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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.
Sexually Transmitted Infections. 2010 Dec; 86 Suppl 2:ii62-6.BACKGROUND: In 2010 the WHO issued a revision of the guidelines on antiretroviral therapy (ART) for HIV infection in adults and adolescents. The recommendations included earlier diagnosis and treatment of HIV in the interest of a longer and healthier life. The current analysis explores the impact on the estimates of treatment needs of the new criteria for initiating ART compared with the previous guidelines. METHODS: The analyses are based on the national models of HIV estimates for the years 1990-2009. These models produce time series estimates of ART treatment need and HIV-related mortality. The ART need estimates based on ART eligibility criteria promoted by the 2010 WHO guidelines were compared with the need estimates based on the 2006 WHO guidelines. RESULTS: With the 2010 eligibility criteria, the proportion of people living with HIV currently in need of ART is estimated to increase from 34% to 49%. Globally, the need increases from 11.4 million (10.2-12.5 million) to 16.2 million (14.8-17.1 million). Regional differences include 7.4 million (6.4-8.4 million) to 10.6 million (9.7-11.5 million) in sub-Saharan Africa, 1.6 million (1.3-1.7 million) to 2.4 million (2.1-2.5 million) in Asia and 710 000 (610 000-780 000) to 950 000 (810 000-1.0 million) in Latin America and the Caribbean. CONCLUSIONS: When adopting the new recommendations, countries have to adapt their planning process in order to accelerate access to life saving drugs to those in need. These recommendations have a significant impact on resource needs. In addition to improving and prolonging the lives of the infected individuals, it will have the expected benefit of reducing HIV transmission and the future HIV/AIDS burden.
London, United Kingdom, IPPF, 2011 Oct.  p.Young people are not a single homogenous group, but a diverse population whose sexual and reproductive health needs are complex, shifting and varied. Youth-friendly service delivery should be based on an understanding of and respect for each person's unique social, cultural and economic identity.
Consultation on strategic information and HIV prevention among most-at-risk adolescents. 2-4 September 2009, Geneva. Consultation report.
New York, New York, UNICEF, 2010. 65 p.The Consultation on Strategic Information and HIV Prevention among Most-at-Risk Adolescents (MARA) focused on experiences in countries where HIV infection is concentrated among men who have sex with men (MSM), injecting drug users (IDUs), and those who sell sex. The meeting facilitated the exchange of information across regions on country-level data collection regarding MARA; identified ways to use strategic information to improve HIV prevention among MARA; and suggested ways to build support for MARA programming among decision-makers.
Uncovering high rates of unsafe injection equipment reuse in rural Cameroon: Validation of a survey instrument that probes for specific misconceptions.
Harm Reduction Journal. 2011 Feb 7; 8(4):1-9.Background: Unsafe reuse of injection equipment in hospitals is an on-going threat to patient safety in many parts of Africa. The extent of this problem is difficult to measure. Standard WHO injection safety assessment protocols used in the 2003 national injection safety assessment in Cameroon are problematic because health workers often behave differently under the observation of visitors. The main objective of this study is to assess the extent of unsafe injection equipment reuse and potential for blood-borne virus transmission in Cameroon. This can be done by probing for misconceptions about injection safety that explain reuse without sterilization. These misconceptions concern useless precautions against cross-contamination, i.e. "indirect reuse" of injection equipment. To investigate whether a shortage of supply explains unsafe reuse, we compared our survey data against records of purchases. Methods: All health workers at public hospitals in two health districts in the Northwest Province of Cameroon were interviewed about their own injection practices. Injection equipment supply purchase records documented for January to December 2009 were compared with self-reported rates of syringe reuse. The number of HIV, HBV and HCV infections that result from unsafe medical injections in these health districts is estimated from the frequency of unsafe reuse, the number of injections performed, the probability that reused injection equipment had just been used on an infected patient, the size of the susceptible population, and the transmission efficiency of each virus in an injection. Results: Injection equipment reuse occurs commonly in the Northwest Province of Cameroon, practiced by 44% of health workers at public hospitals. Self-reported rates of syringe reuse only partly explained by records on injection equipment supplied to these hospitals, showing a shortage of syringes where syringes are reused. Injection safety interventions could prevent an estimated 14-336 HIV infections, 248-661 HBV infections and 7-114 HCV infections each year in these health districts. Conclusions: Injection safety assessments that probe for indirect reuse may be more effective than observational assessments. The auto-disable syringe may be an appropriate solution to injection safety problems in some hospitals in Cameroon. Advocacy for injection safety interventions should be a public health priority.
