with the ability to provide appropriate care in the event of a retained placenta. The obvious recommendation is to ensure that up-to-date, quality training is provided to a broad base of health workers at all types of facilities, particularly at the local facilities that are the first point of contact for women experiencing an obstetric emergency. It is recognized that there are logistical obstacles to increasing the number of health workers who receive training. Further, although we isolated the element of training for this analysis, it is clear from these findings that for optimal service outcome, quality-of-care training has to be undertaken within the context of improved infrastructure and as a support to service delivery.
Language: English
Keywords:
KENYA | RESEARCH REPORT | HEALTH SURVEYS | HEALTH PERSONNEL | EMERGENCY PERSONNEL | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | EMERGENCY SERVICES | OBSTETRICS | QUALITY OF HEALTH CARE | EDUCATIONAL STATUS | PREGNANCY COMPLICATIONS | DELIVERY OF HEALTH CARE | HEALTH SERVICES EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Services | Medicine | Program Evaluation | Programs | Organization and Administration | Socioeconomic Status | Socioeconomic Factors | Diseases
Document Number: 329886

12.
Title: [The experience of the Mexican maternal health care program Arranque Parejo en la Vida] Participacion social en salud: la experiencia del programa de salud materna
Author: Orozco-Nunez E; Gonzalez-Block MA; Kageyama-Escobar LM; Hernandez-Prado B
Source: Salud Publica De Mexico. 2009 Mar-Apr;51(2):104-13.
Abstract: OBJECTIVE: To evaluate the implementation of its participative strategies and the creation of support networks for poor pregnant women. MATERIAL AND METHODS: A qualitative and comparative evaluation was carried on in four states. RESULTS: Coordination and community participation were relevant in relation with major resources allocation and availability, particularly housing and transportation. Governmental actors involvement and leadership favoured linking and coordination. Pregnant women used to valuate as the major support source the one provided by their kinship networks. CONCLUSIONS: To strengthen and to stimulate participative strategies is fundamental in zones with high maternal mortality rates. The wide appreciation of kinship networks, midwives and voluntaries' support to pregnant women in housing and transportation, suggests that these actors are a functional component of the support network; it is insufficient focusing the support network on health services and municipal authorities.
Language: Spanish
Keywords:
MEXICO | RESEARCH REPORT | QUALITATIVE RESEARCH | COMPARATIVE STUDIES | WOMEN | LOW INCOME POPULATION | PREGNANT WOMEN | COMMUNITY PARTICIPATION | MATERNAL HEALTH | KINSHIP NETWORKS | MIDWIVES AND MIDWIFERY | VOLUNTEERS AND VOLUNTARISM | LEADERSHIP | North America | Americas | Developing Countries | Research Methodology | Studies | Demographic Factors | Population | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Population Characteristics | Organization and Administration | Health | Family and Household | Sociocultural Factors | Health Personnel | Delivery of Health Care
Document Number: 342075

13.
Peer Reviewed

Title: Maternal mortality-reduction programme in Andhra Pradesh.
Author: Prakasamma M
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):220-34.
Abstract: Andhra Pradesh, a large state in southern India, has a high maternal mortality ratio of 195 per 100,000 livebirths despite the improvements in social, demographic and health indicators over the last two decades. This contrary situation has been analyzed using findings of different studies on maternal mortality, and four factors have been presented for consistently-high maternal mortality in the state. First, the disproportionately-high focus on family planning towards population stabilization reduced the emphasis on maternal health in the peripheral hospitals, resulting in low use of these facilities for childbirths. Second, the growth of services in Primary Health Centres was not given adequate emphasis, resulting in the weakening of the peripheral health system. Third, there was little emphasis on developing a cadre of midwives who would have primarily focused on maternal health. Lastly, the low status of women in the state has hampered timely referral and access to services.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CASE STUDIES | MIDWIVES AND MIDWIFERY | MATERNAL MORTALITY | CAUSES OF DEATH | MATERNAL HEALTH SERVICES | PROGRAM ACCESSIBILITY | HEALTH FACILITIES | SAFE MOTHERHOOD | PREGNANCY COMPLICATIONS | UTILIZATION OF HEALTH CARE | AWARENESS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Program Evaluation | Programs | Organization and Administration | Maternal Health | Diseases | Knowledge | Sociocultural Factors
Document Number: 341933

14.

