Top PDF Towards Reducing Maternal Mortality in India

Towards Reducing Maternal Mortality in India

Towards Reducing Maternal Mortality in India

Maternal Death (MD) is a death of a woman while pregnant or within 42 days of termination of preg- nancy irrespective of the duration and site of preg- nancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes [1]. Maternal Mortality Ratio (MMR) is the measure of maternal mortality and is defined as the number of MDs during a given time period per 100000 live births (LBs) during the same time period usually over period of one year.

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AN AUDIT OF MATERNAL DEATHS

AN AUDIT OF MATERNAL DEATHS

 To identify complications in pregnancy, a childbirth which result in maternal death, and to identify opportunities for preventive intervention and understand the events leading to death; so that improving maternal health and reducing maternal mortality rate significantly.  To analyze the causes and epidemiological amounts maternal mortality e.g. age parity,

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Supply-side barriers to maternal health care utilization at health sub-centers in India

Supply-side barriers to maternal health care utilization at health sub-centers in India

The provision of quality maternal care services not only depends on skilled health personnel, but it is also reliant on the availability of essential drugs and supplies (Yeager, 2012). In line with previous studies, this investigation finds that the availability of essential obstetric drugs is strongly associated with a higher volume of delivery and postnatal care services at the HSCs (Mkoka et al., 2014). However, regrettably, about 42% of sub-centers are still devoid of all the essential obstetric drugs recommended by the Indian Public Health Standards. A lack of essential obstetric drugs at the facility may have huge implications for maternal mortality at the facility level. A recent study has concluded that increased facility deliveries in India do not contribute to a reduction in maternal deaths because these facilities often have a weak drug and medical supply system, which leads to poor obstetric care quality (Randive, 2016). The lack of drugs has also been found to cause distrust between users and health care providers; it creates a difficult working environment and decreases health workers’ morale as well (Mkoka et al., 2014). All of these factors, when combined, could result in the low utilization of health care services.
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Age and sex pattern of cardiovascular mortality, hospitalisation and associated cost in India.

Age and sex pattern of cardiovascular mortality, hospitalisation and associated cost in India.

Based on the findings, we suggest an increase in the budgetary allocation for non-communicable diseases, in order to expand and modernise the existing infrastructure for treatment of CVDs. Though the Government of India has increased the health spending substantially, little has been earmarked for non- communicable disease. Second, we recommend formulating comprehensive strategies for prevention and control of CVDs. These include strategies on the reduction of risk factors, revamping the public health centres, accreditation of private health centres to provide cost-effective treatment and care, increasing awareness on healthy life style through mass media, free health check up and insurance coverage. Though the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched in 2010 with the primary objective of reducing the risk factors of NCDs in the community, the coverage of the programme is limited [62]. Third, we recommend launching a population based study to bridge the data gap and generate evidence on the prevalence, socio-economic differentials and risk factors of non-communicable diseases. Though a number of population based representative studies have guided us in arriving at evidence based policies to improve the maternal and child health, there are no such studies on non- communicable diseases. Such evidences will be helpful to plan and develop a comprehensive strategy for the prevention, control and treatment of CVDs and other non communicable diseases.
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An appraisal of the maternal mortality decline in Nepal.

An appraisal of the maternal mortality decline in Nepal.

A comparison between the situation in Bangladesh and Nepal is of interest. Both show declines in maternal mortality despite low rates of deliveries with health professionals. The halving of maternal mortality in government service areas in Bangladesh occurred over 30 years, but Nepal has experienced the same change over 10 years. Fertility reductions, better education and improving wealth also occurred in Bangladesh during the time of the maternal mortality decline, although better abortion and emergency obstetric care seemed to have contributed [15]. Other social changes relate to decision making power, ability to independently generate income and participation in the labour force could have contributed and warrant further exploration. The weak explanatory power of deliveries with health professionals in reducing maternal mortality in both Nepal and Bangladesh is notable, but data availability in Nepal did not allow us to investigate related factors such as quality of care provided or timing of maternal death. This may be another area for future research using, for example, assessment of hospital deaths. Antenatal care uptake has increased in both countries, but the pathway through which it might reduce maternal mortality is less obvious, so it was not included in our analyses.
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Análise de casos de mortes maternas em Manaus nos anos 2001 a 2010

