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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.
Optimal feeding of low-birthweight infants in low- and middle-income countries: highlights from the World Health Organization 2011 guidelines.
[Washington, D.C.], MCSP, 2017 Jun. 6 p. (USAID Cooperative Agreement No. AID-OAA-A-14-00028)This brief presents the updated WHO Guidelines on Optimal Feeding of Low Birth-Weight Infants in Low- and Middle-Income Countries, and highlights changes and best practices for optimal feeding of LBW infants. It is intended to assist policymakers, program managers, educators, and health care providers involved in caring for LBW infants to put the recommendations into action. It is hoped that such actions will contribute to improving the quality of care for LBW infants, thereby reducing LBW mortality and improving health outcomes for this group.
Feeding of Low Birth Weight Newborns in Tertiary Care Hospitals in Pakistan: Do They Follow the World Health Organization Latest Guidelines?
Journal of the College of Physicians and Surgeons -- Pakistan. 2015 Aug; 25(8):583-7.OBJECTIVE: To determine the extent the World Health Organization (WHO) guidelines on the care of Low Birth Weight (LBW) newborns are followed in Pakistani hospitals and analyze any difference in policy compliance between different hospitals. STUDY DESIGN: Descriptive analytical study. PLACE AND DURATION OF STUDY: Data was collected from five tertiary care hospitals, one each from Peshawar, Lahore, Quetta, Karachi and Islamabad, from January to June 2012. METHODOLOGY: LBW newborns data derived from medical records was used. It was collected using a questionnaire, which encompassed the recent WHO recommendations for feeding of LBW. Twenty questionnaires were collected from each hospital. STATA11.0 was used to analyze the data. RESULTS: Fifty seven LBW newborns (57%) were fed with mother's own milk, and 9 (9%) were fed on donor human milk. Forty four newborns (44%) were initiated breastfeeding within the first hour after birth. Most of the babies not able to be breastfed were fed with intra gastric tube. Feeding practices varied markedly across hospitals, ranging from one hospital where all newborns were fed formula milk to one where all were fed breast milk. CONCLUSION: The WHO guidelines were only partially implemented, with significant differences between hospitals in level of implementation of recommended practices. Given the benefits expected from the application of the guidelines, efforts should be made for the establishment and promotion of a single national policy for LBW feeding that follows the WHO new guidelines and streamlines the LBW feeding practices across the country.
Washington, D.C., World Bank, 2015 Feb.  p. (From Evidence to Policy)Poor children face barriers to healthy development even before they are born. Their mothers may not have nutritious food or proper prenatal care, which can harm a baby s brain development when it needs it most. Mothers may not deliver in a health facility nor have a skilled birth attendant present, increasing the risk of complications and ultimately putting their life and that of the baby at risk. In Argentina, the World Bank supported a government program, Plan Nacer, to improve maternal-child health outcomes through increased coverage and quality of health services. The program gives provincial authorities financial incentives for enrolling pregnant women and children in the program and for achieving specific primary health care goals. An impact evaluation found that Plan Nacer improved the birth weight of babies and reduced newborn deaths, while improving access to public health facilities and boosting the quality of care. The evidence from this evaluation will equip policy makers in low and middle income countries with additional information when designing health programs aimed at improving specific outcomes. As governments around the world look for ways to create effective programs to help their poorest citizens, the results from this impact evaluation provide an example of how health sector reforms can give children the right start in life.
World Health Organization. Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition. Geneva, Switzerland, 2014.
Advances In Nutrition. 2015 Jan; 6(1):134-5.Add to my documents.
