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Geneva, Switzerland, WHO, Division of Family Health, Programme of Maternal and Child Health and Family Planning, 1991 Dec. , 122 p. (WHO/MCH/91.10)This WHO consultation on maternal and perinatal infections reviews the epidemiology of these infections, examines the effectiveness of known intervention strategies to prevent and treat these infections, notes gaps in current knowledge, and develops recommendations for implementation of appropriate control strategies. The report is geared toward maternal and child health professionals in developing countries where maternal and perinatal infections cause considerable morbidity and death. These countries have limited resources for health care (e.g., US $5-10/person), largely due to the worsening economic situation. The report centers on the feasibility, effectiveness, and cost of interventions to prevent, treat, and control the infections. It has summary cost-effective analyses of maternal and perinatal infections and proposed interventions using 3 different hypothetical country situations to help policymakers decide on priorities and policies on prevention, treatment, and control of these infections. The report dedicates a chapter to each infection (syphilis, neonatal tetanus, malaria, hepatitis, HIV infections, chlamydial infections, herpes simplex infection, Group B Streptococcal infections, and maternal genital infection causing premature birth and low birth weight). Each chapter addresses their clinical and public health significance; prevalence in pregnant women and transmission from mother to fetus/infant; clinical effects; prevention, treatment, and control; and cost effectiveness and feasibility of various interventions. Based on public health importance, feasibility, and affordability, the consultants agreed that national and international programs should place the highest priority on these perinatal infections: gonococcal ophthalmia neonatorum, maternal and congenital syphilis, neonatal tetanus, hepatitis B, and maternal puerperal infections.
IN POINT OF FACT 1990 Sep; (70):1-4.About 50% of children <1 year old in developing countries die during the 1st month of life, and 97% of all infant deaths occur in developing countries. Major factors contributing to these deaths are the mother's poor health before and during pregnancy, unhygienic childbirth practices, and inadequate care after delivery. Low birth weight, linked to mother's health, is considerably related to survival and development and growth. >500,000 women in developing countries die annually due to pregnancy and childbirth. Maternal mortality risk in the poorest countries can be 200 times that of developed countries. Inappropriate timing and spacing, too many pregnancies, unsafe abortion, and insufficient prenatal care and care during delivery contribute to high maternal mortality in developing countries. Mothers <18 years old are at the highest risk of pregnancy complications, delivering a premature infant, and/or death. Postponement of marriage and better access to family planning would improve their and their infants chances of survival. Access to and acceptability of family planning promotes the health of women and children. Literate women and their children are healthier than those of illiterate women. A trained person attends only 20% of births in developing countries. Increasing the number of deliveries with a trained attendant and increasing immunizations of mothers with the tetanus toxoid will greatly reduce mortality. Infants leaving the uterus experience a drop in ambient temperature from 37 to 20 degrees Celsius. If they are not dried off, covered in a dry cloth, and/or allowed to be in physical contact quickly, they can experience considerable heat loss or even death. Further all infants should be exclusively breastfed for 4-6 months to ensure healthy growth and development and to provide protection against infections.
[Unpublished] 1991. Presented at the 119th Annual Meeting of the American Public Health Association [APHA], Atlanta, Georgia, November 11-14, 1991. 7,  p.Maternal health affects child survival in many ways. For example, and infant in Bangladesh whose mother has died during childbirth has a 95% chance of dying in the 1st year. Further children <10 years old in Bangladesh, especially girls, who have lost their mother are 4 times as likely to also die. In addition, there is a relationship between protein energy malnutrition in mothers and low prepregnancy weight and meager wait gain during pregnancy which retards fetal growth resulting in a low birth weight (LBW) infant, LBW infants die at a rate 30 times that of adequate weight infants. In fact, child survival depends on maternal health even before the mother is able to conceive. Daughter as well as mothers in developing countries often eat last and smaller amounts of food than male family members. Females who remain poorly nourished often experience obstructed labor which causes several complications for the infant such as respiratory failure. Maternal infections such as malaria and sexually transmitted diseases are also closely linked to LBW. Some can also bring about preterm birth and congenital infections. Pregnancy and labor complications are responsible for about 500,000 maternal deaths annually. Hemorrhage, sepsis, eclampsia, and obstructed labor cause most of these deaths. A woman's fertility pattern also contributes to child survival. The high risk birth categories include too young, too old, too many children, and too closely spaced. In fact, the median mortality rate for infants born <2 years after the older sibling is 71% greater than that for those born 2-3 years apart. The World Bank recommends improved community based health care, improved referral facilities, and an alarm and transport system to improve maternal health. The World Bank, UNDP, UNFPA, UNICEF, WHO, IPPF, and the Population Council support the Safe Motherhood Initiative which aims to reduce maternal morbidity and death by 50% by 2000.
Maternal anthropometry for prediction of pregnancy outcomes: memorandum from a USAID/WHO/PAHO/MotherCare meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(5):523-32.The memorandum is an abbreviated version of a prepared report on maternal anthropometry which summarizes the general recommendations of a consensus of 50 experts on field applications and priority research issues in developing countries. Consensus was reached at a meeting on Maternal Anthropometry for Prediction of Pregnancy Outcomes held in Washington, D.C. in April 1990. 15 general recommendations are identified for field applications and research priorities. Specific recommendations differentiating field applications from research priorities are provided for prepregnancy weight, weight gain in pregnancy, height, arm circumference, and weight for height and body mass index. For example, the discussion of arm circumference indicates that it is useful as an indicator of maternal nutritional status in nonpregnant women because of its correlation with maternal weight or weight for height. During pregnancy, it is useful as a screen for risk of low birth weight (LBW) and late fetal and infant mortality. Maternal arm circumference has been found to be stable during pregnancy in developing countries and is independent of gestational age. Field applications involve the use 1) to assess the nutritional status of pregnant and nonpregnant women, 2) to screen women at risk of poor maternal stores postpartum because it reflects maternal fat and lean tissue stores, for instance, 3) to screen women and refer to facilities for a more thorough assessment of nutritional risk, and 4) to assess the extent of undernutrition in an area, particularly for surveillance. Community level workers, especially birth attendants (TBA's) should be trained and have access to arm circumference tapes. The technology is simple enough also for use by women in the home. Cutoff points for assessing biological risk are fairly consistent across developing country populations, and range between 21-23.5 cm. Routine monitoring during pregnancy is not necessary because the changes are too small to detect. Where prepregnancy weight is unavailable and weight is monitored, arm circumference may serve as a proxy for prepregnancy weight. All women of childbearing age should be measured. Research priorities are to explore the functional significance with women of difference body compositions (fat versus lean upper arm), the relationship to pregnancy related outcomes, arm changes relative to stages throughout the reproductive period and to weight changes, different instruments such as color-coded tapes or 1 tape for arm measurement and uterine height, combinations of different measurements, the relationship with prepregnancy weight, and the development of arm circumference in weight gain charts as a proxy for prepregnancy weight.