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Effectiveness of the WHO Safe Childbirth Checklist program in reducing severe maternal, fetal, and newborn harm in Uttar Pradesh, India: study protocol for a matched-pair, cluster-randomized controlled trial.
Trials. 2016 Dec 7; 17(1):576.BACKGROUND: Effective, scalable strategies to improve maternal, fetal, and newborn health and reduce preventable morbidity and mortality are urgently needed in low- and middle-income countries. Building on the successes of previous checklist-based programs, the World Health Organization (WHO) and partners led the development of the Safe Childbirth Checklist (SCC), a 28-item list of evidence-based practices linked with improved maternal and newborn outcomes. Pilot-testing of the Checklist in Southern India demonstrated dramatic improvements in adherence by health workers to essential childbirth-related practices (EBPs). The BetterBirth Trial seeks to measure the effectiveness of SCC impact on EBPs, deaths, and complications at a larger scale. METHODS/DESIGN: This matched-pair, cluster-randomized controlled, adaptive trial will be conducted in 120 facilities across 24 districts in Uttar Pradesh, India. Study sites, identified according to predefined eligibility criteria, were matched by measured covariates before randomization. The intervention, the SCC embedded in a quality improvement program, consists of leadership engagement, a 2-day educational launch of the SCC, and support through placement of a trained peer "coach" to provide supportive supervision and real-time data feedback over an 8-month period with decreasing intensity. A facility-based childbirth quality coordinator is trained and supported to drive sustained behavior change after the BetterBirth team leaves the facility. Study participants are birth attendants and women and their newborns who present to the study facilities for childbirth at 60 intervention and 60 control sites. The primary outcome is a composite measure including maternal death, maternal severe morbidity, stillbirth, and newborn death, occurring within 7 days after birth. The sample size (n = 171,964) was calculated to detect a 15% reduction in the primary outcome. Adherence by health workers to EBPs will be measured in a subset of births (n = 6000). The trial will be conducted in close collaboration with key partners including the Governments of India and Uttar Pradesh, the World Health Organization, an expert Scientific Advisory Committee, an experienced local implementing organization (Population Services International, PSI), and frontline facility leaders and workers. DISCUSSION: If effective, the WHO Safe Childbirth Checklist program could be a powerful health facility-strengthening intervention to improve quality of care and reduce preventable harm to women and newborns, with millions of potential beneficiaries. TRIAL REGISTRATION: BetterBirth Study Protocol dated: 13 February 2014; ClinicalTrials.gov: NCT02148952 ; Universal Trial Number: U1111-1131-5647.
Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group.
Vaccine. 2017 Oct 13; 35(43):5738-5750.From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal influenza immunization reduces the risk of adverse birth outcomes was conflicting, and many observational studies were subject to substantial bias. The lack of scientific clarity regarding disease burden or magnitude of vaccine efficacy against severe illness poses challenges for robust estimation of the potential impact of maternal influenza immunization programs. Copyright (c) 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
Option B+ for prevention of vertical HIV transmission has no influence on adverse birth outcomes in a cross-sectional cohort in Western Uganda.
BMC Pregnancy and Childbirth. 2017 Mar 7; 17(82):1-12.Background While most Sub-Saharan African countries are now implementing the WHO-recommended Option B+ protocol for prevention of vertical HIV transmission, there is a lack of knowledge regarding the influence of Option B+ exposure on adverse birth outcomes (ABOs). Against this background, we assessed ABOs among delivering women in Western Uganda. Methods A cross-sectional, observational study was performed within a cohort of 412 mother-newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of stillbirth, pre-term delivery, and small size for gestational age (SGA) was analyzed, looking for influencing factors related to HIV-status, antiretroviral drug exposure and duration, and other sociodemographic and clinical parameters. Results Among 302 HIV-negative and 110 HIV-positive women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in 28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no significant association was found with stillbirth (OR 0.48, p = 0.55), pre-term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to seronegative women. Women enrolled on antiretroviral therapy (ART) before conception (n = 38) had no different risk for ABOs than women on Option B+ or HIV-negative women. Identified risk factors for stillbirth included lack of formal education, poor socio-economic status, long travel distance, hypertension and anemia. Pre-term delivery risk was increased with poor socio-economic status, primiparity, Malaria and anemia. The occurrence of SGA was influenced by older age and Malaria. Conclusion In our study, women on Option B+ showed no difference in ABOs compared to HIV-negative women and to women on ART. We identified several non-HIV/ART-related influencing factors, suggesting an urgent need for improving early risk assessment mechanisms in antenatal care through better screening and triage systems. Our results are encouraging with regard to continued universal scale-up of Option B+ and ART programs.
Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America.
BMC Pregnancy and Childbirth. 2015; 15(1):324.BACKGROUND: No consensus definition of macrosomia currently exists among researchers and obstetricians. We aimed to identify a definition of macrosomia that is more predictive of maternal and perinatal mortality and morbidity in low- and middle-income countries. METHODS: We conducted a secondary data analysis using WHO Global Survey on Maternal and Perinatal Health data on Africa and Latin America from 2004 to 2005 and Asia from 2007 to 2008. We compared adverse outcomes, which were assessed by the composite maternal mortality and morbidity index (MMMI) and perinatal mortality and morbidity index (PMMI) in subgroups with birthweight (3000-3499 g [reference group], 3500-3999 g, 4000-4099 g, 4100-4199 g, 4200-4299 g, 4300-4399 g, 4400-4499 g, 4500-4999 g) or country-specific birthweight percentile for gestational age (50(th)-74(th) percentile [reference group], 75(th)-89(th), 90(th)-94(th), 95(th)-96(th), and >/=97(th) percentile). Two-level logistic regression models were used to estimate odds ratios of MMMI and PMMI. RESULTS: A total of 246,659 singleton term births from 363 facilities in 23 low- and middle-income countries were included. Adjusted odds ratios (aORs) for intrapartum caesarean sections exceeded 2.0 when birthweight was greater than 4000 g (2 . 00 [95 % CI: 1 . 68, 2 . 39], 2 . 42 [95 % CI: 2 . 02, 2 . 89], 2 . 01 [95 % CI: 1 . 74, 2 . 33] in Africa, Asia and Latin America, respectively). aORs of MMMI reached 2.0 when birthweight was greater than 4000 g, 4500 g in Asia and Africa, respectively. aORs of PMMI approached to 2.0 (1 . 78 [95 % CI: 1 . 16, 2 . 74]) when birthweight was greater than 4500 g in Latin America. When birthweight was at the 90(th) percentile or higher, aORs of MMMI and PMMI increased, but none exceeded 2.0. CONCLUSIONS: The population-specific definition of macrosomia using birthweight cut-off points irrespective of gestational age (4500 g in Africa and Latin America, 4000 g in Asia) is more predictive of maternal and perinatal adverse outcomes, and simpler to apply compared to the definition based on birthweight percentile for a given gestational age.
Reproductive Health. 2015; 12:46.In September, the World Health Organization released a statement on preventing and eliminating disrespect and abuse during facility-based childbirth. In addition to this important agenda, attention is also needed for the dignified care of newborns, who also deserve basic human rights and dignified care. In this commentary, we provide examples from the literature and other sources of where respectful care for newborns has been lacking and we give examples of opportunities for integration of maternal and newborn health care going forward. We illustrate the need for respectful treatment and consideration across the continuum of care: for mothers, stillbirths, and all newborns, including those born too soon and those who die in infancy. We explain the need to document cases of neglect and abuse, count all births and deaths, and to include newborns and stillbirths in the respectful care agenda and the post-2015 global reproductive care frameworks.
WHO Better Outcomes in Labour Difficulty (BOLD) project: innovating to improve quality of care around the time of childbirth.
