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Title: Use of and unmet need for injectable contraception.
Author: Family Health International [FHI]
Source: [Unpublished] 2009 Jun 8. 12 p.
Abstract: Understanding trends in contraceptive use and unmet need for family planning is critical to creating policies which respond to current gaps in service delivery and address future needs for services to meet existing and unmet demand. Creating non clinic-based mechanisms to deliver services has the potential to expand access to underserved populations and reduce pressure on weak health systems. This document examines patterns of the current use of and unmet demand for injectable services. Trends in use of clinic and non clinic-based services for injectables, differentials in injectable use by place of residence, and potential negative consequences of increased use of injectables are explored. Information described in this paper is intended to inform the Technical Consultation on Expanding Access to Injectable Contraception. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | TECHNICAL REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | INJECTABLES | CONTRACEPTIVE USAGE | NEEDS | COMMUNITY-BASED DISTRIBUTION | CLINICAL DISTRIBUTION | PHARMACIES | CONTRACEPTIVE DISTRIBUTION | GEOGRAPHIC FACTORS | CONTRACEPTION CONTINUATION | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Economic Factors | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Health Facilities | Delivery of Health Care | Health
Document Number: 331836

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Peer Reviewed

Title: Can a clinical prediction tool guide HIV-testing decisions? Experience at a national hospital in Guatemala.
Author: Anderson MR; Samayoa B; O'Sullivan LF; Fletcher J; Arathoon E
Source: International Journal of STD and AIDS. 2009 Jan;20(1):30-4.
Abstract: The USA and international recommendations no longer emphasize using risk factors to target groups for HIV-testing. Using a Guatemalan database of HIV tests, we developed a clinical prediction rule to guide decisions on HIV-testing. Prior to HIV-testing, data were collected on demographics, risk factors and prior testing. Based on a theoretical construct incorporating demographics, known HIV risk factors and symptoms, we developed a logistic regression model to predict HIV seropositivity. Between 2000 and 2005, 16,471 tests were performed, of which 19.8% were positive. The algorithm successfully predicted 1883 of 2489 HIV-positive tests (sensitivity 76%, likelihood ratio [LR]-positive 2.45) and 6282 of 9086 HIV-negative tests (specificity 69%, LR-negative 0.35). Although the model indices are robust, applying the model in a clinical setting would have little impact on improving selective testing practices. Our findings support current recommendations for universal HIV-testing, not selective testing based on risk factors. Before these recommendations can be adopted widely in Guatemala, treatment access needs to be assured and protections put in place for people diagnosed with HIV infection.
Language: English
Keywords:
GUATEMALA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | MATHEMATICAL MODEL | STATISTICAL REGRESSION | HIV TESTING | HOSPITALS | DECISION MAKING | RISK ASSESSMENT | PROBABILITY | Central America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Theoretical Models | Data Analysis | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Behavior | Evaluation | Statistical Studies
Document Number: 330715

Peer Reviewed

Title: Improved sanitation and income are associated with decreased rates of hospitalization for diarrhoea in Brazilian infants.
Author: Andrade IG; Queiroz JW; Cabral AP; Lieberman JA; Jeronimo SM
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 May;103(5):506-11.
Abstract: Diarrhoeal diseases remain a major cause of morbidity and mortality in Brazilian children. However, from 1992 to 2001 there was a significant decline in hospitalizations for acute diarrhoea in children below 1 year of age in Brazil. A significant improvement in child health was also observed in the state of Rio Grande do Norte (RN), with a decrease in child mortality from 70 to 40 deaths per 1000. Using distributed lag analysis we analysed a number of factors possibly connected with decreased hospitalization in RN and found that hospitalization was correlated up to lag 3 with poverty (P<0.001) and inflation (P<0.001). Improvements in public health infrastructure such as better waste collection, presence of city water supply and increased sanitation, socio-economic variables such as education and literacy, and increased investment in health services were all important in reducing severe early childhood diarrhoeas and thus directly associated with the decrease in hospitalization. We also observed a positive seasonal correlation between rainfall and hospitalizations with an increased in rainfall impacting positively on hospitalization in all lags. The data suggests that increased buying power and reductions in poverty played a crucial role in reducing hospitalizations for acute diarrhoea in infants in RN.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | INFANT | DIARRHEA, INFANTILE | POVERTY | INFANT MORTALITY | SANITATION | HOSPITALS | PUBLIC HEALTH | SOCIOECONOMIC FACTORS | PREVENTION AND CONTROL | South America, Eastern | South America | Latin America | Americas | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diarrhea | Diseases | Economic Factors | Mortality | Population Dynamics | Health | Health Facilities | Delivery of Health Care
Document Number: 342512

Peer Reviewed

Title: Evidence behind the WHO guidelines: hospital care for children: what is the evidence that BCG vaccination should not be used in HIV-infected children?
Author: Bannister C; Bennett L; Carville A; Azzopardi P
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):78-82.
Abstract: The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. The WHO guidelines, and more reviews are available at: http://www.ichrc.org. This review addresses the question: What is the evidence that BCG vaccination should not be used in HIV-infected children? The limited evidence currently available has been the basis of the WHO recommendation that BCG vaccination should not be used in HIV-positive children, as severe complications appear more commonly in HIV-infected individuals [8]. This decision is supported by the findings from the Fallo [13] and Hesseling [18, 20] studies. Although the WHO have suggested that HIV-infected infants should not be vaccinated this is obviously difficult in countries where BCG vaccination is administered before HIV status can be detected. Many high HIV-burden countries do not have viral-specific testing (such as PCR) routinely available to adequately assess the infection status of every new born infant. More research needs to be undertaken in this area to clarify the situation, and treating clinicians need to be made aware of this issue with all its complexity. The WHO recommendation highlights the need for viral-specific testing to be widely available in developing countries. This will ensure HIV-infected infants are not exposed to BCG which may be potentially dangerous and HIV-exposed but uninfected infants are not denied this important vaccine.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | WHO | STANDARDS | CHILDREN | HOSPITALS | DELIVERY OF HEALTH CARE | VACCINES | HIV INFECTIONS | Oceania | Developed Countries | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Facilities | Health | Medical Procedures | Medicine | Health Services | Viral Diseases | Diseases
Document Number: 341013

