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BMC Pregnancy and Childbirth. 2017 Jun 19; 17(1):194.BACKGROUND: WHO proposed the WHO Maternal Near Miss (MNM) tool, classifying women according to several (potentially) life-threatening conditions, to monitor and improve quality of obstetric care. The objective of this study is to analyse merged data of one high- and two low-resource settings where this tool was applied and test whether the tool may be suitable for comparing severe maternal outcome (SMO) between these settings. METHODS: Using three cohort studies that included SMO cases, during two-year time frames in the Netherlands, Tanzania and Malawi we reassessed all SMO cases (as defined by the original studies) with the WHO MNM tool (five disease-, four intervention- and seven organ dysfunction-based criteria). Main outcome measures were prevalence of MNM criteria and case fatality rates (CFR). RESULTS: A total of 3172 women were studied; 2538 (80.0%) from the Netherlands, 248 (7.8%) from Tanzania and 386 (12.2%) from Malawi. Total SMO detection was 2767 (87.2%) for disease-based criteria, 2504 (78.9%) for intervention-based criteria and 1211 (38.2%) for organ dysfunction-based criteria. Including every woman who received >/=1 unit of blood in low-resource settings as life-threatening, as defined by organ dysfunction criteria, led to more equally distributed populations. In one third of all Dutch and Malawian maternal death cases, organ dysfunction criteria could not be identified from medical records. CONCLUSIONS: Applying solely organ dysfunction-based criteria may lead to underreporting of SMO. Therefore, a tool based on defining MNM only upon establishing organ failure is of limited use for comparing settings with varying resources. In low-resource settings, lowering the threshold of transfused units of blood leads to a higher detection rate of MNM. We recommend refined disease-based criteria, accompanied by a limited set of intervention- and organ dysfunction-based criteria to set a measure of severity.
BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Sep; 121 Suppl 4:11-4.In the World Health Organization (WHO) European region despite official high coverage of essential interventions for maternal and neonatal care, there are still significant gaps in the delivery of effective interventions. Since 2001, WHO designed and implemented the Making Pregnancy Safer programme, which includes hands-on training courses in effective perinatal care for maternity teams, development of clinical guidelines, maternal mortality and morbidity case reviews, and assessments of quality of care. This has contributed to enhancing capacity at country level to improve organisation and provision of care. This paper describes the programme's components, challenges, achievements and results. (c) 2014 Royal College of Obstetricians and Gynaecologists.
The introduction of confidential enquiries into maternal deaths and near-miss case reviews in the WHO European region.
Reproductive Health Matters. 2007 Sep; 15(30):145-152.Most maternal deaths can be averted with known, effective interventions but countries require information about which women are dying and why, and what can been done to prevent such deaths in future. This paper describes the introduction of two approaches to reviewing maternal deaths and severe obstetric complications in 12 countries in transition in the WHO European Region - national-level confidential enquiries into maternal deaths and facility-based near-miss case reviews. Initially, two regional meetings involving stakeholders from 12 countries were held in 2004-2005, followed by national meetings in seven of the countries. The Republic of Moldova was the first to pilot the review process, preceded by a technical workshop to make detailed plans, provide training in how to facilitate and carry out a review, finalise clinical guidelines against which the findings of the confidential enquiry and near-miss case review could be judged, and a range of other preparatory work. To date, near-miss case reviews have been carried out in the three main referral hospitals in Moldova, and a national committee appointed by the Ministry of Health to conduct the confidential enquiry has met twice. Several other countries have begun a similar process, but progress may remain slow due to continuing fears of punitive actions against health professionals who have a mother or baby die in their care. (author's)
