Your search found 65 Results

  1. 1
    393009

    World Health Organization Guidelines for Feeding Low Birth Weight Infants: Effects of Implementation in First Referral Level Health Facilities in India.

    Indian Journal of Pediatrics. 2016 Jun; 83(6):522-8.

    OBJECTIVE: To evaluate the effect of implementing World Health Organization (WHO) low birth weight (LBW) feeding guidelines in First Referral Level health facilities in India. METHODS: This was a before-and-after study conducted at two First Referral Level health facilities in India. In the pre and post implementation periods of 4 mo each, the authors compared knowledge and skills of health care providers (HCPs) with regard to feeding of LBW infants using multiple choice and short answer questions and objective structured clinical examinations. The authors also enrolled in the two periods, separate cohorts of LBW infants along with their mothers at birth, and followed them till 2 wk of age or death/discharge. Quality of care received by the infants was assessed at 24-48 h and at discharge/2 wk using pre-determined parameters based on which quality scores were assigned by experienced neonatologists. Knowledge and skills of the mothers were also assessed at these time points through semi structured questionnaires and observation checklists. Guidelines were implemented using specially prepared training material through seminars, workshops, refresher courses and on-job support. RESULTS: Overall knowledge (62 +/- 16 vs. 75 +/- 15, n = 55; p < 0.01) and skill scores (298 +/- 37 vs. 348 +/- 52, p < 0.05) of HCPs improved. Correct knowledge increased among the mothers at the time of discharge (7.1 % vs. 63.4 %; p < 0.01). However, there was no improvement in maternal feeding skills at either 24-48 h or at discharge and key feeding practices remained unchanged. Though there was increased uptake of kangaroo mother care (0 vs. 21.9 %; p < 0.01) and alternate methods of feeding (15.9 % vs. 31.7 %; p = 0.03) by discharge/14 d, there was no significant improvement in overall quality of care of LBW infants (4.8 % vs. 6.7 %; p = 0.55). CONCLUSIONS: For the Guidelines to be fully effective, additional efforts on part of HCPs/additional staff and efforts to promote generic early feeding practices in addition to LBW focused guidelines would be required.
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  2. 2
    391438
    Peer Reviewed

    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.

    Semrau KE; Hirschhorn LR; Kodkany B; Spector JM; Tuller DE; King G; Lipsitz S; Sharma N; Singh VP; Kumar B; Dhingra-Kumar N; Firestone R; Kumar V; Gawande AA

    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.
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  3. 3
    390037
    Peer Reviewed

    Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India.

    Marx Delaney M; Maji P; Kalita T; Kara N; Rana D; Kumar K; Masoinneuve J; Cousens S; Gawande AA; Kumar V; Kodkany B; Sharma N; Saurastri R; Pratap Singh V; Hirschhorn LR; Semrau KE; Firestone R

    Global Health: Science and Practice. 2017 Jun 27; 5(2):217-231.

    BACKGROUND: Adherence to evidence-based essential birth practices is critical for improving health outcomes for mothers and newborns. The WHO Safe Childbirth Checklist (SCC) incorporates these practices, which occur during 4 critical pause points: on admission, before pushing (or cesarean delivery), soon after birth, and before discharge. A peer-coaching strategy to support consistent use of the SCC may be an effective approach to increase birth attendants' adherence to these practices. METHODS: We assessed data from 60 public health facilities in Uttar Pradesh, India, that received an 8-month staggered coaching intervention from December 2014 to September 2016 as part of the BetterBirth Trial, which is studying effectiveness of an SCC-centered intervention on maternal and neonatal harm. Nurse coaches recorded birth attendants' adherence to 39 essential birth practices. Practice adherence was calculated for each intervention month. After 2 months of coaching, a subsample of 15 facilities was selected for independent observation when the coach was not present. We compared adherence to the 18 practices recorded by both coaches and independent observers. RESULTS: Coaches observed birth attendants' behavior during 5,971 deliveries. By the final month of the intervention, 35 of 39 essential birth practices had achieved >90% adherence in the presence of a coach, compared with only 7 of 39 practices during the first month. Key behaviors with the greatest improvement included explanation of danger signs, temperature measurement, assessment of fetal heart sounds, initiation of skin-to-skin contact, and breastfeeding. Without a coach present, birth attendants' average adherence to practices and checklist use was 24 percentage points lower than when a coach was present (range: -1% to 62%). CONCLUSION: Implementation of the WHO Safe Childbirth Checklist with coaching improved uptake of and adherence to essential birth practices. Coordination and communication among facility staff, as well as behaviors with an immediate, tangible benefit, showed the greatest improvement. Difficult-to-perform behaviors and those with delayed or theoretical benefits were less likely to be sustained without a coach present. Coaching may be an important component in implementing the Safe Childbirth Checklist at scale.Note: At the time of publication of this article, the results of evaluation of the impact of the BetterBirth intervention were pending publication in another journal. After the impact findings have been published, we will update this article on the effect of the intervention on birth practices with a reference to the impact findings.
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  4. 4
    389408
    Peer Reviewed

