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Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience.
BMC Pregnancy and Childbirth. 2015; 15:12.BACKGROUND: To study institutionalization of the World Health Organization's Safe Childbirth Checklist (SCC) in a tertiary care center in Sri Lanka. METHOD: A hospital-based, prospective observational study was conducted in the De Soysa Hospital for Women, Colombo, Sri Lanka. Healthcare workers were educated regarding the SCC, which was to be used for each woman admitted to the labor room during the study period. A qualitatively pretested, self-administered questionnaire was given to all nursing and midwifery staff to assess knowledge and attitudes towards the checklist. Each item of the SCC was reviewed for adherence. RESULTS: A total of 824 births in which the checklist used were studied. There were a total of births 1800 during the period, giving an adoption rate of 45.8%. Out of the 170 health workers in the hospital (nurses, midwives and nurse midwives) 98 answered the questionnaire (response rate = 57.6%). The average number of childbirth practices checked in the checklist was 21 out of 29 (95% CI 20.2, 21.3). Educating the mother to seek help during labor, after delivery and after discharge from hospital, seeking an assistant during labor, early breast-feeding, maternal HIV infection and discussing contraceptive options were checked least often. The mean level of knowledge on the checklist among health workers was 60.1% (95% CI 57.2, 63.1). Attitudes for acceptance of using the checklist were satisfactory. Average adherence to checklist practices was 71.3%. Sixty eight (69.4%) agreed that the Checklist stimulates inter-personal communication and teamwork. Increased workload, poor enthusiasm of health workers towards new additions to their routine schedule and level of user-friendliness of Checklist were limitations to its greater use. CONCLUSIONS: Amongst users, the attitude towards the checklist was satisfactory. Adoption rate amongst all workers was 45.8% and knowledge regarding the checklist was 60.1%. These two factors are probably linked. Therefore prior to introducing it to a facility awareness about the value and correct use of the SCC needs to be increased, while giving attention to satisfactory staffing levels.
Obstetrics and Gynecology. 2008 Sep; 112(3):572-8.OBJECTIVE: To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist. METHODS: Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought birth control pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. The women then were interviewed by a blinded nurse practitioner, who also measured blood pressure. RESULTS: The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% confidence interval [CI] 51.7-60.6%), and specificity was 57.6% (95% CI 54.0-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5-86.3%), and specificity was 88.8% (95% CI 86.3-90.9%). Using the checklist, 6.6% (95% CI 5.2-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely because of unrecognized hypertension. Seven percent (95% CI 5.4-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily because of misclassification of migraine headaches. In regression analysis, younger women, more educated women, and Spanish speakers were significantly more likely to correctly self-screen (P<.05). CONCLUSION: Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method likely would be safe, especially for younger women and if independent blood pressure screening were encouraged.
Development of a scale to assess maternal and child health and family planning knowledge level among rural women.
Health and Population: Perspectives and Issues. 2000; 23(1):37-52.This paper presents a tool specifically developed for assessing the knowledge of rural women in Rohtak district of Haryana regarding maternal and child health. This tool can also be used for (i) identification of high risk women groups in the community by the programme managers as well as by the researchers; (ii) quantitative analysis of the relationship between various decisions making variables and the knowledge level of women regarding MCH and FP and (iii) impact evaluation of the IEC programme on the knowledge of women regarding maternal and child health. (author's)
Mid-term review report: 1997-2000 Programme of Cooperation, Government of the Sultanate of Oman-UNICEF.