Title: Impact of a peer-group intervention on occupation-related behaviors for urban hospital workers in Malawi.
Author: Chimango JL; Kaponda CN; Jere DL; Chimwaza A; Crittenden KS; Kachingwe SI; Norr KF; Norr JL
Source: Journal of the Association of Nurses In AIDS Care. 2009 Jul-Aug;20(4):293-307.
Abstract: Using a pre- and posttest design with no control group, the authors evaluated the impact of a peer-group intervention on work related knowledge and behavior for health workers at an urban hospital in Malawi. The authors surveyed unmatched random samples of health workers, observed workers on the job, and interviewed clients about hospital services at baseline and at 6 months after the intervention. Universal precautions knowledge, reported hand washing, and reported client teaching were significantly higher at the final evaluation. The outcome differences remained robust in multivariate analyses with controls for demographic factors of age, gender, education, food security, and job category. Observations reported consistently greater use of universal precautions, more respectful interactions, and more client teaching at final evaluation. Patient surveys reported more discussion with health workers about HIV at the final evaluation. Peer-group interventions can prepare health workers in Malawi for HIV prevention and offer a potential model for other African countries.
Language: English
Keywords:
MALAWI | RESEARCH REPORT | SAMPLING STUDIES | URBAN POPULATION | HEALTH PERSONNEL | PEER EDUCATORS | HIV PREVENTION | INTERVENTIONS | HOSPITALS | TRAINING PROGRAMS | UNIVERSAL PRECAUTIONS | KNOWLEDGE | HANDWASHING | INTERPERSONAL RELATIONS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Education | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Health Facilities | Safety | Public Health | Sociocultural Factors | Hygiene | Behavior
Document Number: 342814

Peer Reviewed

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

Peer Reviewed

Title: Task shifting for emergency obstetric surgery in district hospitals in Senegal.
Author: De Brouwere V; Dieng T; Diadhiou M; Witter S; Denerville E
Source: Reproductive Health Matters. 2009 May;17(33):32-44.
Abstract: Due to a long-term shortage of obstetricians, the Ministry of Health of Senegal and Dakar University Obstetric Department agreed in 1998 to train district teams consisting of an anaesthetist, general practitioner and surgical assistant in emergency obstetric surgery. An evaluation of the policy was carried out in three districts in 2006, covering trends in rates of major obstetric interventions, outcomes in newborns and mothers, and the views of key informants, community members and final year medical students. From 2001 to 2006, 11 surgical teams were trained but only six were functioning in 2006. The current rate of training is not rapid enough to cover all districts by 2015. An increase in the rate of interventions was noted as soon as a team had been put in place, but unmet need persisted. Central decision-makers considered the policy more viable than training gynaecologists for district hospitals, but resistance from senior academic clinicians, a perceived lack of career progression among the doctors trained, and lack of programme coordination were obstacles. Practitioners felt the work was valuable, but complained of low additional pay and not being replaced during training. Communities appreciated that the services saved lives and money, but called for improved information and greater continuity of care.
Spanish Abstract: Debido a la prolongada escasez de obstetras, el Ministerio de Salud de Senegal y el Departamento Obst�trico de la Universidad de Dakar acordaron, en 1998, capacitar a equipos distritales integrados por un anestesista, un m�dico general y un auxiliar quir�rgico en cirug�a obst�trica de emergencia. En 2006, se realiz� una evaluaci�n de la pol�tica en tres distritos, donde se examinaron las tendencias en las tasas de intervenciones obst�tricas importantes, los resultados en reci�n nacidos y madres, y los puntos de vista de informantes clave, miembros de la comunidad y estudiantes de medicina en su �ltimo a�o acad�mico. Del 2000 al 2006, 11 equipos quir�rgicos fueron capacitados, pero s�lo seis funcionaban en 2006. El ritmo actual de capacitaci�n no es suficientemente r�pido para abarcar todos los distritos al cabo del 2015. Se observ� un aumento en el �ndice de intervenciones tan pronto se establec�a un equipo, pero la necesidad insatisfecha persisti�. Las autoridades decisorias centrales estimaron que esta pol�tica era m�s viable que capacitar ginec�logos en los hospitales distritales. Entre los obst�culos figuraban la resistencia de los m�dicos acad�micos s�nior, la percibida falta de ascenso profesional entre los m�dicos capacitados y la falta de coordinaci�n del programa. Los m�dicos estimaron el trabajo valioso, pero se quejaban de la baja paga adicional y de no ser sustituidos durante la capacitaci�n. Las comunidades estaban agradecidas porque los servicios salvaron vidas y ahorraron dinero, pero solicitaron mejor informaci�n y mayor continuidad de servicios.
French Abstract: Face au manque d'obst�triciens � long terme, le Minist�re s�n�galais de la sant� et le D�partement d'obst�trique de l'Universit� de Dakar ont convenu en 1998 de former des �quipes de district compos�es d'un anesth�siste, d'un m�decin g�n�raliste et d'un assistant en chirurgie obst�tricale d'urgence. En 2006, une �valuation de la politique a �t� men�e dans trois districts pour analyser les tendances des principales interventions obst�tricales, les r�sultats pour les nouveau-n�s et les m�res et les opinions des informateurs cl�s, des membres des communaut�s et des �tudiants en derni�re ann�e de m�decine. De 2001 � 2006, 11 �quipes chirurgicales ont �t� form�es mais six seulement fonctionnaient encore en 2006. Le rythme actuel de formation n'est pas assez rapide pour couvrir tous les districts d'ici � 2015. Une augmentation du taux d'interventions a �t� not�e d�s la mise en place d'une �quipe, mais les besoins insatisfaits demeuraient. Pour les d�cideurs centraux, cette politique �tait plus viable que la formation de gyn�cologues pour les h�pitaux de district, mais elle se heurtait � la r�sistance des professeurs cliniciens, � un manque per�u de possibilit�s d'avancement pour les m�decins form�s et � une coordination insuffisante entre programmes. Les praticiens estimaient que le travail �tait utile, mais d�ploraient la faible r�mun�ration compl�mentaire et regrettaient de ne pas �tre remplac�s pendant la formation. Les communaut�s se f�licitaient que les services sauvent des vies et �conomisent de l'argent, mais demandaient davantage d'information et une plus grande continuit� des soins.
Language: English
Keywords:
SENEGAL | RESEARCH REPORT | HEALTH PERSONNEL | EMERGENCY SERVICES | OBSTETRICAL SURGERY | HOSPITALS | CESAREAN SECTION | TRAINING PROGRAMS | PROGRAM EVALUATION | HEALTH POLICY | OBSTACLES | UTILIZATION OF HEALTH CARE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Health Services | Surgery | Treatment | Medical Procedures | Medicine | Health Facilities | Education | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors
Document Number: 342013