    An assessment of staffing needs at a HIV clinic in a Western Kenya using the WHO workload indicators of staffing need WISN, 2011.

    Burmen B; Owuor N; Mitei P

    Human Resources For Health. 2017 Jan 26; 15(1):9.

    BACKGROUND: An optimal number of health workers, who are appropriately allocated across different occupations and geographical regions, are required to ensure population coverage of health interventions. Health worker shortages in HIV care provision are highest in areas that are worst hit by the HIV epidemic. Kenya is listed among countries that experience health worker shortages (<2.5 health workers per 1000 population) and have a high HIV burden (HIV prevalence 5.6 with 15.2% in Nyanza province). We set out to determine the optimum number of clinicians required to provide quality consultancy HIV care services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, JOOTRH, HIV Clinic, the premier HIV clinic in Nyanza province with a cumulative client enrolment of PLHIV of over 20,000 persons. CASE PRESENTATION: The World Health's Organization's Workload Indicators of Staffing Needs (WISN) was used to compute the staffing needs and sufficiency of staffing needs at the JOOTRH HIV clinic in Kisumu, Kenya, between January and December 2011. All people living with HIV (PLHIV) who received HIV care services at the HIV clinic at JOOTRH and all the clinicians attending to them were included in this analysis. The actual staffing was divided by the optimal staff requirement to give ratios of staffing excesses or shortages. A ratio of 1.0 indicated optimal staffing, less than 1.0 indicated suboptimal staffing, and more than 1 indicated supra optimal staffing. The HIV clinic is served by 56 staff of various cadres. Clinicians (doctors and clinical officers) comprise approximately one fifth of this population (n = 12). All clinicians (excluding the clinic manager, who is engaged in administrative duties and supervisory roles that consumes approximately one third of his time) provide full-time consultancy services. To operate at maximum efficiency, the clinic therefore requires 19 clinicians. The clinic therefore operates with only 60% of its staffing requirements. CONCLUSIONS: Our assessment revealed a severe shortage of clinicians providing consultation services at the HIV clinic. Human resources managers should oversee the rational planning, training, retention, and management of human resources for health using the WISN which is an objective and reliable means of estimating staffing needs.
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  5. 5
    374431

    India. Spotlight on family planning: tracking progress on the FP2020 pledges.

    International Planned Parenthood Federation [IPPF]; Family Planning Association of India [FPAI]

    [London, United Kingdom, IPPF, 2015]. 2 p.

    The Spotlight on Family Planning series offers a snapshot on progress governments have made in delivering on their FP2020 pledges, made at the London 2012 Family Planning Summit. The Family Planning Association of India (FPA India), the IPPF Member Association in India) and other civil society organizations (CSOs) have identified a number of ‘high priority’ pledges: progress towards these pledges is critical for increasing access to modern family planning (FP) methods.
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  6. 6
    379999
    Peer Reviewed

    Efficacy of World Health Organization guideline in facility-based reduction of mortality in severely malnourished children from low and middle income countries: a systematic review and meta-analysis.

    Hossain M; Chisti MJ; Hossain MI; Mahfuz M; Islam MM; Ahmed T

    Journal of Paediatrics and Child Health. 2017 May; 53(5):474-479.

