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Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health.
BMC Pregnancy and Childbirth. 2018 Nov 20; 18(1):449.BACKGROUND: Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth. METHODS: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI. RESULTS: The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy. CONCLUSION: Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.
Adaptation of the WHO maternal near miss tool for use in sub-Saharan Africa: an International Delphi study.
BMC Pregnancy and Childbirth. 2017 Dec 29; 17(1):445.BACKGROUND: Assessments of maternal near miss (MNM) are increasingly used in addition to those of maternal mortality measures. The World Health Organization (WHO) has introduced an MNM tool in 2009, but this tool was previously found to be of limited applicability in several low-resource settings. The aim of this study was to identify adaptations to enhance applicability of the WHO MNM tool in sub-Saharan Africa. METHODS: Using a Delphi consensus methodology, existing MNM tools were rated for applicability in sub-Saharan Africa over a series of three rounds. Maternal health experts from sub-Saharan Africa or with considerable knowledge of the context first rated importance of WHO MNM parameters using Likert scales, and were asked to suggest additional parameters. This was followed by two confirmation rounds. Parameters accepted by at least 70% of the panel members were accepted for use in the region. RESULTS: Of 58 experts who participated from study onset, 47 (81%) completed all three rounds. Out of the 25 WHO MNM parameters, all 11 clinical, four out of eight laboratory, and four out of six management-based parameters were accepted, while six parameters (PaO2/FiO2 < 200 mmHg, bilirubin >100 mumol/l or >6.0 mg/dl, pH <7.1, lactate >5 mumol/l, dialysis for acute renal failure and use of continuous vasoactive drugs) were deemed to not be applicable. An additional eight parameters (uterine rupture, sepsis/severe systemic infection, eclampsia, laparotomy other than caesarean section, pulmonary edema, severe malaria, severe complications of abortions and severe pre-eclampsia with ICU admission) were suggested for inclusion into an adapted sub-Saharan African MNM tool. CONCLUSIONS: All WHO clinical criteria were accepted for use in the region. Only few of the laboratory- and management based were rated applicable. This study brought forward important suggestions for adaptations in the WHO MNM criteria to enhance its applicability in sub-Saharan Africa and possibly other low-resource settings.
BMC Pregnancy and Childbirth. 2017 Jun 19; 17(1):194.BACKGROUND: WHO proposed the WHO Maternal Near Miss (MNM) tool, classifying women according to several (potentially) life-threatening conditions, to monitor and improve quality of obstetric care. The objective of this study is to analyse merged data of one high- and two low-resource settings where this tool was applied and test whether the tool may be suitable for comparing severe maternal outcome (SMO) between these settings. METHODS: Using three cohort studies that included SMO cases, during two-year time frames in the Netherlands, Tanzania and Malawi we reassessed all SMO cases (as defined by the original studies) with the WHO MNM tool (five disease-, four intervention- and seven organ dysfunction-based criteria). Main outcome measures were prevalence of MNM criteria and case fatality rates (CFR). RESULTS: A total of 3172 women were studied; 2538 (80.0%) from the Netherlands, 248 (7.8%) from Tanzania and 386 (12.2%) from Malawi. Total SMO detection was 2767 (87.2%) for disease-based criteria, 2504 (78.9%) for intervention-based criteria and 1211 (38.2%) for organ dysfunction-based criteria. Including every woman who received >/=1 unit of blood in low-resource settings as life-threatening, as defined by organ dysfunction criteria, led to more equally distributed populations. In one third of all Dutch and Malawian maternal death cases, organ dysfunction criteria could not be identified from medical records. CONCLUSIONS: Applying solely organ dysfunction-based criteria may lead to underreporting of SMO. Therefore, a tool based on defining MNM only upon establishing organ failure is of limited use for comparing settings with varying resources. In low-resource settings, lowering the threshold of transfused units of blood leads to a higher detection rate of MNM. We recommend refined disease-based criteria, accompanied by a limited set of intervention- and organ dysfunction-based criteria to set a measure of severity.