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.2)Recognizing that accelerated global action is needed to address the pervasive and corrosive problem of the double burden of malnutrition, in 2012 the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified a set of six global nutrition targets that by 2025 aim to: achieve a 40% reduction in the number of children under-5 who are stunted; achieve a 50% reduction of anaemia in women of reproductive age; achieve a 30% reduction in low birth weight; ensure that there is no increase in childhood overweight; increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%; reduce and maintain childhood wasting to less than 5%. As part of its efforts, the World Health Organization (WHO) has developed a series of six policy briefs, linked to each of the global targets, to guide national and local policy-makers on what actions should be taken at scale, in order to achieve the targets. Recognizing that the six targets are interlinked, many evidence-based, effective interventions can help make progress toward multiple targets. The purpose of these briefs is to consolidate the evidence around which interventions and areas of investment need to be scaled up, and to guide decision-makers on what actions need to be taken in order to achieve real progress toward improving maternal, infant and young child nutrition. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.5)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the third target: a 30% reduction in low birth weight. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in reducing rates of low birth weight. (Excerpts)
Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health.
BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Mar; 121 Suppl 1:32-9.OBJECTIVE: To assess the proportion of severe maternal outcomes resulting from indirect causes, and to determine pregnancy outcomes of women with indirect causes. DESIGN: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health. SETTING: A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East. SAMPLE: A total of 314 623 pregnant women admitted to the participating facilities. METHODS: We identified the percentage of women with severe maternal outcomes arising from indirect causes. We evaluated the risk of severe maternal and perinatal outcomes in women with, versus without, underlying indirect causes, using adjusted odds ratios and 95% confidence intervals, by a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. MAIN OUTCOME MEASURES: Severe maternal outcomes and preterm birth, fetal mortality, early neonatal mortality, perinatal mortality, low birthweight, and neonatal intensive care unit admission. RESULTS: Amongst 314 623 included women, 2822 were reported to suffer from severe maternal outcomes, out of which 20.9% (589/2822; 95% CI 20.1-21.6%) were associated with indirect causes. The most common indirect cause was anaemia (50%). Women with underlying indirect causes showed significantly higher risk of obstetric complications (adjusted odds ratio, aOR, 7.0; 95% CI 6.6-7.4), severe maternal outcomes (aOR 27.9; 95% CI 24.7-31.6), and perinatal mortality (aOR 3.8; 95% CI 3.5-4.1). CONCLUSIONS: Indirect causes were responsible for about one-fifth of severe maternal outcomes. Women with underlying indirect causes had significantly increased risks of severe maternal and perinatal outcomes. (c) 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study.
BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Mar; 121 Suppl 1:40-8.OBJECTIVE: To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. DESIGN: Secondary analysis using facility-based cross-sectional data of the World Health Organization Multicountry Survey on Maternal and Newborn Health. SETTING: Twenty-nine countries in Africa, Latin America, Asia and the Middle East. POPULATION: Women admitted for delivery in 359 health facilities during 2-4 months between 2010 and 2011. METHODS: Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes. MAIN OUTCOME MEASURES: Risk of adverse pregnancy outcomes among adolescent mothers. RESULTS: A total of 124 446 mothers aged =24 years and their infants were analysed. Compared with mothers aged 20-24 years, adolescent mothers aged 10-19 years had higher risks of eclampsia, puerperal endometritis, systemic infections, low birthweight, preterm delivery and severe neonatal conditions. The increased risk of intra-hospital early neonatal death among infants born to adolescent mothers was reduced and statistically insignificant after adjustment for gestational age and birthweight, in addition to maternal characteristics, mode of delivery and congenital malformation. The coverage of prophylactic uterotonics, prophylactic antibiotics for caesarean section and antenatal corticosteroids for preterm delivery at 26-34 weeks was significantly lower among adolescent mothers. CONCLUSIONS: Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low- and middle-income countries. (c) 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
Potential interventions for the prevention of childhood pneumonia in developing countries: improving nutrition.
