Your search found 39 Results

  1. 1
    Peer Reviewed

    Implementing WHO hospital guidelines improves quality of paediatric care in central hospitals in Lao PDR.

    Gray AZ; Soulaloun D; Soumphonphakdy B; Duke T

    Tropical Medicine and International Health. 2015 Apr; 20(4):484-492.

    Objectives To evaluate the impact of implementing a multifaceted intervention based on the WHO Pocketbook of Hospital Care for Children on the quality of case management of common childhood illnesses in hospitals in Lao PDR. Methods The quality of case management of four sentinel conditions was assessed in three central hospitals before and after the implementation of the WHO Pocketbook as part of a broader mixed-methods study. Data on performance of key steps in case management in more than 600 admissions were collected by medical record abstraction pre- and post-intervention, and change was measured according to the proportion of cases which key steps were performed as well as an overall score of case management for each condition. Results Improvements in mean case management scores were observed post-intervention for three of the four conditions, with the greatest change in pneumonia (53-91%), followed by diarrhea and low birth weight. Rational drug prescribing, appropriate use of IV fluids and appropriate monitoring all occurred more frequently post-intervention. Non-recommended practices such as prescription of antitussives became less frequent. Conclusions A multifaceted intervention based on the WHO Pocketbook of Hospital Care for children led to better pediatric care in central Lao hospitals. The degree of improvement was dependent on the condition assessed.
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  2. 2

    Atlas of eHealth country profiles 2013. eHealth and innovation in women's and children's health. Based on the findings of the 2013 survey of ColA countries by the WHO Global Observatory for eHealth.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2014. [132] p.

    This atlas is based on the 2013 WHO / ITU joint survey that explored the use of eHealth for women’s and children’s health in countries targeted by the Commission on Information and Accountability for Women’s and Children’s Health (CoIA). The objective of the country profiles is to describe the status in 2013 of the use of ICT for women’s and children’s health in 64 responding CoIA countries. This is a unique reference source for policy makers and others involved in planning and implementing eHealth services in countries.
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  3. 3

    eHealth and innovation in women's and children's health: A baseline review. Based on the findings of the 2013 survey of CoIA countries by the WHO Global Observatory for eHealth. Executive summary.

    World Health Organization [WHO]; International Telecommunication Union [ITU]

    [Geneva, Switzerland], WHO, 2014. [4] p. (WHO/HIS/KER/EHL/14.1)

    Improving the health of women and children is a global health imperative, reflected in two of the most compelling Millennium Development Goals which seek specifically to reduce maternal and infant deaths by 2015. This joint report by the World Health Organization (WHO) and the International Telecommunication Union (ITU), based on a 64-country survey, demonstrates -- as never before in such detail -- the vital role that information and communication technologies (ICTs) and particularly eHealth are playing today in helping achieve those targets. It demonstrates how, every day, eHealth is saving the lives of women, their babies and infants in the some of the most vulnerable populations around the world, in a wide variety of innovative ways.
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  4. 4
    Peer Reviewed

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

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

    BMC Health Services Research. 2011; 11:286.

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

    Legal frameworks for eHealth. Based on the findings of the second global survey on eHealth.

    Wilson P

    Geneva, Switzerland, World Health Organization [WHO], 2012. [89] p. (Global Observatory for eHealth Series Vol. 5)

    Given that privacy of the doctor-patient relationship is at the heart of good health care, and that the electronic health record (EHR) is at the heart of good eHealth practice, the question arises: Is privacy legislation at the heart of the EHR? The second global survey on eHealth conducted by the Global Observatory for eHealth (GOe) set out to answer that question by investigating the extent to which the legal frameworks in the Member States of the World Health Organization (WHO) address the need to protect patient privacy in EHRs as health care systems move towards leveraging the power of EHRs to deliver safer, more efficient, and more accessible health care. (Excerpt)
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  6. 6

    mHealth: New horizons for health through mobile technologies. Based on the findings of the Second Global Survey on eHealth.