    Aim: Globally more than 19 million under-five children suffer from severe acute malnutrition (SAM). Data on efficacy of World Health Organization's (WHO’s) guideline in reducing SAM mortality are limited. We aimed to assess the efficacy of WHO’s facility-based guideline for the reduction of under-five SAM children mortality from low and middle income countries (LMICs). Methods: A systematic search of literature published in 1980–2015 was conducted using electronic databases. Additional articles were identified from the reference lists and grey literature. Studies from LMICs where SAM children (0–59 months) were managed in facilities according to WHO’s guideline were included. Outcome was reduction in SAM mortality measured by case fatality rate (CFR). The review was reported following the Grading of Recommendations Assessment Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and meta-analyses done using RevMan 5.3®. Results: This review identified nine studies, which demonstrated reductions in SAM mortality. CFR ranged from 8 to 16% where WHO guideline applied. High rates of poverty, malnutrition, severe co-morbid condition, lack of resources and differences in treatment practices played a key role in large CFR variation. Most death occurred within 48 h of admission in Asia, between 4 days and 4 weeks in Africa and in Latin America. CFR was reduced by 41% (odds ratio: 0.59; 95% confidence interval: 0.46–0.76) when WHO guideline were applied. A 45% reduction in CFR was achieved after excluding human immunodeficiency virus positive cases. Dietary management also differed among WHO and conventional management. Conclusion: Children receiving SAM inpatient care as per WHO guideline have reduced CFR compared to conventional treatment.
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  7. 7
    379205
    Peer Reviewed

    Developing global indicators for quality of maternal and newborn care: a feasibility assessment.

    Madaj B; Smith H; Mathai M; Roos N; van den Broek N

    Bulletin of the World Health Organization. 2017 Jun; 95(6):445-452I.

    Objective To assess the feasibility of applying the World Health Organization’s proposed 15 indicators of quality of care for maternal and newborn health at health-facility level in low- and middle-income settings. Methods Six of the indicators are about maternal health, five are for newborn health and four are general cross-cutting indicators. We used data collected routinely in facility registers and obtained as part of facility assessments from 963 health-care facilities specializing in maternity services in 10 countries in Africa and Asia. We made a feasibility assessment of the availability of data and the clarity of indicator definitions and identified additional information and data collection processes needed to apply the proposed indicators in real-life settings. Findings Of the indicators evaluated, 10 were clearly defined, of which four could be applied directly in the field and six would require revisions to operationalize them. The other five indicators require further development, with one of them being ready for implementation by using information readily available in registers and four requiring further information before deployment. For indicators that measure coverage of care or availability of services or products, there is a need to further strengthen measurement. Information on emergency obstetric complications was not recorded in a standard manner, thus limiting the reliability of the information. Conclusion While some of the proposed indicators can already be applied, other indicators need to be refined or will need additional sources and methods of data collection to be applied in real-world settings.
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  8. 8
    355272

    Global standards for quality health care services for adolescents. A guide to implement a standards-driven approach to improve the quality of health-care services for adolescents. Volume 4: Scoring sheets for data analysis.

    Chatterjee S; Baltag V

    Geneva, Switzerland, World Health Organization, 2015. 132 p.

    Global initiatives are urging countries to prioritize quality as a way of reinforcing human rights-based approaches to health. Yet evidence from both high- and low-income countries shows that services for adolescents are highly fragmented, poorly coordinated and uneven in quality. Pockets of excellent practice exist, but, overall, services need significant improvement and should be brought into conformity with existing guidelines. The aim of Global standards for quality health-care services for adolescents is to assist policy-makers and health service planners in improving the quality of health-care services so that adolescents find it easier to obtain the health services that they need to promote, protect and improve their health and well-being. This volume is to be used in conjunction with the monitoring tools in Volume 3. Using this data analysis method, countries can determine compliance with quality standards. How to use this volume: The scoring sheets in this volume are organized by criterion. There is a separate scoring sheet for each criterion. The total scores for all the criteria that apply to a standard are averaged to yield an overall score for that standard.
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  9. 9
    355271

    Global standards for quality health care services for adolescents. A guide to implement a standards-driven approach to improve the quality of health-care services for adolescents. Volume 3: Tools to conduct quality and coverage measurement surveys to collect data about compliance with the global standards.

    Chatterjee S; Baltag V

    Geneva, Switzerland, World Health Organization, 2015. 100 p.

