R4D Maternal Health

Hookworm and anaemia prevalence

Thu, 17 May 2012 04:59 GMT

Document Type: Journal Article
Creator: Guyatt, H.L.; Brooker, S.; Peshu, N.; Shulman, C.E.

Production Year: 2000

Citation: Guyatt, H.L.; Brooker, S.; Peshu, N.; Shulman, C.E. Hookworm and anaemia prevalence. Lancet (2000) 356 (9247) 2101. [DOI: 10.1016/S0140-6736(05)74313-0]

Summary: This article is a letter written in response to a previous article published in the Lancet (Torlesse H, Hodges M. Anthelmintic treatment and haemoglobin concentrations during pregnancy. Lancet 2000; 356: 1083) in which the authors report on anthelmintic treatment with albendazole in pregnant women.

Training traditional birth attendants in clean delivery does not prevent postpartum infection.

Wed, 16 May 2012 09:01 GMT

Document Type: Journal Article
Creator: Goodburn, E.A.; Chowdhury, M; Gazi, R.; Marshall, T.; Graham, W.

Production Year: 2000

Citation: Goodburn, E.A.; Chowdhury, M; Gazi, R.; Marshall, T.; Graham, W. Training traditional birth attendants in clean delivery does not prevent postpartum infection. Health Policy and Planning (2000) 15 (4) 394-399. [DOI: 10.1093/heapol/15.4.394]

Summary:

The objective of this study was to compare the maternal outcome, in terms of postpartum infection, of deliveries conducted by trained traditional birth attendants (TBAs) with those conducted by untrained birth attendants.

The study took place in a rural area of Bangladesh where a local NGO (BRAC) had previously undertaken TBA training. Demographic surveillance in the study site allowed the systematic identification of pregnant women. Pregnant women were recruited continuously over a period of 18 months. Data on the delivery circumstances were collected shortly after delivery while data on postpartum morbidity were collected prospectively at 2 and 6 weeks. All women with complete records who had delivered at home with a non-formal birth attendant (800) were included in the analysis. The intervention investigated was TBA training in hygienic delivery comprising the ‘three cleans’ (hand-washing with soap, clean cord care, clean surface). The key outcome measure was maternal postpartum genital tract infection diagnosed by a symptom complex of any two out of three symptoms: foul discharge, fever, lower abdominal pain.

Women's Reports of Severe (Near-miss) Obstetric Complications in Benin.

Wed, 16 May 2012 08:19 GMT

Document Type: Journal Article
Creator: Filippi, V.; Ronsmans, C.; Gandaho, T.; Graham, W.; Alihonou, E.; Santos, P.

Production Year: 2000

Citation: Filippi, V.; Ronsmans, C.; Gandaho, T.; Graham, W.; Alihonou, E.; Santos, P. Women's Reports of Severe (Near-miss) Obstetric Complications in Benin. Studies in Family Planning (2000) 31 (4) 309-324. [DOI: 10.1111/j.1728-4465.2000.00309.x]

Summary: This study examines the validity of a survey instrument on near-miss obstetric complications. Three groups of women–with severe complications, with mild complications, and with a normal delivery–were identified retrospectively in three hospitals in South Benin and interviewed at home. The concept of "near-miss" was used to identify women with severe episodes of morbidity. The questionnaire was able to detect, with some accuracy, eclamptic fits, abnormal bleeding in the third trimester for a recall period of at least three to four years, and all episodes of bleeding independent of timing within a period of two years. Questions concerning dystocia and infections of the genital tract generated disappointing results except when information on treatment was included. Overall, better results were achieved for antepartum and acute events. Severity made a positive difference only in the case of eclampsia, with an increase in sensitivity. The implications of the results for using women's recall of obstetric complications in surveys are discussed.

Vitamin A and causes of maternal mortality: association and biological plausibility.

Wed, 16 May 2012 07:35 GMT

Document Type: Journal Article
Creator: Faisel, H.; Pittrof, R.