Lancet. 2003 Dec 31; 363(9402):75-76.In July, 2003, maternal health specialists from around the world gathered in Bellagio, Italy, to develop a list of proven and promising technologies, appropriate for low resource settings, to reduce maternal mortality. We defined technologies as equipment, consumable supplies including medicines, and techniques. While technology, especially in health care, often provokes thoughts of complex, costly interventions, the technologies identified at the Bellagio meeting are mostly simple and inexpensive. What is lacking are resources, human and financial, to scale-up and put proven technologies into widespread use and to assess and document the effectiveness of promising new interventions. There is an urgent need to accelerate the appropriate use of technologies and to reduce the inequitable burden of pregnancy-related mortality borne by women in poor countries. The 2003 Lancet series on child survival highlighted the interventions needed to ensure the health of children worldwide. We would add that saving the life of the mother is one of the best ways to prevent the death of a child. The half million women who die from pregnancy-related and childbirth-related causes every year leave behind at least 1 million motherless children who are all at increased mortality risk. (excerpt)
EQUILIBRES ET POPULATIONS. 2000 Aug-Sep; (60):3.The president of the study group on demography and global population called for an intensification of the fight against maternal mortality worldwide. In general terms, the minister confirmed that reducing and preventing maternal mortality are Foreign Affairs Ministry priorities. He also noted the theme of projects to prevent risk factors, including the development of reproductive health with UNPFA, women’s promotion, child protection to prevent the genital mutilation of girls, girls’ education, microcredit, cooperation, the development of quality care, personnel training, economic access to quality care, measures against communicable diseases, safe blood transfusion, nutrition, and the implementation of systems to effectively manage supplies of essential medicines, equipment, and supplies. On all of these subjects, the minister declared himself open to the co-financing of decentralized projects in the country’s priority zones. A midwife training project is being implemented in Haiti. A government minister noted that lessons learned from the first multibilateral accord between France and UNFPA will, given its success, open the door to future collaboration and interventions. Comoros and Haiti would be interested. Otherwise, converting the debt of very poor countries into projects would present the opportunity to increase available funding for population policies.
REVISTA PAULISTA DE MEDICINA. 1989 Jan-Feb; 107(1):47-52.In the fight against maternal mortality, the WHO recommended that developing countries adopt effective measures to reduce its high prevalence. One measure is the improvement of data about maternal deaths and major risk factors during pregnancy, delivery, and puerperium. Official figures are underreported by 50% or more, and the cause of death tends to be attributed to an immediate preceding complication. In the US, maternal mortality declined from 37/100,000 live births in 1960 to 8/100,000 in 1984; in Chile from 299 in 1960 to 45 in 1984; in Ecuador from 270 in 1960 to 189 in 1984; and in Paraguay from 327 in 1960 to 283 in 1984, a barely noticeable reduction. Strategies that improve knowledge include the keeping of statistics; epidemiological investigations (case control studies); and the formation of committees on maternal death, which are composed of highly regarded professionals (the UK, Chile, and Cuba obtained good results with them). The education of the populace by radio, television, and print media to utilize prenatal assistance is another measure. The human resources, location, and minimum instrumentation of these health centers are basic requirements. Most maternal deaths occur in hospitals of inadequate staff and material resources. The traditional birth assistant training program of Ceara state, Brazil, is a model for others. Caesareans save many lives in complicated deliveries, but in Sao Paulo state, more than 80% of some groups choose it without justification. Assistance Needs to be extended into the puerperium to monitor normal involution of the genital organs, to confirm normal lactation, and observe any pathology present during pregnancy. Cardiopathy, renal insufficiency, chronic hypertension, grand multiparity, and advanced maternal age are high risk factors for pregnancy. Postabortion deaths account for more than half of mortality in some Latin American countries. In the UK, mortality dropped from 35 in 1969, after the legalization of abortion in 1968 to 8 in 1975. The reverse was observed in Romania when abortion became outlawed. Nonetheless, abortion is a touchy issue and education about contraceptives should be stressed.