    Global initiatives are urging countries to prioritize quality as a way of reinforcing human rights-based approaches to health. Yet evidence from both high- and low-income countries shows that services for adolescents are highly fragmented, poorly coordinated and uneven in quality. Pockets of excellent practice exist, but, overall, services need significant improvement and should be brought into conformity with existing guidelines. The aim of Global standards for quality health-care services for adolescents is to assist policy-makers and health service planners in improving the quality of health-care services so that adolescents find it easier to obtain the health services that they need to promote, protect and improve their health and well-being. This volume includes tools to determine whether the implementation of the standards has been achieved. These tools can be adapted for use in different contexts -be it self-assessments on a limited number of criteria, or external assessments (monitoring visits) by district managers, on a wider, or full range, of standards and criteria. The tools can be equally adapted to develop checklists for supportive supervision. The toolkit included in this volume contains seven tools to collect data about quality of care (as measured by the criteria of the standards) and two tools to gather information about coverage.
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  10. 10
    355270

    Global standards for quality health care services for adolescents. A guide to implement a standards-driven approach to improve the quality of health-care services for adolescents. Volume 2: Implementation guide.

    Chatterjee S; Baltag V

    Geneva, Switzerland, World Health Organization, 2015. 28 p.

    Global initiatives are urging countries to prioritize quality as a way of reinforcing human rights-based approaches to health. Yet evidence from both high- and low-income countries shows that services for adolescents are highly fragmented, poorly coordinated and uneven in quality. Pockets of excellent practice exist, but, overall, services need significant improvement and should be brought into conformity with existing guidelines. The aim of Global standards for quality health-care services for adolescents is to assist policy-makers and health service planners in improving the quality of health-care services so that adolescents find it easier to obtain the health services that they need to promote, protect and improve their health and well-being. This volume, the Implementation guide, provides detailed guidance on identifying what actions need to be taken to implement the standards at the national, district and facility levels. It can be used to develop checklists to assess the status of implementation.
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  11. 11
    355269

    Global standards for quality health care services for adolescents. A guide to implement a standards-driven approach to improve the quality of health-care services for adolescents. Volume 1: Standards and criteria.

    Chatterjee S; Baltag V

    Geneva, Switzerland, World Health Organization, 2015 40 p.

    Global initiatives are urging countries to prioritize quality as a way of reinforcing human rights-based approaches to health. Yet evidence from both high- and low-income countries shows that services for adolescents are highly fragmented, poorly coordinated and uneven in quality. Pockets of excellent practice exist, but, overall, services need significant improvement and should be brought into conformity with existing guidelines. The aim of Global standards for quality health-care services for adolescents is to assist policy-makers and health service planners in improving the quality of health-care services so that adolescents find it easier to obtain the health services that they need to promote, protect and improve their health and well-being. The implementation plan and the monitoring tools that accompany the standards in this document provide guidance on identifying what actions need to be taken to implement the standards and to assess whether the standards have been achieved. The primary intention of the standards is to improve the quality of care for adolescents in government healthcare services; however, they are equally applicable to facilities run by NGOs and those in the private sector. The ultimate purpose of implementing the standards is to increase adolescents’ use of services and, thus, to contribute to better health outcomes.
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  12. 12
    373836
    Peer Reviewed

    Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity.

    Vogel JP; Moore JE; Timmings C; Khan S; Khan DN; Defar A; Hadush A; Minwyelet Terefe M; Teshome L; Ba-Thike K; Than KK; Makuwani A; Mbaruku G; Mrisho M; Mugerwa KY; Puchalski Ritchie LM; Rashid S; Straus SE; Gulmezoglu AM

    PloS One. 2016 Nov 2; 11(11):e0160020.

    BACKGROUND: Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO's Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael's Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these. METHODS: We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers). RESULTS: Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators. CONCLUSION: This approach to identifying barriers, facilitators and potential strategies for improving implementation proved feasible in these four lower-income country settings. Further evaluation of the impact of implementing these strategies is needed.
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  13. 13
    372077
    Peer Reviewed

    Targeted Spontaneous Reporting: Assessing Opportunities to Conduct Routine Pharmacovigilance for Antiretroviral Treatment on an International Scale.