Production Year: 2000

Citation: Faisel, H.; Pittrof, R. Vitamin A and causes of maternal mortality: association and biological plausibility. Public Health Nutrition (2000) 3 (03) 321-327. [DOI: 10.1017/S1368980000000367]

Summary: The objective of this study was to review the association between major causes of maternal mortality and vitamin A, trying to determine if these associations are causal in nature, and to highlight possible biological pathways that may explain vitamin A effects. The study was carried out by means of a literature review, observational studies and clinical trials. The strength of association was determined by applying Bradford Hill criteria of causality.

Effect of supplementation with vitamin A or ß carotene on mortality related to pregnancy. Slight modifications in definitions could alter interpretation of results.

Wed, 16 May 2012 02:56 GMT

Document Type: Miscellaneous
Creator: Ronsmans, C.; Campbell, O.; Collumbien, M.

Production Year: 1999

Citation: Ronsmans, C.; Campbell, O.; Collumbien, M. Effect of supplementation with vitamin A or beta carotene on mortality related to pregnancy. BMJ (1999) 319 (7218) 1201-1201. [DOI: 10.1136/bmj.319.7218.1201a]

Summary: This is a letter written in response to an article published in an earlier issue of the BMJ. West KP Jr., Katz J, Khatry SK, LeClerq SC, Pradhan EK, Shrestha SR, et al. Double blind, cluster randomised trial of low dose supplementation with vitamin A or ß-carotene on mortality related to pregnancy in Nepal. BMJ 1999; 318: 570–575. (27 February.)

Use of hospital data for Safe Motherhood programmes in South Kalimantan, Indonesia

Tue, 15 May 2012 09:15 GMT

Document Type: Journal Article
Creator: Ronsmans, C.; Achadi, E.; Sutratikto, G.; Zazri, A.; McDermott, J.

Production Year: 1999

Citation: Ronsmans, C.; Achadi, E.; Sutratikto, G.; Zazri, A.; McDermott, J. Use of hospital data for Safe Motherhood programmes in South Kalimantan, Indonesia. Tropical Medicine and International Health (1999) 4 (7) 514-521. [DOI: 10.1046/j.1365-3156.1999.00429.x]

Summary: The evaluation of Safe Motherhood programmes has been hampered by difficulties in measuring the preferred outcomes of maternal mortality and morbidity. The need for adequate indicators has led researchers and programme managers alike to resort to indicators of utilization and quality of health services. In this study the authors assess the magnitude of four indicators of use of essential obstetric care (EOC) and one indicator of quality of care in health facilities in three districts in South Kalimantan, Indonesia. The general picture which emerges for South Kalimantan is that the use of obstetric services is low. Even in the more urban district of Banjar where facility-based coverage is highest, fewer than 14% of all deliveries take place in an EOC facility, 2% of expected births are admitted to such a facility with a major obstetric intervention (MOI), and 1% of expected births have an MOI for an absolute maternal indication. The use of facility-based EOC is consistently lower in Barito Kuala compared to the other districts, and the differences persist regardless of the indicators used. In this setting with low utilization rates, general rates of utilization of EOC facilities seem to be as satisfactory an indicator of relative access to EOC as more elaborate indicators specifying the reasons for admission. The inequalities in access to care revealed by the various indicators of use of EOC services may prove to be a more powerful stimulus for change than the widely reported and highly inaccurate accounts of the high levels of maternal mortality.

Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh

Tue, 15 May 2012 07:29 GMT

Document Type: Journal Article
Creator: Hawkes, S.; Morison, L.; Foster, S.; Gausia, K.; Chakraborty, J.; Weeling, R.; Mabey, D.

Production Year: 1999

Citation: Hawkes, S.; Morison, L.; Foster, S.; Gausia, K.; Chakraborty, J.; Weeling, R.; Mabey, D. Reproductive-tract infections in women in low-income, low-prevalence situations: assessment of syndromic management in Matlab, Bangladesh. Lancet (1999) 354 (9192) 1776-1781. [DOI: 10.1016/S0140-6736(99)02463-0]

Summary: In the control of reproductive-tract infections, including sexually transmitted infections (STIs), in low-income and middle-income countries, WHO recommends syndromic management for individuals with symptoms. This intervention was initially developed in areas where prevalence of such infections is high. The authors investigate the clinical effectiveness and cost of this approach among a group of women with a low prevalence of infection.