Peer Reviewed

Title: Avoidable maternal deaths: Three ways to help now.
Author: Prata N; Graff M; Graves A; Potts M
Source: Global Public Health. 2009 Mar 26;:1-12.
Abstract: The current paper examines the realities of women delivering in resource-poor settings, and recommends cost-effective, scalable strategies for making these deliveries safer. Ninety-five percent of maternal deaths occur in poor settings, and the largest proportion of these deaths are women who deliver at home, far away from health care facilities, and without financial access to skilled providers. This situation will improve only when policymakers and programme planners refocus their attention on service delivery and financing interventions, with the potential to reach the largest portion of women living in places where mortality is the highest. We suggest three feasible interventions that can potentially minimise both demand and supply side problems of safe delivery: (1) misoprostol to treat postpartum haemorrhage, an easy to use and heat stable technology to reduce the leading cause of maternal deaths; (2) alternative providers, such as clinical officers, trained to offer emergency obstetric care services; (3) financing safe delivery through vouchers or other mechanisms that can be implemented in poor settings and made attractive to the donor community through output-based assistance (OBA).
Language: English
Keywords:
DEVELOPING COUNTRIES | RECOMMENDATIONS | EVALUATION | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | MATERNAL MORTALITY | CHILDBIRTH | HOME CARE | MICROECONOMIC FACTORS | DELIVERY OF HEALTH CARE | MATERNAL HEALTH SERVICES | MISOPROSTOL | POSTPARTUM | BLEEDING | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Health | Mortality | Population Dynamics | Pregnancy Outcomes | Pregnancy | Reproduction | Care and Support | Health Services | Maternal-Child Health Services | Primary Health Care | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Puerperium | Signs and Symptoms | Diseases
Document Number: 341477

15.
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

16.

Peer Reviewed

Title: Education gender gaps in Pakistan: Is the labor market to blame?
Author: Urquieta J; Angeles G; Mroz R; Lamadrid-Figueroa H; Hernandes B
Source: Economic Development and Cultural Change. 2009 Apr;57(3):539-558.
Abstract: Oportunidades (formerly PROGRESA) is a conditional cash transfer program ran by the Mexican federal government designed to break the intergenerational cycle of poverty. Among other activities, it provides free delivery attendance for women enrolled in the program. Skilled attendance at delivery has been identified as an effective strategy to reduce maternal mortality, an important health problem in Mexico. In this paper we assess the impact of Oportunidades on skilled attendance at delivery taking advantage of the experimental design implemented for the evaluation of this program in rural areas and using a variety of analytical techniques. The main results of the study indicate that Oportunidades had, at best, only a small effect on skilled attendance at delivery in treatment communities. The program had larger effects on those women who had one birth just prior to the experimental treatment and another birth subsequent to the experimental treatment. These results should lead to a review about the strategies used by Oportunidades to increase skilled attendance at delivery.
Language: English
Keywords:
MEXICO | RESEARCH REPORT | CASE CONTROL STUDIES | KAP SURVEYS | STATISTICAL REGRESSION | MATHEMATICAL MODEL | MIDWIVES AND MIDWIFERY | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | RURAL POPULATION | LOW INCOME POPULATION | CHILDBIRTH | GOVERNMENT PROGRAMS | POVERTY | INTERVENTIONS | North America | Americas | Developing Countries | Studies | Research Methodology | Surveys | Sampling Studies | Data Analysis | Theoretical Models | Health Personnel | Delivery of Health Care | Health | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Social Class | Socioeconomic Status | Socioeconomic Factors | Pregnancy Outcomes | Pregnancy | Reproduction | Programs | Organization and Administration
Document Number: 341096

17.