Current Opinion In HIV and AIDS. 2010 Jan; 5(1):97-102.PURPOSE OF REVIEW: To present the methodology used to calculate coverage of antiretroviral therapy (ART) and review global and regional trends in ART coverage. RECENT FINDINGS: There has been a steady increase in ART coverage over the last decade with a more rapid increase in recent years. Current estimates of ART coverage are 43% for adults and 38% for children (ages 0-14 years). Methods for calculating coverage rely on good-quality patient monitoring systems in countries, and well informed models are needed to estimate the number of people in need of treatment. SUMMARY: The estimated coverage rates show that ART programs have improved over the past 8 years; however, approximately 58% (53-60%) of those people in need of ART are still not on treatment. High quality data are needed to accurately measure changes in ART coverage.
The level of Internet access and ICT training for health information professionals in sub-Saharan Africa.
Health Information and Libraries Journal. 2008 Sep; 25(3):175-85.BACKGROUND: Information and Communication Technologies (ICTs) are important tools for development. Despite its significant growth on a global scale, Internet access is limited in sub-Saharan Africa (SSA). Few studies have explored Internet access, use of electronic resources and ICT training among health information professionals in Africa. OBJECTIVE: The study assessed Internet access, use of electronic resources and ICT training among health information professionals in SSA. METHODS: A 26-item self-administered questionnaire in English and French was used for data collection. The questionnaire was completed by health information professionals from five Listservs and delegates at the 10th biannual Congress of the Association of Health Information and Libraries in Africa (AHILA). RESULTS: A total of 121 respondents participated in the study and, of those, 68% lived in their countries' capital. The majority (85.1%) had Internet access at work and 40.8% used cybercafes as alternative access points. Slightly less than two-thirds (61.2%) first learned to use ICT through self-teaching, whilst 70.2% had not received any formal training in the previous year. Eighty-eight per cent of respondents required further ICT training. CONCLUSIONS AND RECOMMENDATIONS: In SSA, freely available digital information resources are underutilized by health information professionals. ICT training is recommended to optimize use of digital resources. To harness these resources, intergovernmental and non-governmental organizations must play a key role.
The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds.
Sexually Transmitted Infections. 2008; 84(Suppl 1):i24-i30.The approach to national and global estimates of HIV/AIDS used by UNAIDS starts with estimates of adult HIV prevalence prepared from surveillance data using either the Estimation and Projection Package (EPP) or the Workbook. Time trends of prevalence are transferred to Spectrum to estimate the consequences of the HIV/AIDS epidemic, including the number of people living with HIV, new infections, AIDS deaths, AIDS orphans, treatment needs and the impact of treatment on survival. The UNAIDS Reference Group on Estimates, Modelling and Projections regularly reviews new data and information needs and recommends updates to the methodology and assumptions used in Spectrum. The latest update to Spectrum was used in the 2007 round of global estimates. Several new features have been added to Spectrum in the past two years. The structure of the population was reorganised to track populations by HIV status and treatment status. Mortality estimates were improved by the adoption of new approaches to estimating non-AIDS mortality by single age, and the use of new information on survival with HIV in non-treated cohorts and on the survival of patients on antiretroviral treatment (ART). A more detailed treatment of mother-to-child transmission of HIV now provides more prophylaxis and infant feeding options. New procedures were implemented to estimate the uncertainty around each of the key outputs. The latest update to the Spectrum program is intended to incorporate the latest research findings and provide new outputs needed by national and international planners.
