Asia

French version available in IDRC Digital Library: Trouver des méthodes contraceptives sûre

Sea Surface Salinity Measurements in the Historical Database

We have examined historical distributions of sea surface salinity (SSS) observations in a data set consisting of a combination of the World Ocean Database 1998 (WOD98) and a thermosalinograph and bucket salinity database collected from volunteer observing ships. It is well known that SSS in much of the world\u27s ocean is measured infrequently or not at all. We find that 27% of one-degree squares in the world ocean (open and coastal, excluding the Arctic Ocean) had no observations of SSS in the historical database, and 70% had 10 or fewer. Systematic sampling of SSS (more than 10,000 observations per year globally) did not start until after 1960. Most SSS observations in the WOD98 are concentrated in the North Sea and coast of northern Europe, the east and west coasts of North America, and around Japan. About 28% of SSS measurements are in coastal waters. We plotted frequency histograms of SSS for some selected well-sampled one-degree squares in the North Atlantic and tropical Pacific. We found most frequency histograms to be non-Gaussian. The main departure from normal distribution is due to anomalous low-salinity measurements creating a negative skewness. This conclusion is verified as a global phenomenon by examining statistics of mean-median SSS difference within one-degree squares. This quantity is found to be predominantly negative over the global ocean. These anomalous low-salinity values may be due to rainfall events, but there are other plausible physical mechanisms, like frontal movement and eddy activity. There were also areas where the distributions were bimodal due to the presence of meandering fronts with little cross-frontal mixing. Examples are shown where the non-Gaussian nature of the distributions in the areas examined is both a short-term and a long-term phenomenon. That is, the distributions are skewed on a nearly instantaneous (similar to1 month) basis and averaged over long time periods (1+years). This has important implications for climatologies because the differences between mean and modal SSS, for the analyzed one-degree squares, is of order 0.1. Furthermore, the implication for validation studies for remote sensing missions is that the studies must make enough measurements of SSS to determine the extent to which the probability density is not Gaussian

Responding to the maternal health care challenge: The Ethiopian Health Extension Program

Background: Responding to challenges in achieving Millennium Development Goals (MDG), the Ethiopian government initiated the Health Extension Program in 2003 as part of the Health Sector Development Program (HSDP) to improve equitable access to preventive, promotive and select curative health interventions through paid community level health extension workers.Objective: To explore Ethiopia’s progress toward achieving MDG 5 that focuses on improved maternal health through the Health Extension Program.Methods: This paper reviews available survey data and literature to determine the feasibility of reaching the targets specified for MDG 5 and for HSDP.Important findings: Achieving the set targets is a daunting task despite reaching the physical targets of two health extension workers per kebele. The 2015 MDG target for the Maternal Mortality Ratio (MMR) is 218 while the 2005 MMR estimate is 673. The HSDP target is 32% skilled birth attendant use by 2010 but only about 12% use was found in the four most populated regions of the country in 2009.Conclusions: Accelerating progress towards these targets is possible through the Health Extension Program at the worker level through improved promotion of family planning and specific maternal interventions, such as misoprostol for active management of third stage of labor, immediate postpartum visits, and improved coordination from community to referral level. [Ethiop. J. Health Dev. 2010;24 Special Issue 1:105-109

Dynamic sea surface topography, gravity and improved orbit accuracies from the direct evaluation of SEASAT altimeter data

A method for the simultaneous solution of dynamic ocean topography, gravity and orbits using satellite altimeter data is described. A GEM-T1 based gravitational model called PGS-3337 that incorporates Seasat altimetry, surface gravimetry and satellite tracking data has been determined complete to degree and order 50. The altimeter data is utilized as a dynamic observation of the satellite's height above the sea surface with a degree 10 model of dynamic topography being recovered simultaneously with the orbit parameters, gravity and tidal terms in this model. PGS-3337 has a geoid uncertainty of 60 cm root-mean-square (RMS) globally, with the uncertainty over the altimeter tracked ocean being in the 25 cm range. Doppler determined orbits for Seasat, show large improvements, with the sub-30 cm radial accuracies being achieved. When altimeter data is used in orbit determination, radial orbital accuracies of 20 cm are achieved. The RMS of fit to the altimeter data directly gives 30 cm fits for Seasat when using PGS-3337 and its geoid and dynamic topography model. This performance level is two to three times better than that achieved with earlier Goddard earth models (GEM) using the dynamic topography from long-term oceanographic averages. The recovered dynamic topography reveals the global long wavelength circulation of the oceans with a resolution of 1500 km. The power in the dynamic topography recovery is now found to be closer to that of oceanographic studies than for previous satellite solutions. This is attributed primarily to the improved modeling of the geoid which has occurred. Study of the altimeter residuals reveals regions where tidal models are poor and sea state effects are major limitations

Cultural Theories of Postpartum Bleeding in Matlab, Bangladesh: Implications for Community Health Intervention