Peer Reviewed

Title: Non-physician clinicians can safely provide first trimester medical abortion.
Author: Yarnall J; Swica Y; Winikoff B
Source: Reproductive Health Matters. 2009 May;17(33):61-69.
Abstract: Mid-level clinicians are integral to provision of pregnancy-related care in many settings. Yet midwives and other non-physician clinicians are excluded from training and from providing medical abortion. A substantial body of evidence exists demonstrating that mid-level providers, including nurses and midwives specialized in pregnancy-related care for women, are either already competently involved in providing medical abortions or have the requisite skills to expand their scope of practice to include medical abortion with a short course of additional training. While additional evidence may be needed to show that second trimester medical abortion can be safely and effectively provided by trained mid-level providers, we argue that for first trimester medical abortion the evidence is sufficient for governments to implement, monitor and evaluate programmes that allow mid-level clinicians to offer first trimester medical abortion independently. Because mid-level clinicians often work in rural or remote areas where physicians are scarce or where there are few surgical facilities or equipment, the expansion of the medical abortion provider pool has the potential to greatly improve the reproductive health of women worldwide.
Spanish Abstract: En muchos lugares, el personal m�dico de nivel intermedio es fundamental en la atenci�n relacionada con el embarazo. No obstante, las parteras profesionales y otros profesionales de la salud no m�dicos son excluidos de recibir capacitaci�n y proporcionar servicios de aborto con medicamentos. Existe un considerable conjunto de pruebas que demuestran que los prestadores de servicios de nivel intermedio, como las enfermeras y parteras profesionales especializadas en la atenci�n del embarazo, ya participan competentemente en efectuar procedimientos de aborto con medicamentos o cuentan con las habilidades necesarias para realizar abortos con medicamentos si atienden un curso corto de capacitaci�n adicional. Aunque se necesitan m�s pruebas para demostrar que los profesionales de nivel intermedio capacitados pueden efectuar procedimientos de aborto con medicamentos en el segundo trimestre de manera segura y eficaz, arg�imos que para el primer trimestre existe suficiente evidencia para que los gobiernos establezcan, monitoreen y eval�en programas que permitan que los profesionales de la salud de nivel intermedio ofrezcan servicios de aborto con medicamentos de primer trimestre independientemente. Dado que estos profesionales suelen trabajar en zonas rurales o remotas donde los m�dicos son escasos o donde existen pocos centros o equipos quir�rgicos, al ampliarse el grupo de prestadores de servicios de aborto con medicamentos se podr�a mejorar notablemente la salud reproductiva de las mujeres del mundo.
French Abstract: Les cliniciens de niveau interm�diaire font souvent partie int�grante des soins li�s � la grossesse. Pourtant, les sages-femmes et autres cliniciens non m�decins sont exclus de la formation et de la pratique de l'avortement m�dicamenteux. Or, une somme consid�rable de donn�es montre que les prestataires de niveau interm�diaire, notamment les infirmi�res et les sages-femmes sp�cialis�es dans les soins li�s � la grossesse, sont d�j� engag�s avec comp�tence dans les avortements m�dicamenteux ou poss�dent les aptitudes requises pour �largir leur pratique et y inclure l'avortement m�dicamenteux apr�s une br�ve formation compl�mentaire. Si des recherches suppl�mentaires seront peut-�tre n�cessaires pour montrer que les prestataires de niveau interm�diaire peuvent pratiquer efficacement et en toute s�curit� l'avortement m�dicamenteux du deuxi�me trimestre, nous estimons qu'il existe suffisamment de preuves pour que les gouvernements appliquent, surveillent et �valuent des programmes qui autoriseront les cliniciens de niveau interm�diaire � proposer de mani�re ind�pendante des avortements m�dicamenteux du premier trimestre. Comme ces cliniciens travaillent souvent dans des zones rurales ou �loign�es, o� les m�decins sont rares ou qui disposent de peu de centres ou d'�quipements chirurgicaux, l'expansion du corps de prestataires de l'avortement m�dicamenteux peut am�liorer sensiblement la sant� g�n�sique des femmes dans le monde.
Language: English
Keywords:
GLOBAL | CRITIQUE | MIDWIVES AND MIDWIFERY | NURSE-MIDWIVES | PARAMEDICAL PERSONNEL | ABORTION | PREGNANCY, FIRST TRIMESTER | SAFETY | TRAINING PROGRAMS | GESTATIONAL AGE | HEALTH POLICY | LEGISLATION | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Public Health | Education | Fetus | Policy | Political Factors | Sociocultural Factors
Document Number: 342015 Notification

18.

19.

20.

21.