Análise de casos de mortes maternas em Manaus nos anos 2001 a 2010

Introduction - maternal mortality (MM) is one of the most important public health indicators and reducing their need is urgent. Studying statistics and specific characteristics of a particular country or region will contribute to propose specific strategies for the prevention of these deaths. Purpose - to examine the cases of MM, which occurred in the city of Manaus / AM in the period 2001-2010. Method - descriptive study, exploratory, from secondary database , the Municipal Health Manaus / AM and Information System on Live Births ( SINASC ). We evaluated the characteristics, causes and evolution of MMR and its causes in the years of the period. We used a general linear model with binomial distribution, followed by multiple comparison tests to assess the differences between the years. We adopted a significance level of 5 % for all tests, with p < 0.05. Results - identified 241 cases of MM, corresponding MMR of 63.2 / 100 000 NV and percentage of direct and indirect causes of, respectively, 67.2 and 25.7 %. The highest proportion was observed in women aged 20-29 years ( 46.0 % ) and among adolescents (15.0 %), with 4-7 years of schooling ( 34.8 % ), single ( 52.3 % ) of non-white race ( 69.7 % ), occurring predominantly in public hospitals ( 72.2 % ) and Eastern areas ( 32.0 % ) and South ( 20.0 % ) of Manaus / AM. The evolution of MMR occurred in two peaks in 2003 and 2009. The direct causes of MM were predominant, with higher incidence in the years 2001 and 2006. Among the indirect causes of MM , the highest prevalence was observed in 2004. Conclusion - In the period 2001-2010, the indicators of MM Manaus/AM reproduced the characteristic landscape of developing countries.
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Safe Motherhood 2000 programs: objective, design, and evaluation

Safe Motherhood 2000 programs: objective, design, and evaluation

Risk-free maternity is a fundamental objective of human development. While maternal deaths are relatively uncommon events, each one constitutes profound personal problems for survivors and com- plex social problems for their communities. In 1987, the United Nations 40th General Assembly empha- sized the reduction of maternal mortality in a “Call to Action” that exhorted Member States to vigor- ously promote the conditions conducive to good health, and women’s health in particular. Three years later, the Twelfth Meeting of the Pan Ameri- can Health Conference adopted the explicit objec- tive of reducing maternal mortality in the Region by half by the year 2000.
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Under-five mortality in high focus states in India: a district level geospatial analysis.

Under-five mortality in high focus states in India: a district level geospatial analysis.

by Moseley and Chen [6]. According to them, socioeconomic factors such as education and income affect disease incidence and outcomes through five broad groups of ‘‘proximal determinants’’ of child survival: maternal factors, nutrient deficiency, environ- mental contamination, injury and personal illness control charac- terized by the availability of health services and the capacity to use them [7]. The importance of these factors has been repeatedly confirmed in the reports issued by the World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and United Nations Population Fund (UNFPA). Coupled with early mother- hood, poor nutrition including anemia, low use of antenatal care and skilled delivery care potentially aggravates the chances of child deaths [8–10]. India with nearly 60 million malnourished children and more than 50% suffering from anemia was estimated to be amongst the highest in the world for under-five child deaths [11,12]. A growing body of evidence suggests that diarrhea, malaria – the diseases that are responsible for child mortality in developing countries, are results of climate change [13,14]. Changes in precipitation and the warming pattern are likely to affect the quality and quantity of water supplies, thus compound- ing the impact of poor water and sanitation, as well as malnutrition to the poorest in particular [15,16,17].
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The midwives service scheme in Nigeria.

The midwives service scheme in Nigeria.