Perceptions of soil-eating and anaemia among pregnant women on the Kenyan coast

Tue, 15 May 2012 06:53 GMT

Document Type: Journal Article
Creator: Geisslera, P.W.; Princeb, R.J.; Levenec, M.; Podad, C.; Beckerlegc, S.E.; Mutemid, W.; Shulmand, C.E.

Production Year: 1999

Citation: Geisslera, P.W.; Princeb, R.J.; Levenec, M.; Podad, C.; Beckerlegc, S.E.; Mutemid, W.; Shulmand, C.E. Perceptions of soil-eating and anaemia among pregnant women on the Kenyan coast. Social Science and Medicine (1999) 48 (8) 1069-1079. [DOI: 10.1016/S0277-9536(98)00409-2]

Summary:

After a clinical study at Kilifi District hospital had shown a high prevalence of geophagy among pregnant women, and a strong association of geophagy, anaemia and iron depletion, 52 pregnant women from the same hospital, and 4 traditional healers from the surroundings of Kilifi in Kenya were interviewed on the topic of soil-eating and its perceived causes and consequences. The findings were substantiated by results from an earlier anthropological study on maternal health and anaemia in the same study area.

Most of the pregnant women (73%) ate soil regularly. They mainly ate the soil from walls of houses, and their estimated median daily ingestion was 41.5 g. They described soil-eating as a predominantly female practice with strong relations to fertility and reproduction. They made associations between soil-eating, the condition of the blood and certain bodily states: pregnancy, lack of blood (upungufu wa damu), an illness called safura involving ``weak'' blood, and worms (minyolo).

The relationships the women described between soil-eating and illness resemble to some extent the causalities explored in biomedical research on soil-eating, anaemia and intestinal worm infections. However the women did not conceptualise the issue in terms of the single causal links characteristic of most scientific thought. Instead, they acknowledged the existence of multiple links between phenomena which they observed in their own and other women's bodies.

The women's ideas about soil-eating and their bodies shows the significance of both social and cultural context on the ways in which women derive knowledge from, and make sense of their bodily states. The cultural associations of soil-eating with blood, fertility and femininity exist alongside knowledge of its links to illness. Our findings show that soil-eating is more than just a physiologically induced behaviour; it is a rich cultural practice.

Understanding the incremental cost of increasing access to maternal health care services: Perspectives from a Voucher Scheme in Eastern Uganda

Tue, 15 May 2012 03:30 GMT

Document Type: PowerPoint Presentation
Creator: Mayora, C.; Ekirapa-Kiracho, E.; Ssengooba, F.; Baine, S.O.; Okui, O.

Production Year: 2011

Citation: Mayora, C.; Ekirapa-Kiracho, E.; Ssengooba, F.; Baine, S.O.; Okui, O. Understanding the incremental cost of increasing access to maternal health care services: Perspectives from a Voucher Scheme in Eastern Uganda. Presented at iHEA's 8th World Congress on Health Economics, Toronto, Canada, 11 July 2011. (2011) 19 pp.

Summary: Chrispus Mayora of the Makerere University School of Public Health looks at the incremental costs of implementing a voucher scheme for ante-natal, delivery and post-natal care in several districts in Uganda.

Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

Tue, 15 May 2012 02:08 GMT

Document Type: Journal Article
Creator: Ekirapa-Kiracho, E.; Waiswa, P.; Rahman, M.H.; Makumbi, F.; Kiwanuka, N.; Okui, O.; Rutebemberwa, E.; Bua, J.; Mutebi, A.; Nalwadda, G.; Serwadda, D.; Pariyo, G.W.; Peters, D.H.

Production Year: 2011

Citation: Ekirapa-Kiracho, E.; Waiswa, P.; Rahman, M.H.; Makumbi, F.; Kiwanuka, N.; Okui, O.; Rutebemberwa, E.; Bua, J.; Mutebi, A.; Nalwadda, G.; Serwadda, D.; Pariyo, G.W.; Peters, D.H. Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study. BMC International Health and Human Rights (2011) 11 (Suppl 1) S11. [DOI: 10.1186/1472-698X-11-S1-S11]

Summary: Background Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders.

Methods This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented.

Results Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing.

Conclusions Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.