    Rachlis B; Karwa R; Chema C; Pastakia S; Olsson S; Wools-Kaloustian K; Jakait B; Maina M; Yotebieng M; Kumarasamy N; Freeman A; de Rekeneire N; Duda SN; Davies MA; Braitstein P

    Drug Safety. 2016 Jun 9; 1-18.

    Introduction: Targeted spontaneous reporting (TSR) is a pharmacovigilance method that can enhance reporting of adverse drug reactions related to antiretroviral therapy (ART). Minimal data exist on the needs or capacity of facilities to conduct TSR. Objectives: Using data from the International epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium, the present study had two objectives: (1) to develop a list of facility characteristics that could constitute key assets in the conduct of TSR; (2) to use this list as a starting point to describe the existing capacity of IeDEA-participating facilities to conduct pharmacovigilance through TSR. Methods: We generated our facility characteristics list using an iterative approach, through a review of relevant World Health Organization (WHO) and Uppsala Monitoring Centre documents focused on pharmacovigilance activities related to HIV and ART and consultation with expert stakeholders. IeDEA facility data were drawn from a 2009/2010 IeDEA site assessment that included reported characteristics of adult and pediatric HIV care programs, including outreach, staffing, laboratory capacity, adverse event monitoring, and non-HIV care. Results: A total of 137 facilities were included: East Africa (43); Asia–Pacific (28); West Africa (21); Southern Africa (19); Central Africa (12); Caribbean, Central, and South America (7); and North America (7). Key facility characteristics were grouped as follows: outcome ascertainment and follow-up; laboratory monitoring; documentation—sources and management of data; and human resources. Facility characteristics ranged by facility and region. The majority of facilities reported that patients were assigned a unique identification number (n = 114; 83.2 %) and most sites recorded adverse drug reactions (n = 101; 73.7 %), while 82 facilities (59.9 %) reported having an electronic database on site. Conclusion: We found minimal information is available about facility characteristics that may contribute to pharmacovigilance activities. Our findings, therefore, are a first step that can potentially assist implementers and facility staff to identify opportunities and leverage their existing capacities to incorporate TSR into their routine clinical programs.
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  14. 14
    337158

    The prevention and elimination of disrespect and abuse during facility-based childbirth. WHO statement.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2014. [4] p. (WHO/RHR/14.23)

    Many women experience disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment not only violates the rights of women to respectful care, but can also threaten their rights to life, health, bodily integrity, and freedom from discrimination. This statement calls for greater action, dialogue, research and advocacy on this important public health and human rights issue.
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  15. 15
    362679
    Peer Reviewed

    Completion of the modified World Health Organization (WHO) partograph during labour in public health institutions of Addis Ababa, Ethiopia.

    Yisma E; Dessalegn B; Astatkie A; Fesseha N

    Reproductive Health. 2013; 10:23.

    BACKGROUND: The World Health Organization (WHO) recommends using the partograph to follow labour and delivery, with the objective to improve health care and reduce maternal and foetal morbidity and death. The partograph consists of a graphic representation of labour and is an excellent visual resource to analyze cervix, uterine contraction and foetal presentation in relation to time. However, poor utilization of the partograph was found in the public health institutions which reflect poor monitoring of mothers in labour and/or poor pregnancy outcome. METHODS: A retrospective document review was undertaken to assess the completion of the modified WHO partograph during labour in public health institutions of Addis Ababa, Ethiopia. A total of 420 of the modified WHO partographs used to monitor mothers in labour from five public health institutions that provide maternity care were reviewed. A structured checklist was used to gather the required data. The collected data were analyzed using SPSS version 16.0. Frequency distributions, cross-tabulations and a graph were used to describe the results of the study. RESULTS: All facilities were using the modified WHO partograph. The correct completion of the partograph was very low. From 420 partographs reviewed across all the five health facilities, foetal heart rate was recorded into the recommended standard in 129(30.7%) of the partographs, while 138 (32.9%) of cervical dilatation and 87 (20.70%) of uterine contractions were recorded to the recommended standard. The study did not document descent of the presenting part in 353 (84%). Moulding in 364 (86.7%) of the partographs reviewed was not recorded. Documentation of state of the liquor was 113(26.9%), while the maternal blood pressure was recorded to standard only in 78(18.6%) of the partographs reviewed. CONCLUSIONS: This study showed a poor completion of the modified WHO partographs during labour in public health institutions of Addis Ababa, Ethiopia. The findings may reflect poor management of labour or simply inappropriate completion of the instrument and indicate the need for pre-service and periodic on-job training of health workers on the proper completion of the partograph. Regular supportive supervision, provision of guidelines and mandatory health facility policy are also needed in support of a collaborative effort to reduce maternal and perinatal deaths.
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  16. 16
    359157
    Peer Reviewed

    Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study.