Prioritizing second-line antiretroviral drugs for adults and adolescents: a public health approach. Report of a WHO working group meeting, World Health Organization, HIV Department, Geneva, Switzerland, 21-22 May 2007.
Geneva, Switzerland, WHO, 2007. 43 p.Antiretroviral therapy has dramatically improved the survival of HIV infected individuals and is critically needed to save millions of lives. As resource-limited countries rapidly expand their HIV/AIDS treatment programmes, increasingly countries are faced with the need to make second-line ART regimens available. The 2006 WHO ARV treatment guidelines outline the strategic approaches that should inform updated national treatment guidelines for first- and second-line therapies, and outline which agents should be considered for use in first line and second line. National programmes, however, are requesting additional operational guidance on the composition of their 2nd line ART formularies based on programmatic efficiencies and costs. As the ARV formulary is generally limited in developing countries, there is an increasing and urgent need for principles and criteria by which to prioritize ARV options. Regulatory bodies both nationally and internationally (e.g. the WHO pre-qualification project) are also requesting guidance on how to select the most needed therapeutic ARV agents for rapid appraisal. WHO therefore convened an expert meeting to review the scientific evidence and programmatic data available, in order to develop guidance for national programmes, regulatory authorities and implementing partners on selection, prioritization and planning for second-line ARV drugs. (excerpt)
New York, New York, Family Care International, 2007.  p.This publication explores knowledge, attitudes, and perspectives on pregnancy, delivery, and fistula from 31 country-level needs assessments conducted in 29 countries in the Campaign to End Fistula (see inside back cover for the complete list). Experiences of women living with obstetric fistula, their families, community members, and health care providers are brought to light. This information represents important research on the social, cultural, political, and economic dimensions of obstetric fistula, drawing attention to the factors underlying maternal death and disability. We hope this publication will serve as an advocacy tool to strengthen existing programmes and encourage further research on how to increase access to vital maternal health services, including fistula prevention and treatment. We implore policy makers, programmers, and researchers to listen to these women's voices and consider the promising practices and strategic recommendations described herein. What we have learned so far can help point the way, but much more still needs to be done. We cannot afford to wait-the costs to women, communities, and health systems are simply too great to delay action. Too many of the world's most disadvantaged and vulnerable women have suffered this preventable and treatable condition in silence. Too many women are dying unnecessarily in childbirth. It is time to put an end to the injustice of fistula and maternal death. (author's)
Supporting and sustaining national responses to children orphaned and made vulnerable by HIV and AIDS: Experience from the RAAAP exercise in sub-Saharan Africa.
Vulnerable Children and Youth Studies. 2006 Aug; 1(2):170-179.The growing number of children orphaned and made vulnerable by HIV and AIDS in sub-Saharan Africa presents an enormous socioeconomic and public policy challenge. Despite international commitments to increase resource allocation and scale up services and support for AIDS-affected children, families and communities, the national- and sub-national-level state responses have been inadequate. The rapid assessment, analysis and action planning (RAAAP) process for orphans and vulnerable children, conceived in late 2003, was intended as a multicountry incentive to identify and resource immediate actions that can be taken to scale in 16 heavily affected countries. This review of experiences to date with the RAAAP process highlights some key areas of learning, including: (a) fund mobilization has been slow and has reached approximately only one-third of what is required; (b) ownership and integration into development planning of the issue of orphans and vulnerable children at country level has been undermined by the perception that the response is an 'emergency' and externally (donor) driven exercise; (c) centralized planning has failed to appreciate the complexity of context and responses at the meso- and micro-levels within countries, entailing the need to support a comprehensive decentralization process of planning and implementation; (d) comprehensive multisectoral and interagency collaboration, involving civil society, is an important but overlooked element of the planning process; and (e) definitional variation between countries has led to large variations in budgets and coverage targets. While the RAAAP process has undoubtedly raised awareness at state level of the nature and extent of the 'orphan crisis' and raised vital resources, only full integration of the new planning process for orphans and vulnerable children within the range of macro and national development tools will allow the response to be sustainable in the longer term. (author's)
