摘要:

AbstractPragmatic approaches to safe motherhood consider the needs of both clients and providers: the sociological and physical environments within which a woman lives and moves through to reach a level of care that fulfills her health needs; and the conditions of formal and traditional health care systems within which a health care provider works and moves through to reach a level of professional satisfaction and quality care that fulfills her/his needs and responsibilities. These movements toward higher levels of ‘care’ are interdependent; without one, the other falters. Clients and providers are partners in this ‘dance’ of health. Five approaches employed by the MotherCare Project shape maternal health programs. Presented in geometric form, they each describe movements leading client and provider to more satisfying positions in receiving and giving health care, respectively. Strategies to enhance these movements are the subject of the subsequent chapters of this supplement.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02318-7

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractThe magnitude of maternal morality in developing countries and its disparity with similar statistics from the developed world has touched a responsive chord among policy makers and health services program officials. What is not well appreciated, however, is that maternal mortality is only the tip of the iceberg — for every one maternal death, acute obstetrical complications cause suffering in nearly 100 women, 250 women contract a sexually transmitted disease, and 1000 women suffer stunting and/or anemia. All of these problems impact on the pregnancy outcome, both for the woman as well as for the newborn. Through a review of the literature, the magnitude, interrelationships and consequences of these various problems are described. The woman and the newborn are a dyad, a unit; what affects the woman typically affects the fetus and is manifest in the newborn. Safe motherhood programs need to pay attention to both, realizing that interventions aimed at the woman can benefit the next generation.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02322-4

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractEnthusiasm for ‘doing something about Safe Motherhood” has been expressed in many developing countries, but priorities for action cannot be identified without adequately assessing a country's maternal mortality situation. It is also important, however, to avoid embarking on time‐consuming research measuring indicators which are not essential to developing programs. After presenting an overview of ideal Safe Motherhood program components, the paper lists a series of questions which serve as an assessment tool for collecting useful information and for identifying data sources on maternal mortality and health. The framework for these questions centers around the following steps: (1) gaining an overview of health policy relevant to maternal mortality and morbidities; (2) assessing the magnitude and causes of maternal mortality and morbidity, and the characteristics of groups at particular risk; and (3) assessing the available inputs in terms of services (access, quality, providers, what is provided at various tiers, etc.) and in terms of the culture and existing resources and groups.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02319-8

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractIn settings where most births occur at home, collection of data on complications experienced around the time of delivery is often dependent on self‐reported data, collected through individual interviews. This paper describes a study designed to validate interview data on obstetric complications by comparing women's responses with data extracted from their medical records. The major complications of hemorrhage, dystocia, sepsis, and eclampsia were the main focus of the study. The sample was drawn from women hospitalized for delivery in a Manila hospital within the past 4 years. The main goal of the study was to assist in development of a survey instrument to be used in a national sample survey of women in the Philippines. The best sensitivity and specificity, respectively, for combinations of questions on these four conditions were: for hemorrhage, 0.70 and 0.78; for dystocia, 0.69 and 0.97; for sepsis, 0.89 and 0.83; and for eclampsia, 0.44 and 0.96. There were no significant differences in the duration of the recall periods according to diagnosis.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02320-C

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractThe MotherCare Project has as its goal the reduction of maternal and neonatal mortality and related morbidities, and the promotion of the health of women and newborns. To achieve these goals, maternal and family planning programs were strengthened in both rural and urban settings through three intervention strategies — policy reform, affecting behaviors and improving services. The fundamental premise in each project was to strengthen the weakest part of the maternity care pyramid, ensuring linkages among all levels of service — from community through to the referral hospital level. In rural Andean populations of Bolivia, knowledge of danger signs and women's response to them improved, increasing in use of prenatal and family planning services through a participatory problem‐solving and community‐based strategy. In West Java, Indonesia, bringing professional midwifery services and facilities closer to women together has resulted in a positive response to their use. Augmenting this intervention with a transport and intercommunication system together with improved hospital practice through perinatal mortality meetings and in‐service training for doctors and midwives has reduced the maternal and perinatal mortality over a four year period. Hospital practice has improved in Uganda and in two states of Nigeria, maternal mortality and morbidity have been reduced in the training facility where seminars for physicians, training of midwives in life saving midwifery and interpersonal communication skills have taken place, and equipment and supplies have been improved. Furthermore, in rural Guatemala, implementation of norms and protocols, expert supervision and sensitization of hospital staff to the needs of the community has increased referral by traditional birth attendants (TBAs) to the hospital and reduced perinatal mortality.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02321-3