American Journal of Clinical Nutrition. 1999 Sep; 70(3):309-320.Acute respiratory infections are the leading cause of childhood death in developing countries. Current efforts at mortality control focus on case management and immunization, but other preventive strategies may have a broader and more sustainable effect. This review, commissioned by the World Health Organization, examines the relations between pneumonia and nutritional factors and estimates the potential effect of nutritional interventions. Low birth weight, malnutrition (as assessed through anthropometry), and lack of breast-feeding appear to be important risk factors for childhood pneumonia, and nutritional interventions may have a sizeable effect in reducing deaths from pneumonia. For all regions except Latin America, interventions to prevent malnutrition and low birth weight look more promising than does breast-feeding promotion. In Latin America, breast-feeding promotion would have an effect similar to that of improving birth weights, whereas interventions to prevent malnutrition are likely to have less of an effect. These findings emphasize the need for tailoring interventions to specific national and even local conditions. (author's)
Eastern Mediterranean Health Journal. 2001 Nov; 7(6):956-965.The infant mortality rates for 1978 and 1998 of 16 Arab countries in the Eastern Mediterranean region were studied. The data were extracted from World Health Organization and United Nations Children’s Fund sources. The impact of demographic, social, perinatal care and economic indicators on infant mortality rates in 1998 was studied using Spearman rank coefficient to detect significant correlations. All countries, except Iraq, showed a sharp decline in rates from 1978 to 1998. Infant mortality rates were directly related to population size, annual total births, low birth weight and maternal mortality ratios. Also, infant mortality rates were inversely related to literacy status of both sexes, annual gross national product per capita and access to safe drinking water and adequate sanitation facilities. (author's)
Improving neonatal health in South-East Asia Region. Report of a regional consultation, New Delhi, India, 1-5 April 2002.
New Delhi, India, WHO, Regional Office for South-East Asia, 2002 Sep.  p. (SEA-MCH-219)The WHO Regional Office and BASICS II/ USAID in collaboration with the WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India jointly organized a South-East Asia Regional Consultation on Improving Newborn Health from 1- 5 April 2002 at New Delhi. The participants in this consultation included the Directors-General of Health Services, programme managers and senior officials of the governments from nine Member Countries, as well as partners and stakeholders concerned with neonatal health. These comprised staff from WHO/HQ, Regional Office and country offices, technical managers from USAID and BASICS II, UNICEF, Saving Newborn Lives (SNL) of Save the Children Foundation (USA), DFID, Save the Children Foundation (USA), PATH, CARE India, JSI Nepal, Kangaroo Foundation, representatives from WHO collaborating centres in the Region, experts from community-based NGOs, researchers who have done innovative work in the field, and office bearers of professional societies. The specific objectives of the consultation were as follows: (1) To develop consensus on essential care package for neonatal health for different levels of health care delivery system; (2) To agree on key in dicators for monitoring and evaluation of neonatal health; (3) To promote partnership towards development of plans for resource mobilization and networking, and (4) To review existing tools and guidelines and develop plans for adaptation and adoption. (excerpt)
Geneva, Switzerland, WHO, Division of Family Health, Programme of Maternal and Child Health and Family Planning, 1991 Dec. , 122 p. (WHO/MCH/91.10)This WHO consultation on maternal and perinatal infections reviews the epidemiology of these infections, examines the effectiveness of known intervention strategies to prevent and treat these infections, notes gaps in current knowledge, and develops recommendations for implementation of appropriate control strategies. The report is geared toward maternal and child health professionals in developing countries where maternal and perinatal infections cause considerable morbidity and death. These countries have limited resources for health care (e.g., US $5-10/person), largely due to the worsening economic situation. The report centers on the feasibility, effectiveness, and cost of interventions to prevent, treat, and control the infections. It has summary cost-effective analyses of maternal and perinatal infections and proposed interventions using 3 different hypothetical country situations to help policymakers decide on priorities and policies on prevention, treatment, and control of these infections. The report dedicates a chapter to each infection (syphilis, neonatal tetanus, malaria, hepatitis, HIV infections, chlamydial infections, herpes simplex infection, Group B Streptococcal infections, and maternal genital infection causing premature birth and low birth weight). Each chapter addresses their clinical and public health significance; prevalence in pregnant women and transmission from mother to fetus/infant; clinical effects; prevention, treatment, and control; and cost effectiveness and feasibility of various interventions. Based on public health importance, feasibility, and affordability, the consultants agreed that national and international programs should place the highest priority on these perinatal infections: gonococcal ophthalmia neonatorum, maternal and congenital syphilis, neonatal tetanus, hepatitis B, and maternal puerperal infections.