Reproductive Health. 2015; 12:48.As most pregnancy-related deaths and morbidities are clustered around the time of childbirth, quality of care during this period is critical to the survival of pregnant women and their babies. Despite the wide acceptance of partograph as the central tool to optimize labour outcomes for over 40 years, its use has not successfully improved outcomes in many settings for several reasons. There are also increasing questions about the validity and applicability of its central feature - "the alert line" - to all women regardless of their labour characteristics. Apart from the known deficiencies in labour care, attempts to improve quality of care in low resource settings have also failed to address and integrate women's birth experience into quality improvement processes. It was against this background that the World Health Organization (WHO) embarked on the Better Outcomes in Labour Difficulty (BOLD) project to improve the quality of intrapartum care in low- and middle-income countries. The main goal of the BOLD project is to reduce intrapartum-related stillbirths, maternal and newborn mortalities and morbidities by addressing the critical barriers to the process of good quality intrapartum care and enhancing the connection between health systems and communities. The project seeks to achieve this goal by (1) developing an evidence-based, easy to use, labour monitoring-to-action decision-support tool (currently termed Simplified, Effective, Labour Monitoring-to-Action - SELMA); and (2) by developing innovative service prototypes/tools, co-designed with users of health services (women, their families and communities) and health providers, to promote access to respectful, dignified and emotionally supportive care for pregnant women and their companions at the time of birth ("Passport to Safer Birth"). This two-pronged approach is expected to positively impact on important domains of quality of care relating to both provision and experience of care. In this paper, we briefly describe the rationale for innovative thinking in relation to improving quality of care around the time of childbirth and introduce WHO current plans to improve care through research, design and implementation of innovative tools and services in the post-2015 era.Please see related articles ' http://dx.doi.org/10.1186/s12978-015-0029-4 ' and ' http://dx.doi.org/10.1186/s12978-015-0028-5 '.
Geneva, Switzerland, WHO, 2014.  p.The action plan sets out a vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential. Nearly 3 million lives could be saved each year if the actions in the plan are implemented and its goals and targets achieved. Based on evidence of what works, and developed within the framework for Every Woman Every Child, the plan enhances and supports coordinated, comprehensive planning and implementation of newborn-specific actions within the context of national reproductive, maternal, newborn, child and adolescent health strategies and action plans, and in collaboration with stakeholders from the private sector, civil society, professional associations and others. The goal is to achieve equitable and high-quality coverage of care for all women and newborns through links with other global and national plans, measurement and accountability.
Geneva, Switzerland, WHO, 2014.  p.The action plan sets out a vision of a world in which there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full potential. Nearly 3 million lives could be saved each year if the actions in the plan are implemented and its goals and targets achieved. Based on evidence of what works, and developed within the framework for Every Woman Every Child, the plan enhances and supports coordinated, comprehensive planning and implementation of newborn-specific actions within the context of national reproductive, maternal, newborn, child and adolescent health strategies and action plans, and in collaboration with stakeholders from the private sector, civil society, professional associations and others. The goal is to achieve equitable and high-quality coverage of care for all women and newborns through links with other global and national plans, measurement and accountability. Strategic objectives and targets to achieve the goal of ending preventable maternal deaths have also been prepared. The objectives are complementary to those of the Every Newborn action plan and intended for coordinated implementation.
Bulletin of the World Health Organization. 2008 Jun; 86(6):460-466.This paper discusses the problems of defining and measuring late-fetal mortality (stillbirths). It uses evidence from 11 developed countries to trace long-term trends in fetal mortality. Issues associated with varying definitions and registration practices are identified, as well as the range of possible rates, key turning points and recent convergence. The implications for developing countries are spelt out. They emphasize the possible limitations of WHO estimation methods and survey-based data by examining the cross-sectional associations among 187 countries in the year 2000. The important role of skilled birth attendants is emphasized in both data sets, but the different effects on maternal mortality and late-fetal mortality are also noted. (author's)
Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. [Tasas de cesáreas y resultados de embarazos: la encuesta mundial de la OMS del año 2005 sobre salud materna y perinatal en América Latina]