Muscat, Oman, Ministry of Social Affairs, Labour and Vocational Training, 1999. 65 p.The Mid-Term Review of the 1997-2000 Programme of Cooperation between the Government of Oman and UNICEF was held - after a long and productive process of consultation - in May 1999, in Muscat, under the coordination of the Ministry of Social Affairs, Labour and Vocational Training. A total of 55 participants from Government ministries and national bodies attended, along with representatives from UNICEF Muscat, Regional Office for the Middle East and North Africa, and New York headquarters. Discussions were wide-ranging and productive, with frank appraisals of programme processes and achievements and useful intersectoral perspectives on programme cooperation. (excerpt)
[New York, New York], Population Council, 2000. viii, 28 p.In 1993 UNICEF/Myanmar launched an innovative project aimed at preventing the further spread of HIV/AIDS in Myanmar through the promotion of reproductive health. One of the activities undertaken was life-skills training for women and youth, conducted in collaboration with the Myanmar Red Cross Society (MRCS) and the Myanmar Maternal and Child Welfare Association (MMCWA). The objective of the life-skills training activities was to encourage and promote informed decision making and care-seeking behavior among youth and women. The training aims to provide detailed and accurate information concerning sexuality, birth spacing, sexually transmitted diseases (STDs), and HIV/AIDS, and to provide skills for youth and women to enable them to cope with their daily lives and become proponents of community mobilization. This report presents findings of a participatory evaluation of the life-skills training activities implemented in late 1997 and early 1998. At the time of the evaluation, life-skills training had been conducted in 27 project townships. MRCS activities targeted youth aged 15-25 years, and MMCWA worked primarily with married women aged 20-40 years. Eight project townships were identified as project evaluation areas and one township was selected as a comparison township for each of the implementing organizations. In each of the selected project townships in-depth interviews and focus-group discussions were conducted with trained and non-trained individuals in urban and rural areas. The evaluation used a highly participatory approach in order to encourage self-reflection among the local implementing agencies. This report summarizes the findings and recommendations resulting from the participatory evaluation. (excerpt)
The impact of changes on Latin American and Caribbean women: education, knowledge and demographic trends. Discussion note.
[Unpublished] 1992. Presented at the International Conference on Population and Development [ICPD], 1994, Expert Group Meeting on Population and Women, Gaborone, Botswana, June 22-26, 1992. 9 p. (ESD/P/ICPD.1994/EG.III/DN.10)Current theoretical and conceptual frameworks have included broader notions of social welfare and the quality of life within development discussions. Gender issues have been more easily integrated into development models. Modernization, as advances in economic conditions and the growth of technology, has rapidly changed societies. Although democracy has been included as a given for human development, a wider gap has appeared between the rich and poor. In Latin America expectations were set up for the social mobility of women and young people, when the debt crisis hit. Future models of women in development must eliminate the gender dichotomies and offer perspectives that explain the contradictions. A proposal was offered for achieving international competitiveness by changing production patterns, using innovation to achieve efficiency and equity, and creating possibilities for international cooperation. Gender equity means redistribution within socioeconomic groups and involvement of women in development. In Latin America, importance was placed on how women were integrated into development. Flexibility and innovation will be the goals of education, which should be compatible with the past traditional role women have carried. Specific measures will need to be introduced for maternal and child care, prenatal care, and flexible working hours. Child care must be part of a coordinated effort among public, private, business, and community sectors. The domestic burden of women will need to be lightened. Reproduction rights in Latin America and the Caribbean must be secured not only for women but also for men. Advances in medicine have reduced risk in childbirth, raised life expectancies, and provided options for women to control unwanted fertility. Excess female mortality due to preventable causes was highest among poor women. Access to education has increased but without a companion increase in labor market opportunity or income levels. In 1977, ECLAC adopted a Regional Plan of Action for the Integration of Women into Latin American and Caribbean Development which recognized women's vulnerability and the need for comprehensive, periodic assessments.
In: Missing links: gender equity in science and technology for development, [compiled by] United Nations. Commission on Science and Technology for Development. Gender Working Group. Ottawa, Canada, International Development Research Centre [IDRC], 1995. 55-81.This document is the third chapter in a book complied by the UN Gender Working Group (GWG) that explores the overlay of science and technology (S&T), sustainable human development, and gender issues. This chapter addresses the nature of indigenous knowledge systems, their potential role in sustainable and equitable development, and possible strategies for promoting mutually beneficial exchanges between local and S&T knowledge systems. The introduction notes 1) that local knowledge science systems differ from modern S&T because they are managed by users of knowledge and are holistic, 2) gender roles lead to differentiation in the kind of local knowledge and skills acquired by women and by men, and 3) sustainable and equitable development depends upon full recognition and reinforcement of local knowledge systems. The chapter continues with an analysis of 1) gender, biodiversity, and new agrotechnologies; 2) gender and intellectual property rights, especially in regard to biotechnological developments based on local knowledge; and 3) the work of governments, universities, nongovernmental organizations (NGOs), and local groups in the areas of S&T programs with women, general women's programs, and programs focused on indigenous knowledge (with an emphasis on research in gender and indigenous knowledge systems, women promoting diversity, the comparative advantage of indigenous knowledge, and the role of NGOs and information networks). Next, the chapter considers the work of the UN and its agencies through a review of documents containing S&T agreements; support for women's rights; and work in the areas of indigenous people, biodiversity, and intellectual property rights. The chapter ends by identifying areas of critical concern and research needs.