    Paulo Souza JP; Gülmezoglu AM; Vogel J; Carroli G; Lumbiganon P; Qureshi Z; Costa MJ; Fawole B; Mugerwa Y; Nafiou I; et al.

    Lancet. 2013 May 18; 381(9879):1747-1755.

    Background: We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities. Methods: In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; i.e., maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (e.g., the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (i.e., the ability to produce a positive effect on health outcomes) through standardised mortality ratios. Results: From May 1, 2010, to Dec 31, 2011, we included 314 623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23,015 (7.3%) women had potentially life-threatening disorders and 3024 (1.0%) developed an SMO. 808 (26.7%) women with an SMO had post-partum haemorrhage and 784 (25.9%) had pre-eclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0.826 [95% CI 0.802-0.851]). Interpretation: High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy.
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  17. 17
    354311
    Peer Reviewed

    The world health organization multicountry survey on maternal and newborn health: study protocol.

    Souza JP; Gulmezoglu AM; Carroli G; Lumbiganon P; Qureshi Z

    BMC Health Services Research. 2011; 11:286.

    BACKGROUND: Effective interventions to reduce mortality and morbidity in maternal and newborn health already exist. Information about quality and performance of care and the use of critical interventions are useful for shaping improvements in health care and strengthening the contribution of health systems towards the Millennium Development Goals 4 and 5. The near-miss concept and the criterion-based clinical audit are proposed as useful approaches for obtaining such information in maternal and newborn health care. This paper presents the methods of the World Health Organization Multicountry Study in Maternal and Newborn Health. The main objectives of this study are to determine the prevalence of maternal near-miss cases in a worldwide network of health facilities, evaluate the quality of care using the maternal near-miss concept and the criterion-based clinical audit, and develop the near-miss concept in neonatal health. METHODS/DESIGN: This is a large cross-sectional study being implemented in a worldwide network of health facilities. A total of 370 health facilities from 29 countries will take part in this study and produce nearly 275,000 observations. All women giving birth, all maternal near-miss cases regardless of the gestational age and delivery status and all maternal deaths during the study period comprise the study population. In each health facility, medical records of all eligible women will be reviewed during a data collection period that ranges from two to three months according to the annual number of deliveries. DISCUSSION: Implementing the systematic identification of near-miss cases, mapping the use of critical evidence-based interventions and analysing the corresponding indicators are just the initial steps for using the maternal near-miss concept as a tool to improve maternal and newborn health. The findings of projects using approaches similar to those described in this manuscript will be a good starter for a more comprehensive dialogue with governments, professionals and civil societies, health systems or facilities for promoting best practices, improving quality of care and achieving better health for mothers and children.
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  18. 18
    332015

    The Fistula Fortnight: Healing Wounds, Renewing Hope, 21 February - 6 March 2005, Kano, Katsina, Kebbi and Sokoto States, Nigeria.

    Iliyasu Z; Idoko L; Ramsey K

    New York, New York, United Nations Population Fund [UNFPA], [2007]. 46 p.

    The Fistula Fortnight accomplished a number of goals: it mobilized resources for obstetric fistula and safe motherhood; increased public awareness that fistula is preventable; contributed to combating the marginalization of women who suffer from fistula; strengthened institutional capacity to manage fistula; and began to address the broader needs of women living with the disability. While the surgeries conducted represent only a small portion of the backlog, the Fistula Fortnight provided a strategic opportunity to raise awareness and motivate action among policymakers, national and local leaders, and the general public about the need to increase efforts to both prevent and treat fistula. (Excerpt)
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  19. 19
    341765
    Peer Reviewed

    The WHO/PEPFAR collaboration to prepare an operations manual for HIV prevention, care, and treatment at primary health centers in high-prevalence, resource-constrained settings: defining laboratory services.