Title: A survey of mothers' comfort discussing contraception with infant providers at well-child visits.
Author: Fagan EB; Rodman E; Sorensen EA; Landis S; Colvin GF
Source: Southern Medical Journal. 2009 Mar;102(3):260-4.
Abstract: OBJECTIVE: To determine whether mothers feel comfortable with their infants' providers discussing contraception with them at their infants' well-child checks. METHODS: A cross-sectional survey was conducted using a convenience sample of 114 mothers presenting at a community family medicine residency program for well-child visits among infants up to 17 months old. RESULTS: Almost all mothers (87%) felt comfortable talking with their infants' providers about contraception and were likely to accept the advice of their infants' providers to see their own doctors regarding contraception (83%) or to use a prescription from their infants' providers for contraception (75%). CONCLUSION: Many mothers miss or delay their postpartum visits but see their infants' doctor multiple times within the first year. Mothers are comfortable talking with infant providers about contraception. By discussing contraception with mothers at well-child visits, physicians may encourage mothers to use contraception and prevent unintended pregnancies.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | MOTHERS | INFANT | CLINICS | PHYSICIANS | CLINIC VISITS | CONTRACEPTION | POSTPARTUM | INFORMATION | PROVIDERS WITH CLIENTS | Developed Countries | North America | Americas | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Health Personnel | Service Statistics | Program Activities | Programs | Organization and Administration | Family Planning | Puerperium | Reproduction | Health Services
Document Number: 330896

10.

Title: Maternal care under minimal conditions during the war in Croatia.
Author: Habek D
Source: International Journal of Gynaecology and Obstetrics. 2009 May 22;
Abstract: The Medical Corps Unit (MCU) of the 105th Croatian Army Brigade from Bjelovar, Croatia, provided medical care for military personnel wounded in action and civilians living close to the frontline and some distance from civilian medical facilities. Medical treatment was provided in the conflict areas of Novska, East Slavonia, and Posavlje during the 1991-1992 conflict and in 1995 during the Flash and Storm military actions. The MCU was structured as a mobile surgical unit for primary surgical management with an inpatient clinic and complete surgical and resuscitation facilities. It was attended continuously by a resident in surgical specialties, along with a specialist in conservative medicine, medical technicians, and drivers. The Brigade pharmacy was supplied with adequate equipment, medical supplies, and medicines. This report provides an overview of the patients treated for gynecologic-obstetric problems.
Language: English
Keywords:
CROATIA | SUMMARY REPORT | MILITARY PERSONNEL | PROVIDERS WITH CLIENTS | MATERNAL HEALTH SERVICES | OBSTETRICS | EMERGENCY SERVICES | WAR | MOBILE HEALTH UNITS | Europe, Southeastern | Europe | Developing Countries | Government | Political Factors | Sociocultural Factors | Health Services | Delivery of Health Care | Health | Maternal-Child Health Services | Primary Health Care | Medicine | Health Facilities
Document Number: 341450

11.

12.

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 art�culo 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 atenci�n calificada a madres y reci�n nacidos las 24 horas del d�a. Independientemente, ellas detectan y manejan complicaciones y deciden cu�ndo remitir a las mujeres al hospital m�s cercano para que reciban atenci�n de urgencia, en consulta telef�nica con un m�dico 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% present� una complicaci�n que puso en riesgo su vida, o su afecci�n antecedente, y el 16% fueron aconsejadas referencia y, de �stas, dos terceras partes accedieron. El cumplimiento de la referencia fue m�s alto para las afecciones maternas que para las fetales. Entre las 202 mujeres que llegaron con complicaciones antenatales, se aconsej� referencia postaborto o posparto al 70%, de las cuales el 72% accedieron. El sistema de referencia incluy� consejer�a, planes de transporte, acompa�ar a las mujeres, facilitar admisi�n y atenci�n con apoyo a las pacientes internadas, por lo cual aumentaron las tasas de cumplimiento de referencias. En nueve a�os hubo una sola muerte materna. Concluimos que las enfermeras-parteras profesionales capacitadas pueden mejorar considerablemente el acceso a la atenci�n 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 atenci�n inicial brindada por enfermeras-parteras profesionales puede detener la evoluci�n de algunas complicaciones y evitar la necesidad de referencia.
French Abstract: Dans deux centres de sant� d�un service de soins de sant� primaires situ� dans des zones rurales de l�int�rieur du Rajasthan m�ridional, en Inde septentrionale, des infirmi�res sages-femmes form�es assurent des soins de la m�re et du nouveau-n� tous les jours, 24 heures sur 24. Les infirmi�res sages-femmes d�c�lent et prennent en charge ind�pendamment les complications et d�cident quand transf�rer les femmes � l�h�pital le plus proche pour des soins d�urgence, si n�cessaire en consultation t�l�phonique avec un m�decin. De 2000 � 2008, les infirmi�res sages-femmes se sont occup�es de 2771 femmes en couches et de 202 femmes avec d�autres urgences maternelles. Sur les femmes en couches, 21% pr�sentaient une complication pouvant entra�ner la mort ou son stade pr�c�dent ; et 16% se sont vu conseiller un transfert et les trois quarts l�ont accept�. L�acceptation du transfert �tait plus �lev�e pour les probl�mes maternels que f�taux. Un transfert a �t� conseill� � 70% des 202 femmes pr�sentant des complications pr�natales, post-avortement ou post-partum, et 72% d�entre elles l�ont accept�. Le syst�me de transfert comprenait des conseils, l�organisation du transport, l�accompagnement des patientes, l�aide � l�admission et aux soins hospitaliers ; il a accru les taux d�acceptation du transfert. Un seul d�c�s maternel a �t� enregistr� en neuf ans. Nous en concluons que, dans les zones rurales, les infirmi�res sages-femmes form�es peuvent notablement �largir l�acc�s � des soins maternels et n�onatals comp�tents, et prendre en charge les complications maternelles n�cessitant ou non un transfert. Les protocoles doivent reconna�tre qu�il arrive que des familles ne suivent pas les recommandations de transfert et aussi que les soins donn�s initialement par des infirmi�res sages-femmes peuvent r�gler certaines complications et �viter la n�cessit� 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