Lancet. 2006 Jun 3; 367(9525):1819-1829.Caesarean delivery rates continue to increase worldwide. Our aim was to assess the association between caesarean delivery and pregnancy outcome at the institutional level, adjusting for the pregnant population and institutional characteristics. For the 2005 WHO global survey on maternal and perinatal health, we assessed a multistage stratified sample, comprising 24 geographic regions in eight countries in Latin America. We obtained individual data for all women admitted for delivery over 3 months to 120 institutions randomly selected from of 410 identified institutions. We also obtained institutional-level data. We obtained data for 97 095 of 106 546 deliveries (91% coverage). The median rate of caesarean delivery was 33% (quartile range 24--43), with the highest rates of caesarean delivery noted in private hospitals (51%, 43--57). Institution-specific rates of caesarean delivery were affected by primiparity, previous caesarean delivery, and institutional complexity. Rate of caesarean delivery was positively associated with postpartum antibiotic treatment and severe maternal morbidity and mortality, even after adjustment for risk factors. Increase in the rate of caesarean delivery was associated with an increase in fetal mortality rates and higher numbers of babies admitted to intensive care for 7 days or longer even after adjustment for preterm delivery. Rates of preterm delivery and neonatal mortality both rose at rates of caesarean delivery of between 10% and 20%. High rates of caesarean delivery do not necessarily indicate better perinatal care and can be associated with harm. (author's)
BMJ. British Medical Journal. 2004; 328: p..A Roma woman who alleges she was sterilised without her consent during an emergency procedure at a Hungarian hospital is taking her case to the United Nations. Records show that the woman, then aged 28, who was undergoing labour pains and bleeding heavily, was taken by an emergency vehicle to Szatmár-Beregi Hospital in Fehérgyarmat in northeastern Hungary on 2 January 2001. Examinations determined that the placenta had ruptured and that her unborn infant had died, said Dr András Kanyó, who, with other members of the hospital's emergency team, had been alerted by emergency medical personnel to the woman's imminent arrival. "Following the ultrasound and a physical examination, I asked her about her family, and she said she had three children. I asked if she planned to have any more, and she said no," said Dr Kanyó, a gynaecologist, anaethesiologist, and intensive care specialist. (excerpt)
New York, New York, United Nations. Department for Economic and Social Information and Policy Analysis. Statistical Division, 1995. x, 1,032 p. (No. ST/ESA/STAT/SER.R/24)This is a comprehensive collection of international demographic statistics published annually by the United Nations. "The tables in this issue of the Yearbook are presented in two parts, the basic tables followed by the tables devoted to population censuses, the special topic in this issue. The first part contains tables giving a world summary of basic demographic statistics, followed by tables presenting statistics on the size, distribution and trends in population, natality, foetal mortality, infant and maternal mortality, general mortality, nuptiality and divorce. In the second part, this issue of the Yearbook serves to update the census information featured in the 1988 issue. Census data on demographic and social characteristics include population by single years of age and sex, national and/or ethnic composition, language and religion. Tables showing data on geographical characteristics include information on major civil divisions and localities by size-class. Educational characteristics include population data on literacy, educational attainment and school attendance. In many of the tables, data are shown by urban/rural residence."
Strengthening maternal and child health programmes through primary health care. Guidelines for countries of the Eastern Mediterranean Region. Based on the deliberations of the Intercountry Meeting on the Integration of MCH into Primary Health Care, Amman, Jordan, 11-15 December 1988.
Alexandria, Egypt, WHO, EMRO, 1991. 75 p. (WHO EMRO Technical Publication No. 18)All countries in the WHO Eastern Mediterranean Region (EMRO) have had maternal and child health (MCH) programs for many years, yet maternal mortality and morbidity and infant mortality remain high. The EMRO office in Jordan, recognizing this dilemma, convened a meeting of national managers from the 22 EMRO member states to discuss how to integrate MCH programs with primary health care (PHC). The meeting resulted in the publication of guidelines and goals to help each country integrate MCH into PHC which would strengthen MCH services and improve MCH status. The managers noted the need to switch from a pregnancy-oriented approach to a holistic approach in which MCH/PHC programs and society consider women as more than childbearers. MCH/PHC programs and society need to be concerned about the well-being of females beginning with infancy and should place considerable health promotion for girls during the pubertal spurt and adolescence. They should also promote prevention of iron deficiency anemia in women. Since maternal mortality is especially high is EMRO, the national managers clearly laid out approaches for health services to reduce maternal mortality caused by obstetrical complications. They also recognized the need for a practical alternative to obstetric care provided by health workers--training traditional birth attendants in each village. They also provided guidance on improving prenatal care to reduce perinatal and neonatal mortality such as vaccination of every pregnant woman with the tetanus toxoid. Since the causes of death in the postneonatal period, MCH/PHC programs need to take action to reduce malnutrition and infection. For example, they must promote breast feeding for at least the first 6 months of life. The managers suggested the implementation of the Child Survival and Development Strategy which includes growth monitoring.
