Maternal health and human rights

In Malawi the maternal mortality ratio is extremely high. Since almost all maternal deaths are avoidable, maternal mortality is also an issue of human rights. This paper examines the root causes of high maternal mortality in Malawi and applies a human rights-based approach to the reduction of maternal mortality. It recommends roles for the various duty-bearers. It describes indicators to monitor and evaluate the strategy and suggests how transparency and accountability should be ensured. In conclusion, full and effective implementation of the strategy is indispensable for achieving the fifth Millennium Development Goal that calls for the reduction of maternal mortality.     

Child rights and Child and Adolescent Mental Health Services (CAMHS) in Ireland

This paper explores children’s rights in the child and adolescent mental health arena in Ireland. It begins by outlining the legal and policy contexts of both children’s services and mental health policy and practice. It specifically focuses on the notion of participation as a key factor in addressing rights-based approaches in the provision of services. The article explores current practice in Child and Adolescent Mental Health Services, highlights some of the disparities in services, which result in questions about human rights. Mainly reflective in its approach, it does, however, provide data from a small scale qualitative study carried out in relation to young people diagnosed with ADHD and their perceptions of psychopharmacological approach. The issue of consent is explored as an example of how current practice approaches fall short of a rights-based framework. It concludes with recommendations for changes incorporating a more participatory and collaborative approach.     

Analyzing hospital mortality. The consequences of diversity in patient mix

Consumers and payers increasingly demand data with which to evaluate health care providers. While publication of risk-adjusted hospital-specific death rates is one response, debate continues over whether higher than predicted mortality is a warning about quality of care or rather a reflection of a hospital's atypical patient population. To help inform this debate, we compared the characteristics of Medicare patients discharged from 187 hospitals that the Health Care Financing Administration (HCFA) had labeled "high-mortality outliers" with those of Medicare patients from 5373 hospitals not so designated. Hospitals were most likely to be flagged as high-mortality outliers by HCFA when they had large shares of very elderly patients (age greater than or equal to 85 years), patients with high-risk diagnoses, or patients requiring nursing home care. After adjustments were made to compensate for these biases, nearly half the hospitals flagged as outliers by HCFA were no longer so designated. Statistics purporting to measure effectiveness of care from hospital death rates should be modified to account for diversity in patient mix.     

The importance of "throwing money at" the problem of global health

More funding from wealthy countries is required to improve health care and the infectious disease situation in developing countries. Although progress has been made, funds for fighting AIDS, tuberculosis, and malaria remain inadequate. These treatable and preventable diseases together kill over 6 million people every year. Funds are needed to improve access to existing medicines as well as to increase research and development of drugs. The idea that "throwing money at the problem is not going to solve it" rightly holds that increased funding is not sufficient for solving the health care problems of developing countries. In order to work, funds must be spent wisely. This does not mean that increased funding is unnecessary.     

Some international comparisons of mortality amenable to medical intervention

A series of outcome indicators was proposed for assessing the curative aspects of health care using several diseases for which evidence suggested that death was largely avoidable provided that appropriate medical treatment could be given in time. International data were examined for those causes for which data were readily available. Time trends in mortality were compared for each of these conditions for six countries that had experienced appreciable growth in health services during 1950-80. Mortality from the heterogeneous "avoidable" causes had declined faster than mortality from all other causes in each of the six countries. Despite problems of diagnosis, reporting, and classification of diseases that may have existed among countries, making international comparisons of absolute mortality difficult, the trends of declining mortality were similar, lending credibility to the use of these causes of mortality as indices of health care within countries. Changes within countries may also have been attributable to changes in social, environmental, genetic, and diagnostic factors, which were not examined. Nevertheless, the consistency in mortality trends for this group of "amenable" diseases suggested that improvements in medical care were a factor in their rapid decline.     