14.

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

15.

Peer Reviewed

Title: Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan.
Author: Kandasamy T; Merialdi M; Guidotti RJ; Betran AP; Harris-Requejo J
Source: International Journal of Gynecology and Obstetrics. 2009;104:14-17.
Abstract: Objective: To use an active facility-based maternal and newborn surveillance system to describe cesarean delivery practices and outcomes in a resource-poor setting. Methods: Using data from operating room logbooks, 392 cesarean deliveries were evaluated between April 1 and June 30 2006 at a large public maternity hospital in Kabul, Afghanistan. Results: The perinatal mortality rate was 89 per 1000 births: 57% antepartum and 37% intrapartum stillbirths. Fetuses with normal birth weight comprised 85% of intrapartum stillbirths. Obstructed labor, uterine rupture, and malpresentation accounted for more than 50% of perinatal deaths. The cesarean delivery rate was 10.2% and there were 2 maternal deaths. Conclusion: The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives.
Language: English
Keywords:
AFGHANISTAN | RESEARCH REPORT | DATA COLLECTION | CESAREAN SECTION | HOSPITALS | MONITORING | OBSTETRICS | ANESTHESIA | QUALITY OF HEALTH CARE | PERINATAL MORTALITY | MATERNAL MORTALITY | FETAL DEATH | BIRTH WEIGHT | Asia, Southern | Asia | Developing Countries | Research Methodology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Evaluation | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Body Weight | Physiology | Biology
Document Number: 340226

16.
Peer Reviewed

Title: Routine offering of HIV testing to hospitalized pediatric patients at university teaching hospital, Lusaka, Zambia: acceptability and feasibility.
Author: Kankasa C; Carter RJ; Briggs N; Bulterys M; Chama E; Cooper ER; Costa C; Spielman E; Katepa-Bwalya M; M'soka T; Ou CY; Abrams EJ
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):202-8.
Abstract: OBJECTIVES: The difficulties diagnosing infants and children with HIV infection have been cited as barriers to increasing the number of children receiving antiretroviral therapy worldwide. Design: We implemented routine HIV antibody counseling and testing for pediatric patients hospitalized at the University Teaching Hospital, a national reference center, in Lusaka, Zambia. We also introduced HIV DNA polymerase chain reaction (PCR) testing for early infant diagnosis. METHODS: Caregivers/parents of children admitted to the hospital wards were routinely offered HIV counseling and testing for their children. HIV antibody positive (HIV+) children <18 months of age were tested with PCR for HIV DNA. RESULTS: From January 1, 2006, to June 30, 2007, among 15,670 children with unknown HIV status, 13,239 (84.5%) received counseling and 11,571 (87.4%) of those counseled were tested. Overall, 3373 (29.2%) of those tested were seropositive. Seropositivity was associated with younger age: 69.6% of those testing HIV antibody positive were <18 months of age. The proportion of counseled children who were tested increased each quarter from 76.0% in January to March 2006 to 88.2% in April to June 2007 (P < 0.001). From April 2006 to June 2007, 1276 PCR tests were done; 806 (63.2%) were positive. The rate of PCR positivity increased with age from 22% in children <6 weeks of age to 61% at 3-6 months and to 85% at 12-18 months (P < 0.001). CONCLUSIONS: Routine counseling and antibody testing of pediatric inpatients can identify large numbers of HIV-seropositive children in high prevalence settings. The high rate of HIV infection in hospitalized infants and young children also underscores the urgent need for early infant diagnostic capacity in high prevalence settings.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | INFANT | CLIENTS | HIV TESTING | COUNSELING | HOSPITALS | CHILD HEALTH SERVICES | LABORATORY EXAMINATIONS AND DIAGNOSES | IMPLEMENTATION | PROGRAM ACCEPTABILITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Health Facilities | Maternal-Child Health Services | Primary Health Care | Program Evaluation
Document Number: 341754

17.