Geneva Switzerland, World Health Organization [WHO], 2017. 8 p. (Evidence-to-Action Brief; WHO/RHR/17.18)This policy brief is designed to help countries implement the Global STI Strategy. By taking action to build sustainable national and institutional capacity for addressing STIs, countries can ensure that key cost- effective interventions reach the greatest number of people in need.
Casting light on old shadows: Ending sexually transmitted infection epidemics as public health concerns by 2030.
Geneva Switzerland, World Health Organization [WHO], 2017. 8 p. (Advocacy Brief; WHO/RHR/17.17)Countries can boost the response to STIs and improve the health of millions of women, men and adolescents by adopting WHO’s Global STI Strategy. Some viral STIs, like human papillomavirus (HPV) and HIV, are still incurable and can be deadly, while some bacterial STIs – like chlamydia, gonorrhoea, syphilis and trichomoniasis – are curable if detected and treated. This brief provide milestones and targets and five strategic directions for countries to develop their own national plans.
Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: a cross-sectional study.
BMC Public Health. 2016 Mar 5; 16(229):1-13.Background Severe maternal conditions have increasingly been used as alternative measurements of the quality of maternal care and as alternative strategies to reduce maternal mortality. We aimed to study severe maternal morbidity and maternal near miss among women in two tertiary hospitals in Kota Bharu, Kelantan, Malaysia. Methods A cross-sectional study with record review was conducted in 2014. Severe maternal morbidity and maternal near miss were classified using the new World Health Organization criteria. Health indicators for obstetric care were calculated and descriptive analyses were performed using SPSS version 22.0. Results In total, 21,579 live births, 395 women with severe maternal morbidity, 47 women with maternal near miss and two maternal deaths were analyzed. The severe maternal morbidity incidence ratio was 18.3 per 1000 live births and the maternal near miss incidence ratio was 2.2 per 1000 live births. The maternal near miss mortality ratio was 23.5 and the mortality index was 4.1%. The process indicators for essential interventions were almost 100.0%. Haemorrhagic disorders were the most common event for severe maternal morbidity (68.6%) and maternal near miss (80.9%) and management-based criteria accounted for 85.1%. Conclusions Comprehensive emergency care and intensive care as well as overall improvements in the quality of maternal health care need to be achieved to substantial reduce maternal death.
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.
Feasibility and validity of using WHO adolescent job aid algorithms by health workers for reproductive morbidities among adolescent girls in rural North India.
BMC Health Services Research. 2015 Sep 21; 15(1):400.Background: High prevalence of reproductive morbidities is seen among adolescents in India. Health workers play an important role in providing health services in the community, including the adolescent reproductive health services. A study was done to assess the feasibility of training female health workers (FHWs) in the classification and management of selected adolescent girls' reproductive health problems according to modified WHO algorithms. Methods: The study was conducted between Jan-Sept 2011 in Northern India. Thirteen FHWs were trained regarding adolescent girls' reproductive health as per WHO Adolescent Job-Aid booklet. A pre and post-test assessment of the knowledge of the FHWs was carried out. All FHWs were given five modified WHO algorithms to classify and manage common reproductive morbidities among adolescent girls. All the FHWs applied the algorithms on at least ten adolescent girls at their respective sub-centres. Simultaneously, a medical doctor independently applied the same algorithms in all girls. Classification of the condition was followed by relevant management and advice provided in the algorithm. Focus group discussion with the FHWs was carried out to receive their feedback. Results: After training the median score of the FHWs increased from 19.2 to 25.2 (p - 0.0071). Out of 144 girls examined by the FHWs 108 were classified as true positives and 30 as true negatives and agreement as measured by kappa was 0.7 (0.5-0.9). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 94.3 % (88.2-97.4), 78.9 % (63.6-88.9), 92.5 % (86.0-96.2), and 83.3 % (68.1-92.1) respectively. Discussion: A consistent and significant difference between pre and post training knowledge scores of the FHWs were observed and hence it was possible to use the modified Job Aid algorithms with ease. Limitation of this study was the munber of FHWs trained was small. Issues such as time management during routine work, timing of training, overhead cost of training etc were not taken into account. Conclusions: Training was successful in increasing the knowledge of the FHWs about adolescent girls' reproductive health issues. The FHWs were able to satisfactorily classify the common adolescent girls' problems using the modified WHO algorithms.
