Determinants of maternal mortality in rural China.

A case-control study of maternal mortality was conducted in selected rural areas of two provinces in China: Henan province, which has a relatively lower socio-economic status and higher maternal mortality rates, and Jiangsu province with higher socio-economic status and lower maternal mortality rates. The major cause of maternal mortality in the two provinces was postpartum hemorrhage and the largest proportion of deaths occurred on the road between the women's home and the health care facility. Results indicate that the expectant mother's socio-economic status, knowledge of maternal care, and the nature and level of maternal care provided all influence rural maternal death rates. However, socio-economic factors were only significant predictors of mortality in the poorer province. Implications for health policy and future research are discussed.     

Probabilistic record linkage: an application to severe maternal morbidity (near miss) and maternal mortality

This article presents an experience with record linkage from the Brazilian Hospital Information System (SIH) with the Mortality Information System (SIM), and the SIH with itself, applied to severe maternal morbidity (near miss) and maternal mortality. This was an empirical study using Brazilian data for the state capitals and Federal District in 2002. For the two linkages separately applied in each capital, a three simple step blocking strategy was established, plus related multiple steps and also two clerical review strategies. From the total number of true pairs found after the two linkages, simple steps failed to find fewer than 8%, while the multiple step strategy failed to find only 0.7%. This approach allowed exploring the issue of severe maternal morbidity and mortality in these databases. The number of pairs found and reviewed under the multiple steps strategy was lower than the sum of pairs obtained with the three simple steps, and fewer pairs were lost. However, for the record linkage of the SIH with itself, both strategies are suggested.     

Determinants of genocide fear in a rural Texas community: a research note.

Data were collected via a questionnaire administered to females 15-44 years of age and their most significant male partner from a 7% stratified random sample in Waller County, Texas. Analysis revealed that five independent variables combined explained 19% of the variance in race genocide fear (R2 = .19; p less than .01). The most important predictors of genocide fear were sex (Beta = .33; p less than .001) and education (Beta = .14; p less than .01).     

The decline in maternal mortality in Sweden: the role of community midwifery

The maternal mortality rate in Sweden in the early 20th century was one third that in the United States. This rate was recognized by American visitors as an achievement of Swedish maternity care, in which highly competent midwives attend home deliveries. The 19th century decline in maternal mortality was largely caused by improvements in obstetric care, but was also helped along by the national health strategy of giving midwives and doctors complementary roles in maternity care, as well as equal involvement in setting public health policy. The 20th century decline in maternal mortality, seen in all Western countries, was made possible by the emergence of modern medicine. However, the contribution of the mobilization of human resources should not be underestimated, nor should key developments in public health policy.     

Certain aspects of infant mortality -- a prospective study in a rural community

A prospective study on infant mortality was conducted in the field practice area of Rural Health Training Center (RHTC), Jawan, Aligarh. A sample of 1792 registered families in 9 villages under RHTC with a population of 12,118 were selected. The household survey was done in March 1989 by a questionnaire on type and composition of family, socioeconomic status, family environment, age, parity, and interval between the births. All live births and infant deaths in these villages during the period of April 1989 to March 1990 were considered. There were 416 births in the study year, giving a birth rate of 34.02/1000 mid-year population. Male and female births were 52.8% and 47.12%, respectively. 33 infants died during the period, giving an infant mortality rate of 79.32/1000 live births. Infant deaths equalled 39.4% for males and 60.6% for females. Neonatal and postneonatal deaths made up 63.6% and 36.4%, respectively. 33.3% of the neonatal deaths occurred in the first 24 hours, 23.8% in the next 6 days, and 42.9% beyond this period. The mortality risk was high in 5th and higher parity births and lowest in 2nd to 4th parity births. Diarrhea (21.2%), pneumonia (18.18%), tetanus (15.15%), prematurity (9.1%), and unqualified fever (9.1%) constituted main causes of infant death. Pneumonia and prematurity were responsible for more than 70% of infant deaths. In the 2nd to 4th parity groups, diarrhea and tetanus were the main causes. Deaths during the first 24 hours were mainly caused by birth injury, while, during the next 6 days, pneumonia and tetanus were the leading causes. Beyond this period, in addition to the above causes, diarrhea played a major role. In the postnatal period, diarrhea, pneumonia, and malnutrition were the main causes. To reduce infant mortality further, training of health workers, strengthening of delivery systems, maximum utilization of existing health infrastructure, environmental hygiene and health education regarding oral rehydration, and control of respiratory infection are needed.     