International Journal of Gynecology and Obstetrics. 1998 Aug; 62(2):117-27.The impact on pregnancy outcome of use of the World Health Organization (WHO) partograph was evaluated in 1990-91 in 35,484 deliveries at 8 hospitals in Indonesia, Malaysia, and Thailand. This paper presents the results from this study of the 1740 participating women with a breech presentation. 923 breech presentations occurred before and 817 after implementation of the WHO partograph. The partograph was actually used in only 346 (42.4%) of the latter deliveries, however, as a result of the large number of elective or immediate emergency cesarean deliveries. The overall cesarean section rate was 29.7% (21.6% emergency). Partograph use was associated with a reduction in the cesarean section rate among multigravida from 27.1% before introduction to 19.3%, but the rate among primigravida (38.5% and 38.7%, respectively) was not affected. Prolonged labor (over 18 hours) was reduced significantly (p < 0.05) among both multigravida and primigravida after partograph introduction, despite reduced use of oxytocin. The intrapartum stillbirth rate fell from 1.9% to 1.1%. Fetal outcome, assessed by intrapartum deaths and Apgar scores <7 at 1 minute, was significantly (p < 0.05) improved when delivery was by cesarean section, regardless of partograph use. The intrapartum fetal death rate was 0.19% in cesarean section deliveries compared with 1.82% for vaginal deliveries. These findings confirm the benefits of partograph use for monitoring progress and timing decisions in the management of breech labor. Given, however, that fetal outcome was better where delivery was by cesarean section, careful consideration should be given to the correct selection of women with breech presentation who are allowed to labor.
WORLD HEALTH FORUM. 1991; 12(4):449-50.Staff at the Shivajinagar Urban Health Centre in Deonar (population 250,000) near Bombay, India conducted a cluster survey in 30 sectors of the slum using the WHO methodology for evaluating immunization coverage to measure neonatal and perinatal mortality among births that occurred between November 1986-April 1988. They gathered information on 54 births for the case group and 9 controls from each cluster. 1610 live births and 19 stillbirths occurred in the study period. There were 27.6 perinatal deaths for every 1000 total births (standard error=1.108). Neonatal deaths equalled 28.6/1000 live births (standard error-1.126). Confidence intervals for perinatal mortality rate and neonatal mortality rate were 25.39-29.82 and 26.35-30.85 and significant (p<.05). 26.4% of births occurred at home. Untrained women attended 84.6% of these deliveries. The remaining births occurred at the municipal general hospital or at a municipal maternity home. 60% of the fetal deaths were females. 77% of the 26 early neonatal deaths were males, but the male female ratio of deaths after 7 days was the same. The leading causes of neonatal mortality were prematurity and low birth weight. Other causes included congenital malformations and neonatal tetanus. Obstructed labor resulted in fetal death in 40% of stillbirths. The researchers at the Shivajinagar Urban Health Centre in Deonar, India concluded that the 30-cluster survey technique was effective in measuring perinatal and neonatal mortality in a community with >50,000 people in a developing country.
Meeting of principal investigators of risk approach study in MCH care, report of an intercountry meeting, Rangoon, Burma, 30 December 1985-3 January 1986.