    World Health Organization [WHO]. Global Observatory for eHealth

    Geneva, Switzerland, WHO, 2011. [112] p. (Global Observatory for eHealth Series Vol. 3)

    This report aims to make policy-makers aware of the mHealth landscape and the main barriers to implement or scale mHealth projects. It combines the results and analysis of the data gathered from the mHealth survey and is complemented by five country case studies and a review of the current literature related to mHealth. (Excerpt)
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  7. 7

    Achieving contraceptive security in El Salvador.

    John Snow [JSI]. DELIVER

    Arlington, Virginia, JSI, DELIVER, 2004 Nov. [4] p. (On Track)

    El Salvador has already reached several important milestones in its efforts to achieve contraceptive security-the guarantee that all people who wish to use contraceptives can choose, obtain, and use them at all times. With support from the United States Agency for International Development (USAID), the Salvadoran Ministry of Health (MOH) has recently worked to expand people's access to contraceptives, particularly through community-based distribution. It has also helped to improve product management in health facilities by training service providers and by implementing a contraceptive logistics management information system. El Salvador's next challenge on the pathway to contraceptive security is to become financially self-sufficient in procuring reproductive health commodities. USAID is progressively phasing out its contraceptive donations to the country, and is providing technical assistance to guarantee that the MOH will be able to accurately forecast contraceptive demand and manage its own budget for meeting that demand. (author's)
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  8. 8

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

    World Health Organization [WHO]

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

    All first-level health care facilities, namely primary health care clinics and outpatient departments based in district hospitals, use medicines and related supplies. It takes a team effort to manage these supplies, involving all health care facility staff: doctors, nurses, health workers and storekeepers. This is especially true in small facilities with only one or two health workers. Each staff member should know how to manage all supplies at the health care facility correctly. Each staff member has an important role. The Handbook of Supply Management at First-Level Health Care Facilities describes all major medicines and supply management tasks, known as the standard procedures of medicines supply management at first-level health care facilities. Each chapter covers one major task, explains how the task fits into the process of maintaining a consistent supply of medicines, and recommends which standard procedures to use. Annexes at the back of the handbook contain various checklists and examples of forms which can be introduced as needed at your health care facility. This handbook is part of a package used in an integrated training and capacity-building course targeted at first-level health care facilities. It can be used in conjunction with the existing Integrated Management of Adult and Adolescent Illness (IMAI) strategy developed by WHO. It can also be used for basic training activities independent of IMAI training courses. (excerpt)
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  9. 9

    Inconsistencies between tuberculosis reporting by the Ministry of Health and the World Health Organization. Mexico, 1981-1998. Discrepancias entre los datos ofrecidos por la Secretaría de Salud y la Organización Mundial de la Salud sobre tuberculosis en México, 1981-1998.

    Báez-Saldaña AR; Pérez-Padilla JR; Salazar-Lezama MA

    Salud Pública de México. 2003 Mar-Apr; 45(2):78-83.

    The objective was to describe the tuberculosis morbidity and mortality trends in Mexico, by comparing the data reported by the Ministry of Health (MH) and the World Health Organization (WHO) between 1981 and 1998. The number of cases notified in the past few years, their rates, and the trends of the disease in Mexico were analyzed. The incidence of smear-positive pulmonary tuberculosis was estimated for 1997 and 1998 with the annual tuberculosis infection risk (ATIR), to estimate the percentage of bacilliferous cases in 1997-1998. WHO reported more tuberculosis cases for Mexico than the MH. However, this difference has decreased throughout the years. The notification of smear-positive cases remained stable during 1993-1998. The estimated percentages of detection were 66% for 1997 and 26% for 1998 (based on ATIR of 0.5%). Tuberculosis mortality decreased gradually (6.7% per year) between 1990 and 1998, whereas the number of new cases increased, suggesting the persistence of disease transmission in the population. Inconsistencies between case notifications from national data and WHO were considerable, but decreased progressively during the study period. According to ATIR estimations, a considerable number of infectious tuberculosis cases are not detected. (author's)
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  10. 10

    Use of maternity register data in Benin.