New York, New York, UNICEF, Planning and Coordination Office, Statistics and Monitoring Section, 1993 Mar.  p.UNICEF has put together 88 individual country profiles with detailed national level data on child malnutrition (i.e., underweight, stunting, and wasting) from the 1970s to 1992. The profiles include break-downs by degree of severity, gender, rural-urban residence, and age and incidence of low birth weight. Trends over time are available for 35 countries. The profiles are based on data available to UNICEF/New York as of August 1993. They serve as a basis for countries as they move towards the goal of the World Summit for Children--reducing severe and moderate malnutrition among children aged 5 or less (under-fives) by 50% between 1990 and 2000. The profiles consist of tables and graphs. The countries range from Algeria to Zimbabwe. Children whose weight is less than 2 standard deviations from the median weight-for-age of the NCHS standard reference population are considered moderately or severely underweight. The major sources for new data include the Demographic and Health Surveys, WHO's Nutrition Unit, the UN Administrative Committee on Coordination/Subcommittee on Nutrition, PAHO, the World Bank (Social Dimensions of Adjustment Surveys and Living Standards and Measurement Surveys), the PAPCHILD surveys, and UNICEF staff in headquarters and field offices.
Use of a simple anthropometric measurement to predict birth weight. WHO Collaborative Study of Birth Weight Surrogates.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1993; 71(2):157-63.The study was undertaken in 22 centers throughout the world to collect data on a consecutive sample of 400 births. 3 measurements were made for each baby: birth weight, mid-arm circumference, and chest circumference. In addition, the baby's sex and gestational age at birth were recorded. The main problem with data quality was a tendency for weights to be recorded in round hundred grams and circumferences in whole centimeters. The primary objective was to identify cut-off points below which a baby is diagnosed to be at risk for conditions associated with low birth weight. Centers in South Asia, such as Delhi and Chandigarh, had the lowest average birth weight and anthropometric measures, whereas those in Europe, such as St. Petersburg (Russia), Szeged (Hungary), and Yerevan (Armenia) has some of the highest. In 18 of the 22 centers, the correlations between birth weight and chest circumference were greater than those for arm circumference. Regression analyses demonstrated that the best model in each center was birth weight predicted by chest circumference. However, a different regression equation had to be estimated for each center. The estimated regression coefficients varied between the extremes of Islamabad and Chandigarh, where an increase of 1 cm in chest circumference predicted birth weight increases of 260 and 156 gm, respectively. For practical use in developing countries, cut-off points for chest circumference and end-points for birth weight need to be defined for the prediction of low birth weight. Therefore, the standard WHO end-point of 2500 gm was adopted, and babies below this were defined as having low birth weight. Cut-off points of 29 and 30 cm are proposed. Babies with a chest circumference <29 cm would be diagnosed as highly at risk, and they should be referred to a health center immediately. Those with a chest circumference of 29-30 cm would be diagnosed as at risk, and their progress should be monitored carefully.
PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1992; (23):2-3.A study sponsored by the Special Program of Research, Development and Research Training in Human Reproduction of the World Health Organization was carried out in Thailand involving groups of women with 1573 accidental pregnancies. There were 830 accidental pregnancies while using the injectable contraceptive depot-medroxyprogesterone acetate (DMPA), while 743 women had become pregnant before use. There were also 601 accidental pregnancies in oral contraceptive (OC) users. The comparison group of a total of 2587 controls comprised women whose pregnancies were planned as opposed to the exposed group. Women using DMPA had more pregnancy risk factors compared to other groups owing to low socioeconomic status, lower maternal weight and height, smoking and alcohol use during pregnancy, and unplanned pregnancy. However, even after adjusting for these factors, DMPA users had a 50% higher than normal risk of having a low-birth-weight child. The same level of statistically not significant risk was also found among the OC users. Among those who had had accidental pregnancies during DMPA use, and in whom conception was estimated to have occurred within 4 weeks of a DMPA injection, the risk of low birth weight was 90% higher than that in the control group. The increase in risk appeared to decline to 50% when the interval between conception and DMPA injection was 5-8 weeks, and to 20% when the interval between conception and DMPA injection was 5-8 weeks, and to 20% when the interval was >or= 9 weeks. This trend was highly significant. Early, high-dose exposure in utero to DMPA seemed to affect fetal growth. There was no increase in the risk of mortality in the 1st year of life for infants exposed to OCs as compared to infants not exposed. However, infants from DMPA-exposed pregnancies had an 80% higher than normal risk of dying during the 1st year of life. Therefore, some infants born out of accidental pregnancies that occur during DMPA use may be at an increased risk of infant death.
ANNALS OF THE NEW YORK ACADEMY OF SCIENCES. 1991; 626:1-10.WHO defines reproductive health as people having the ability to reproduce, to regulate fertility, and to practice and enjoy sexual relationships. It also means safe pregnancy, child birth, contraceptives, and sex. Procreation should include a successful outcome as indicated by infant and child survival, growth, and healthy development. 60-80 million infertile couples live in the world. Core infertility, i.e., unpreventable and untreatable infertility, ranges from 3% to 5%. Sexually transmitted diseases, aseptic abortion, or puerperal infection are common causes of acquired infertility. Sub-Saharan Africa has the highest prevalence of acquired infertility. In 1983, the world contraceptive use rate stood at 51% with the developed countries having the highest rate (70%) and Africa the lowest rate (14%). About 40 countries in Africa and the Arabian Peninsula practice female circumcision. The percent of low birth weight infants is greater in developing countries than in developed countries (17% vs. 6.8%). Intrauterine growth retardation is responsible for most low birth weight infants in developing countries while in developed countries it is premature birth. About 15 million infants and children die each year. Maternal mortality risk is highest in developing countries especially those in Africa (1:21) and lowest in developed countries (1:9850). Sexually transmitted diseases continue to be a major problem in the world especially in developing countries. Chlamydia afflicts 50 million people each year. The proportion of women with AIDS is growing so that between the 1980s and 1990s it will grow between 25% and 50%. More available contraceptive choices enhance safety in fertility regulation. Socioeconomic conditions that determine reproductive health are poverty, literacy, and women's status. Sexual behavior, reproductive behavior, breast feeding, and smoking are life style determinants of reproductive health. Availability, utilization, and efficiency of health care services and level of medical knowledge also determine women's reproductive health.
ICCW NEWS BULLETIN. 1991 Jul-Dec; 39(3-4):12-5.In 1924, the League of Nations adopted the 1st international law recognizing that children have inalienable rights and are not the property of their father. The UN Declaration on the Rights of the Child emerged in 1959. 1979 was the International Year of the Child. In 1990 there was the World Summit on Children and the UN General Assembly adopted the Global Convention on the Rights of the Child. The convention included civil, economic, social, cultural, and political rights of children all of which covered survival, development, protection, and participation. At the end of 1990, 60 countries had ratified the convention, thus including it into their national legislation. Even though India had not yet endorsed the Convention by the end of 1991, it expressed its support during the 1st workshop on the Rights of the Child which focused on girls. India has a history of supporting children as evidenced by 250 central and state laws on their welfare such as child labor and child marriage laws. In 1974, India adopted the National Policy for Children followed by the establishment of the National Children's Board in 1975. The Board's activities resulted in the Integrated Child Development Services Program which continues to include nutrition, immunization, health care, preschool education, maternal education, family planning, and referral services. Despite these laws and actions, however, the Indian government has not been able to improve the status of children. For example, between 1947-88, infant mortality fell only from 100/1000 to 93/1000 live births and child mortality remained high at 33.3 in 1988 compared with 51.9 in 1971. Population growth poses the biggest problem to improving their welfare. Poverty also exacerbates their already low status.