Title: Effect of WHO Newborn Care Training on neonatal mortality by education.
Author: Chomba E; McClure EM; Wright LL; Carlo WA; Chakraborty H
Source: Ambulatory Pediatrics. 2008 Sep-Oct;8(5):300-304.
Abstract: Background.-Ninety-nine percent of the 4 million neonatal deaths per year occur in developing countries. The World Health Organization (WHO) Essential Newborn Care (ENC) course sets the minimum accepted standard for training midwives on aspects of infant care (neonatal resuscitation, breastfeeding, kangaroo care, small baby care, and thermoregulation), many of which are provided by the mother. Objective.-The aim of this study was to determine the association of ENC with all-cause 7-day (early) neonatal mortality among infants of less educated mothers compared with those of mothers with more education. Methods.-Protocol- and ENC-certified research nurses trained all 123 college-educated midwives from 18 low-risk, first-level urban community health centers (Zambia) in data collection (1 week) and ENC (1 week) as part of a controlled study to test the clinical impact of ENC implementation. The mothers were categorized into 2 groups, those who had completed 7 years of school education (primary education) and those with 8 or more years of education. Results.-ENC training is associated with decreases in early neonatal mortality; rates decreased from 11.2 per 1000 live births pre- ENC to 6.2 per 1000 following ENC implementation (P <.001). Prenatal care, birth weight, race, and gender did not differ between the groups. Mortality for infants of mothers with 7 years of education decreased from 12.4 to 6.0 per 1000 (P < .0001) but did not change significantly for those with 8 or more years of education (8.7 to 6.3 per 1000, P �.14). Conclusions.-ENC training decreases early neonatal mortality, and the impact is larger in infants of mothers without secondary education. The impact of ENC may be optimized by training health care workers who treat women with less formal education.
Language: English
Keywords:
ZAMBIA | URBAN AREAS | RESEARCH REPORT | STATISTICAL STUDIES | NURSES AND NURSING | MIDWIVES AND MIDWIFERY | MOTHERS | EDUCATIONAL STATUS | NEONATAL MORTALITY | WHO | TRAINING PROGRAMS | TRAINING OF TRAINERS | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Infant Mortality | Mortality | Population Dynamics | Demographic Factors | UN | International Agencies | Organizations | Political Factors | Education | Program Evaluation | Programs | Organization and Administration
Document Number: 340233

22.

Peer Reviewed

Title: Addressing the attitudes of service providers: increasing access to professional midwifery care in Nepal.
Author: Clapham S; Pokharel D; Bird C; Basnett I
Source: Tropical Doctor. 2008 Oct;38(4):197-201.
Abstract: Increasing access to professional care during labour and delivery is the central strategy in Nepal's commitment to reducing its maternal mortality ratio. This paper outlines a number of complementary interventions used by the Nepal Safer Motherhood Project to address the negative attitudes prevalent among service providers, which is a contributing factor to the under-utilization of the health-care services. The perspectives of the community and the service providers are presented, with a discussion of the importance of effective communication, the establishment of positive relationships and a demonstration of the critical role of local ownership and involvement in bringing about a positive change.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | KAP SURVEYS | MIDWIVES AND MIDWIFERY | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | DELIVERY OF HEALTH CARE | PROGRAM ACCESSIBILITY | ATTITUDES | CHILDBIRTH | GOVERNMENT PROGRAMS | OWNERSHIP | COMMUNITY PARTICIPATION | UTILIZATION OF HEALTH CARE | OBSTACLES | Developing Countries | Asia, Southern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Health Personnel | Health | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Program Evaluation | Programs | Organization and Administration | Psychological Factors | Behavior | Pregnancy Outcomes | Pregnancy | Reproduction | Socioeconomic Factors | Health Services
Document Number: 329322

23.

24.

Title: What do midwives in one region in Turkey know about cold chain?
Author: Efe E; Oncel S; Ozer ZC
Source: Midwifery. 2008 Sep;24(3):328-34.
Abstract: OBJECTIVE: to discover what midwives in one region in Turkey know about cold-chain equipment. DESIGN: a descriptive interview study. SETTING: primary health-care units in Antalya, Turkey. PARTICIPANTS: 340 midwives working in 35 primary health-care units between March and April 2005. FINDINGS: all participants were women and their mean age was 34 years (standard deviation [SD]=5.24). Eighty (23.5%) of the midwives had worked for 10 years or less, 109 (32.1%) for 11-15 years, and 151 (44.4%) for 16 years or more. Most of the midwives who had worked for 11-15 years (n=105, 96.3%), or had worked for 10 years or less (n=77, 96.3%), were aware of the need to keep vaccines in a refrigerator between 2-8 degrees C, but 63 (42.3%) of the midwives who had worked for 16 years or more did not know the length of time vaccines that had never been used could be stored under primary health-care-centre conditions. CONCLUSION: most midwives in this research had adequate knowledge of the cold chain. However, with continuing education, knowledge deficits can be corrected, and awareness of their roles and responsibilities can be increased to achieve one of Turkey's priority goals for the 21st century.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | INTERVIEWS | MIDWIVES AND MIDWIFERY | COLD CHAIN | LOGISTICS | VACCINES | KNOWLEDGE | Developing Countries | Europe, Southeastern | Europe | Data Collection | Research Methodology | Health Personnel | Delivery of Health Care | Health | Management | Organization and Administration | Medical Procedures | Medicine | Health Services | Sociocultural Factors
Document Number: 328863