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractThe Regionalization of Perinatal Care, an intervention study carried out in Tanjungsari, a subdistrict in rural West Java, aimed to develop a comprehensive maternal health program to improve maternal and perinatal health outcomes. The main inputs included training at all levels of the health care system (informal and formal) and the establishment of birthing homes in villages to make services more accessible. Special attention was given to referral, transportation, communication and appropriate case management, A social marketing program was conducted to inform people of the accessible birthing homes for clean delivery, located near the women, and with better transportation and communications to referral facilities should complications arise. The study design was longitudinal, following all pregnant women from early pregnancy until 42 days postpartum in an intervention and a comparison area. The population was ± 90 000 in the intervention area and 40 000 in the comparison area. Inclusion criteria were all mother and infant units delivered between June 1st, 1992 and May 31st, 1993.Analysis showed the following results:•Most women sought antenatal care (>95%). In Tanjungsari, nearly 90% sought such care from professional providers as versus 75% in the control area of Cisalak.•Most women with bleeding or bleeding and edema during pregnancy sought professional assistance in both the study and control areas. However, fever for more than 3 days received more attention in the study area versus control area (93 vs. 69%).•Greater than 85% of deliveries in both areas were conducted by TBAs. However, in the study area, nearly one‐third of those with intrapartum complications (17%) delivered in a health facility compared to one‐tenth in the control area. This meant a hospital delivery, primarily with assistance of a doctor or doctor/midwife combination.•Overall referral rates by TBAs were low −13% of women with complications in Tanjungsari and 6% in Cisalak. More women with intrapartum complications were referred in the study area than in the control, and more complied when referred.•Women who suffered intrapartum complications were more likely to have a perinatal death. Perinatal deaths declined in Tanjungsari, but not significantly. However, the trend over the period of the intervention shows an improvement in the deliveries managed by TBAs with more deaths resulting in the hands of professionals. Either

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02323-5

出版商:Wiley    

年代:2013

数据来源: WILEY

摘要:

AbstractA hospital staff training program was conducted in Guatemala to improve outcomes for patients with obstetrical and neonatal complications. This study examines the effect of the training program on the subset of women referred to the hospital by traditional birth attendants (TBAs). The program's goals were to institute standards of care for obstetrical and neonatal patients as well as to improve relations between hospital staff and TBAs. The training program was evaluated by comparing changes in the number of referrals, patient satisfaction, patient management, as well as Apgar scores and perinatal mortality. Evaluations were based on 756 questionnaires administered to TBA referred mothers. There was a significant increase in the overall numbers of referred women as well as improvement in patient satisfaction and decreased waiting time between admission and treatment. Apgar scores and perinatal mortality also improved, but changes were not statistically significant.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02324-6

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractPregnant and non‐pregnant women in Indramayu, West Java were examined for nutritional status, using anthropometric indicators. For the pregnant women, longitudinal data on nutritional status, iron consumption and weight gain were examined in relation to neonatal weight and length. Comparing the non‐pregnant women's average nutritional status with reference tables for height, weight and MUAC, they placed at the 25th percentile or less on all indicators. Using original formulae to estimate pre‐pregnancy weight and pregnancy weight gain, the study showed that 18% of pregnant women had a pre‐pregnancy weight of under 40 kg and the average pregnancy weight gain was under 9 kg. Comparing estimated pregnancy weight gain with the amount of weight gain needed to compensate for generally low pre‐pregnancy weight, only about 9% of women gained adequately.In multiple regression models that controlled for other maternal and neonatal factors, iron consumption during pregnancy was a significant predictor of full‐term (37 weeks or more) neonatal weight (P= 0.01) and length (P= 0.01). Consumption of one or more tablets (200 mg ferrous sulfate and 0.25 mg folic acid) per week by women during pregnancy was associated with increased neonatal weight (by 172 g on average) and length (by 1 cm on average). Adequate weight gain during pregnancy and maternal height also contributed to the specification of the neonatal weight model (P= 0.07 for both). In the neonatal length model, maternal height was also nearly significant (P= 0.03). The same models did not explain the variability in neonatal weight and length in the pre‐term group (<37 weeks gestation).

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02325-7

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractA decentralized syphilis control program in pregnant women was implementd in nine Nairobi City Council antenatal clinics between July 1992 and August 1993, whereby pregnant women were screened for syphilis, treated before leaving the clinic if RPR seroreactive, and counselled on the importance of partner treatment and sexual abstinence during treatment in order to protect their unborn babies from getting congenital syphilis. A total of 13 131 pregnant women were screened for syphilis (RPR test), 87.3% of seroreactive women were treated on site and 50% of partners returned to the clinic and were treated. The prevalence of RPR reactivity was 6.5%. Based on other data the program could theoretically have prevented 413 cases of congenital syphilis at a cost of approximately 50 USD per prevented case. This demonstration project shows that decentralized prevention of congenital syphilis in antenatal clinics by nurses is feasible and inexpensive and should receive priority in resource allocation in reproductive health and child survival programs.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02326-8

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractThe status of women's health and nutrition is affected by the absence or presence of government and private sector policies to promote women's rights to access quality maternal and family planning services. While both family planning and child survival literature pays substantial attention to the ‘policy environment’, little information is available with regard to the promotion of policies to support Safe motherhood Initiatives. Through a review of the family planning and child survival literature and from lessons learned from experiences of MotherCare country projects, this paper explores the issues and processes of policy formulation, implementation and sustainability. The paper also highlights specific Safe Motherhood strategies requiring policy attention with suggestions and examples of advocacy activities, research and demonstration projects which have been successful in creating and/or stimulating policy formulation. While there is no magic formula for policy promotion, experience has shown that a ‘body of constituents’, including women themselves as beneficiaries, is the key to moving the political process in the favor of Safe Motherhood.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02327-9

出版商:Wiley    

年代:2000

数据来源: WILEY