    Kodjogbé N; Fourn L; Stanton C

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

    This report describes a study of the content and use of routinely collected data from maternity registers for the purposes of monitoring for maternal and newborn health at the health facility level in two departments of Benin. Specifically, the objectives of the study are to: Describe the scope, quality, completeness and use of the information collected in maternity registers in the departments of Atlantique and Zou; Calculate indicators which reflect clinical practices and outcome, such as: the cesarean section rate (for health facilities with surgical capacity), the referral rate, the rate of referred patients who are treated at the referral site, the episiotomy rate, the rate of “directed” deliveries (i.e., deliveries where oxytocics were used) and stillbirth and maternal death rates in health facilities in the departments of Atlantique and Zou; Validate the data regarding cesarean section operations recorded in the delivery register against that recorded in the surgical register; Describe the process by which data are recorded in the maternity registers. (excerpt)
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  11. 11

    Feasibility study on accelerating the improvement of civil registration and vital statistics systems of the Philippines.

    United Nations. Department for Economic and Social Information and Policy Analysis. Statistical Division. International Programme for Accelerating the Improvement of Vital Statistics and Civil Registration Systems

    New York, New York, United Nations, 1995. vii, 119, [1] p. (ST/ESA/STAT/110)

    This evaluation of the Philippines Vital Statistics and Civil Registration system was conducted by the International Institute for Vital Registration and Statistics. The aim is to ascertain whether system improvements are feasible. It is concluded that substantial financial assistance and external cooperation with the Filipino government will be required. The report is presented in three parts: 1) an analysis of the legal, administrative, and technical constraints on the civil registration and vital statistics systems; 2) nationwide strategies for improving quality and reliability; and 3) concrete recommendations for reforming the system within five years. Constraints to registration are identified. Filipinos perceive that the system pertains to Christians only. The central filing office is inaccessible from rural barangays. Ethnic minorities have different customs (naming, polygamy, divorce, burial) that do not fit the system. Civil registration is not an immediate requirement for living one's life. Births are not always registered under the name of the natural mother. Births should be registered by place of occurrence, but migrants may delay registration or register twice. There are civil and religious marriages and sometimes double registration. Civil registers are sometimes left with incomplete information or lost. It is recommended that government responsibilities for registration management be defined, all local chief executives be instructed in legal procedures for registration, and assessments be made of over and under staffing patterns. Incentives, taxpayer reporting requirements, and work registration were other suggestions. Long term solutions include the establishment of a National Civil Registration Office and the inclusion of minority reporting. Recommendations, which were made in the five year agenda (1992-96), were implemented in part during 1992-93.
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  12. 12

    Global Blood Safety Initiative. Minimum targets for blood transfusion services. Geneva, 20-22 March 1989.

    World Health Organization [WHO]. Global Programme on AIDS. Health Laboratory Technology Unit; League of Red Cross and Red Crescent Societies

    [Unpublished] 1989. 4 p. (WHO/GPA/INF/89.14; WHO/LAB/89.5)

    The World Health Organization's minimum targets for blood transfusion services are multiple and may be implemented at different levels of sophistication. The following outline is to be a minimum requirement to ensure a safe blood supply. A national blood transfusion advisory committee should be formed and a blood policy should be formulated. Directors, supporting personnel, and ancillary staff must be of adequate numbers and possess levels of training that meet a minimum standard set by the committee. Operational responsibility should be clearly defined. collaboration with the military should create a national pool of resources in order to better respond to emergencies. Blood donations must collected in an organized manner with adequate record keeping to ensure a healthy and adequate supply. Safety must be of a minimum level in order to ensure adequate public response. Blood collection centers should include refrigerators that can reliably maintain a temperature of 20-6 degrees C. Rh typing and ABO grouping must be consistent and reliable. Screening for HIV, hepatitis, and other blood transmittable diseases must be reliable and efficient. Verifiable records must be kept and inventory must be tightly controlled. Hospital transfusion services should be similarly set up. Training and education programs must be set up for health care professionals.
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  13. 13

    Prototype home-based mother's record: a guideline for its use, and adaptation in maternal and child health/family planning programmes and a reference manual for field testing and evaluation.