TIDSSKRIFT FOR DEN NORSKE LAEGEFORENING. 1991 May 30; 111(14):1729-33.The 4 cornerstones of reproductive health according to the WHO are family maternal care neonatal and infant care, and the control of sexually transmitted diseases. In recent years, the AIDS epidemic has caused concern in the world. The world's population doubled to 4 billion from 1927 to 1974, and it will reach 6 billion by the year 2000. The rate of growth is 1.4% in China and 2% in India vs. .3% in Europe. Contraceptive prevalence is 15-20% in Africa, 30% in South Asia, and 75% in East Asia. Shortage of contraceptives leads to abortion in eastern Europe. In 1985 in the USSR, there were 115.7 abortions/1000 women (mostly married) aged 15-44; and 6.4 million abortions for 5.5 million births in 1989. RU-486 or mifepristone combined with prostaglandin has produced abortion in 90% of first trimester pregnancies. After approval in France in 1987, it was used in 40,000 abortions in the following year. 90% of the estimated annual 500,000 maternal deaths occur in developing countries. In Norway, the rate is fewer than 10/100,000 births vs. 100/100,000 in Jamaica. In the mid-1980s, 26% of rural women in Thailand, 49% in Brazil, 54% in Senegal, and 87% in Morocco went without maternal care. In Norway, infant mortality is 6-8/1000 live births vs. 75-150/1000 in developing countries. A WHO investigation on causes of infertility in 25 countries found a 31% rate of tubal pathology in 5800 couples. In Africa, over 85% f infertility in women was infection related. Venereal diseases and infertility are associated with premarital sexual activity in young people. Various donor agencies and the WHO Special Program of Research, Development, and Research Training in Human Reproduction are providing help and resources including AIDS research.
[Unpublished] . 100 p. (WHO/MCH/MSM/91.6)The Maternal Health and Safe Motherhood Programme under WHO's Division of Family Health has compiled maternal mortality data in its 3rd edition of Maternal Mortality Ratios and Rates. The report contains data up to 1991. These data come from almost all WHO member countries. 1988 estimates reveal that 509,000 women die each year from causes related to pregnancy and childbirth. Most die from preventable causes such as aseptic abortions and lack of adequate health care. 4000 of these maternal deaths occur in developed countries. Thus developing countries, where 87% of the world's births occur, experience 99% of maternal deaths. In fact, the lifetime risk of death from causes related to pregnancy and childbirth in developing countries is 1:57 compared to 1:1825 in developed countries. Women in countries of western Africa have the greatest risk (1:18) and those in North America the smallest risk (1:4006). Even though the maternal mortality ratio for developing countries fell from 450-520 per 100,000 live births between 1983-1988, it increased in western African countries (700-760). This report consists mainly of tables of maternal mortality estimates for each country and in some cases certain areas of each country, for the world and various regions and subregions, and changes in maternal mortality since 1983 for the world and various regions and subregions. The world comparison table includes live births, maternal deaths, maternal mortality ratios and rates, lifetime risk, and total fertility. Country tables list year, data sources, maternal mortality ratio, indication if abortion deaths were included or not, and reference.
Targets for health for all. Targets in support of the European regional strategy for health for all.
Copenhagen, Denmark, WHO, Regional Office of Europe, 1985. x, 201 p.This book sets out the fundamental requirements for people to be healthy, to define the improvements in health that can be realized by the year 2000 for the peoples of the European Region of the World Health Organization (WHO), and to propose action to secure those improvements. Its purposes are as follows: propose improvements in the health of the people in order to achieve health for all by the year 2000; indicate where action is called for, the extent of the collective effort required, and the lines along which it should be directed; provide a tool for countries and the Region to Monitor progress toward the goal and revise their course of action if necessary. The targets proposed are intended to indicate the improvements that could be expected if all the will, knowledge, resources, and technology already available were pooled in the pursuit of a common goal. The target levels set are based on historical trends in the fields concerned, their expected future evolution, and the knowledge available on the probable effects of intervention. These levels are intended to inspire and motivate Member States when they are determining their own priorities, targets, and capabilities and thus the degree to which they can contribute to reaching the regional targets. The base year for all the targets in 1980. The year 2000 is the completion data retained for all targets related to health improvements. Targets related to lifestyles, the environment and care respectively have 1990 or 1995 as their date of completion unless specific problems justify the allocation of a later year. Targets embodying measures to bring about the changes in research and health development support should be reached before 1990. The aim is to give people a positive sense of health so that they can make full use of their physical, mental, and emotional capacities. A well informed, well motivated, and actively participating community is a key element to the attainment of the common goal. The focus of the health care system should be on primary health care -- meeting the basic health needs of each community through services provided as close as possible to where people live and work, readily accessible and acceptable to all, and based on full community participation. Health problems transcend national frontiers.