实施以家庭为中心的人性化护理对产科护理质量和顾客满意度的影响

目的:探讨实施以"家庭为中心"的人性化护理对产科护理质量和顾客满意度的影响。方法:选取200例住院分娩的产妇,随机分为观察组和对照组,对照组实施常规护理,观察组实施实施以"家庭为中心"的人性化护理,比较两组产妇卫生及心理状况、生殖器恢复情况、母乳喂养成功率及患者满意度方面的情况。结果:观察组的产妇卫生及心理状况、生殖器恢复情况、母乳喂养成功率及患者满意度方面均优于对照组,两组比较,差异均有统计学意义(P<0.05)。结论:实施以"家庭为中心"的人性化护理可提高产妇相关知识的知晓率、母乳喂养成功率以及患者满意度,产妇卫生及心理状况良好,值得借鉴。     

Contributing death factors in very low-birth-weight infants by path method analysis

Background:

Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. Therefore, efforts to achieve the UN Millennium Development Goal 4 of reducing childhood mortality by two-thirds by 2015 are focused on reducing neonatal deaths in high-mortality countries. The aim of present study was to determine death factors among very low-birth-weight infants by path method analysis.

Materials and Methods:

In this study, medical records of 2,135 infants admitted between years 2008 and 2010 in neonatal intense care unit of Alzahra Educational-Medical centre (Tabriz, Iran) were analysed by path method using statistical software SPSS 18.

Results:

Variables such as duration of hospitalisation, birth weight, gestational age have negative effect on infant mortality, and gestational blood pressure has positive direct effect on infant mortality that at whole represented 66.5% of infant mortality variance (F = 1018, P < 0.001). Gestational age termination in the positive form through birth weight, and also gestational blood pressure in negative form through hospitalisation period had indirect effect on infant mortality.

Conclusion:

The results of the study indicated that the duration of low-birth-weight infant''s hospitalisation is also associated with infant''s mortality (coefficient -0.7; P < 0.001). This study revealed that among the maternal factors only gestational blood pressure was in relationship with infants’ mortality.     

The changing American health scene. Sometimes things get better.

Since the increased efforts to improve medical care for Americans were initiated 15 years ago, it is generally believed they had little impact on the problems addressed. Review of national data suggests otherwise. American medical care and health status are getting better. We have improved the availability of physician services and largely eliminated the gap between visits made by rich and poor, or white and black citizens. We have greatly expanded the number of health professionals who provide medical care. Better organized programs to provide care to groups with special health problems have reduced both mortality and morbidity. Age-adjusted death rates, infant and maternal mortality, and death rates from coronary artery disease have fallen. While there remains an important agenda for the future, there seems room for cautious optimism about the abilities of American society to make forward progress.     

1994-2013年我国孕产妇死亡率及其与孕产保健服务利用的关系

目的:了解我国孕产妇死亡率(MMR)、孕产保健利用率变化趋势,探究两者关系,为进一步降低我国MMR提供参考。方法:挖掘《中国卫生统计年鉴》及中国妇幼卫生相关监测数据,采用灰色关联分析探讨孕产妇死亡水平与孕产保健利用率关联性。结果:1994-2013年全国MMR由64.8/10万降至23.2/10万(下降64.2%),降幅农村高于城市;死因产科出血仍居第1位,羊水栓塞上升至第2位。孕产保健利用率上升,升幅农村高于城市,其中住院分娩率上升最快。关联分析显示全国和农村MMR与六项孕产保健利用率均呈明显负相关关系(P<0.01),城市MMR仅与住院分娩率呈显著负相关关系(P<0.01)。存在问题:MMR地区差异仍然存在;流动人口成为孕产保健重点人群。结论:二十年来我国MMR下降明显,但随着孕产保健利用效应最大化,未来仅依靠提高住院分娩率等措施来降低MMR的作用已非常有限,需思考新的策略与措施。     

Holistic approach to health education on AIDS

Ｔｈｅｒｅｓｅａｒｃｈａｎｄｄｅｖｅｌｏｐｍｅｎｔ（Ｒ＆Ｄ）ｏｆｓｃｉｅｎｔｉｆｉｃｃｏｍｍｕｎｉｃａｔｉｏｎｆｏｒｃｏｍｍｏｎｐｒｏｂｌｅｍｓｏｌｖｉｎｇｃａｎｂｅａｄｊｕｓｔｅｄａｃｏｒｄｉｎｇｔｏｃｈａｎｇｉｎｇｎｅｄｓｗｉｔｈｉｎａｃｏｍｍｕ...     

Anaesthesia in underdeveloped world: Present scenario and future challenges

The overall mortality and morbidity in underdeveloped countries are still unchanged and preventable risks factors constitute the main burden. Among these, anaesthesia-related mortality is largely preventable. Various contributory factors related to human resources, technical resources, education/teaching system and other utilities needs further attention in poor income group countries. Therefore, we have made an attempt to address all these issues in this educational article and have given special reference to those factors that might gain importance in (near) future. Proper understanding of anaesthesia-related resources, their overall impact on health care system and their improvisation methods should be thoroughly evaluated for providing safer anaesthesia care in these countries which would certainly direct better outcome and consequently influence mortality.     