    World Health Organization [WHO]. Division of Family Health. Maternal and Child Health Unit

    [Unpublished] 1985. [2], 119 p. (MCH/85.13)

    There is a need for a simple, home-based maternal record that can monitor breastfeeding and family planning practices during the interpregnancy period, identify high-risk women, and guide health care workers in the timely management of care to be provided in the home and at the next referral level. This record should further serve as an educational tool that promotes the concept of participation in self- care. Maternal cards used in clinics and hospitals are difficult for primary health care workers with limited education to complete and are not designed to be adapted to the changing health problems and health needs in a given community. In response to this situation, the World Health Organization's Maternal-Child Health Unit has designed a prototype home-based mother's record that can serve as a starting point for the design of more area-specific ones. The record contains 6 panels: 1 for data and risk conditions suggested by past history; 3 for data on past pregnancies, deliveries, and postpartum periods; 1 to monitor health progress before the 1st pregnancy or during the interpregnancy interval; and 1 for recording recommendations to the referral center. It is important that any mothers' records developed should be field tested to evaluate the physical condition of the card after 1 year of use, the extent of use of the record, the quantity of information collected and its usefulness, the assessment of health workers about the value of the record, risk factors identified, utilization of referral sources and family planning services, and linkages with other health records.
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  14. 14

    Home-based maternal records. Guidelines for development, adaptation and evaluation.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1994. viii, 85 p.

    The home-based maternal record--like the child growth chart--represents a simple, appropriate technology that can have a significant impact on maternal and child health. A prototype home-based maternal record was developed by the World Health Organization (WHO) in 1982 to facilitate the early detection of risk conditions, promote timely referral of at-risk cases, improve the monitoring of health status for up to 10 years after pregnancy, and increase community involvement in health care. A multicenter review of the maternal health card conducted by WHO in 14 countries in 1984-88 indicated this tool increased the referral rate, the use of prenatal care, attendance at postpartum check-ups, and childhood immunization rates while also promoting self-reliance and the participation of mothers in their own health care. Since that time, the WHO prototype record has been adapted to local health needs and conditions by almost 30 centers. The protocol presented in this volume is intended for use by decision makers in health ministries, obstetricians, program managers, and community health leaders who want to introduce the maternal record to their own health system. Detailed information is provided on the functions and benefits of the records, how they should be adapted and introduced to the primary care system, and steps that should be taken in advance of large-scale use. Also included is information on the training of community health workers, nurse-midwives, and physicians.
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  15. 15

    Providing contraceptives through community based services with clinical back-up: a model protocol for quality of care.

    Huezo C; Malhotra U

    London, England, International Planned Parenthood Federation [IPPF], Medical Department, 1992 Jun. [3], 6, [8] p.

    Presented is a protocol for the community-based distribution of oral contraceptives (OCs) aimed at safeguarding the quality and effectiveness of care. Specific components include adequate screening of clients, follow up of OC acceptors, clinical back up for community-based activities, and referral services. Sought is a balance between the needs to maintain adequate client records yet not overwhelm community workers with paper work. Community workers are supplied with a checklist to facilitate client screening for OCs, a record form for contraceptives provided and problems encountered, and a referral card to send with the client to the clinic and subsequently returned to the community worker. It is important, however, that these forms are adapted to the local situation. Training programs for community-based workers and their supervisors should cover ways to provide information on all available contraceptive options, contraindications to OC use, indications of the need to make a referral, and the use of client record forms for client management and program evaluation. Also proposed are seminars involving community-based workers and personnel from the clinic to which referrals are made.
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  16. 16
    Peer Reviewed

    Childhood blindness: a new form for recording causes of visual loss in children.