    Spira T; Lindegren ML; Ferris R; Habiyambere V; Ellerbrock T

    American Journal of Clinical Pathology. 2009 Jun; 131(6):887-94.

    The expansion of HIV/AIDS care and treatment in resource-constrained countries, especially in sub-Saharan Africa, has generally developed in a top-down manner. Further expansion will involve primary health centers where human and other resources are limited. This article describes the World Health Organization/President's Emergency Plan for AIDS Relief collaboration formed to help scale up HIV services in primary health centers in high-prevalence, resource-constrained settings. It reviews the contents of the Operations Manual developed, with emphasis on the Laboratory Services chapter, which discusses essential laboratory services, both at the center and the district hospital level, laboratory safety, laboratory testing, specimen transport, how to set up a laboratory, human resources, equipment maintenance, training materials, and references. The chapter provides specific information on essential tests and generic job aids for them. It also includes annexes containing a list of laboratory supplies for the health center and sample forms.
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  20. 20
    322021

    Handbook of supply management at first-level health care facilities. 1st version for country adaptation.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2006. 73 p. (WHO/HIV/2006.03)

    All first-level health care facilities, namely primary health care clinics and outpatient departments based in district hospitals, use medicines and related supplies. It takes a team effort to manage these supplies, involving all health care facility staff: doctors, nurses, health workers and storekeepers. This is especially true in small facilities with only one or two health workers. Each staff member should know how to manage all supplies at the health care facility correctly. Each staff member has an important role. The Handbook of Supply Management at First-Level Health Care Facilities describes all major medicines and supply management tasks, known as the standard procedures of medicines supply management at first-level health care facilities. Each chapter covers one major task, explains how the task fits into the process of maintaining a consistent supply of medicines, and recommends which standard procedures to use. Annexes at the back of the handbook contain various checklists and examples of forms which can be introduced as needed at your health care facility. This handbook is part of a package used in an integrated training and capacity-building course targeted at first-level health care facilities. It can be used in conjunction with the existing Integrated Management of Adult and Adolescent Illness (IMAI) strategy developed by WHO. It can also be used for basic training activities independent of IMAI training courses. (excerpt)
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  21. 21
    285487
    Peer Reviewed

    Program note: using UN process indicators to assess needs in emergency obstetric services: Bolivia, El Salvador and Honduras. [Nota de programa: utilización de los indicadores de procesos de Naciones Unidas para evaluar las necesidades en los servicios obstétricos de emergencia: Bolivia, El Salvador y Honduras]

    Bailey P

    International Journal of Gynecology and Obstetrics. 2005 May; 89(2):221-230.

    The UN process indicators are used to assess the availability, utilization and quality of emergency obstetric care (EmOC). Needs assessments for EmOC in Bolivia, El Salvador and Honduras show reasonable availability of comprehensive EmOC facilities for their population sizes, but a scarcity of basic facilities. Utilization rates among women with obstetric complications are high in El Salvador and Honduras. Case fatality rates tend to be below 1% in all three countries, but the more rural areas in each have poorer indicators. (author's)
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  22. 22
    281236

    Antenatal care: report of a Technical Working Group.

    World Health Organization [WHO]. Technical Working Group on Antenatal Care (1994: Geneva)

    Geneva, Switzerland, WHO, 1996. [30] p. (WHO/FRH/MSM/96.8)

    A Technical Working Group on Antenatal Care was convened in Geneva, 31 October - 4 November 1994, by the World Health Organization. The original objectives of the Technical Working Group were: 1. To review current antenatal care practices and make recommendations for the identification of high-risk pregnancies and their management, taking into account the timing of the pregnancy, resources available, and skills of the health worker; 2. To draw up recommendations on antenatal care and specifically outline the tasks and procedures health workers are expected to perform at different levels of the health care system; 3. To review the basic equipment, procedures, and supplies used in antenatal care from the point of view of cost, maintenance, scientific validity, and skills required to employ them appropriately; 4. To examine how to optimize antenatal care in terms of clinical tasks and procedures in relationship to the timing of the visits, distance to referral centres, and frequency of attendance. (excerpt)
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  23. 23
    279034

    Use of maternity register data in Benin.