Efforts to better reach underserved communities have been on task shifting to community health workers (CHWs) [7]. While task shifting has offered a cost- effective expansion of the overall HRH pool, skilled attendance at birth is essen- tial to reducing the burden of maternal mortality [8]. The shortage of skilled birth attendants in rural Nigeria impacts nega- tively on utilisation of services by women in these areas [5]. Launched in December 2009 , the Midwives Service Scheme (MSS) was set up to address the HRH needs in rural primary care, based on the evidence that when the number of mid- wives increases, utilisation of services increases, women’s satisfaction with care improves, and maternal and newborn mortality decrease [8,9]. To do this, three categories of midwives were recruited as part of the MSS: the newly graduated, the
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Editorial Maternal Mortality in Brazil: Proposals and Strategies for its Reduction

Editorial Maternal Mortality in Brazil: Proposals and Strategies for its Reduction

Brazil has a history of innovative public policies for women. However, reducing maternal morbimortality indi- cators still requires specific government attention. The im- plementation of these policies must be reformulated. Even though the theoretical conception of these policies is com- prehensive, the health care provided to pregnant women is still precarious in several contexts in Brazil. Today, the role of obstetric care services in reducing maternal mortality is undeniable. Maternal death cannot be attributed to one single factor; therefore, actions must be formulated system- atically if they are to enable the reduction of such high maternal mortality rates.
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Maternal mortality in India: causes and healthcare service use based on a nationally representative survey.

Maternal mortality in India: causes and healthcare service use based on a nationally representative survey.

Our study is the first nationally representative study of maternal mortality in India. The strength of this study is its size, as maternal deaths are relatively rare, permitting comparison across regions of India. Previous studies have been limited by small sample size, non-representative sampling, and measurement bias that does not differentiate between primary care provider versus emergency consultation care, and planned versus actual place of birth ([29– 32]). In the SRS, households are surveyed monthly and every six month, recording all pregnancies, births and deaths. This dual- reporting system, as well as prospective ascertainment of pregnancy, should be particularly robust in capturing maternal deaths, compared to case finding methods of other study designs. The survey also captures ‘usual residents’ so the tradition of the woman returning to her maternal home for delivery should not have lead to an undercount of deaths for this reason.
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Progress on the maternal mortality ratio reduction in Wuhan, China in 2001-2012.

Progress on the maternal mortality ratio reduction in Wuhan, China in 2001-2012.

]. The project aimed to reduce the cost of health care for labor and birth for poor families, establish an emergency obstetric service (called Green Channel) and an emergency aid center, develop training programs for obstetrics and gynecology personnel and pediatric staff, and develop a high-quality healthcare system, reduce charges for prenatal, delivery, and postnatal care, and provide health education. Political will and commitment to improving maternal health played a key role in reducing maternal mortality [20] and resolving problems with personnel management and implementa- tion of health education messages. This stage continued to see an increased investment in healthcare by the Chinese government. Implementation of this project led to a significant MMR reduction [19,21], and by the end of 2006 the MMR had fallen by more than 50% in the autonomous regions of Guangxi and Ningxia, 40%–50% in Shanxi, Anhui, Henan, Hubei and Xinjiang, 30%– 40% in Jilin, Hunan, Hainan, Chongqing, Sichuan and Gansu, and 20% and 10% in Tibet and Yunnan, respectively. The overall MMR in China dropped from 76 per 100,000 live births in 2001 to 49 in 2006, with a total decline of 35.8%, and an annual decline of 8.4% [19,22,23].
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Mobile phones: the next step towards healthcare delivery in rural India?

Mobile phones: the next step towards healthcare delivery in rural India?