25.

Peer Reviewed

Title: Symphysiotomy in Zimbabwe; postoperative outcome, width of the symphysis joint, and knowledge, attitudes and practice among doctors and midwives.
Author: Ersdal HL; Verkuyl DA; Bjorklund K; Bergstrom S
Source: PLoS One. 2008;3(10):e3317.
Abstract: BACKGROUND: Obstructed labour remains one of the leading causes of maternal and foetal death and morbidity in poorly resourced areas of the world, where the 24 hours availability of a caesarean section (CS) cannot be guaranteed, and the CS related mortality rate is still high. In these settings, reinstatement of symphysiotomy has been advocated. The objectives were, in1994; to study perioperative and long-term complications of symphysiotomy and compare them to those related to CS for similar indications, in 1996; to measure the symphyseal width after symphysiotomy and compare it to that after normal vaginal delivery, and, in 1998; to assess knowledge, attitudes and practice related to symphysiotomy among doctors and midwives in Zimbabwe. METHODS AND FINDINGS: Thirty-four women who had undergone symphysiotomy and 29 women who had undergone a CS for obstructed labour were interviewed. The symphyseal widths of 19 women with a previous symphysiotomy were compared to that of 92 women with previous normal vaginal deliveries, using ultrasound technique. Forty-one doctors and 39 midwives, in three central hospitals and seven district hospitals in Zimbabwe, were interviewed about symphysiotomy. None of the 34 women reported serious soft tissue injuries or infections post symphysiotomy. Long-term complications after symphysiotomy do not differ notably from those after CS for similar indications. The intra-articular width of the symphysis pubis is increased after a symphysiotomy. Seventy-nine of the 80 interviewed health care workers knew about symphysiotomy. One obstetrician had performed symphysiotomies. Two-thirds of the participants considered symphysiotomy an obsolete and second-class operation, but lifesaving and appropriate in remote areas of Zimbabwe. Ten of 13 midwives in remote areas wanted to carry out symphysiotomies themselves. CONCLUSIONS: No severe complications due to symphysiotomy were revealed in this study. The results suggest that a modest permanent enlargement of the pelvis post symphysiotomy (together with the absence of a scarred uterus) may facilitate subsequent vaginal delivery. Doctors and midwives working in district hospitals have a more positive attitude to symphysiotomies than the colleagues in central hospitals. Obstetricians (who would have to do the teaching), working in the large urban hospitals almost exclude symphysiotomy as an alternative management in Zimbabwe.
Language: English
Keywords:
ZIMBABWE | RESEARCH REPORT | KAP SURVEYS | CLINICAL RESEARCH | PHYSICIANS | MIDWIVES AND MIDWIFERY | OBSTETRICAL SURGERY | FETAL DEATH | CHILDBIRTH | COMPLICATIONS | ATTITUDES | KNOWLEDGE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Mortality | Population Dynamics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Psychological Factors | Behavior | Sociocultural Factors
Document Number: 329080

26.