In: The United Nations Population Award, 1993. Laureates: Dr. Frederick T. Sai and Population Problems Research Council of the Mainichi Shimbun. Acceptance speeches and other statements. Award ceremony, New York, 16 September 1993. [Unpublished] 1993. 10-6.The 1993 UN Population award was given to Dr. Frederick R. Sai of Ghana. In his acceptance speech, Dr. Sai gave special thanks to President Hurtado of Mexico and thanks for the opportunity of working at the International Conference on Population in Mexico City in 1984. A special tribute was given by Dr. Sai to his 92-year-old mother, who though illiterate, widowed early, and very poor, encouraged her son educationally. His wife and family received thanks for their support of his chosen profession in clinical and public health nutrition. This field opened up his awareness of the need for family planning. The horror of kwashiorkor remains an important remembrance of the too close spacing of births. Special thanks were directed to Professor Scrimshaw of the Massachusetts Institute of Technology and Harvard University, the late Professors Ben Platt of the University of London and Jean Mayer of Harvard and Tufts Universities, and Dr. Julia Henderson at the International Planned Parenthood Federation. Thanks also were given to Dr. Sai's staff and volunteers at IPPF and to the many unrewarded and unrecognized people who devote themselves to concerns for motherhood and child health, human rights, and quality of life through family planning. Dr. Sai dedicated his prize to all the malnourished children and their parents who trusted in the future and helped with the studies without knowing for certain whether they would survive the next rainy season. These mothers are the hope of Africa. The quotation from Thomas Gray's Elegy in a Country Churchyard is reoriented to the African context and restated as "Fair science frowns not on her humble birth, and Melancholy marks her for her own." Drudgery and melancholy appear daily in the lives of African girls whose lack of access to general and science education influences their ability to care for themselves and their children. The education of women is of great concern, and progress worldwide is still limited. The call is for all to work together, regardless of differences, to improving conditions for the education of women. Safe motherhood is still a goal. Technology is available, but women's full control of their own fertility and quality information and services are the best method.
PLANNED PARENTHOOD CHALLENGES. 1994; (2):42-4.INPPARES, the International Planned Parenthood Federation affiliate in Peru, has provided family planning and other services to the Peruvian population since 1976. The organization concentrates upon interventions targeted to women of low socioeconomic status. One of the group's most important strategies has been to distribute contraceptives at the community level in rural and peri-urban areas of the country through a network of centers managed by promoters. These promoters are virtually all female. The organization in 1993 supplied 812 distribution centers. Promoters and their supervisors have received training in contraception, basic data recording, community work, and related topics. INPPARES, however, suspected that the quality of the project would be improved if promoters and supervisors were trained about the role of women in the community and their rights and identity as women. The personnel would then be able to better understand the role of contraception and reproductive health in women's lives. To that end, INPPARES in 1992-93 developed a project in coordination with the Manuela Ramos Association, a Peruvian women's organization. A questionnaire was given to forty promoters on issues related to women's roles, values, attitudes, the place of women in society and the family, family planning, sexual relations, and decision making. Their responses pointed to a real need to provide promoters and supervisors with more information through workshops on women in Peruvian society, women's identity and roles, women's sexual rights, and the quality of care in service provision. Four pamphlets were drafted from a seminar of fifty supervisors from both organizations to be used in a series of twelve workshops for 256 promoters. Post-intervention evaluation of the original forty participants confirm the significant effectiveness of both subjects covered and materials used in achieving desired project goals. Four workshops were subsequently held in which project results were presented to 261 promoters. Promoters and supervisors are now using flipcharts and pamphlets in their training activities.
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 28-9.As the AIDS epidemic and HIV transmission in India increasingly resembles that observed in sub-Saharan Africa, Indian society's arrogant perception of invulnerability to the pandemic is proving to be considerably ill-conceived. The dimensions of the epidemic have multiplied greatly since AIDS was 1st identified among prostitutes in Madras, with the trends observed in Maharashtra and Tamil Nadu being especially ominous. AIDS has forced Indian society and research professionals to acknowledge the existence of domestic prostitution, homosexuals, and drug users. While only 103 AIDS cases and 6,400 HIV infections have been officially identified, it is clear that these cases represent only a tiny fraction of the true extent of the epidemic in India. The government will therefore spend up to US$7.75 million on an anti-AIDS program aimed at ensuring secure blood supplies, and checking heterosexual transmission through education and the promotion of condoms. The program also targets IV-drug users and truck drivers for education and behavioral change. India is the 2nd country after Zaire to accept foreign loans for such a purpose. It will receive US$85 million over 5 years from the World Bank in addition to supplemental funds from the WHO and the U.S. Weak attempts, however, have been made to test blood supplies, with only 15% being tested in Tamil Nadu. A large gap also remains between health educators and needy target groups. Finally, while some top officials realize the need for immediate action against AIDS, broad public awareness and coping will come only after AIDS mortality begins to mount in the population.