Title: The hidden figure: sexual intimate partner violence among Pakistani women.
Author: Kapadia MZ; Saleem S; Karim MS
Source: European Journal of Public Health. 2009 Aug 7;
Abstract: BACKGROUND: The objectives of the present study were to determine the magnitude and factors associated with sexual intimate partner violence (SIPV) in women presenting to tertiary-care hospitals of Karachi, Pakistan. METHODS: Five hundred women who presented to four tertiary-care hospitals to deliver were interviewed from September to December 2005. SIPV was assessed by using questions on sexual abuse in WHO Domestic Violence Module designed to determine intimate partner violence. Multiple logistic regression analysis was applied to determine factors associated with SIPV. RESULTS: Twenty-one percent of women reported experiencing sexual violence in their married life. Gravida with five or more pregnancies [adjusted odds ratio (AOR) = 2.78; 95% confidence interval (CI) 1.12-6.96], index pregnancy as unwanted (AOR = 2.64; CI 1.16-6.02) and conflict with in-laws (AOR 1.9 CI 1.14-3.16) were independently associated with sexual abuse. Women who had social support were less likely to be abused by their intimate partners (AOR 0.76; CI 0.58-0.98). CONCLUSION: One in five women reported spousal sexual abuse in their married life. Women having more than five children, unwanted pregnancies or reporting differences with in-laws are more likely to be subjected to such abuse. Social support protects women from sexual abuse by intimate partner.
Language: English
Keywords:
DEVELOPING COUNTRIES | PAKISTAN | RESEARCH REPORT | WOMEN | CLIENTS | TERTIARY SECTOR | HOSPITALS | DOMESTIC VIOLENCE | RISK FACTORS | SEXUAL ABUSE | SOCIAL PROTECTION | Asia, Southern | Asia | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Macroeconomic Factors | Economic Factors | Health Facilities | Delivery of Health Care | Health | Crime | Social Problems | Sociocultural Factors | Political Factors
Document Number: 342536

18.
Title: Baseline survey on functioning of abortion services in government approved CAC centers in three pilot districts of Nepal.
Author: Karki C; Ojha M; Rayamajhi RT
Source: Kathmandu University Medical Journal. 2009 Jan- Mar;7(25):31-9.
Abstract: BACKGROUND: Abortion has been legalized in Nepal since September 2002 and under this law, Comprehensive Abortion Care (CAC) service is being provided through listed service providers and listed health facilities from 2004. Nepal Government has prioritized the national safe abortion program and is working with many government and non government partners for providing this service. Till date medical abortion services are not made available at any of the health facility. Government is now preparing to introduce this service in six selected pilot districts. OBJECTIVE: This survey was carried out to assess the functioning of existing abortion services in 12 Government approved CAC sites of three districts. MATERIALS AND METHODS: Direct observation of the functioning of these centers, assessment of physical facilities and service provider's skill was done. At the same time service provider's attitude and knowledge on CAC service and other abortion services were also assessed through semi structured interviews. Quality of record keeping and the feasibility of initiating the medical abortion service in these sites were also studied. RESULT: Number of listed centers in six pilot districts was twenty nine. Study districts have 16 listed centers. Visited sites were twelve; four managed by Government and eight by non government organizations. Thirty three thousand nine hundred and twenty women have availed this service so far: only 4.76% of them received service from Government facilities. Marie Stopes International (MSI) topped the list in providing service to the maximum number of clients (75.64%) and Family planning association of Nepal (FPAN) was the second. MSI centre was also first to initiate the service. Government facilities provide 24 hours service unlike private facilities which are open only up to 5.00 pm. Cost for the service varies from rupees 900/- to rupees 1365/- and is cheaper at Government facilities. Private sectors have separate setups and Government have allocated some space within their already existing infrastructure for CAC service. Private sectors were better in providing the information to public about the availability of service. There were total 20 trained service providers for first trimester abortion service. They are more at Government facilities. They seem to be positive to CAC service and had good knowledge and skill of service delivery. Complications were not recorded at most of the sites. Pain management and infection prevention practice needs improvement at the Government sites. All the sites had identified their referral sites and had one or the other arrangement for referral. CONCLUSION: CAC service has become accessible and affordable to Nepalese women even at peripheral level. CAC sites are functioning well. Initiation of medical abortion and second trimester abortion services at these sites are feasible and would expand the option and choices available.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | ABORTION | PILOT PROJECTS | HEALTH PERSONNEL | HEALTH SERVICES EVALUATION | FEES | ATTITUDES | KNOWLEDGE | EQUIPMENT AND SUPPLIES | Developing Countries | Asia, Southern | Asia | Fertility Control, Postconception | Family Planning | Studies | Research Methodology | Delivery of Health Care | Health | Health Facilities | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Psychological Factors | Behavior | Sociocultural Factors | Medical Procedures | Medicine | Health Services
Document Number: 342477 Notification

19.

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

20.

Title: Emergency contraception services for adolescents: a National Survey of Children's Hospital Emergency Department Directors.
Author: Kavanaugh ML; Saladino RA; Gold MA
Source: Journal of Pediatric and Adolescent Gynecology. 2009 Apr;22(2):111-9.
Abstract: STUDY OBJECTIVE: To assess emergency contraception (EC) counseling and prescribing practices of children's hospital emergency department (ED) directors and the use of EC protocols in these settings. DESIGN: Cross-sectional study of children's hospital ED directors responding to a 15-minute 44-item semi-structured survey during telephone interviews. PARTICIPANTS: 50 of 96 eligible directors of children's hospital EDs in the United States. MAIN OUTCOME MEASURES: EC protocols, EC counseling processes, EC prescribing practices. RESULTS: Most (80%) ED directors reported always offering EC as part of sexual assault care; 66% were more likely to provide onsite EC in these situations. Only 52% identified the progestin-only regimen as the EC dispensed in their ED, and most (96%) limited provision to fewer than 120 hours after sex. Although 58% of ED directors reported ever prescribing ongoing contraception when providing EC, none had prescribed EC for future use. Written ED protocols for providing EC were more common for sexual assault care (76%) than for non-sexual assault care (14%). Directors who worked at hospitals with a sexual assault program were less likely to discuss all the recommended topics for EC counseling. CONCLUSIONS: The recommended standard of care for providing EC to adolescents in children's hospital EDs is not being met. Although risk of pregnancy following sexual assault and consensual unprotected sex is identical, discrepant practices emerged from this survey of pediatric ED directors. Increased education and policy initiatives within children's hospital EDs are needed to standardize EC services for adolescents in this setting.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | ADMINISTRATIVE PERSONNEL | HEALTH PERSONNEL | ADOLESCENTS, FEMALE | EMERGENCY CONTRACEPTION | HOSPITALS | EMERGENCY SERVICES | COUNSELING | PRESCRIPTIONS | RAPE | CONTRACEPTIVE AVAILABILITY | TIME FACTORS | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Organization and Administration | Delivery of Health Care | Health | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Health Facilities | Health Services | Clinic Activities | Program Activities | Programs | Distributional Activities | Crime | Social Problems | Sociocultural Factors | Population Dynamics
Document Number: 330952

21.