Early recognition can reduce maternal disability and deaths due to postpartum haemorrhage. This study identified cultural theories of postpartum bleeding that may lead to inappropriate recognition and delayed care-seeking. Qualitative and quantitative data obtained through structured interviews with 149 participants living in Matlab, Bangladesh, including women aged 18-49 years, women aged 50+ years, traditional birth attendants (TBAs), and skilled birth attendants (SBAs), were subjected to cultural domain. General consensus existed among the TBAs and lay women regarding signs, causes, and treatments of postpartum bleeding (eigenvalue ratio 5.9, mean competence 0.59, and standard deviation 0.15). Excessive bleeding appeared to be distinguished by flow characteristics, not colour or quantity. Yet, the TBAs and lay women differed significantly from the SBAs in beliefs about normalcy of blood loss, causal role of the retained placenta and malevolent spirits, and care practices critical to survival. Cultural domain analysis captures variation in theories with specificity and representativeness necessary to inform community health intervention

Obstetric Complications and Psychological Well-being: Experiences of Bangladeshi Women during Pregnancy and Childbirth

Women in developing countries experience postnatal depression at rates that are comparable with or higher than those in developed countries. However, their personal experiences during pregnancy and childbirth have received little attention in relation to postnatal depression. In particular, the contribution of obstetric complications to their emotional well-being during the postpartum period is still not clearly understood. This study aimed to (a) describe the pregnancy and childbirth experiences among women in Bangladesh during normal childbirth or obstetric complications and (b) examine the relationship between these experiences and their psychological well-being during the postpartum period. Two groups of women - one group with obstetric complications (n=173) and the other with no obstetric complications (n=373) - were selected from a sample of women enrolled in a community-based study in Matlab, Bangladesh. The experiences during pregnancy and childbirth were assessed in terms of a five-point rating scale from 'severely uncomfortable=1' to 'not uncomfortable at all=5'. The psychological status of the women was assessed using a validated local version of the Edinburgh Postnatal Depression Scale (EPDS) at six weeks postpartum. Categorical data were analyzed using the chi-square test and continuous data by analysis of variance. Women with obstetric complications reported significantly more negative experiences during their recent childbirth [95% confidence interval (CI) 1.36-1.61, p<0.001] compared to those with normal childbirth. There was a significant main effect on emotional well-being due to experiences of pregnancy [F (4,536)=4.96, p=0.001] and experiences of childbirth [F (4,536)=3.29, p=0.01]. The EPDS mean scores for women reporting severe uncomfortable pregnancy and childbirth experiences were significantly higher than those reporting no such problems. After controlling for the background characteristics, postpartum depression was significantly associated with women reporting a negative childbirth experience. Childbirth experiences of women can provide important information on possible cases of postnatal depression

The Midwives Service Scheme in Nigeria

Seye Abimbola and colleagues describe and evaluate their programme in Nigeria of recruiting midwives to rural areas to provide skilled attendance at birth, which is much poorer than in urban areas

Staff experiences of Providing Maternity Services in Rural Southern Tanzania -- A Focus on Equipment, Drug and Supply Issues.

The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse maternal outcomes through delaying care provision. We aim to describe staff experiences of providing maternal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures that carried potential health risks to themselves as a result. Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions

Delivering at Home or in a Health Facility? Health-Seeking Behaviour of Women and the Role of Traditional birth attendants in Tanzania.

Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women's health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health

Occurrence and Determinants of Postpartum Maternal Morbidities and Disabilities among Women in Matlab, Bangladesh

The burden of maternal ill-health includes not only the levels of maternal mortality and complications during pregnancy and around the time of delivery but also extends to the standard postpartum period of 42 days with consequences of obstetric complications and poor management at delivery. There is a dearth of reliable data on these postpartum maternal morbidities and disabilities in developing countries, and more research is warranted to investigate these and further strengthen the existing safe motherhood programmes to respond to these conditions. This study aims at identifying the consequences of pregnancy and delivery in the postpartum period, their association with acute obstetric complications, the sociodemographic characteristics of women, mode and place of delivery, nutritional status of the mother, and outcomes of birth. From among women who delivered between 2007 and 2008 in the icddr,b service area in Matlab, we prospectively recruited all women identified with complicated births (n=295); a perinatal mortality (n=182); and caesarean-section delivery without any maternal indication (n=147). A random sample of 538 women with uncomplicated births, who delivered at home or in a facility, was taken as the control. All subjects were clinically examined at 6-9 weeks for postpartum morbidities and disabilities. Postpartum women who had suffered obstetric complications during birth and delivered in a hospital were more likely to suffer from hypertension [adjusted odds ratio (AOR)=3.44; 95% confidence interval (CI)=1.14-10.36], haemorrhoids (AOR=1.73; 95% CI=1.11-3.09), and moderate to severe anaemia (AOR=7.11; 95% CI=2.03- 4.88) than women with uncomplicated normal deliveries. Yet, women who had complicated births were less likely to have perineal tears (AOR=0.05; 95% CI=0.02-0.14) and genital prolapse (AOR=0.22; 95% CI=0.06-0.76) than those with uncomplicated normal deliveries. Genital infections were more common amongst women experiencing a perinatal death than those with uncomplicated normal births (AOR=1.92; 95% CI=1.18-3.14). Perineal tears were significantly higher (AOR=3.53; 95% CI=2.32-5.37) among those who had delivery at home than those giving birth in a hospital. Any woman may suffer a postpartum morbidity or disability. The increased likelihood of having hypertension, haemorrhoids, or anaemia among women with obstetric complications at birth needs specific intervention. A higher quality of maternal healthcare services generally might alleviate the suffering from perineal tears and prolapse amongst those with a normal uncomplicated delivery