    Gilbert C; Foster A; Negrel AD; Thylefors B


    In London, the International Centre for Eye Health (ICEH), a WHO Collaborating Centre for Blindness Prevention, and WHO have developed a standardized protocol for reporting causes of blindness in children, primarily those in schools for the blind and those attending hospital clinics. There is a section for blind children identified during population-based prevalence surveys. A set of coding instructions and a database for analysis accompany the WHO/PBL Eye Examination Record for Children with Blindness and Low Vision. ICEH and WHO hope the new form will identify preventable and treatable causes of childhood blindness. It will also serve as a mechanism to monitor changing patterns of childhood blindness over time in response to changes in health care services, specific interventions, and socioeconomic development. Further, it will allow eye doctors to assess the requirements of individual children for medical and/or surgical treatment optical correction, and low vision services. Finally, it will give educators the opportunity to assess the educational needs of blind children. The contents of the form include census, personal details, visual assessment, general assessment, previous eye surgery, eye examination (site of abnormality leading to blindness and etiology of blindness), refraction/low vision aid assessment, action needed, prognosis for vision, education, full diagnosis, and names of the examiners. Both ICEH in London, and WHO in Geneva will maintain a centralized data blank. Local ophthalmologists with an interest in pediatric ophthalmology and those assigned to develop the form tested the form while examining about 1600 children in schools for the blind in 4 continents. Ophthalmologists can examine and complete the form on 5-8 children/hour in schools for the blind.
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  17. 17

    Evaluating the effectiveness of newly introduced interventions in Pathfinder Community Based Service (CBS) projects: a report on an operations research project.

    Alauddin F; Sorcar NR; Rahman A

    Chevy Chase, Maryland, University Research Corporation, Family Planning Operations Research / Asia Project, 1987 Dec 20. 78 p. (BAN-07; USAID Contract No. DPE-3030-C-00-5043-00)

    In Bangladesh, the Pathfinder Fund operates community-based distribution (CBD) family planning (FP) projects in 24 urban areas. While implementing these projects, Pathfinder discovered a number of interrelated operational problems including inadequate coverage of clients, inaccurate record-keeping, and poor planning and supervision of field operations. Therefore, 3 management interventions, a new workplan system, reduced client-worker ratio, and a simplified recordkeeping and control system, were tested in different combinations or packages in 7 of the 24 areas served. An operations research study, which cost US $58,612, examined whether the interventions had been implemented as planned and assessed the impact of the interventions on improving coverage, acceptance, and prevalence of FP. A nonexperimental design was used, because the program was not set up as a research project and no baseline data or control groups existed. Data were collected from secondary sources, service statistics, interviews with project staff and key informants, and a representative survey of 1,400 married women of reproductive age, 200 from each of the project areas. A combination of all 3 interventions proved to be the most effective package, followed by a combination of the workplan and reduced client/worker ratio. The new workplan alone seems to be the most effective single intervention. Contraceptive prevalence was highest in an area when all 3 interventions were introduced and lowest when only one was introduced. The workplan systematized the workers' activities, ensured regular visits to assigned couples, facilitated supervision, expanded coverage, and improved contact. The simplified recordkeeping system systematized recordkeeping, helped promote effective supervision and monitoring, and aided in evaluation of worker performance. Based on the findings, Pathfinder has introduced the 3 interventions in all its CBD project sites.
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  18. 18

    Management information systems in health and family welfare programmes: observations from experimental projects.