Poverty in Focus. 2007 Oct; (12): p.The prospects for achieving the Millennium Development Goals (MDGs) look bad in various developing countries, notably in Sub-Saharan Africa. To turn the tide, recent reports by the UN Millennium Project and the Commission for Africa issued urgent calls to increase official development aid substantially and, thereby, close the gap between donor rhetoric and reality. Qualitative aspects of aid allocation have received considerably less attention even though they may be as important for effectively meeting recipient needs. In particular, a needs-based targeting of aid in priority sectors such as health and education should have an important say on whether donors help achieving the MDGs. Hence, in addition to the usual ranking of donors according to their overall 'generosity', the structure of aid portfolios offers interesting insights as to whether aid has been prioritised in line with the MDGs. The sectoral composition of aid by all donors taken together has changed quite dramatically since the early 1990s. Most notable in the context of the MDGs, the share of aid devoted to the social sector has almost doubled (to about 35 per cent in 2002-04), with higher spending on education, health and population programs, though not on water and sanitation. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Mar. 97 p. (UNAIDS/07.08E; JC1311E)In April 2003, the Committee of Cosponsoring Organizations of the Joint United Nations Programme on HIV/AIDS (UNAIDS) approved a Learning Strategy to help UN system staff develop competence on HIV and AIDS. The goals of the Learning Strategy are: to develop the knowledge and competence of the UN and its staff so that they are able to best support national responses to HIV and AIDS; and to ensure that all UN staff members are able to make informed decisions to protect themselves from HIV and, if they are infected or affected by HIV, to ensure that they know where to turn for the best possible care and treatment. This includes ensuring that staff members fully understand the UN's HIV and AIDS workplace policies and how they are implemented. To support UN country teams to implement the Learning Strategy, Learning Facilitators were selected at country level and trained in a series of regional workshops. The Learning Facilitators were then expected to ensure - along with the country teams-that the standards of the Learning Strategy were realized. This report is comprised of UN HIV/AIDS Learning Strategy case studies from sixteen countries: Botswana, Brazil, Burkina Faso, Cape Verde, India, Indonesia, Macedonia, Madagascar, Morocco, Nigeria, the Pan American Health Organization headquarters (United States), Pakistan, Paraguay, Vienna (Austria), Viet Nam, and Yemen. It presents each country's unique experience in implementing the strategy since its adoption in 2003. (excerpt)
Changing course: alternative approaches to achieve the Millennium Development Goals and fight HIV / AIDS.
Washington, D.C., ActionAid International USA, 2005 Sep. 60 p.In September 2005, more than 170 world leaders will assemble at the United Nations Millennium Declaration Summit in New York to assess global progress towards achieving the Millennium Development Goals (MDGs). With this report, ActionAid International USA is sending a message to the global community that the International Monetary Fund (IMF)-led consensus which has dominated economic development policy in the poor world for 25 years is not sufficient to meet the MDGs. Indeed, in many cases, the IMF-imposed macroeconomic policies used in poor countries are hindering both achievement of the Goals and an effective fight against HIV/AIDS. Based on a comprehensive analysis of existing research on the impacts of IMF-led policies, on the investment required to meet the MDGs and control HIV/AIDS, and on in-depth frontline research in five developing countries, this report argues that alternative paths forward must be urgently explored. The high level summit in New York presents an ideal opportunity to start this process. ActionAid has criticized the MDGs for not being ambitious enough in seeking only to halve global poverty by 2015. Nevertheless, the fact that the international community has rallied behind them offers a key opportunity to assess the degree to which contemporary macroeconomic policies will enable countries to attain these goals by the target date of 2015-or not. Part 1 of this report lays out the status quo, including the dominant IMF model of economic development and the UN estimates of the costs and spending levels required over the next decade to achieve the MDGs and to fight HIV/AIDS effectively. It then contrasts these projected figures with the amount of spending currently possible in countries that have agreed to implement IMF loan programs. Our conclusions show a yawning gap between MDG needs and spending realities under business as usual policies, raising disturbing questions for governments and the international anti-poverty movement. (excerpt)
