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  1. 1

    No reason to change WHO guidelines on cleansing the umbilical cord. Comment.

    Osrin D; Colbourn T

    Lancet Global Health. 2016 Nov; 4(11):e766-e768.

    Along with the individual trial findings, the figure [contained in this comment]: "Log odds of neonatal mortality associated with chlorhexidine cord cleansing, by proportion of home deliveries in control group (A) and neonatal mortality in control group (B)" is consonant with the current WHO guidelines for cord care, to which we recommend no change. Cord cleanliness is part of the suite of hard-won improvements that accompany the increases in survival being seen worldwide. In settings in which neonatal mortality rates remain high, we recommend the kinds of programme that have been associated with reductions in all-cause mortality. These include improvements in institutional quality of care and efforts to improve community-based practices, both central to the 2014 Every Newborn Action Plan. (Excerpts) © The Author(s). Published by Elsevier Ltd. Open Access.
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  2. 2
    Peer Reviewed

    Jidda: the traditional midwife of Yemen?

    Scheepers LM

    Social Science and Medicine. 1991; 33(8):959-62.

    An investigation on the "jidda," the traditional birth attendant (TBAs) of Yemen, was undertaken in 1989 because WHO training of TBAs in Yemen was regarded to have had mixed results. Information was collected through semistructured interviews between July and November 1989 in villages in the Anis region of the central highlands of Yemen: Taalibi, Hamaan Ali, Dhi Hud, Al Mashahidhah, and Al Masna'ah. Taalibi and Hamaan Ali were two of the original training sites, at which all 16 TBAs were trained. Of these, 14 TBAs plus approximately 28 untrained TBAs and village women were selected at random and interviewed. Quantitative data on the number of deliveries made before and after the training by 7 of the TBAs were made available. The term "jidda" was designated as the appropriate Yemini Arabic name for TBA and was generally accepted within the Primarily Health Care (PHC) terminology within Yemen. The term literally means grandmother. WHO policy assumes that the training of one or two TBAs in each village will provide all women with basic mother and child health care. Initially a confusing mixture of terms was used in the villages to refer to women who assist at deliveries. These terms included references to the woman who cut the cord. A final understanding was reached that the term "jidda" will mean WHO project-trained women. Nontrained women are called "those who cut the cord." The term "jidda" as a person with specialized knowledge and experience with deliveries is not connected to traditional terms for women, who of old, assisted at deliveries. Assistance at delivery is provided by variety of kin, neighbors, and related women living proximate to the women delivering. Remuneration is the promise of rewards in the afterlife. The job is not a fulltime occupation. The delivery process is describe, and it is clear that the assistant provides emotional support and literally cuts the cord. Providing an image of professionally and specialization and the bag of instruments to a few "jidda" has lead to inequality and confusion. "Jidda" still cut the cord, and the 7 trained "jidda" have not expanded their area outside if their neighborhoods. It is suggested that training be given to midwives and that research into the local situation occur prior to training activities in order for objectives to be achieved. In this situation less sophisticated training should be given to all women assisting in deliveries.
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  3. 3

    Association for Voluntary Sterilization - Consultant Team. Trip report: the People's Republic of China, Beijing, Chongqing, Wuhan, Guangzhou, June 19-30, 1985.

    Huber D; Fathalla M; Gojaseni P; Goldstein M; Lippes J; Minor K; Rauff M; Sciarra J; Rauff A

    [Unpublished] 1985. 41, [6] p.

    The Association for Voluntary Sterilization consultant team visited Beijing, Chongqing, Wuhan and Guangzhou, China in June 1985, to review innovative nonsurgical methods of male and female sterilization. There are 2 variations on vasectomy, performed with special clamps that obviate a surgical incision. The 1st is a circular clamp for grasping the vas through the skin, and the 2nd is a small, curved, sharp hemostat for puncturing the skin and the vas sheath, used for ligation. Vas occlusion with 0.02 ml of a solution of phenol and cyanoacrylate has been performed on 500,000 men since 1972. The procedure is done under local anesthesia, and is controlled by injecting red and blue dye on contralateral sides. If urine is not brown, vasectomy by ligature is performed. The wound is closed with gauze only. Semen analysis is not done, but patients are advised to use contraception for the 1st 10 ejaculations. Pregnancy rates after vasectomy by percutaneous injection were reported as 0 in 5 groups of several hundred men each, 11.4% in 1 group and 2.4% in another group. The total complication rate after vasectomy by clamping was 1.8% in 121,000 men. 422 medical school graduates with surgical training have been certified in this vasectomy method. Chinese men are pleased with this method because it avoids surgery by knife, and asepsis, anesthesia and counseling are excellent. Female sterilization by blind transcervical delivery of a phenol-quinacrine mixture has been done on 200,000 women since 1970 by research teams in Guangzhou and Shanghai. A metal cannula is inserted into the tubal opening, tested for position by an injection of saline, and 0.1-0.12 ml of sclerosing solution is instilled. Correct placement is verified by x-ray, an IUD is inserted, and after 3 months a repeat hysteroscopy is done to test uterine pressure. Pregnancy rates have been 1-2.5%, generally in the 1st 2 years. Although this technique is tedious, requiring great skill and patient cooperation, it can be mastered by paramedicals. The WHO is assisting the Chinese on setting up large studies on safety and effectiveness, as well as toxicology studies needed, to export the methods to other countries.
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  4. 4

    Techniques of male sterilization.


    In: Morris, N. and Arthure, H. Sterilization as a means of birth control in men and women. London, Peter Owen, 1976. p. 80-100

    Vasectomy was 1st used at the start of the 20th century and became prominent in the 1950s in family planning programs in Asian countries. The secondary sex characteristics do not change after vasectomy, and there is normal erectile power, libido, orgasm, and ejaculatory volume. Spermatogenesis continues normally in men following vasectomy, and plasma testosterone levels remain unchanged. Vasectomy involves cutting both vasa deferentes through an incision in the scrotum which is usually performed with local anesthesia without hospitalization. Preliminary counseling is necessary so that both partners understand the nature and effects of the operation. Semen banks may be used when available for men undergoing vasectomy. There is no evidence for the greater efficiency of 1 technique over the other. Patients must submit sperm samples for examination after 8-12 weeks and then every 4 weeks until 2 consecutive specimens are negative. Possible complications include: 1) a vasovagal reaction; 2) skin discoloration; 3) edema of the scrotal skin, 4) postoperative pain, 5) infection; 6) ulceration and gangrene of the scrotal skin, and 7) hydrocele or epididymo-orchitis. Successful reanastamosis of the vas deferens with reappearance of sperm can be accomplished in 50-80% of the patients, and the semen is not of quality to insure impregnation in 1/4 of these cases.
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