    Kodjogbé N; Fourn L; Stanton C

    Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2003 Aug. [34] p. (USAID Cooperative Agreement No. HRN-A-00-97-00018-00)

    This report describes a study of the content and use of routinely collected data from maternity registers for the purposes of monitoring for maternal and newborn health at the health facility level in two departments of Benin. Specifically, the objectives of the study are to: Describe the scope, quality, completeness and use of the information collected in maternity registers in the departments of Atlantique and Zou; Calculate indicators which reflect clinical practices and outcome, such as: the cesarean section rate (for health facilities with surgical capacity), the referral rate, the rate of referred patients who are treated at the referral site, the episiotomy rate, the rate of “directed” deliveries (i.e., deliveries where oxytocics were used) and stillbirth and maternal death rates in health facilities in the departments of Atlantique and Zou; Validate the data regarding cesarean section operations recorded in the delivery register against that recorded in the surgical register; Describe the process by which data are recorded in the maternity registers. (excerpt)
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  24. 24
    274803

    Technical bases for the WHO recommendations on the management of pneumonia in children at first-level health facilities.

    World Health Organization [WHO]. Programme for the Control of Acute Respiratory Infections

    Geneva, Switzerland, WHO, Programme for the Control of Acute Respiratory Infections, 1991. [26] p. (WHO/ARI/91.20)

    About 13 million children under 5 years of age die every year in the world, 95% of them in developing countries. Pneumonia is one of the leading causes, accounting for about 4 million of these deaths. Despite this fact, for a combination of technical and operational reasons, pneumonia has been a neglected problem until very recently. Clinicians and epidemiologists thought that the control of respiratory infections did not deserve high priority because of the difficulties involved in preventing and managing these infections; it was said that antibiotics might not be an effective treatment against pneumonia because patients are often weakened by conditions such as chronic malnutrition and parasitic infections, and that a wide variety of viruses and bacteria are associated with pulmonary infections making it impossible to identify the specific etiological agent in each patient (1.) On the other hand, some public health experts felt that a programme aimed at preventing mortality from pneumonia could not succeed because it would be difficult to deliver the available technology (antibiotics) through peripheral health units and community-based health workers. At most, one quarter of the pneumonia cases in children can be prevented by the measles and pertussis vaccines included in the immunization schedule of the Expanded Programme on Immunization. There is a clear need for research to develop and test vaccines against the most frequent agents of pneumonia in children. Such research has been pursued by WHO, notably within the Programe for the Control of Acute Respiratory Infections (ARI) and the Vaccine Development Programme; however, WHO has simultaneously been utilizing current clinical knowledge to formulate a case management strategy to reduce the high mortality from pneumonia in children. The present document is not intended to provide detailed case management guidelines. These are to be found in the manual "Acute respiratory infections in children: Case management in small hospitals in developing countries. A manual for doctors and other senior health workers", document WHO/ARI/90.5 (1990). (excerpt)
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  25. 25
    192484

    Infection control for viral haemorrhagic fevers in the African health care setting.

    Lloyd E; Perry H

    Atlanta, Georgia, United States Centers for Disease Control and Prevention [CDC], National Center for Infectious Diseases, Division of Viral and Rickettsial Diseases, Special Pathogens Branch, 1998 Dec. [10], 198 p.

    This manual describes a system for using VHF Isolation Precautions to reduce the risk of transmission of VHF in the health care setting. The VHF Isolation Precautions described in the manual make use of common low-cost supplies, such as household bleach, water, cotton cloth, and plastic sheeting. Although the information and recommendations are intended for health facilities in rural areas in the developing world, they are appropriate for any health facility with limited resources. The information in this manual will help health facility staff to: 1. Understand what VHF Isolation Precautions are and how to use them to prevent secondary transmission of VHF in the health facility. 2. Know when to begin using VHF Isolation Precautions in the health care setting. 3. Apply VHF Isolation Precautions in a large-scale outbreak. (When a VHF occurs, initially as many as 10 cases may appear at the same time in the health facility.) 4. Make advance preparations for implementing VHF Isolation Precautions. 5. Identify practical, low-cost solutions when recommended supplies for VHF Isolation Precautions are not available or are in limited supply. 6. Stimulate creative thinking about implementing VHF Isolation Precautions in an emergency situation. 7. Know how to mobilize community resources and conduct community education. (excerpt)
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