Child maltreatment and intimate partner violence

Abstract : This study aimed to 1) evaluate the prevalence of intimate partner violence (IPV) and revictimization among a representative sample of 1,001 women living in Quebec, Canada; 2) examine whether IPV was predicted by experiences of child maltreatment; and 3) explore the role of polyvictimization on IPV beyond the effect of any type of exposure. Results indicate the prevalence rates of lifetime IPV (10.5%), IPV over the last year (2.5%), and revictimization (7.2%). All forms of child maltreatment predicted an increased risk of IPV victimization, yet polyvictimization was related to IPV beyond the effects of the specific forms of child maltreatment

Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali

Also published in the project's final report as annex AA maternity referral system that included basic and comprehensive emergency obstetric care, transportation to obstetric health services, and community cost-sharing schemes was implemented in six rural health districts in Kayes region, Mali. Maternal mortality rates decreased more among women referred for emergency obstetric care than among those who presented to the district health centre without referral. Nearly half (47.5%) of the reduction in deaths was attributable to fewer deaths from hemorrhage, demonstrating that national programmes can be implemented in low-income countries that are able to rapidly improve the coverage of obstetric services and reduce the risk of maternal mortality

Mother and newborn survival according to point of entry and type of human resources in a maternal referral system in Kayes (Mali)

The study assesses maternal and newborn survival in women presenting with an obstetric complication in Kayes (Mali). It compares the effects of the point of entry into the referral system on joint mother-newborn survival, and the effects of the configuration of healthcare teams at the community health centers (CHC). Results show that entry at the CHC while coming from a distance of less than 5 km increased the likelihood of joint survival by 8.50%. The size of the healthcare team at the CHC is significantly associated with mother-newborn survival only when distance traveled is 5 km or less

Improving obstetric care in low-resource settings: implementation of facility-based maternal death reviews in five pilot hospitals in Senegal

<p>Abstract</p> <p>Background</p> <p>In sub-Saharan Africa, maternal and perinatal mortality and morbidity are major problems. Service availability and quality of care in health facilities are heterogeneous and most often inadequate. In resource-poor settings, the facility-based maternal death review or audit is one of the most promising strategies to improve health service performance. We aim to explore and describe health workers' perceptions of facility-based maternal death reviews and to identify barriers to and facilitators of the implementation of this approach in pilot health facilities of Senegal.</p> <p>Methods</p> <p>This study was conducted in five reference hospitals in Senegal with different characteristics. Data were collected from focus group discussions, participant observations of audit meetings, audit documents and interviews with the staff of the maternity unit. Data were analysed by means of both quantitative and qualitative approaches.</p> <p>Results</p> <p>Health professionals and service administrators were receptive and adhered relatively well to the process and the results of the audits, although some considered the situation destabilizing or even threatening. The main barriers to the implementation of maternal deaths reviews were: (1) bad quality of information in medical files; (2) non-participation of the head of department in the audit meetings; (3) lack of feedback to the staff who did not attend the audit meetings. The main facilitators were: (1) high level of professional qualifications or experience of the data collector; (2) involvement of the head of the maternity unit, acting as a moderator during the audit meetings; (3) participation of managers in the audit session to plan appropriate and realistic actions to prevent other maternal deaths.</p> <p>Conclusion</p> <p>The identification of the barriers to and the facilitators of the implementation of maternal death reviews is an essential step for the future adaptation of this method in countries with few resources. We recommend for future implementation of this method a prior enhancement of the perinatal information system and initial training of the members of the audit committee – particularly the data collector and the head of the maternity unit. Local leadership is essential to promote, initiate and monitor the audit process in the health facilities.</p

18. Une évaluation des processus d’un programme de référence-évacuation au Mali

Ce chapitre traite de l’évaluation d’un programme de référence-évacuation des urgences obstétricales dans un pays à faibles ressources, le Mali. Cette évaluation, qui est toujours en cours, consiste en une analyse de l’implantation et des effets du programme. Elle répond aux besoins d’information des acteurs locaux et régionaux qui ont participé activement à sa définition et à sa mise sur pied, et ce, dans une région précise du Mali. Nous décrirons tout d’abord le programme ainsi que le conte..

Évaluation des processus et des effets d'un programme de référence-évacuation des urgences obstétricales au Mali

Également publié dans le rapport final du projet comme annexe CCe chapitre traitera de l'évaluation d'un programme de référence-évacuation des urgences obstétricales dans un pays à faibles ressources, le Mali. Cette évaluation, qui est toujours en cours, consiste en une analyse de l'implantation et des effets du programme. Elle répond aux besoins d'information des acteurs locaux et régionaux qui ont participé activement à son implantation, et ce, dans une région spécifique du Mali. Nous décrirons tout d'abord le programme ainsi que le contexte dans lequel il s'inscrit. Nous présenterons ensuite succinctement les principales approches utilisées dans l'analyse de l'implantation et le protocole d'évaluation retenu. Enfin, nous détaillerons le processus d'évaluation et présenterons les résultats obtenus et les leçons apprises jusqu'à ce jour

Evidence-based strategies for implementing guidelines in obstetrics:a systematic review

To estimate effective strategies for implementing clinical practice guidelines in obstetric care and to identify specific barriers to behavior change and facilitators in obstetrics