Geneva, Switzerland, WHO, 2015.  p. (WHO/RHR/15.17)This document presents the evidence base supporting the WHO recommendations on interventions to improve preterm birth outcomes in tabular form with over 50 tables presenting data on the interventions and their variations.
Geneva, Switzerland, WHO, 2015.  p.The present guideline is focused on interventions that could be provided during pregnancy, labour and during the newborn period with the aim of improving outcomes for preterm infants. Recommendations on interventions to prevent and reduce the risk of preterm birth or modify risk in at-risk pregnant women are outside the scope of this guideline.The primary audience for this guideline includes health-care professionals who are responsible for developing national and local health-care protocols and policies, as well as managers of maternal and child health programmes and policy-makers in all settings. The guideline will also be useful to those directly providing care to pregnant women and preterm infants, such as obstetricians, paediatricians, midwives, nurses and general practitioners. The information in this guideline will be useful for developing job aids and tools for pre- and in-service training of health workers to enhance their delivery of maternal and neonatal care relating to preterm birth. (Excerpts)
Geneva, Switzerland, WHO, 2015.  p.World Health Statistics 2015 contains WHO’s annual compilation of health-related data for its 194 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets. WHO presents World Health Statistics 2015 as an integral part of its ongoing efforts to provide enhanced access to comparable high-quality statistics on core measures of population health and national health systems.
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.
Mode and timing of twin delivery and perinatal outcomes in low- and middle-income countries: 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 1:89-100.OBJECTIVE: To describe the mode and timing of delivery of twin pregnancies at >/=34 weeks of gestation and their association with perinatal outcomes. DESIGN: Secondary analysis of a cross-sectional study. POPULATION: Twin deliveries at >/=34 weeks of gestation from 21 low- and middle-income countries participating in the WHO Multicountry Survey on Maternal and Newborn Health. METHODS: Descriptive analysis and effect estimates using multilevel logistic regression. MAIN OUTCOME MEASURES: Stillbirth, perinatal mortality, and neonatal near miss (use of selected life saving interventions at birth). RESULTS: The average length of gestation at delivery was 37.6 weeks. Of all twin deliveries, 16.8 and 17.6% were delivered by caesarean section before and after the onset of labour, respectively. Prelabour caesarean delivery was associated with older maternal age, higher institutional capacity and wealth of the country. Compared with spontaneous vaginal delivery, lower risks of neonatal near miss (adjusted odds ratio, aOR, 0.63; 95% confidence interval, 95% CI, 0.44-0.94) were found among prelabour caesarean deliveries. A lower risk of early neonatal mortality (aOR 0.12; 95% CI 0.02-0.56) was also observed among prelabour caesarean deliveries with nonvertex presentation of the first twin. The week of gestation with the lowest rate of prospective fetal death varied by fetal presentation: 37 weeks for vertex-vertex; 39 weeks for vertex-nonvertex; and 38 weeks for a nonvertex first twin. CONCLUSIONS: The prelabour caesarean delivery rate among twins varied largely between countries, probably as a result of overuse of caesarean delivery in wealthier countries and limited access to caesarean delivery in low-income countries. Prelabour delivery may be beneficial when the first twin is nonvertex. International guidelines for optimal twin delivery methods are needed. (c) 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
Development of criteria for identifying neonatal near-miss cases: analysis of two WHO multicountry cross-sectional studies.