    Khan ME

    In: Monitoring and evaluating family planning programmes in the 1990s, [compiled by] United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]. Bangkok, Thailand, ESCAP, 1990. 169-87. (Asian Population Studies Series No. 104; ST/ESCAP/945; UNFPA Project No. RAS/86/P09)

    The primary health center (PHC) data systems serves the delivery of health care in rural India with a medical officer in charge. PHC provides health and family welfare services to at least 30,000 people. Subcenters are staffed by 2 paramedics and cover 5000 people or more. Recordkeeping consists of village records, family folders, prenatal, natal, and postnatal services, eligible couple registers, monthly reports, vital events, conventional contraceptive registers, IUD registers, sterilization registers, and oral pill registers. Monthly meetings are held and monthly reports are compiled on blood smears, malaria-positive cases, DDT spraying, tuberculosis, gastroenteritis, diarrhea cases, and mortality of major diseases. Shortcomings of the existing system include data that are incomplete, frequently of poor quality, and unsatisfactory maintenance of eligible couple registers. An effective management information system (MIS) is indispensable for planning and implementation of programs. In the Dindori block of the Nashik district of Maharashtra state the Economic and Social Commission for Asia and Pacific (ESCAP) provided technical assistance to improve MIS for 200,000 people. An experimental MIS model was tested in 1987. A family health card was developed for data on household members, immunization coverage of children, malaria, TB, and leprosy incidence. In 1986 an experimental computerized MIS was also developed at Bavala, Ahmedabad district covering 260,000 people in 3 blocks with records of 38,000 mothers and 18,000 children under 3. WHO supported an experimental MIS project in 1988 in the state of Gujarat whose objective of reducing records kept was attained.
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  19. 19

    Serve the unmet needs.

    Nahariya R

    INTEGRATION. 1992 Aug; (33):34-7.

    The Philippine Family Planning Program component of the UN Population Fund (UNFPA) defines the demand for family planning (FP) as the desire of couples to space or limit their children, and reduce the risks of pregnancy and childbirth. Although the teachings of the Catholic Church oppose FP, at the local level priests do not enforce this strict code. Funding is relatively sufficient, but the public support of legislators is lacking, and implementation is problematic. Nongovernmental organizations (NGOs) are instrumental in delivering 38% of FP health care service focusing on comprehensive reproductive health concerns of low- and middle-class women in urban areas exclusive of the very poor. The reporting system is ill-functioning, perinatal deaths often go unreported, and in remote areas underreporting is the rule. The collected data are not used for management or in the communities and municipalities. The prevalence of FP is 42-44%, but only 22-24% of it consists of effective methods. 23% of women aged 15-44 have unmet needs of FP. The program could be improved significantly in view of a 90% female literacy rate in 1991, an independent streak in women in urban areas, and a less male-oriented culture. The program of the UNFPA is on a 5-year cycle, and from 1993 the support of USAID, the World Bank, the German government, and the Japan International Cooperation Agency is expected.
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  20. 20
    Peer Reviewed

    Accuracy of recall of use of an intrauterine device.

    Nischan P; Thomas DB; Ebeling K

    CONTRACEPTION. 1992 Apr; 45(4):363-8.

    Researchers analyzed interview and physician records' data on 45 women with breast cancer (cases) admitted to the Central Institute of Cancer Research in Berlin, East Germany between November 1982-June 1986 and born in 1983 or later and 194 women (controls) admitted to the Klinikum Berlin-Buch also in East Germany for conditions other than breast cancer to compare recall accuracy in women who had ever used an IUD. These women were drawn from case control study of the relationship between breast cancer and oral contraceptive use was part of the WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Agreement between patient recall and physician records was exceptional for duration of IUD use (p<.001), number of IUD episodes (kappa=0.79), time since 1st IUD and time since last IUD use (p<.001). Agreement rates did not differ between cases and controls. 75% of the women could not name the IUD brand used so the researcher could not examine agreement of brand name. Thus, other than brand name, this study showed that validity of information on IUD use obtained from interviews is significant. In fact, it also pointed out that case control studies probably yield sound relative risk estimates.
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  21. 21

    Monitoring TT coverage through routine reporting: present and proposed methods.

