Global report on preterm birth and stillbirth (4 of 7): delivery of interventions

<p>Abstract</p> <p>Background</p> <p>The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies.</p> <p>Barriers to scaling up interventions</p> <p>Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment.</p> <p>Strategies and examples</p> <p>Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention.</p> <p>Conclusion</p> <p>Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities.</p

Epidemiological characteristics of carcinoma of the cervix in the federal capital territory of Nigeria

No Abstract. Nigrian Journal of Clinical Practice Vol. 10 (2) 2007: pp. 143-14

Emergency Contraception: A Wareness And Knowledge Among Hospital Workers In Abuja, Nigeria

A cross sectional descriptive survey of awareness and knowledge of emergency contraception among medical/paramedical and non-medical workers was carried out in the National Hospital Abuja, Nigeria. Most of the hospital workers were not aware of emergency contraceptive methods. 59.9% were not aware of emergency contraceptive pills, while 81.4% were not aware of the use of intrauterine contraceptive device. Medical and Paramedical workers show more awareness about emergency contraception than non-medical workers (

Maternal Mortality at the University of Nigeria Teaching Hospital, Enugu, Before and After Kenya

A comparative retrospective analysis of maternal deaths at the University of Nigeria Teaching Hospital, Enugu, Nigeria, was carried out for two ten-year periods ? 1976-1985 and 1991-2000 ? in order to evaluate the effect of Safe Motherhood Initiative on maternal mortality in the hospital. Variables for the two periods were compared by means of the t-test at 95% confidence level. Maternal mortality ratio was significantly higher in Period II than in Period I (1406 versus 270 per 100,000; p = 0.00). The leading causes of maternal death were uterine rupture for Period I and septicaemia for Period II. Although from the first to the second ten-year period there was a significant decrease in the number of midwives, physicians and nurse anaesthetists, there was more than a proportionate decrease in the number of deliveries. There was also increase in the incidence of anaemia due to diminished standards of living and in the mean decision-intervention interval (1.5 ± 0.5 versus 5.8 ± 1.2 hours; p = 0.000) as a result of worker dissatisfaction and changes in hospital policies. We conclude that since the launching of the Safe Motherhood Initiative, MMR at the University of Nigeria Teaching Hospital, Enugu, Nigeria, has increased five-fold as a result of institutional delays and a deterioration in the living standards of Nigerians, both consequences of a depressed economy. To halt this trend, we recommend that the living standard of all Nigerians should be improved. Furthermore, healthcare personnel should be motivated through enhanced salaries and provision of working materials including efficient mobile telephone services. (Afr J Reprod Health 2001; 5[2]: 90-97) RÉSUMÉ Mortalité matrenelle au Centre Hospitalier Universitaire à Enugu, Nigéria: Avant et après le Kenya. Une analyse retrospective comparée des décès maternels au Centre Hospitalier Universitaire à Enugu au Nigeria a été faite au cours de deux périodes de dix ans chacune, 1976-1985 et 1991-2000. Le but de l'analyse était d'évaluer l'effet de la Safe Motherhood Initiative sur la mortalité maternelle dans l'hôpital. Des variables pour les deux périodes ont été comprarés à l'aide du test de t à un niveau de confiance de 95%. Le rapport de mortalité maternelle était, de manière significative, plus élevé dans la période II que dans la Période I (1406 par opposition à 270 par 100,000, p = 0,00). Les causes principales du décès maternel étaient la rupture de l'utérine pour la Période I et la septicémie pour la Période II. Bien que depuis la première jusqu'à la deuxième période de dix ans il y ait une baisse significative dans le nombre de sages-femmes, de médecins et d'infirmières anesthésistes, il y avait plus qu'une baisse proportionnelle dans le nombre d'accouchements. Il y avait également une augmentation de l'incidence d'anémie à cause du niveau de vie baissé et dans l'espace de la moyenne décision-intervention (1,5 ± 0,5 par opposition à 5,8 ± 1,2 heures; p = 0,000) à cause du mécontentement chez les salariés et des changements dans la politique de l'hôpital. Nous concluons que depuis qu'on a lancé la Safe Motherhood Initiative, le taux de mortalité maternelle a augmenté cinq fois au Centre Hospitalier Universitaire à Enugu, Nigéria, a cause des délais institutionnels et à cause de la déterioration du niveau de vie des Nigérians, deux conséquences d'une économie en déclin. Pour mettre fin à cette tendance, nous recommandons que le niveau de vie de tous les Nigérians soit amélioré. En plus, les membres du personnel du service de santé doivent être motivés à travers les salaires augmenté et en mettant à la disposition des membres du personnel tous les matériels du travail y compris les services du téléphone portable. (Rev Afr Santé Reprod 2001; 5[2]: 90-97 ) KEY WORDS: Increasing, maternal mortality ratio, Enugu, Nigeria, Keny