BJOG: An International Journal of Obstetrics and Gynaecology. 2014 Mar; 121 Suppl 1:110-8.OBJECTIVE: To develop and test markers of neonatal severe morbidity for the identification of neonatal near-miss cases. DESIGN: This is a database analysis of two World Health Organization cross-sectional studies: the Global Survey on Maternal and Perinatal Health (WHOGS) and the Multicountry Survey on Maternal and Newborn Health (WHOMCS). SETTING: The WHOGS was performed in 373 health facilities in 24 countries (2004-2008). The WHOMCS was conducted in 359 health facilities in 29 countries (2010-2011). POPULATION: Data were collected from hospital records of all women admitted for delivery and their respective neonates. METHODS: Pragmatic markers (birthweight <1750 g, Apgar score at 5 minutes <7, and gestational age <33 weeks) were developed with WHOGS data and validated with WHOMCS data. The diagnostic accuracy of neonatal characteristics and management markers of severity was determined in the WHOMCS. RESULTS: This analysis included 290 610 liveborn neonates from WHOGS and 310 436 liveborn neonates from WHOMCS. The diagnostic accuracy of pragmatic and management markers of severity for identifying early neonatal deaths was very high: sensitivity, 92.8% (95% CI 91.8-93.7%); specificity, 92.7% (95% CI 92.6-92.8%); positive likelihood ratio, 12.7 (95% CI 12.5-12.9); negative likelihood ratio, 0.08 (95% CI 0.07-0.09); diagnostic odds ratio, 163.4 (95% CI 141.6-188.4). A positive association was found between the frequency of neonatal near-miss cases and Human Development Index. CONCLUSION: Newborn infants presenting selected markers of severity and surviving the first neonatal week could be considered as neonatal near-miss cases. This definition and criteria may be seen as a basis for future applications of the near-miss concept in neonatal health. These tools can be used to inform policy makers on how best to apply scarce resources for improving the quality of care and reducing neonatal mortality. (c) 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.
Maternal near miss and mortality in a rural referral hospital in northern Tanzania: a cross-sectional study.
BMC Pregnancy and Childbirth. 2013; 13:141.BACKGROUND: Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. In order to lower maternal morbidity and mortality in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study is to assess the occurrence of severe maternal morbidity and mortality in a rural referral hospital in Tanzania as proposed by the WHO near miss approach and to assess implementation levels of key evidence-based interventions in women experiencing severe maternal morbidity and mortality. METHODS: A prospective cross-sectional study was performed from November 2009 until November 2011 in a rural referral hospital in Tanzania. All maternal near misses and maternal deaths were included. As not all WHO near miss criteria were applicable, a modification was used to identify cases. Data were collected from medical records using a structured data abstraction form. Descriptive frequencies were calculated for demographic and clinical variables, outcome indicators, underlying causes, and process indicators. RESULTS: In the two-year period there were 216 maternal near misses and 32 maternal deaths. The hospital-based maternal mortality ratio was 350 maternal deaths per 100,000 live births (95% CI 243-488). The maternal near miss incidence ratio was 23.6 per 1,000 live births, with an overall case fatality rate of 12.9%. Oxytocin for prevention of postpartum haemorrhage was used in 96 of 201 women and oxytocin for treatment of postpartum haemorrhage was used in 38 of 66 women. Furthermore, eclampsia was treated with magnesium sulphate in 87% of all cases. Seventy-four women underwent caesarean section, of which 25 women did not receive prophylactic antibiotics. Twenty-eight of 30 women who were admitted with sepsis received parenteral antibiotics. The majority of the cases with uterine rupture (62%) occurred in the hospital. CONCLUSION: Maternal morbidity and mortality remain challenging problems in a rural referral hospital in Tanzania. Key evidence-based interventions are not implemented in women with severe maternal morbidity and mortality. Progress can be made through up scaling the use of evidence-based interventions, such as the use of oxytocin for prevention and treatment of postpartum haemorrhage.
The role of FIGO in women's health and reducing reproductive morbidity and mortality. Special communication.
International Journal of Gynecology and Obstetrics. 2012; 119 Suppl:S3-S5.This special communication discusses the vision, values and mission of FIGO, the role of FIGO in women's health, and FIGO's channels for improving women's health.
Bulletin of the World Health Organization. 2011 May 1; 89(5):390-2.This article focuses on antimicrobial resistance, which challenges the control of infectious diseases, jeopardizes progress on health outcomes by increasing morbidity and mortality, and imposes huge costs on societies. It discusses several aspects related to antimicrobial resistance including: the lack of commitment and data, un-assured drug quality, poor prevention and control of infections, and weaker research efforts. It concludes by outlining the World Health Organization's policy package to combat antimicrobial resistance, which reframes the critical actions to be taken by governments to stimulate change by all stakeholders.