IN POINT OF FACT 1990 Sep; (70):1-4.About 50% of children <1 year old in developing countries die during the 1st month of life, and 97% of all infant deaths occur in developing countries. Major factors contributing to these deaths are the mother's poor health before and during pregnancy, unhygienic childbirth practices, and inadequate care after delivery. Low birth weight, linked to mother's health, is considerably related to survival and development and growth. >500,000 women in developing countries die annually due to pregnancy and childbirth. Maternal mortality risk in the poorest countries can be 200 times that of developed countries. Inappropriate timing and spacing, too many pregnancies, unsafe abortion, and insufficient prenatal care and care during delivery contribute to high maternal mortality in developing countries. Mothers <18 years old are at the highest risk of pregnancy complications, delivering a premature infant, and/or death. Postponement of marriage and better access to family planning would improve their and their infants chances of survival. Access to and acceptability of family planning promotes the health of women and children. Literate women and their children are healthier than those of illiterate women. A trained person attends only 20% of births in developing countries. Increasing the number of deliveries with a trained attendant and increasing immunizations of mothers with the tetanus toxoid will greatly reduce mortality. Infants leaving the uterus experience a drop in ambient temperature from 37 to 20 degrees Celsius. If they are not dried off, covered in a dry cloth, and/or allowed to be in physical contact quickly, they can experience considerable heat loss or even death. Further all infants should be exclusively breastfed for 4-6 months to ensure healthy growth and development and to provide protection against infections.
[Unpublished] 1991. Presented at the 119th Annual Meeting of the American Public Health Association [APHA], Atlanta, Georgia, November 11-14, 1991. 7,  p.Maternal health affects child survival in many ways. For example, and infant in Bangladesh whose mother has died during childbirth has a 95% chance of dying in the 1st year. Further children <10 years old in Bangladesh, especially girls, who have lost their mother are 4 times as likely to also die. In addition, there is a relationship between protein energy malnutrition in mothers and low prepregnancy weight and meager wait gain during pregnancy which retards fetal growth resulting in a low birth weight (LBW) infant, LBW infants die at a rate 30 times that of adequate weight infants. In fact, child survival depends on maternal health even before the mother is able to conceive. Daughter as well as mothers in developing countries often eat last and smaller amounts of food than male family members. Females who remain poorly nourished often experience obstructed labor which causes several complications for the infant such as respiratory failure. Maternal infections such as malaria and sexually transmitted diseases are also closely linked to LBW. Some can also bring about preterm birth and congenital infections. Pregnancy and labor complications are responsible for about 500,000 maternal deaths annually. Hemorrhage, sepsis, eclampsia, and obstructed labor cause most of these deaths. A woman's fertility pattern also contributes to child survival. The high risk birth categories include too young, too old, too many children, and too closely spaced. In fact, the median mortality rate for infants born <2 years after the older sibling is 71% greater than that for those born 2-3 years apart. The World Bank recommends improved community based health care, improved referral facilities, and an alarm and transport system to improve maternal health. The World Bank, UNDP, UNFPA, UNICEF, WHO, IPPF, and the Population Council support the Safe Motherhood Initiative which aims to reduce maternal morbidity and death by 50% by 2000.