In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 83-100.Researchers studied 62 pregnant women intending to not terminate their pregnancy and to continue their studies and 27 nonpregnant women to learn about female student fertility related behavior. They were all enrolled at the University of Zambia either during the 1987-1988 or 1989-1990 academic years. Methodology consisted of interviews, questionnaires, and focus group discussions. 68% of all women were single with 40% of them having at least 1 child. 75% of the women were sexually active. 42.7% knew traditional family planning methods with friends, grandmothers, and social aunts telling 25.9% of all the women about such methods. Yet mass media provided most women (49.4%) with knowledge about modern methods. 50.6% thought the pill to be the most effective method. >65% considered the 24-26 as the ideal age at marriage. The mean ideal family size was 3.5, somewhat less than family size for urban women in Zambia. 71.9% considered children to be assets since children are a means to social security (33%), self fulfillment (8%), and companionship (7%). 94.4% approved of family planning mainly for purposes of child spacing (29.2%), limiting (23.6), and spacing and limiting (32.6%). Even though they knew about and approved of family planning and claimed modern attitudes concerning ideal age at marriage and ideal family size, 62% of single pregnant students and 59% of married pregnant students did not use or regularly use contraception. This suggested that they considered early childbearing to be an asset. The leading reasons for contraception nonuse included perception of low pregnancy risk (40%) and desire for a child (28%). Only 3.2% claimed method failure. 64% of all women said partners did not approve of contraceptive use. Access to family planning and cost were not a problem. Only 22% of pregnant students said pregnancy would reduce their chances of marriage. In conclusion, many women became pregnant surreptitiously.
Socio-economic development and fertility decline: an application of the Easterlin synthesis approach to data from the World Fertility Survey: Colombia, Costa Rica, Sri Lanka and Tunisia.
New York, New York, United Nations, 1991. ix, 115 p. (ST/ESA/SER.R/101)The relationship between fertility decline and development is explored for Colombia, Costa Rica, Sri Lanka, and Tunisia. The study applies Richard Easterlin and Eileen Crimmins; theoretical and empirical approach to analyzing World Fertility Survey (WFS) data in a comparative context. The paper specifically questions the strengths and weaknesses of the Easterlin-Crimmins framework when applied to developing country data, and what the framework implies about comparative fertility in these countries. 3 stages in all, an analyst 1st decomposes a couple's final number of children ever born through an intermediate variables framework. Stage 2 emphasized understanding the determinants of contraceptive use, while stage 3 explains the remaining stage-1 and stage-2 variables. A model linking the supply of children, the demand for children, and the cost of contraceptive regulation results. Stage 1 results were promising, stage 2 results were less encouraging, while stage 3 revealed a theoretically incomplete approach employing empirically weak WFS data. While the Easterlin-Crimmins approach may be promising, econometric, theoretical, and data quality and collection improvements are necessary. Among stage-3 variables open to manipulation, higher socioeconomic status was associated with delayed age at 1st marriage, lower infant and child death rates, lower numbers of children desired, increased knowledge of contraception, and reduced levels of breastfeeding. Apart from regional differences, the educational and occupational roles of women in the countries studied were of primary importance in understanding differential fertility.
NETWORK. 1991 Sep; 12(2):14-7, 27.Many unwanted births and pregnancies could be avoided by improving instructions for and comprehension of the use of oral contraceptives. Employed less than only the IUD, the oral contraceptive pill is the 2nd- most widely used reversible form of contraception, used by 8% of all married women of reproductive age. 6-20% of pill users, however, fall pregnant due to improper pill use. Improving instructions in the pill pack, ensuring that instructions are correct, and working to facilitate user understanding and motivation have been identified as priorities in maximizing the overall potential effectiveness of the pill against pregnancy. Since packets in developing countries may consist of pills in cycles of 21, 22, 28, or 35 days, providers must also be trained to instruct users in a manner consistent with the written instructions. Pictorial information should be available especially for semi-literate and illiterate audiences. The essay describes recommendation for instruction standardization and simplification put forth by Family Health International, and endorsed by the U.S. Food and Drug Administration. International Planned Parenthood Federation efforts to increase awareness of this issues are discussed.