Geneva, Switzerland, WHO, 2011.  p.World Health Statistics 2011 contains WHO’s annual compilation of health-related data for its 193 Member States, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets. This volume's indicators, taken together, provide a comprehensive summary of the current status of nine aspects of national health and health systems: life expectancy and mortality; cause-specific mortality and morbidity; selected infectious diseases; health service coverage; risk factors; health workforce, infrastructure and essential medicines; health expenditure; health inequities; and demographic and socioeconomic statistics.
Geneva, Switzerland, WHO, 2010.  p.World Health Statistics 2010 contains WHO's annual compilation of data from its 193 Member States, and includes a summary of progress towards the health-related Millennium Development Goals and targets. This volume's indicators, taken together, provide a comprehensive summary of the current status of nine aspects of national health and health systems: mortality and burden of disease; cause-specific mortality and morbidity; selected infectious diseases; health service coverage; risk factors; health workforce, infrastructure and essential medicines; health expenditure; health inequities; and demographic and socioeconomic statistics.
Iron supplementation of young children in regions where malaria transmission is intense and infectious disease highly prevalent. WHO statement.
Geneva, Switzerland, WHO, .  p.Iron deficiency with its attendant anaemia is the most prevalent micronutrient disorder on a worldwide basis. In 2001, the UN General Assembly at the Special Session on Children recommended that the prevalence of iron deficiency and anaemia be reduced by one third in children by the year 2010. If achieved, this would contribute greatly to the realization of the Millenium Development Goals. In most countries, national policies have been implemented to provide iron supplements to pregnant women, and to a lesser extent to young children, as the primary strategy for preventing iron deficiency and anaemia. Although the benefits of iron supplementation have generally been considered to outweigh the putative risks, there is some evidence to suggest that supplementation at levels recommended for otherwise healthy children carries the risk of increased severity of infectious disease in the presence of malaria and/or undernutrition. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2007.  p. (WHO Discussion Papers on Adolescence; Issues in Adolescent Health and Development)The World Health Organization (WHO) has been contributing to meeting the Millennium Development Goals (MDGs) by according priority attention to issues pertaining to the management of adolescent pregnancy. Three of the aims of the MDGs - empowerment of women, promotion of maternal health, and reduction of child mortality - embody WHO's key priorities and its policy framework for poverty reduction. The UN Special Session on Children has focused on some of the key issues affecting adolescents' rights, including early marriage, access to sexual and reproductive health services, and care for pregnant adolescents. This review of the literature was conducted to identify (1) the major factors affecting the pregnancy outcome among adolescents, related to their physical immaturity and inappropriate or inadequate healthcare-seeking behaviour, and (2) the socioeconomic and political barriers that influence their access to health-care services and information. The review also presents programmatic evidence of feasible measures that can be taken at the household, community and national levels to improve pregnancy outcomes among adolescents. (excerpt)
Obstetric fistula: Guiding principles for clinical management and programme development, a new WHO guideline.
International Journal of Gynecology and Obstetrics. 2007 Nov; 99 Suppl 1:S117-S121.It is estimated that more than 2 million women are living with obstetric fistulas (OFs) worldwide, particularly in Africa and Asia, and yet this severe morbidity remains hidden. As a contribution to the global Campaign to End Fistula, the World Health Organization (WHO) published Obstetric fistula: Guiding principles for clinical management and programme development, a manual intended as a practical working document. Its 3 main objectives are to draw attention to the urgency of the OF issue and serve as an advocacy document for prompt action; provide policy makers and health professionals with brief, factual information and principles that will guide them at the national and regional levels as they develop strategies and programs to prevent and treat OFs; and assist health care professionals as they acquire better skills and develop more effective services to care for women treated for fistula repair. (author's)
Deaths and disease burden by cause: global burden of disease estimates for 2001 by World Bank country groups. Revised.
