High maternal mortality estimated by the sisterhood method in a rural area of Mali

<p>Abstract</p> <p>Background</p> <p>Maternal mortality is high in Mali. Nevertheless, there are few studies on this topic from rural areas, and current estimates are mostly based on studies from urban settings. Our objective was to estimate the maternal mortality ratio in Kita, rural Mali.</p> <p>Methods</p> <p>Using the "sisterhood method", we interviewed participants aged 15-50 years from 20 villages in Kita, Mali, and thereby created a retrospective cohort of their sisters in reproductive age. Based on population and fertility estimates, we calculated the lifetime risk of maternal death, and from that the estimated approximate maternal mortality ratio.</p> <p>Results</p> <p>The 2,039 respondents reported 4,628 sisters who had reached reproductive age. Of these 4,628 sisters, almost a third (1,233; 27%) had died, and 429 (9%) had died during pregnancy or childbirth. This corresponded to a lifetime risk of maternal death of 20% and a maternal mortality ratio of 3,131 per 100,000 live births (95% confidence interval 2,967-3,296), with a time reference around 1999.</p> <p>Conclusions</p> <p>We found a very high maternal mortality in rural Mali and this highlights the urgent need for obstetric services in the remote rural areas.</p

Risque foetal, perinatal et pronostic de la grossesse et de l\'accouchement gemellaires a la clinique de gynecologie et d\'obstetrique du cnhu de Cotonou,Benin: Etude rétrospective descriptive

Il s\'agissait de déterminer la fréquence des grossesses gémellaires, d\'analyser les risques obstétricaux, d\'étudier les indicateurs de morbidité et de mortalité et le pronostic. L\'étude rétrospective descriptive cas-témoins était menée sur une période de 3 ans à la CUGO de Cotonou. L\'échantillon était réparti en 249 grossesses gémellaires (cas) et 498 mono foetales (témoins). Les tests statistiques spécifiques étaient utilisés pour analyser les indicateurs de morbidité et le risque estimé par le calcul de l\'Odds ratio(Or) et son intervalle de confiance (IC) à 95% en acceptant une probabilité p&#8804; 0,05. La fréquence des grossesses gémellaires était de 3,85%. Aux 1er et 2ème trimestres le risque de fausses couches spontanées était multiplié par 4. Au troisième trimestre le risque de syndrome vasculo- rénal était multiplié par 2 (Khi² = 34,96 ; Or= 2,47 ; IC : 1,87- 3,36 ; p= 0,000), celui de menace d\'accouchement prématuré par 4 (Khi² = 45,47 ; Or= 4,05 ; IC: 2,59 - 6,34 ; p= 0,000) et d\'hydramnios par 2. La morbidité foetale liée à la césarienne était due à la présentation vicieuse du premier jumeau avec un risque multiplié par près de 15, le placenta praevia, la souffrance foetale aiguë et l\'éclampsie dont le risque respectif était multiplié par 9, 9 et 7. Le risque de décès maternel par hémorragie de la délivrance était multiplié par 2. La morbidité néonatale était dominée par la prématurité (p=0,048), le faible poids de naissance 8 fois plus élevé et un taux de mortalité périnatale multiplié par 3 par rapport aux témoins. L\'identification des risques liés à la gémellité est capitale d\'un double point de vue individuel et collectif dans le but d\'améliorer les indicateurs de morbidité et de mortalité maternelles et néonatale.This study was aimed at determining the frequency of twin pregnancies, assessing obstetrical risks, morbidity and mortality, and outcome. It was a retrospective and descriptive case - control study over a 3 years period at the Gynecology and Obstetric clinic (CUGO) of the National Teaching Hospital in Cotonou. The study sample constituted 249 twin pregnancies (cases) and 498 singleton pregnancies (controls). Odds ratio (Or) and the confidence interval (CI) at 95% and considering a probability (p) d” 0.05 were used to study the correlation between morbidity indicators and estimated risk. The frequency of twin pregnancies was 3.85%. In the 1st and 2nd trimesters, the risk of spontaneous abortion was four times higher. In the third trimester the risk of a vascular-renal syndrome was twice higher (Khi² = 34.96 ; Or= 2.47 ; IC: 1.87 - 3,36 ; p = 0.000), the risk of premature childbirth four times (Khi² = 45.47; Or = 4.05 ; IC :2.59 – 6.34 ; p = 0.000) and that of hydramnios twice higher. Fetal morbidity from caesarean sections was due to abnormal presentation of the first twin (risk multiplied by 15), placenta praevia, neonatal asphyxia and eclampsia with a risk multiplied by 9, 9 and 7 respectively. The risk of maternal death from immediate post partum haemorrhage was multiplied by two. Neonatal morbidity was dominated by the prematurity (p=0.048), low weight birth (8 times higher), and a perinatal mortality rate 3 times higher than in the control group. We concluded that iidentification of risk factors associated with twin pregnancies is individually and collectively fundamental in order to reduce maternal and neonatal morbidity and mortality. Keywords: Twin pregnancy - Obstetrical risks - Outcome.Clinics in Mother and Child Health Vol. 4 (2) 2007 pp. 771-77

Clinical trials of cancer screening in the developing world and their impact on cancer healthcare

Several research and training initiatives were organized by the International Agency for Research on Cancer (IARC) in collaboration with national institutions in countries such as Angola, Brazil, Burkina Faso, China, Republic of Congo, Guinea, India, Mali, Mauritania, Nepal, Niger, Peru, Tanzania and Thailand among others, to address feasible and effective means of early detection and prevention of cervical, breast and oral cancers. The impact of these activities, that involved over 600 000 participants and more than 1200 healthcare personnel trained on strengthening the local health services in terms of infrastructure, human resources and service delivery aspects in host countries and other regions, is addressed here. These studies, inbuilt in appropriate health services platforms, have resulted in the development and sustenance of several continuing point of care services of screening and treatment in most host countries, particularly in sub-Saharan Africa, and have catalysed regional early detection programmes in India, China and Thailand. The IARC collaborative studies have evolved into major focal points of training and extending services in many countries. The large evidence base, resulting from ours and other studies is likely, in due course, to facilitate much wider scaling up of screening and treatment services through organised programmes

Clinical trials of cancer screening in the developing world and their impact on cancer healthcare

Several research and training initiatives were organized by the International Agency for Research on Cancer (IARC) in collaboration with national institutions in countries such as Angola, Brazil, Burkina Faso, China, Republic of Congo, Guinea, India, Mali, Mauritania, Nepal, Niger, Peru, Tanzania and Thailand among others, to address feasible and effective means of early detection and prevention of cervical, breast and oral cancers. The impact of these activities, that involved over 600 000 participants and more than 1200 healthcare personnel trained on strengthening the local health services in terms of infrastructure, human resources and service delivery aspects in host countries and other regions, is addressed here. These studies, inbuilt in appropriate health services platforms, have resulted in the development and sustenance of several continuing point of care services of screening and treatment in most host countries, particularly in sub-Saharan Africa, and have catalysed regional early detection programmes in India, China and Thailand. The IARC collaborative studies have evolved into major focal points of training and extending services in many countries. The large evidence base, resulting from ours and other studies is likely, in due course, to facilitate much wider scaling up of screening and treatment services through organised programmes