[Unpublished] 1986 Sep 5. ii, 42 p. (SEA/MCH/183; RAS/85/P23)Objectives of the intercountry meeting of principal investigators of risk approach study in maternal-child health (MCH) care were: 1) to review the results of the risk approach studies in Burma, India, and Thailand that have been done to identify research design and method problems, and to propose solutions for improved study; 2) to identify research issues relevant to study, and applying the risk strategy; 3) to explore the devices for application of the risk approach results in delivery of MCH/family planning (FP); and 4) to find further areas for research. In Burma, some problems were: there were no proper patient records; and staff was not being scheduled properly. There was a drop in the overall incidence of low birth weight deliveries from 21% in 1977-78 to 10-16% in 1983-83. The Indian project was started in January 1981, and lasted until the end of December, 1984. Study design was a "before and after" model. The overall risk detection rate was 80%. In Thailand a "before and after" model was used in 136 villages of 18 subdistricts in the Bang Pa In district of Ayuthaya Province. The before intervention situation took place in 1977-78; the after period runs from May, 1980 to April, 1983. Overall results show better coverage of prenatal, natal, and child care; and improvement in diarrhea and tetanus morbidity in newborns. The Amphur Nong Rua area of Khon Kaen was chosen as the 2nd Thailand project area. Its population is 77,209 (1983) living in 116 villages. A stratified random sampling technique was used. All women who miscarried or delivered from January 1, 9182 to December 31, 1983 and all infants born to these mothers were included. The health system of Bhutan is discussed, as well as health organization in Burma, India, Indonesia, Nepal, Sri Lanka, and Thailand. Researchable issues include low birth weight, social-behavioral, nutritional deficiency, and mental health studies. An action program is described.
Geneva, Switzerland, WHO, 1986. 22 p.Maternal care is the most appropriate target for reducing the high perinatal and neonatal mortality typical of the least developed countries. The principles formulated by the 25th session of the WHO/UNICEF Joint Committee on Health Policy in 1985 are outlined here. Perinatal mortality is defined as infant death from 1000 g, even if intrauterine or stillborn, to 1 week of age. Neonatal mortality is that occurring in the 1st month of life. Half of infant mortality (up to 1 year of age) occurs in the 1st month, most of that during the 1st week, and these deaths are directly related to maternal care during pregnancy and delivery. They are caused by low birth weight, intrauterine or birth asphyxia, birth trauma, or infections, usually of the cord or amniotic fluid. Tetanus is the primary lethal infection. Tetanus can be prevented by immunizing women, or giving tetanus toxoid to pregnant women, but also very effectively by training birth assistants in hygiene. Traumatic deaths can best be prevented by training midwives and strengthening the support system for referral to clinics. The most cost-effective strategies for improving maternal health are nutritional intervention, malaria prevention, treatment of infections and of toxemia, reducing heavy workload of pregnant women, and family planning services. Points where community involvement is effective are discussed. WHO and UNICEF will increase support in health education, tetanus immunization, training of birth attendants, equipping birth facilities, appropriate technology, and operational research.
Proceedings of the International Collaborative Effort on Perinatal and Infant Mortality, Vol. 1. Papers presented at the International Symposium on Perinatal and Infant Mortality, 1984; Bethesda, Maryland; sponsored by National Center for Health Statistics
Hyattsville, Md, United States. National Center for Health Statistics [NCHS], 1985. xv,  p.These are the proceedings of an international symposium held in August 1984 in Bethesda, Maryland. The objective of the symposium was to improve coordination between the U.S. National Center for Health Statistics [NCHS] and other institutions in developed countries working in the area of perinatal and infant mortality. Emphasis was placed on how to develop programs and activities designed to improve infant health and to remove the disparities that exist among racial, ethnic, and socioeconomic groups in the United States. A series of papers is included on recent trends in perinatal and infant mortality in the United Kingdom, the Federal Republic of Germany, Japan, the United States, Israel, Norway, and Sweden, together with a comparative overview. A second group of papers describes health care systems in the countries concerned. A third section deals with current research into perinatal and infant mortality in these countries. The proceedings conclude with working group and discussant reports.
Comparative study of social and biological effects on perinatal mortality. Etude comparative des effets des facteurs sociaux et biologiques sur la mortalite perinatle.