    Steinglass R

    Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1988 Jun. 22 p. (USAID Contract No. DPE-5927-C-00-5068-00)

    Reported tetanus toxoid (TT) coverage is lower than that of other childhood vaccines in almost all developing countries. Further WHO and UNICEP TT coverage rates differ. For example, UNICEF estimates are 203 times higher than WHO's. Professionals are working on a standardized and shared computerized reporting system to help alleviate these discrepancies. In addition, TT indicators used by WHO globally and within the national Expanded Programme on Immunization (EPI) are not valid: WHO and EPI do not consider TT2 immunizations administered during the recent past even though they provide protection for 3 years. In fact, the number of immunizations administered in a year is incorrectly used to determine actual TT coverage levels. Besides this system fosters inappropriate delivery strategies and targets. REACH proposes applying the present routine reporting system to a simple alternative management tool. For example, the numerator consists of the number of TT2 immunizations given during the past 3 full years. This number is then divided by the population of eligible females to derive TT2 coverage. This method also allows for monitoring of TT3 immunization. Further it gives a point prevalence of maternal protection versus a period prevalence in any particular year. Instead of using a mother's health card, a child's immunization card, or a child's growth chart for recording TT immunization, REACH suggests TT protection cards covered in inexpensive transparent plastic. They should allow for the recording of 5 doses of TT and have important cultural symbols, such as religious symbols, printed on them. To ensure valid TT monitoring, clinic reporting forms should list TT immunization by does (TT1, TT2, TT3, TT4, and TT5) and target group (e.g., pregnant women).
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  22. 22

    Natural family planning. A guide to provision of services.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1988. vi, 82 p.

    There are 4 natural family planning (NFP) methods: rhythm, cervical mucus (Billings), basil body temperature, and symptothermal. The rhythm method is one in which cycle history of last 6-12 months is used to estimate the possible days of fertility. In the cervical mucus method a women must be able to detect changes in the cervical mucus discharge during the cycle. The basil body temperature method uses the difference in temperature that occurs after ovulation, and can only be used to detect the infertile time after ovulation. The symptothermal method combines the mucus method and the basil body temperature methods. In addition it uses other physiological indicators such as breast tenderness, pain, bleeding, and abdominal heaviness. The use of natural planning methods demands the cooperation and motivation of both partners to be successful. The methods can be taught by midwives, nurses doctors and other health care professionals. NFP teacher training is the cornerstone of the NFP programs and service. Teachers must have the technical ability and practical experience to carry out training programs. NFP programs can only be successful in areas that are receptive to NFP and have high literacy rates. To plan and implement NFP services, one must take into account community needs, resources available, and the structures needed to deliver these services. It is important to evaluate the effectiveness of the program, including formal evaluation of the teachers, monitoring of the users, and getting feedback from both.
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  23. 23

    The home-based maternal record: a tool for family involvement in health care.

    Shah PM; Shah KP; Belsey MA

    IPPF MEDICAL BULLETIN. 1988 Apr; 22(2):2-3.

    The home-based maternal record offers an opportunity for family involvement in health care. Home-based records of maternal health have been used in several developing countries, and have led to increased detection and monitoring of women at high risk for complications during pregnancy. Home-based cards that include menstrual information remind health workers to educate and motivate women for family planning, and serve as a source of health statistics. Records that use pictures and symbols have been used by illiterate traditional birth attendants, and had an accurate completion rate of over 90%. The WHO has prepared a prototype record and guidelines for local adaptation. The objectives were to provide continuity of care throughout pregnancy, ensure recognition of at-risk women, encourage family participation in health care, an provide data on maternal health, breastfeeding, and family planning. The guidelines have been evaluated and results show that the records have improved the coverage, acceptability, and quality of MCH/FP care. The records have also led to an increase in diagnosis and referral of at-risk women and newborns, and the use of family planning and tetanus toxoid immunization has increased in the 13 centers where the reports are being used. Focus group discussions have shown that mothers, community members, primary health workers, and doctors and nurses liked the records. It is important to adapt criteria for high-risk conditions to the local areas where the records will be used to ensure the relevance of risk diagnosis. The evidence shows that home-based maternal and child records can be an important tool in the promotion of self-reliance and family participation in health care. In addition, home-based records can be used for the implementation of primary health care at the local level, and serve as a resource for data collection.
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  24. 24