Addressing depression and anxiety among new fathers

Fathers may be unintentionally marginalised by perinatal health services and by the maternal focus of social practices surrounding new babies. There is increasing recognition that a fathers' depression and anxiety in the perinatal period can have serious consequences for his family. Health services could better support new fathers by providing them with information on parenting from a father's perspective, or by running father-specific sessions as part of routine antenatal care programs.     

Low cost methods for secondary prevention of cervical cancer in developing countries

BACKGROUND: Cervical cancer is both a preventable and a curable disease- preventable because the pre-invasive stage can be detected by screening and curable because the very early stage can be cured. It is the commonest genital cancer among females in Nigeria. The incidence and mortality from this disease in developing countries is very high. This is due to the unavailability of organised screening programmes. To address this problem, effective and practical alternatives to cytology are being investigated in many studies. OBJECTIVE: To examine the strengths and limitations of new methods currently undergoing evaluation for secondary prevention of cervical cancer in developing countries. MATERIAL AND METHODS: We conducted a computerised literature search for published articles. Mesh phrases used for the search were cervical cancer screening, cervical cancer screening in developing countries, cervical cancer screening- new techniques. Hand searches of journals and the proceedings of major conferences were also done. RESULTS: The visual tests for screening for cervical cancer was found to be highly sensitive and can be performed by not only physician but also other trained health care providers. The "single visit approach" to prevention of cervical cancer also referred to as "see and treat" has been tried in some countries in Asia and Africa and found to be effective and acceptable to women and their partners. CONCLUSION: Several studies conducted in many developing countries have shown that low cost methods for cervical cancer prevention do have a place in reducing the incidence of this deadly disease.     

AIDS treatment and maternal mortality in resource-poor countries

The crisis of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), particularly in resource-poor countries in Africa, Asia, and Latin America, is one of the most devastating pandemics in history and adds a cruel burden on women. High rates of maternal mortality and morbidity continue to take a drastic toll on women worldwide. These health challenges provide a window of opportunity to combine urgent global health needs with women's fundamental right to health care, including targeting resources to provide woman-centered treatment for HIV/AIDS and to avert pregnancy-associated death and morbidity. Governments and organizations have a tremendous responsibility in addressing these health issues. The Global Fund to Fight AIDS, Tuberculosis and Malaria was established last year to make significant funds available for treatment and care. Programs such as MTCT-Plus, which provides treatment for HIV-positive mothers and prevents mother-to-child transmission of HIV, can begin to alleviate the tremendous health burden women bear. Addressing women's health needs and women's right to health care is the essential first step in providing services to millions living with HIV/AIDS and pregnancy-related complications.     

International Maternal Mortality Reduction: Outcome of Traditional Birth Attendant Education and Intervention in Angola

Background. As a result of war and periodic natural disasters, Angola has among the highest infant and maternal mortality rates in the world. In response to the acute health needs of the population, the International Medical Corps (IMC) developed a traditional birth attendant educational course designed to reduce the preventable causes of maternal and infant mortality. Methods. From 1994 until 1998, Angolan traditional birth attendants (TBAs) participated in an intensive 38-hr training course on prenatal, delivery, and postnatal care. Following the birth of a child, the trained TBAs completed a registration form containing information regarding the health of the mother. Previous studies of Angolan maternal mortality served as historic comparisons. Findings. Complete data including maternal mortality data were available for 19,666 deliveries (83% of total). Fifty five maternal deaths were recorded, which corresponds to a maternal mortality rate of 293 per 100,000 live births. The average historic maternal mortality rate for available comparison groups was 1241 per 100,000 live births. Interpretation. The maternal mortality rate was reduced among women managed by IMC-trained TBAs when compared with historical control data.     