A large proportion of the respondents in our study were women with access to mobile phones. In the Indian context, women are often responsible for the health and hygiene in their family. They are primarily involved in cooking, cleaning and caring for children and elderly in their households [47]. It is therefore not surprising that nutrition and maternal and child health were popular among information requested. The existing experience with caregiving within families may have resulted in women preferring less frequent adherence reminders in our study. Women were also less likely to be employed making their schedules more flexible and conducive to ensuring better medication adherence in comparison to men [32]. Our finding that women were more likely to communicate directly with their doctor in the management of an acute illness may indicate that they had lesser knowledge about health issues and needed assistance. It is also noteworthy that they were able to take cognizance of a situation where they were out of their depth, and were willing to assume responsibility in procuring the necessary expertise required.
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Pathways of economic inequalities in maternal and child health in urban India: a decomposition analysis.

Pathways of economic inequalities in maternal and child health in urban India: a decomposition analysis.

From the implication point of view, the study brings out crucial suggestions: first, public health and social policy initiatives and programmes aimed at reducing social disparity and income- related inequality in health should be targeted at specific dimensions of health for specific populations for example illiteracy of women in terms of no ANCs care and poor economic status in terms of underweight children. Second, India needs to adopt the dual strategy, of strengthening the existing social safety nets to protect socially and economically disadvantaged population and concurrently applying, health policy interventions for urban areas focusing ideally on both health averages and inequalities. Finally, this study demonstrates that obtaining equity in terms of maternal and child health status for the urban population of different economic groups in India may not seem achievable in the near future, unless the quality of urbanization and equity of distribution of the urban resources are ensured. A serious effort must be made to remove the socioeconomic dispossession, thereby reducing the health disparities in order to building healthy and sustainable cities in urban India. Healthy urbanization programmes should generate new resources and stimulate action to iron out urban health inequity. Therefore, achieving health equity for India’s urban children remains a critical challenge of recently proposed national urban health mission.
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Characterization of persons served in the family health strategy: a contribution to obstetric nursing           /           Caracterização de gestantes atendidas na estrategia de saúde da família: uma contribuição para enfermagem obstétrica

Characterization of persons served in the family health strategy: a contribution to obstetric nursing / Caracterização de gestantes atendidas na estrategia de saúde da família: uma contribuição para enfermagem obstétrica

A study carried out in Minas Gerais to demonstrate the relevance of prenatal care by the Family Health Strategy, shows a differentiated line of care for pregnant women starting with the identification, by Community Health Agents (CHA), of women with menstrual delay, the which already indicates the probable pregnancy diagnosis. Upon detection, an appointment is immediately scheduled or sent to the Family Health Unit in order to start the consultation with the team’s doctor or nurse. Given the importance of the quality of prenatal care in reducing maternal and perinatal morbidity and mortality, several studies were carried out to evaluate the quality of care provided to pregnant women and it was evidenced that the Family Health Strategy provides quality prenatal care, and that the link established between professionals at the unit and the CHA with the pregnant women is essential for their adherence to the Prenatal Care Program. 16
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Do Maternal Knowledge and Attitudes towards Childhood Immunizations in Rural Uganda Correlate with Complete Childhood Vaccination?

Do Maternal Knowledge and Attitudes towards Childhood Immunizations in Rural Uganda Correlate with Complete Childhood Vaccination?

In 2013 approximately 6.2 million children under the age of five died worldwide, and 3 million of these deaths occurred in Sub-Saharan Africa (SSA) [1]. In 2009, the World Health Organiza- tion (WHO) estimated that if global vaccine coverage increased to 90% by 2015, then approxi- mately two million deaths of children under the age of five would be prevented [2]. In the Sub- Saharan African country Uganda, vaccine coverage rates remain well below the WHO goal of 90%, with 82% of children receiving the measles vaccine and 78% completing the three dose series of pentavalent vaccine providing protection against diphtheria, tetanus, pertussis, hepati- tis B, and Haemophilis influenza type B (DPT-HB-Hib) in 2013 [3]. One recent study demon- strated that the western region of Uganda, where this study was conducted, has the lowest rate of complete childhood vaccination in the country [4]. Immunizations are a key strategy for reducing the prevalence of infectious diseases, and especially in under-resourced areas, immu- nizations are a highly cost-effective foundation for developing health systems to invest in [5].
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Near miss maternal: influencing factors and guidelines for reducing maternal morbidity and mortality