Maternal anthropometry for prediction of pregnancy outcomes: memorandum from a USAID/WHO/PAHO/MotherCare meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(5):523-32.The memorandum is an abbreviated version of a prepared report on maternal anthropometry which summarizes the general recommendations of a consensus of 50 experts on field applications and priority research issues in developing countries. Consensus was reached at a meeting on Maternal Anthropometry for Prediction of Pregnancy Outcomes held in Washington, D.C. in April 1990. 15 general recommendations are identified for field applications and research priorities. Specific recommendations differentiating field applications from research priorities are provided for prepregnancy weight, weight gain in pregnancy, height, arm circumference, and weight for height and body mass index. For example, the discussion of arm circumference indicates that it is useful as an indicator of maternal nutritional status in nonpregnant women because of its correlation with maternal weight or weight for height. During pregnancy, it is useful as a screen for risk of low birth weight (LBW) and late fetal and infant mortality. Maternal arm circumference has been found to be stable during pregnancy in developing countries and is independent of gestational age. Field applications involve the use 1) to assess the nutritional status of pregnant and nonpregnant women, 2) to screen women at risk of poor maternal stores postpartum because it reflects maternal fat and lean tissue stores, for instance, 3) to screen women and refer to facilities for a more thorough assessment of nutritional risk, and 4) to assess the extent of undernutrition in an area, particularly for surveillance. Community level workers, especially birth attendants (TBA's) should be trained and have access to arm circumference tapes. The technology is simple enough also for use by women in the home. Cutoff points for assessing biological risk are fairly consistent across developing country populations, and range between 21-23.5 cm. Routine monitoring during pregnancy is not necessary because the changes are too small to detect. Where prepregnancy weight is unavailable and weight is monitored, arm circumference may serve as a proxy for prepregnancy weight. All women of childbearing age should be measured. Research priorities are to explore the functional significance with women of difference body compositions (fat versus lean upper arm), the relationship to pregnancy related outcomes, arm changes relative to stages throughout the reproductive period and to weight changes, different instruments such as color-coded tapes or 1 tape for arm measurement and uterine height, combinations of different measurements, the relationship with prepregnancy weight, and the development of arm circumference in weight gain charts as a proxy for prepregnancy weight.
In: Mortality and health issues in Asia and the Pacific: report of a seminar held at Beijing in collaboration with the Institute of Population Research, People's University of China from 22 to 27 October 1986. New York, New York, United Nations, 1987. 107-32. (Asian Population Studies Series No. 78.; ST/ESCAP/485.)Around 1980, half of the population of the Economic and Social Commission for Asia and the Pacific (ESCAP) region was already living in countries where the average life expectancy at birth is 65 years. Impressive as this progress is, its interpretation as a proof for improvement of the health status of the populations has not remained unchallenged. Repeatedly, it has been argued that as a consequence of the import of sophisticated modern medical technology, as well as large-scale foreign aid inspired and financed public health programs, the reduction of mortality has outpaced improvements in health. Similar reservations against the use of mortality data as evidence for trends and differentials in health status have been put forward in the more developed countries of the ESCAP region, particularly vocally in Japan. The debate is not academic but concerns crucial policy issues. In many countries of the ESCAP region, the health care delivery system is neither sufficiently organized nor staffed, in numbers and qualifications, to cope with the problems raised by a rapidly increasing population, particularly in certain high risk groups such as pregnant women, infants, and children. This challenge is compounded by the fact that very often traditional health problems exist side by side with newly emerging hazards. The dominant conclusion of an analysis of all the available information is that in contrast to the significant advances in the control of mortality, the morbidity situation has either stagnated or, at any rate, failed to match the gains in longevity. Impressive advances in some areas and countries exist side by side with grave setbacks in others. On the whole, the diversity of national health conditions has increased, with some countries approaching a "modern" epidemiological scenario, others lagging behind, and another group tackling old and new disease problems concurrently. Likewise, within countries, similar differences exist or gradually emerge between urban and rural populations. Malnutrition, in synergistic action with diarrhoeal diseases and acute respiratory infections, as well as malaria, are the main challenge in the ESCAP region, particularly for the countries of Middle South Asia. Successful agricultural policies have laid the foundation for overcoming the age-old threat of mal- and undernutrition. As regards malaria, the current situation hardly justifies optimism. In the developed countries of the region, the common causes of illness are cardiovascular diseases, cancer, and accidents.