World Health Statistics Report. Rapport de Statistiques Sanitaires Mondiales. 1976; 29(4):228-34.The World Health Organization's (WHO) comparative study, in 8 countries (Austria, Cuba, Hungary, Japan, New Zealand, Sweden, UK, and the US), of social and biological effects on perinatal mortality is discussed, including the background and the objectives of the study, reportingon the progress achieved thus far, and some of the results likely to emerge. Perinatal mortality, as currently defined, comprises late fetal deaths (stillbirths) and early neonatal deaths, i.e., it includes deaths between the 28th week of pregnancy and the end of the 1st week after birth. In developed countries between 1.6-4% of all pregnancies result in perinatal death. Although many less developed countries give priority to the reduction of postneonatal and early childhoo mortality, with increasing success in their efforts, the hard core of perinatal mortality will gain in importance. Perinatal mortality may be considered as reflecting standards of obstetric and pediatric care as well as the effectiveness of social measures in general and of public health actions in particular. In a 1968 joint UN/WHO Meeting on Programs of Analysis of Mortality Trends and Levels reference was made to the serious gaps in knowledge of the magnitude and determinants of perinatal mortality. In a 1971 follow-up, WHO Consultation on Fetal, infant, and Childhood Mortality, it was recommended that WHO initiate and coordinate studies of the biological, socioeconomic, and cultural factors associated with perinatal mortality and that detailed guidelines for the collection, classification, and tabulation of these biological, socioeconomic, and cultural factors for both national and international purposes be worked out. The proposed study would have the following general objectives: it would serve as a stimulus to countries to make better use of the information to be derived from vital statistics and would encourage detailed studies of the determinants of perinatal mortality and their interrelationships as a basis for the planning of public health programs designed to reduced perinatal mortality; it would enable WHO to obtain precise and detailed information on the significance and the international comparability of perinatal mortality rates and would provide a basis for WHO to develop guidelines concerning the collection, processing, and presentation of national perinatal mortality data as an important part of a national health information system. To achieve the general objectives a draft study protocol was developed. The specific aims established for the study are outlined. More attention will be directed to the problem of perinatal mortality and how it might be reduced.
In: World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death. Vol. 1. Geneva, Switzerland, WHO, 1977. 761-8.This presentation defines live birth, fetal death, causes of death, underlying causes of death, birthweight and low birthweigth, gestational age, preterm, term, postterm, and maternal mortality. It makes recommendations regarding the following: responsibility for medical certification of cause of death; form of medical certificate of cause of death; confidentiality of medical information; selection of the cause for mortality tabulation; use of the International Classification of Diseases; perinatal mortality statistics; maternal mortality statistics, statistical tables; and tabulation of causes of death. Medical certification of cause of death should normally be the responsibility of the attending phsician. In the statistical use of the medical certificate of cause of death and other medical records, administrative procedures should provide such safeguards as are necessary to preserve the confidential nature of the information given by the position. It is recommended that national perinatal statistics should include all fetuses and infants delivered weight at least 500 gm (or, when birthweight is unavailable, the corresponding gestational age--22 weeks--or body length (25 cm crown heel), whether alive or dead). The maternal mortality rate, the direct obstetric death rate, and the indirect obstetric death rate should be expressed as rates per 1000 livebirths. The degree of detail in cross classification by cause, sex, age, and area of territory will depend partly on the purpose and range of the statistics and partly on the practical limits as regards the size of the tables. The patterns listed, designed to promote international comparability, consist of standard ways of expressing various characteristics.
[Perinatal assistance of a basic level in Latin America in 1978: description of projects under execution in 1978] Asistencia perinatal a nivel primario en areas rurales de America Latina en 1978: descripcion de proyectos en ejecucion en 1978.
Montevideo, Uruguay, Centro Latinoamericano e de Perinatalogia y Desarrollo Humano, 1979 Feb. 128 p. (Publicacion Cientifica del C.L.A.P. No. 790.)This report investigates the status of maternal-infant services in the rural areas of 18 Latin American countries, and presents statistics on fetal, infant, and maternal mortality in the same countries. Methods and types of personnel used for the attention of pregnancy and delivery are described, together with recommendations for improvements from such international organizations as WHO and PAHO. The important role of practical midwives in all Latin American countries is stressed, as is the need for their training, especially for what concerns the identification of high risk pregnancies. The report includes a brief description of programs already implemented in 14 countries, and compares them to similar ones existing in the U.S., Holland, Nigeria, Tanzania, Thailand, China, and Ethiopia. The report concludes with recommendations from the Latin American Center for Perinatology and Human Development on simplifying perinatal care in Latin American countries.
World Health Organization, Technical Report Series.. 1970; 50.Add to my documents.