Peer Reviewed

Title: Humanizing access to modern contraceptive methods in national hospitals in Guatemala, Central America.
Author: Kestler E; Barrios B; Hernandez EM; del Valle V; Silva A
Source: Contraception. 2009 Jul;80(1):68-73.
Abstract: BACKGROUND: The overall situation in Guatemala, Central America, regarding programs caring for women's reproductive health has been lagging behind for some decades. Since the year 2000, 56% of Guatemalan families have lived below the poverty line. Guatemala has one of the highest fertility rates (lifetime births per woman) in Latin America and the Caribbean countries, comparable to those observed in less developed countries in Africa. Considering the lack of sex education, poor access to effective contraceptive methods and issues of unwanted pregnancy, Guatemalan women engage in illegal and unsafe abortions, which often causes harm and sometimes death. A key strategy designed to improve women's health is through free and informed access to contraceptive methods that are effective and accepted by Guatemalan women. STUDY DESIGN: From July 1, 2003, to December 31, 2006, specially hired trained facilitators visited 22 public hospitals for 1 week to train corresponding physician staff in postabortion counseling, enabling them to assist patients to select and use an effective contraceptive method. To monitor the progress achieved, the trained facilitators returned 4 weeks later. The main purpose of the training was to focus in strengthening the understanding and technical capacity of the hospital staff to implement postabortion contraceptive counseling and to enable women to obtain an effective contraceptive method prior to hospital discharge. RESULTS: Out of 22 hospitals, 21 managed to improve their record for counseling patients admitted for postabortion complications, from 31% to 96%. Furthermore, the percentage of women being discharged from the hospital with an effective contraceptive method rose from 20% to 64% from 2003 to 2006. CONCLUSION: The successful results obtained during this study to meet postabortion demands by Guatemalan women point out to the urgent need for the government to expand this initiative within the national health system, including health centers nationwide. This is one of the worldwide recommendations previously made by the World Health Organization.
Language: English
Keywords:
GUATEMALA | RESEARCH REPORT | POSTABORTION CARE | CONTRACEPTION | COUNSELING | HOSPITALS | HEALTH SERVICES | PROGRAM ACCESSIBILITY | Central America | Latin America | Americas | Developing Countries | Delivery of Health Care | Health | Family Planning | Clinic Activities | Program Activities | Programs | Organization and Administration | Health Facilities | Program Evaluation
Document Number: 341581

22.

Title: UK centres for Implanon removal [letter]
Author: Mansour D
Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):130.
Abstract: Mea culpa -when writing the article on the UK provision for removal of non-palpable contraceptive implants I forgot to include Dr Martyn Walling in Table 1. Martyn has the UK's greatest experience in removing deep implants and is based at Lincolnshire PCT, Orchard House, Greyleas, Sleaford NG34 8PP, UK. He is very happy to accept written referrals sent to this address. Martyn has also been working as an independent practitioner, travelling the length and breadth of the UK, training doctors to locate and remove non-palpable implants. (full-text)
Language: English
Keywords:
UNITED KINGDOM | DIRECTORY | PHYSICIANS | CONTRACEPTIVE IMPLANTS | REFERRAL AND CONSULTATION | PHYSICIAN'S OFFICE | TRAINING ACTIVITIES | Developed Countries | Europe, Western | Europe | Health Personnel | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Program Activities | Programs | Organization and Administration | Health Facilities | Training Programs | Education
Document Number: 341649

23.

Title: Perinatal audit using the 3-delays model in western Tanzania.
Author: Mbaruku G; van Roosmalen J; Kimondo I; Bilango F; Bergstrom S
Source: International Journal of Gynaecology and Obstetrics. 2009 May 11;
Abstract: OBJECTIVE: To audit intrapartum fetal and early neonatal deaths of infants weighing >/=2000 g in a regional hospital in western Tanzania. METHODS: The 3-delays methodology was applied to a cohort of perinatal deaths from July 2002 to July 2004. RESULTS: The overall perinatal mortality rate in the hospital was 38 per 1000 live births, and in just over half of these cases the birth weight was >/=2000 g. The leading clinicopathologic causes of death were birth asphyxia (19.0%), prolonged or obstructed labor (18.5%), antepartum hemorrhage (11.5%), and uterine rupture (9.0%). First delays occurred in 19.0% of the cases, second delays occurred in 21.5%, and third delays occurred in 72.5%. CONCLUSION: For women who delivered in this hospital, most of the substandard care occurred after admission to the health facility. The improvement of institutional health care may have a significant impact on the decision to attend health institutions and, thereby, reduce first delays.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | COHORT ANALYSIS | PERINATAL MORTALITY | BIRTH WEIGHT | HOSPITALS | QUALITY OF HEALTH CARE | CAUSES OF DEATH | TRANSPORTATION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Body Weight | Physiology | Biology | Health Facilities | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Economic Factors
Document Number: 341453

24.