[Geneva, Switzerland], UNAIDS, . 29 p.AIDS is affecting women and girls in increasing numbers: globally, women comprise almost 50% of women living with HIV. Nearly 25 years into the epidemic, gender inequality and the low status of women remain two of the principal drivers of HIV. Yet current AIDS responses do not, on the whole, tackle the social, cultural and economic factors that put women at risk of HIV, and that unduly burden them with the epidemic's consequences. Women and girls have less access to education and HIV information, tend not to enjoy equality in marriage and sexual relations, and remain the primary caretakers of family and community members suffering from AIDS-related illnesses. To be more effective, AIDS responses must address the factors that continue to put women at risk. The world's governments have repeatedly declared their commitment to improve the status of women and acknowledged the linkage with HIV. In some areas, progress has been made. By and large, though, efforts have been small-scale, half-hearted and haphazard. Major opportunities to stem the global AIDS epidemic have been missed. It is time the world's leaders lived up to their promises. That's why the UNAIDS-led Global Coalition on Women and AIDS is calling for a massive scaling up of AIDS responses for women and girls. (excerpt)
Vienna, Austria, United Nations, Office on Drugs and Crime, 2006.  p.The present Toolkit was prepared because there is still much to be learned about what works best to prevent and combat human trafficking under various circumstances. It presents a selection of conceptual, legislative and organizational tools in use in different parts of the world. The Toolkit is based on the premise that the problem of trafficking in persons, whether at the national or local level, can only be addressed effectively on the basis of comprehensive strategies that are based on human rights and that take into account the transnational nature of the problem, the many associated criminal activities, the frequent involvement of organized criminal groups and the profound pain, fear and damage suffered by the victims. Although the Toolkit offers a few examples of comprehensive national strategies, most of the tools that it offers focus on one specific aspect of the comprehensive response required. Individual tools may be used to develop comprehensive strategies, or to augment or strengthen some of the essential components of existing ones. Many of these tools will need to be adapted to national or local circumstances. None of the tools, by itself, is sufficient to provide an effective response to the problem. (excerpt)
Using UN process indicators assess needs in emergency obstetric services:Gabon, Guinea-Bissau, and The Gambia.
International Journal of Gynecology and Obstetrics. 2007 Mar; 96(3):233-240.We report on assessments of the needs for emergency obstetric care in 3 West African countries. All (or almost all) medical facilities were visited to determine whether there are sufficient facilities of adequate quality to manage the expected number of obstetric emergencies. Medical facilities able to provide emergency obstetric care were poorly distributed and often were unable to provide needed procedures. Too few obstetricians and other providers, lack of on-the-job training and supervision were among the challenges faced in these countries. (author's)
Final technical report to the United States Agency for International Development (USAID): Strengthening Nutrition Management in the Occupied Palestinian Territory, Grant No. 294-G-00-04-00208-00.
Geneva, Switzerland, WHO, 2006. 6 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-528; USAID Grant No. 294-G-00-04-00208-00)The general objective of the project is to strengthen the MoH Nutrition Department (ND) in order to achieve an effective, sustainable and functioning body in the area of nutrition. The Nutrition Department will be in charge of policy, planning, monitoring, evaluation and coordination, considering both short-term emergency interventions and long-term activities related to nutrition. (excerpt)
Civil society involvement in rapid assessment, analysis and action planning (RAAAP) for orphans and vulnerable children. An independent review.