[Washington, D.C.], World Bank, Disease Control Priorities Project, 2005 Jan.  p. (Disease Control Priorities Project Working Paper No. 18)The World Health Organization has undertaken a new assessment of the GBD for the year 2000 and subsequent years. The three goals articulated for the GBD 1990 (8) remain central: to decouple epidemiological assessment of the magnitude of health problems from advocacy by interest groups of particular health policies or interventions; to include in international health policy debates information on non-fatal health outcomes along with information on mortality; and to undertake the quantification of health problems in time-based units that can also be used in economic appraisal. The specific objectives for GBD 2000 are similar to the original objectives: to quantify the burden of premature mortality and disability by age, sex, and region for 135 major causes or groups of causes; to develop internally consistent estimates of the incidence, prevalence, duration, and case-fatality for over 500 sequelae resulting from the above causes; to describe and value the health states associated with these sequelaeof diseases and injuries; to analyze the contribution to this burden of major physiological, behavioral, and social risk factors by age, sex and region; to develop alternative projection scenarios of mortality and non-fatal health outcomes over the next 30 years, disaggregated by cause, age, sex and region. (excerpt)
Journal of Tropical Pediatrics. 2007 Apr; 53(2):125-130.Health experts worldwide recognize breastmilk as the superior infant food. Recommendations from the American Academy of Pediatrics and the World Health Organization (WHO) identify exclusive breastfeeding for the first half-year of life and continuation of breastfeeding into toddlerhood as offering maximum protection from illness, providing a substrate for immunological protection. Data from developed countries identify increasing morbidity and mortality rates for infants who have never received breastmilk in life and demonstrate that infants benefit from exclusive breastfeeding, especially, in areas of severe poverty. Preterm infants, most at risk for morbidity and mortality in developing countries, are identified as needing their own mother's milk for survival. Exclusive feeding of own mothers' milk (OMM) is associated with improved infant survival; however, inadequate maternal milk volume (MMV) often necessitates adding artificial feedings or exogenous substances to OMM. The objective of this study was to compare mean daily MMV for mothers of premature or sick infants in special care nurseries (SCN) using one of three methods of OMM expression: electric breast pump, non-electric pedal breast pump, and hand (manual) expression. We studied 65 mothers whose infants were cared for in two SCN in Africa (Kenya and Nigeria) and were unable to feed directly at the breast. In this randomized trial, mothers were randomly assigned to one of three milk expression groups at birth. MMV, the dependent variable, was measured for an average of 8.7 days. MMV for the electric and pedal pump and hand milk expression was 578 ± 228 ml (n = 22), 463 ± 302 ml (n = 24) and 323 ±199 ml (n = 19), respectively. Data were evaluated using a one-way ANOVA (p = 0.014). The Tukey revealed significant differences (p<0.01) between electric breast pump expression and hand expression but not between the electric and pedal pump or the pedal pump and hand expression. Findings revealed greater MMV with electric breast pumps than hand-expression for mothers of infants in African nurseries. This data has important implications for international policy if exclusive OMM feeding is to be achieved for the vulnerable infant. Funded by West Virginia University Department of Research and Graduate Studies HSC Grant # 2U023U; Non-monetary donations of breast pumps and breast pump kits were made by Medela. (author's)
Assessment of ultrasound morbidity indicators of schistosomiasis in the context of large-scale programs illustrated with experiences from Malian children.
American Journal of Tropical Medicine and Hygiene. 2006 Dec; 75(6):1042-1052.We assessed morbidity indicators for both Schistosoma haematobium and Schistosoma mansoni infections and evaluated the appropriateness of the World Health Organization (WHO) guidelines for ultrasound in schistosomiasis in the context of large-scale control interventions. Abdominal and urinary tract ultrasonography was performed on 2,247 and 2,822 school children, respectively, from 29 randomly selected schools in Mali before the implementation of mass anthelminthic drug administration. Using two-level logistic regression models, we examined associations of potential factors with the risk of having a positive ultrasound global score (morbidity indicative of S. haematobium infection), abnormal image pattern scores, dilatation of the portal vein, and/or enlarged liver (morbidity indicative of S. mansoni infection). The WHO protocol was found useful for detection of S. haematobium pathology but overestimated the risk of portal vein dilatation and left liver lobe enlargement associated with S. mansoni infection. We conclude that ultrasonography should be included in large-scale control interventions, where logistics allow, but cautiously. (author's)