Title: Ventilator-associated pneumonia in a paediatric intensive care unit in a developing country with high HIV prevalence.
Author: Morrow BM; Argent AC
Source: Journal of Paediatrics and Child Health. 2009 Mar;45(3):104-11.
Abstract: AIM: To obtain preliminary prevalence, aetiological and outcome data on South African paediatric patients with ventilator-associated pneumonia (VAP). METHODS: Non-bronchoscopic bronchoalveolar lavage (BAL) specimens taken between January 2004 and September 2005 were prospectively recorded and related clinical data were retrospectively reviewed. VAP was defined as a new isolate on BAL and a modified Clinical Pulmonary Infection Score > or =5. RESULTS: A total of 230 patients aged 3.9 (2.2-9.1) months (median interquartile range (IQR) ) underwent 309 BALs during 244 paediatric intensive care unit (PICU) admissions. Most patients (84%) were admitted with acute infectious diseases, with a 70% incidence of comorbidity. Thirty-three patients (14.3%) were HIV-exposed but uninfected and 58 (25.2%) were HIV-infected. Of 172 BALs taken > or =48 h after intubation, 63 specimens from 55 patients fulfilled VAP criteria. Acinetobacter baumannii was the most common VAP pathogen, followed by Klebsiella pneumoniae, viruses, yeasts and Staphylococcus aureus. Patients who developed VAP had a higher proportion of comorbid conditions (76% vs. 55%, P= 0.01) and reintubations (39% vs. 12%, P < 0.0001) when compared with non-VAP patients. Median (IQR) length of PICU stay was 12.5 (5-21) days versus 8 (5-14) days (P= 0.03); and the risk adjusted PICU mortality was 1.38 versus 0.79 (P= 0.002) in VAP versus non-VAP patients, respectively. CONCLUSIONS: VAP is associated with significant morbidity and mortality and may relate to the high incidence of comorbid conditions in this population. Primary VAP pathogens differ from developed countries.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLIENTS | INFANT | PNEUMONIA | SIGNS AND SYMPTOMS | HOSPITALS | ANTIBIOTICS | MORBIDITY | INFANT MORTALITY | HIV INFECTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Pulmonary Effects | Physiology | Biology | Diseases | Health Facilities | Delivery of Health Care | Health | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Mortality | Population Dynamics | Viral Diseases
Document Number: 341838

25.

Peer Reviewed

Title: Screening for Chlamydia trachomatis in secondary schools, family planning and occupational health centres in Luxembourg.
Author: Mossong J; Muller M; Majery N; Mardaga C; Decruyenaere F; Schneider F
Source: Sexually Transmitted Infections. 2009 Jul 1;
Abstract: BACKGROUND: We conducted a prospective pilot screening study in three settings in Luxembourg where routine urine testing is carried out independently for other purposes with a short sexual behaviour questionnaire to estimate prevalence and determine risk factors of urogenital Chlamydia trachomatis (CT) infection. METHODS: Screening was offered to sexually active volunteer participants aged less than 25 years in three settings: i) women in 3 family planning centres (FPC), ii) young women and men in 29 secondary schools and iii) women and men in an occupational health centre (OHC) for newly recruited employees and workers. First catch urine samples were tested using the COBAS Amplicor and an in-house assay. Multiple logistic regression was performed to analyse risk factors. RESULTS: Overall prevalence among 4141 participants was 7.7% (95% confidence interval (CI) 6.3-9.2) in FPCs, 1.9% (95% CI 1.2-2.8) in secondary schools and 4.5% (95% CI 3.5-5.6) in the OHC. Depending on the setting, identified risk factors included being 18-22 years old, female sex, having three or more sexual partners in the past year, and inconsistent condom use. CONCLUSION: Screening is feasible in the three settings, but the prevalence of CT infection among men and women is highest in age groups that have left secondary school. Family planning centres were the setting with the highest CT prevalence and the only setting in our study able to provide case management, follow-up and repeat testing.
Language: English
Keywords:
LUXEMBOURG | RESEARCH REPORT | PROSPECTIVE STUDIES | PILOT PROJECTS | CHLAMYDIA | SCREENING | SECONDARY SCHOOLS | FAMILY PLANNING CENTERS | OCCUPATIONAL HEALTH | PREVALENCE | RISK FACTORS | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Schools | Education | Health Facilities | Measurement
Document Number: 341862

26.

Peer Reviewed

Title: Impact of change in maternal age composition on the incidence of Caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999-2005.
Author: Muganyizi PS; Kidanto HL
Source: BMC Pregnancy and Childbirth. 2009 Jul 21;9(1):30.
Abstract: ABSTRACT: BACKGROUND: Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS) and low birth weight deliveries (LBWT) at Muhimbili National Hospital in Tanzania. METHODS: We conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain trends in the risks of CS and LBWT. The impact of age composition changes on CS and LBWT was estimated by calculating annual numbers of these outcomes with and without the major changes in age composition, all others remaining equal. In all statistics, a p value < 0.05 was considered significant. RESULTS: The proportion of teenage mothers (12-19 years) progressively decreased over time while that of 30-34 years age group increased. From 1999, the risk of Caesarean delivery increased steadily to a maximum in 2005[adjusted OR=1.7; 95%CI (1.6-1.8)] whereas that of LBWT declined to a minimum in 2005 (adjusted OR=0.76; 95% CI (0.71-0.82). The current major changes in age trend were responsible for shifts in the number of CS of up to 206 cases per year. Likewise, the shift in LBWT was up to 158 cases per year, but the 30-34 years age group had no impact on this. CONCLUSIONS: The population of mothers giving birth at MNH is progressively becoming older with substantial impact on the incidence of CS and LBWT. Further research is needed to estimate the health cost implications of this change.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | DATA ANALYSIS | STATISTICAL REGRESSION | MATERNAL AGE | CESAREAN SECTION | LOW BIRTH WEIGHT | INCIDENCE | HOSPITALS | INFORMATION RETRIEVAL SYSTEMS | RISK FACTORS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Parental Age | Age Factors | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Birth Weight | Body Weight | Physiology | Biology | Measurement | Health Facilities | Data Storage and Retrieval | Information Processing | Information
Document Number: 342290

27.