London, England, UK Consortium on AIDS and International Development, 2005 Jul. 63 p. (Orphans and Vulnerable Children)The Rapid Assessment, Analysis, and Action Planning (RAAAP) Initiative for orphans and other vulnerable children (OVC) was launched by UNICEF, USAID, UNAIDS, and WFP in November 2003. The first round of RAAAPs were carried out in 16 countries in Sub-Saharan Africa in 2004. The purpose of the RAAAP is to undertake an analysis of the situation of OVC and the response in each country, and then, based on this analysis, to produce a national plan of action to scale up and improve the quality of the response to OVC. This plan is then ratified by the government and provides a unifying framework that brings together the activities of all the different stakeholders under a set of common objectives and strategies. This includes all interventions for OVC, including activities of national and local government, donors and civil society organisations (CSOs). The first round of the RAAAP process consisted of a desk study, additional data collection and analysis in country, and a stakeholder workshop to validate the findings and draw up the OVC National Plan of Action. The process was led and coordinated by a national steering group which consisted of the government ministry with responsibility for OVC, other relevant government ministries and departments, development partners including UNICEF, USAID, UNAIDS and WFP and representatives of civil society organisations (CSO). The involvement of different stakeholders in the analysis and planning process is critical for ensuring their ownership of the resulting action plan. (excerpt)
BMJ. British Medical Journal. 2006 Mar 11; 332(7541):569.Efforts to combat malnutrition should be targeted at pregnant women and at children aged under two years, when most irreparable damage happens, says a World Bank report. The report says that trying to improve nutrition in children later in life is too late, too expensive, and ineffective. "There is actually a very, very tight window of opportunity, which is from conception through to the first two years of life. If we miss this window we miss a whole generation," said Meera Shekar, a senior nutrition specialist at the World Bank and the report's lead author. (excerpt)
UN Chronicle. 1998 Winter; 35(4): p..According to the 1998 revised estimates and projections of the United Nations, the world population currently stands at 5.9 billion persons and is growing at 1.33 per cent per year, an annual net addition of about 78 million people. World population in the mid-twenty-first century is expected to be in the range of 7.3 to 10.7 billion, with a figure of 8.9 billion by the year 2050 considered to be most likely. Global population growth is slowing, thanks to successful family planning programmes. But because of past high fertility, the world population will continue to grow by over 80 million a year for at least the next decade. In mid-1999, the total will pass 6 billion-twice what it was in 1960. More young people than ever are entering their childbearing years. At the same time, the number and proportion of people over 65 are increasing at an unprecedented rate. The rapid growth of these young and old new generations is challenging societies' ability to provide education and health care for the young, and social, medical and financial support for the elderly. (excerpt)
Chinese Primary Health Care. 2002; 16(4):33-34.The authors analyzed expenses of Poverty Medical Alleviation for Poor Maternal of Health VI Project Loaned by World Bank, which is based on some of the project counties in five years. The main results are: (1) The Poverty Medical Alleviation Project had improved the utilization equity of Maternal and Child Health in poor areas. (2) Project counties should strengthen the management and sustainability of Poverty Alleviation Fund. (3) Information system should be improved. (author's)
Population 2005. 2003 Dec; 5(4):1, 3-4, 6 passim.December 19, 2001, the United Nations General Assembly created resolution 56/131 in regard to violence against women migrant workers. The G.A. emphasized the need for governments to strengthen their efforts to protect and promote the rights and welfare of women migrant workers, through sustained bilateral, regional, interregional and international cooperation and by developing strategies and joint action. The Assembly detailed recommendations to prevent violence against women migrant workers, punish abusers and create a supporting environment for victims of this type of abuse. Also in the resolution was the request for the Secretary-General to submit a report on the problem of violence against women migrant workers and on the implementation of the resolution 56/131 to be submitted to the fifty-eighth session of the General Assembly. (excerpt)
Population 2005. 2003 Dec; 5(4):9.A survey conducted by the United Nations Population Fund (UNFPA), in collaboration with the International Center for Migration and Health, has tracked startling statistics regarding the health system in Iraq. According to UNFPA, the number of women who die from pregnancy and childbirth in Iraq has close to tripled since 1990. Among the causes of the reported 310 deaths per 100,000 live births in 2002 are bleeding, ectopic pregnancies and prolonged labor. In addition, stress and exposure to chemical contaminants are also partly to blame for the rise in miscarriages among Iraqi women. Access to medical facilities is becoming more difficult for women due to breakdowns in security and weakened communication and transport systems. This has caused nearly 65 per cent of Iraqi women to give birth at home, the majority without skilled help. (excerpt)
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]
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)