Using process indicators to monitor and evaluate obstetric services in developing countries

Measuring progress toward safe motherhood goals is an increasingly important priority for developing countries and their development partners. A defined set of process indicators is increasingly being used to monitor and evaluate the availability, use, and quality of emergency obstetric services as a practical alternative to maternal mortality (MM) measures. Measuring MM requires either efficient vital registration systems or large expensive surveys. Some of the data for process indicators are available from the existing recording systems at health facilities, and others are increasingly being incorporated into routine health information systems. The use of process indicators has demonstrated how poorly health services meet the basic needs of pregnant women and has already influenced major policy shifts in a number of countries. As more countries adopt the 6 basic indicators developed by the United Nations, work continues to identify and implement additional indicators, particularly those that will improve measurements of quality of care.     

Infant mortality in Delaware: the need to improve maternal health and reduce premature births

Delaware's high infant mortality rate continues to be driven by an increasing number of premature births. Premature birth is a complex problem with both social and medical roots. Based on the CDC road map, programs aimed at improving preconception health of women of childbearing age are blossoming in Delaware. In addition, Delaware's infant mortality rate can only be reduced if we are able to diminish disparities in health care delivery, and improve the social factors influencing infant mortality. These factors include diminishing family support, low high school graduation rate, poor housing, and a lack of health insurance.     

从“人人享有卫生保健”看“临终关怀”与“安乐死”

卫生保健权益包括卫生保健资源和卫生保健权益,卫生保健资源又包括物质资源和物化资源（服务）;卫生保健权益包括提供服务者的权益和接受服务者的权益,卫生保健责任是指最大限度地消除自然因素、社会因素和自身因素对群体健康的影响。     

Did we do it right?--an evaluation of the colour coding system for antenatal care in Malaysia

Identification of pregnancies that are at greater than average risk is a fundamental component of antenatal care. The objective of this study was to assess the level of appropriate management and outcomes among mothers with hypertensive disorders of pregnancy, postdates and anemia in pregnancy, and to determine whether the colour coding system had any effect on the maternal mortality ratios. A retrospective follow-through study confined to users of government health services in Peninsular Malaysia was carried out in 1997. The study areas were stratified according to their high or low maternal mortality ratios. The study randomly sampled 1112 mothers out of 8388 mothers with the three common obstetric problems in the selected study districts. The study showed that the prevalence of anemia, hypertensive disorders in pregnancy and postmaturity among mothers with these conditions were according to known international standards. There was no significant difference in the colour coding practices between the high and low maternal mortality areas. Inappropriate referrals were surprisingly lower in the areas with high maternal mortality. Inappropriate care by diagnosis and by assigned colour code were significantly higher in the areas with high maternal mortality. The assigned colour code was accurate in only 56.1% of cases in the low maternal mortality areas and in 55.8% of the cases in the high maternal mortality areas and these two areas did not differ significantly in their accurate assignment of the colour codes. The colour coding system, as it exists now should be reviewed. Instead, a substantially revised system that takes cognisance of evidence in the scientific literature should be used to devise a more effective system that can be used by health care personnel involved in antenatal care to ensure appropriate level of care and referrals.     

Safe motherhood--a long way to achieve

Maternal mortality ratio (MMR) is the most important index for monitoring the progress of safe motherhood programmes. A retrospective analysis of all maternal deaths at RG Kar Medical College and Hospital, Calcutta from 1st January, 1995 to 31st December, 1997 was carried out. There were 29,563 live births and 203 maternal deaths giving cumulative MMR of 686.67 per 100,000 live births. Among the victims 25.6% were < or = 20 years of age, majority (73.4%) were unbooked, mostly from rural (59.6%) or urban slum (20.2%) and from low socio-economic status (59.6%). Most (60.10%) were multiparous and 50.74% patients died within 24 hours of hospital admission. Direct causes were responsible for 83.25%, indirect causes for 14.78% and unrelated causes for 1.97% of maternal deaths. Toxaemia was the leading cause (53.20%) of maternal mortality. Other important causes were haemorrhage (16.75%), sepsis (12.31%), severe anaemia (6.4%), infective hepatitis (1.47%) and heart disease (3.44%). In comparison to previous years no significant changes in MMR had been found though there were temporary decline in some years. The contribution of toxaemia in maternal deaths is significantly high and is on the rise. The other national and global pictures were reviewed. India is among the countries of high MMR and far away from achieving safe motherhood. Majority of deaths are preventable. The medical causes of maternal deaths are in fact, the end point of a longer chain of many underlying factors like low socio-economic status, poverty, illiteracy, high parity and inadequate or no health care. An active community-based health care system accessible to every mother with strong referral system is the most effective approach to achieve safe motherhood.