Peer Reviewed

Title: Local differences in human immunodeficiency virus prevalence: a comparison of social venue patrons, antenatal patients, and sexually transmitted infection patients in eastern kinshasa.
Author: Mwandagalirwa K; Jackson EF; McClamroch K; Bollinger R; Ryder RW; Weir SS
Source: Sexually Transmitted Diseases. 2009 Jul;36(7):406-12.
Abstract: BACKGROUND: This study compares the sexual behavior and HIV prevalence of men and women at social venues where people meet new sexual partners in Eastern Kinshasa with that of sexually transmitted infection (STI) treatment and antenatal clinic (ANC) patients in the same area. METHODS: ANC patients, STI clinic patients, and social venue patrons were interviewed, asked to provide a blood sample on-site, and provided with information about obtaining test results. Every patron at identified social venues in the study area was invited to participate. RESULTS: One thousand one hundred sixteen pregnant women; 66 male and 229 female STI clinic patients; and 952 male and 247 female patrons of social venues were interviewed and tested for HIV. HIV prevalence differed by group: ANC patients (4%); female venue patrons (12%); female STI patients (16%); male venue patrons (2%); and male STI patients (23%). HIV prevalence among sex workers at social venues (29%) was higher than HIV prevalence among other female patrons with new or multiple partnerships in the past four weeks (19%) and higher than HIV prevalence among female patrons denying sex work (6%). However, the absolute number of infected women was higher among women reporting recent new or multiple partnerships than among the smaller group of sex workers (23 vs. 18). Two-thirds of the infected female STI patients (24/36) reported no more than one and no new sexual partner in the past year. CONCLUSION: Improving prevention programs in Kinshasa is essential. Prevention efforts should not neglect women at social venues who do not self-identify as sex workers but who have high rates of new sexual partnership formation.
Language: English
Keywords:
DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | MULTIPLE PARTNERS | HIV INFECTIONS | PREVALENCE | ANTENATAL CARE | SEXUALLY TRANSMITTED DISEASES | CLINICS | VOLUNTARY COUNSELING AND TESTING | INTERVIEWS | CONDOM USE | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Sexual Partners | Sex Behavior | Behavior | Viral Diseases | Diseases | Measurement | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Reproductive Tract Infections | Infections | Health Facilities | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Data Collection | Risk Reduction Behavior
Document Number: 342831

28.

Title: Assessment of HIV-positive in-patients using the International Classification of Functioning, Disability and Health (ICF) at Chris Hani Baragwanath Hospital, Johannesburg.
Author: Myezwa H; Stewart A; Musenge E; Nesara P
Source: African Journal of AIDS Research. 2009 Apr;8(1):93-105.
Abstract: The International Classification of Functioning, Disability and Health (ICF) short-version checklist was used to assess the impairments, activity limitations and participation restrictions experienced by a sample of HIV-positive in-patients admitted to Chris Hani Baragwanath Hospital in Johannesburg, South Africa. Laboratory tests, observation and review of patients' medical records were used to complete the ICF Checklist. Eighty patients were assessed (23 males and 57 females). Common impairments related to the following functions: digestive, metabolic and endocrine systems (83.9%); sensory (83.5%); haematological, immunological and respiratory systems (82.5%); neuromusculoskeletal movement (73.8%); mental (72.6%); energy and drive (75%); sleep (71%); emotional (62%); and muscle power (75%). Activity limitations were present in the area of mobility (56.4%), major life areas (55.1%), and community, social and civic life (50%). Associations found among impairments, activity limitations and participation restrictions were that patients with sensory problems were five-times more likely to have problems in self-care than people without sensory problems. Patients with impairments in the digestive, genitourinary and neuromusculoskeletal systems experienced problems with general tasks (confidence interval [CI]: 4.05-103.03; p < 0.01). Patients with cardiovascular, haematological, immunological and respiratory system problems were 14-times more likely to have problems with execution of general tasks (odds ratio [OR] 14.06, CI: 2.75-71.94; p = 0.002). Activities of participation restriction, difficulties with general tasks and demands (OR 9.68, CI: 1.20-77.92), interpersonal relationships (OR 3.62, CI: 1.09-12.00), domestic life (OR 3.97, CI: 1.12-14.16), and community, social and civic life (OR 4.13, CI: 1.05-16.20) were closely associated with barriers in obtaining products for personal use and using technology. Understanding the prevalence and associations of disability and function in the course of HIV disease may serve as a baseline for developing appropriate and context-sensitive rehabilitation interventions and management strategies for people living with HIV or AIDS.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLASSIFICATION | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HOSPITALS | HEALTH STATUS INDEXES | LABORATORY EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Health Facilities | Delivery of Health Care | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services
Document Number: 341291

29.

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

30.

Title: Awareness and attitude of health workers at a Nigerian HIV treatment clinic toward HIV/AIDS and HAART adherence.
Author: Olowookere SA; Fatiregun AA; Osagbemi KG
Source: Journal of the International Association of Physicians in AIDS Care. 2009 May-Jun;8(3):208-12.
Abstract: OBJECTIVE: To assess the awareness and attitude of antiretroviral clinic workers to HIV/AIDS and highly active antiretroviral therapy (HAART). METHODS: A descriptive cross-sectional study design using a self-administered questionnaire was used. RESULTS: Of the 43 staff, 39 (92.5%) completed the questionnaire. Their mean age was 35.1 + 7.6 years. There were 19 (48.7%) males and 20 (51.7%) females. The majority (87.2%) had tertiary education. More than three fifths (61.5%) were married. There were 20 (51.3%) professional staff and 19 (48.7%) support staff. Only 28.2% of staff members had ever received on-the-job training in HIV/AIDS care. None of the adherence counselors had ever received any training in HIV/AIDS care and HAART adherence counseling. Despite this lack of training, this majority of the clinic staff had good knowledge about and a positive attitude to HIV/AIDS and HAART adherence. CONCLUSION: Adherence counselors and support staff required on-the-job training for optimum job performance.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | HEALTH PERSONNEL | AIDS | HIV INFECTIONS | CLINICS | AWARENESS | ATTITUDES | KNOWLEDGE | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Viral Diseases | Diseases | Health Facilities | Sociocultural Factors | Psychological Factors | Behavior | HIV
Document Number: 342455


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