Title: Do women respond to expansions in reproductive health care?
Author: Frankenberg E; Buttenheim A; Sikoki B; Suriastini W
Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2008 Mar. 28 p. (MEASURE Evaluation Working Paper Series WP-08-103)
Abstract: We use data from the Indonesia Family Life Survey to investigate the impact of a major expansion in access to midwifery services on use of prenatal care and delivery assistance for women of reproductive age. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in relatively poor communities that were relatively distant from health centers. We show that regardless of a woman's educational level, additions of village midwives to communities are associated with significant increases in receipt of iron tablets and in choices about care during delivery, which reflect a movement away from reliance on traditional birth attendants. For women with relatively low levels of education, village midwives have the additional benefits of increasing use of any prenatal care and use of prenatal care during the first trimester. The results are robust to the inclusion of fixed effects at the individual level, a strategy that addresses many of the concerns about biases because of non-random program placement. (author's)
Language: English
Keywords:
INDONESIA | RESEARCH REPORT | LONGITUDINAL STUDIES | SURVEYS | WOMEN | MIDWIVES AND MIDWIFERY | ANTENATAL CARE | PROGRAM ACCEPTABILITY | UTILIZATION OF HEALTH CARE | PROGRAM EFFECTIVENESS | SOCIOECONOMIC STATUS | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Sampling Studies | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Program Evaluation | Programs | Organization and Administration | Socioeconomic Factors | Economic Factors
Document Number: 325777

27.

Title: Evaluation of an educational programme in Ege University, Turkey: Medical student�s home visits with midwife preceptors.
Author: Gursoy ST; Ocek ZA; Ciceklioglu M; Aksu F; Soyer MT
Source: Midwifery. 2008 Jun;24(2):226-237.
Abstract: The objective was to evaluate the efficiency of the midwife preceptors in teaching comprehensive health care for women and their families through exploring how they perceive their roles as educators and from the perspectives of medical students; to assess the number of educational goals achieved. For midwives, a quantitative method was used for pre- and post-evaluation of a 'Medical Students' Home Visits with Midwife Preceptors' course. Focus-group interviews were used to gather qualitative data. Students were evaluated after undertaking home visits with the midwives. The setting was an urban health centres in Western Turkey and Ege University Faculty of Medicine. Participants: a sample of four clusters of second year medical students (130 out of 284) and all midwives (n = 32) linked with the health centres participated in the programme. In general, both the midwives and the medical students found the programme useful. Students declared that they achieved their learning objectives and midwives stated that they had contributed to this achievement. Scores of eight of the 20 learning objectives significantly increased in the midwives' post-test evaluation. Midwives and students valued the effective communication they had with each other. All midwives participated in focus-group interviews, and reported that the course before the home visits was useful to them. Nearly all of the midwives suggested that the home visits course should be longer, repeated, or both. It was difficult to organise home visits for all of the medical students, and access to some households to enable students to gain training experience was refused. This programme encouraged the medical students to adopt broad public health approaches in assessing the health needs of defined communities. It also increased their awareness of the importance of multi-professional teamwork and comprehensive health care for women and their families. At the same time, the programme improved the professional knowledge of midwives, and they were able to appreciate their roles and functions in primary health care, and enhance their self-esteem. The findings also indicated that this programme is an effective way of promoting multi-professional education in medical schools. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | FOCUS GROUPS | MEDICAL STUDENTS | MIDWIVES AND MIDWIFERY | HOME VISITS | WOMEN'S HEALTH | PROGRAM EVALUATION | UNIVERSITIES | EDUCATIONAL ACTIVITIES | Europe, Southeastern | Europe | Developing Countries | Data Collection | Research Methodology | Students | Education | Health Personnel | Delivery of Health Care | Health | Communication | Programs | Organization and Administration | Schools
Document Number: 326862

28.
Peer Reviewed

Title: Male midwives: preferred managers of sexually transmitted infections in men in developing countries?
Author: Hsieh EJ; Garcia PJ; Roca SL
Source: Revista Panamericana de Salud P�blica / Pan American Journal of Public Health. 2008 Oct;24(4):271-5.
Abstract: OBJECTIVES: To describe demographic and practice characteristics of male and female midwives in private practice (MIPPs) in 10 cities of Peru, and their role in the delivery of reproductive health care, specifically management of sexually transmitted infections (STIs). METHODS: As part of an intervention trial in 10 cities in the provinces of Peru designed to improve STI management, detailed information was collected regarding the number of midwives in each city working in various types of practices. A door-to-door survey of all medical offices and institutions in each city was conducted. Each MIPP encountered was asked to answer a questionnaire regarding demographics, training, practice type(s), number of STI cases seen per month, and average earnings per consultation. RESULTS: Of the 905 midwives surveyed, 442 reported having a private practice, either exclusively or concurrently with other clinical positions; 99.3% of these MIPPs reported managing STI cases. Andean cities had the highest density of MIPPs, followed by jungle and coastal cities, respectively. Jungle cities had the largest proportion of male MIPPs (35.5%). While both male and female MIPPs reported seeing male patients, male MIPPs saw a significantly greater number than their female counterparts. CONCLUSIONS: In areas of Peru where physicians are scarce, MIPPs provide needed reproductive health services, including STI management. Male MIPPs in particular appear to serve as health care providers for male patients with STIs. This trend, which may exist in other developing countries with similar healthcare workforce demographics, highlights the need for new areas of training and health services research.
Language: English
Keywords:
PERU | RESEARCH REPORT | KAP SURVEYS | MIDWIVES AND MIDWIFERY | MEN | URBAN POPULATION | SEXUALLY TRANSMITTED DISEASES | SEX FACTORS | MANAGEMENT | DEMOGRAPHIC FACTORS | PRIVATE SECTOR | FEES | HUMAN GEOGRAPHY | South America, Western | South America | Latin America | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Population | Population Characteristics | Reproductive Tract Infections | Infections | Diseases | Organization and Administration | Macroeconomic Factors | Economic Factors | Financial Activities | Geography | Social Sciences | Science | Sociocultural Factors
Document Number: 330332