    Report on the evaluation of UNFPA assistance to the strengthening of the civil registration and vital statistics system in Sierra Leone: project SIL/79/P03.

    Kannisto V; Mehta DC; McWilliam J

    New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Dec. x, 28 p.

    While Sierra Leone has a long tradition in registering births and deaths, dating back to the mid-1880s, registration has remained low. In order to improve registration coverage, the original project formulated in 1979 by the government included 3 immediate objectives; the strengthening of the civil registration system in a model area, the experimentation with field organization procedures most suitable for the registration system in the country, and the production of estimates of demographic variables in the model area and in the rest of the country. In the Tripartite Project Review held in 1981, 2 additional objectives were added to the project; the unification of the civil registration laws, including the provision of a uniform and universal legislation for the entire country, and the reorganization and training of the registration hierarchy. While the strategy to use a model area for the development was a sound one, without the law being enacted, new forms and registers could not be printed and thus few of the planned activities could take place. Of the 5 immediate objectives of the project, only one has been achieved--the passage of the Act of 1983 which provides the legal framework for registration to take place nationwide under the new system. Little progress has been made in the achievement of the 4 remaining objectives. The Evaluation Mission made recommendations concerning the need to reformulate the extension document early in 1985, taking into account the results of the Evaluation Mission, the concentration of government action on registration in the non-model areas, and thereafter the gradual expansion of registration to adjacent areas where more complete coverage is possible.
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  25. 25

    Family planning through child health: a case study of El Kef project in Tunisia.

    Bouzidi M; Jones M

    Joicfp Review. 1985; (9):12-7.

    In 1970, a Dutch medical team began work in the city of El Kef in Tunisia on a project designed to bring family planning into rural areas. The project aimed to persuade the rural people to use urban health centers, but this approach failed partly because of the remoteness of the communities and their reluctance to discuss personal matters with strangers. Funded by UNFPA, a new project began to recruit and train local girls as home health visitors or aides-familiales, an approach which became the central focus of the El Kef project. The International Planned Parenthood Federation (IPPF) took over the project and expanded it to include nutrition, health care, health education, family planning, disease prevention and domestic crafts. 4 goals were fixed for the project: total vaccination coverage for children; elimination of severe malnutrition; reduction of infant mortality; and use of family planning practice by at least 1/2 the women of childbearing age. An efficient recordkeeping system enabled the project to be carefully evaluated and provides much-needed data, showing where it has achieved its aims and where new efforts should be directed. The project resulted in large numbers of women receiving ante-natal advice, child care and family planning from their local health centers. 860 pregnant women were followed up during the 3-year study period. Some 57% of pregnant women went for advice; only 15% went for postnatal care, but 50% of the women under 50 attended child welfare sessions during the study period for weight checks, nutrition advice, vaccination and treatment for minor ailments. Over the 3 years, the number of contraceptive users more than trebled, from 14% to 54%. The IUD was the most popular method. The most successful aspect of the project was the emphasis on maternal and child health, and the home visits were the most motivating feature. Vaccination became more popular. A further aspect of the project was the training in home improvement skills, like sewing, knitting and gardening. After 4 years in the field the aides familiales were a valuable resource of skill and experience. Family planning was integrated with maternal and child health in the government program through the health infrastructure.
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