Predictors of maternal mortality in institutional deliveries in Nigeria

Background: Maternal mortality in poor countries reflects the under-development in these societies. Global recognition of the burden of maternal mortality and the urgency for a reversal of the trend underpin the Millenium Development Goals (MDGs). Objective: To determine risk factors for maternal mortality in institutional births in Nigeria. Method: Twenty one health facilities in three states were selected using stratified multi-stage cluster sampling strategy. Information on all delivered mothers and their newborn infants within a three-month period was culled from medical records. Results: A total of 9 208 deliveries were recorded. About one-fifth (20.5%) of women had no antenatal care while 79.5% had at least one antenatal visit during pregnancy. Four-fifths (80.5%) of all deliveries were normal deliveries. Elective and emergency caesarean section rates were 3.1% and 11.5% respectively. There were 79 maternal deaths and 8 526 live births, giving a maternal mortality ratio of 927 maternal deaths per 100 000 live births. No antenatal care, parity, level of education, and mode of delivery were significantly associated with maternal mortality. Low maternal education, high parity, emergency caesarean delivery, and high risk patients risk independently predicted maternal mortality. Conclusion: Meeting goal five of the MDGs remains a major challenge in Nigeria. Multi-sectoral approaches and focused political will are needed to revert the high maternal mortality

Mortes perinatais e avaliação da assistência ao parto em maternidades do Sistema Único de Saúde em Belo Horizonte, Minas Gerais, Brasil, 1999 Perinatal deaths and childbirth healthcare evaluation in maternity hospitals of the Brazilian Unified Health System in Belo Horizonte, Minas Gerais, Brazil, 1999

Este trabalho analisa a associação entre a morte perinatal e o processo de assistência hospitalar ao parto, considerando-se que grande parte das mortes perinatais pode ser prevenível pela atenção qualificada de saúde e que a avaliação da qualidade da assistência perinatal ao parto é necessária para a redução da morbi-mortalidade perinatal. Realizou-se estudo caso-controle de base populacional dos óbitos perinatais (n = 118) e nascimentos (n = 492), ocorridos em maternidades do Sistema Único de Saúde (SUS) de Belo Horizonte, Minas Gerais, Brasil. Sexo masculino, prematuridade, doenças na gravidez, baixo peso ao nascer, doenças do recém-nascido, não realização de pré-natal, não utilização de partograma e menos de uma avaliação fetal por hora durante o trabalho de parto apresentaram associação estatisticamente significativa com o óbito perinatal. No modelo de regressão logística múltipla, não utilização do partograma durante o trabalho de parto e tipo de maternidade apresentaram-se como fatores de risco independentes para a morte perinatal. O estudo indica que é deficiente a qualidade da assistência hospitalar ao parto e que aspectos da estrutura dos serviços e do processo de assistência relacionam-se com a mortalidade perinatal por causas evitáveis.<br>This paper analyzes the association between perinatal mortality and factors related to hospital care during labor, considering that healthcare assessment is needed in order to reduce perinatal mortality. A population-based case-control study was conducted with 118 perinatal deaths (cases) and 492 births (controls) that took place in maternity hospitals of the Brazilian Unified Health System (SUS) in Belo Horizonte, Minas Gerais, Brazil. Male sex, prematurity, diseases during pregnancy, low birth weight, newborn diseases, lack of prenatal care, lack of partograph use during labor, and less than one fetus assessment per hour during labor were significantly associated with perinatal deaths. In the multiple regression analysis, lack of partograph use during labor and type of hospital were associated with perinatal deaths. These results indicate inadequate quality of care in maternity hospitals and show that health services structure and health care process are related to perinatal mortality due to preventable causes