Near miss maternal: influencing factors and guidelines for reducing maternal morbidity and mortality

Objective: to analyze the scientific evidence about the factors influencing maternal near miss cases and possible guidelines for reducing maternal morbidity and mortality. Methods: integrative review with 2895 articles found and 17 selected articles. Results: the factors influencing the near miss cases were: delays in obstetric care; unprepared health team; precarious conditions of services; limited availability of blood derivatives; and prenatal disability, the limited use of evidence-based practices and audits. As main directions to minimize these events, we have evidenced: to strengthen the network of reference and counter-reference; carry out professional training; improve prenatal coverage; and invest in infrastructure, process management and clinical audits. Conclusion: the factors that influence the maternal near miss cases range from delayed care to failure to perform prenatal care, whose management improvement is the main direction.
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Regional strategy for maternal mortality and morbidity reduction

Regional strategy for maternal mortality and morbidity reduction

Progress in legal and policy frameworks must be achieved nationally, where laws and regulations that directly affect women’s lives are passed and enforced. As a result of their participation in international forums, many of the countries in the Region have made concerted efforts to propose legislation supporting the implementation of social protection strategies for women. This includes legislation protecting women against violence. However, much work still needs to be done in terms of promoting and enforcing this legislation. Most countries in the Region have supported policies or standards emphasizing the importance of safe motherhood and a target of reducing maternal mortality by 50% by the year 2000. Bolivia, Brazil, Ecuador, and Mexico have been able to place safe motherhood prominently on the political agenda. The stimulus for action came from high-level political leadership, allied with strong grassroots support expressed through women’s advocacy groups. Particularly noteworthy in all countries that have achieved low levels of maternal mortality is the fact that high-level political commitment to the issue is sustained over time, along with the availability of resources.
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Inequalities in maternal health care utilization in sub-Saharan African countries: a multiyear and multi-country analysis.

Inequalities in maternal health care utilization in sub-Saharan African countries: a multiyear and multi-country analysis.

This study has pointed out the importance of key maternal care services and related socioeco- nomic and geographic inequality against the backdrop of maternal mortality status in six SSA countries. The findings revealed persistent inequalities in the use of three key maternal health services, favouring wealthy and urban women. Relative inequality by wealth and rural-urban residence decreased over time in countries making progress towards reducing maternal mortal- ity, but it was not the case in countries made insufficient progress. Although our findings highlighted the importance of disparities in maternal care services on MMR in the selected countries, it should be noted that other factors such as governance, socioeconomic, infrastruc- tural and environmental conditions play an important role in reduction of disparities and hence MMR in each country [37,42,43]. Thus, the findings presented in this paper should be the subject of further research in order to establish a causal relationship between the utilization of care and maternal mortality. As we strive for universal health coverage, future health policies and interventions must be strengthened to increase the use of maternal care services, and be more able to address the disparities in the utilization of maternal care, especially for those who are poor and live in rural areas in SSA countries. It is through this kind of action that these countries can hope to achieve the MDG targets and beyond.
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A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

This study provides the following insights. Firstly, most primary healthcare facilities in Nigeria are unable to adequately provide basic EmOC services or meet an increasing demand for obstetric care. To put this proper perspective, consider the following: of the 20,000 or so registered healthcare facilities in Nigeria (both public and private), about 80% are primary healthcare facilities, less than 1% are tertiary [3,17] and referral facilities can seldom be found in rural areas (which harbor two thirds of the population) [18]. Even as the newly introduced Midwifery Service Scheme (MSS) has increased the availability of nurses and midwives in primary healthcare centers, service provision still remains low [19]. While most women will experience normal delivery, it is well document- ed that all women are at risk for pregnancy-related complications and resultant morbidity and mortality. It is for this very reason that primary healthcare centers accessible to all women are necessary but not sufficient to reduce maternal mortality. These facilities also Quality of Obstetric Care in Nigerian Hospitals
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