29.

Title: Trends in economic differentials in population and health outcomes. Further analysis of the 2006 Nepal Demographic and Health Survey.
Author: Johnson K; Bradley SE
Source: Calverton, Maryland, Macro International, MEASURE DHS, 2008 May. 35 p. (Nepal Further Analysis No. 53USAID Contract No. GPO-C-00-03-00002-00)
Abstract: Nepal has made a surprising number of improvements in population and health outcomes during a trying period in its history. In this report, the authors have focused on the equity of the improvements that have been made, given the concern that national level indicators can improve while masking subnational economic inequalities. They found that in many cases, both levels and equity differentials of critical indicators have improved over time, such as in the case of increased access to safe water and school attendance among children age 6-10. Nevertheless, there is also evidence of severe and worsening economic inequity in some population and health outcomes as well as in access to and use of important health services. It is also important to note that there is no way of knowing how the mortality and displacement of a large number of Nepali people during the course of recent internal conflict have biased the results of this trends analysis.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | HOUSEHOLDS | MIDWIVES AND MIDWIFERY | WOMEN IN DEVELOPMENT | SOCIOECONOMIC STATUS | INEQUALITIES | WOMEN'S STATUS | FERTILITY | CHILD SURVIVAL | CHILD HEALTH | Developing Countries | Asia, Southern | Asia | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Family and Household | Sociocultural Factors | Health Personnel | Delivery of Health Care | Health | Economic Development | Economic Factors | Socioeconomic Factors | Survivorship | Length of Life | Mortality
Document Number: 327744

30.

Peer Reviewed

Title: Reducing maternal mortality and improving maternal health: Bangladesh and MDG 5.
Author: Koblinsky M; Anwar I; Mridha MK; Chowdhury ME; Botlero R
Source: Journal of Health, Population, and Nutrition. 2008 Sep;26(3):280-94.
Abstract: Bangladesh is on its way to achieving the MDG 5 target of reducing the maternal mortality ratio by three-quarters between 1990 and 2015, but the annual rate of decline needs to triple. Although the use of skilled birth attendants has improved over the past 15 years, it remains less than 20% as of 2007 and is especially low among poor, uneducated rural women. Increasing the numbers of skilled birth attendants, deploying them in teams in facilities, and improving access to them through messages on antenatal care to women, have the potential to increase such use. The use of caesarean sections is increasing although not among poor, uneducated rural women. Strengthening appropriate quality emergency obstetric care in rural areas remains the major challenge. Strengthening other supportive services, including family planning and delayed first birth, menstrual regulation, and education of women, are also important for achieving MDG 5.
Language: English
Keywords:
BANGLADESH | RECOMMENDATIONS | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | MATERNAL MORTALITY | GOALS | UN | PROGRAM ACCESSIBILITY | CHILDBIRTH | PERFORMANCE IMPROVEMENT | DELIVERY OF HEALTH CARE | CESAREAN SECTION | EMERGENCY SERVICES | Developing Countries | Asia, Southern | Asia | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Health | Mortality | Population Dynamics | Planning | Organization and Administration | International Agencies | Organizations | Political Factors | Sociocultural Factors | Program Evaluation | Programs | Pregnancy Outcomes | Pregnancy | Reproduction | Management | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services
Document Number: 328890


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