1996～2006年城市和农村地区孕产妇死亡公平性分析

目的:利用全国妇幼卫生监测数据库,比较1996～2006年城乡之间、东中西部地区之间的孕产妇死亡率及公平性变化情况。方法:分别计算1996～1998年、1999～2001年、2002～2004年和2005～2006年城市和农村地区、东中西部地区的孕产妇死亡率,并计算率差、率比、人群归因危险度百分比、集中指数和绘制集中曲线图,比较4个时间段城乡之间、东中西部地区之间的孕产妇死亡公平性变化。结果:孕产妇总死亡率由1996～1998年的91.8/10万下降到2005～2006年的28.1/10万。农村地区的孕产妇死亡率高于城市,西部地区高于中部,中部高于东部。农村和城市地区的孕产妇率差为13.1/10万～44.6/10万,率比为1.2～2.7,人群归因危险度百分比为10.7%～51.3%;西部与东部的率差为54.5/10万～150.1/10万,率比为4.2～4.8;中部与东部的率差为24.4/10万～48.9/10万,率比2.1～3.0;人群归因危险度百分比为51.4%～61.1%。无论是城乡比较还是东中西部比较,4个时间段的集中指数均为负值,且变化不大;集中曲线均位于平等线之上。结论:1996～2006年,城市和农村之间、东中西部地区之间的孕产妇死亡存在不公平,且未见改善。     

Fertility profile of a rural community of Kashmir in longitudinal association with maternal age

The study was conducted among 264 rural women past menopause who had never used contraception and who attended Hajin Health Block attached to the Community Medicine Department of the SKIMS Srinigar, Kashmir Valley, India. Retrospective reports of pregnancy histories and outcomes were collected. 1405 live births occurred: 654 (46.55%) were male and 751 (53.45%) were female. The sex ratio at birth was 1148 females per 1000 males. 39.29% of births occurred to women 20-25 years old. By the age of 35 years and higher, only 5.90% of births occurred. 1217 children survived: 578 male and 639 female. The survival ratio was 1105 females to 1000 males. Child survival was 92.20% among women under 20 years old and only 57.83% among women 35 years and older. Child survival decreased with increasing age; maternal age and child survival were found to be highly significantly correlated for male children and for both sexes. Average number of children during the entire reproductive period was 5.32 children: 2.48 male and 2.84 females. 84.77% of children were born by the maternal age of 30 years. An average of 4.62 children survived per woman: 2.19 male and 2.43 female. 87.23% of infants born to mothers under 30 years old survived. 1.41 children were born to women by the age of 20 years; 1.30 children survived, which represented 26.50% of the average family size. The gross reproduction rate in this study was 2.84, and the net reproduction rate was 2.43. An increase in marriage age to 20 years would reduce fertility by 26.50%. The most cost effective approach to family planning would concentrate on women 20-25 years old, the most fertile years of the reproductive period. Permanent methods could be introduced among women 25-30 years old, because 85% of family size would have already been achieved.     

南宁市2008至2012年孕产妇死亡分析

目的：通过对南宁市2008至2012年孕产妇死亡监测情况和死因变化趋势分析,掌握孕产妇主要死因及其相关因素,有针对性的提出干预措施以降低孕产妇死亡率。方法对南宁市2008至2012年南宁市6县6城区孕产妇保健情况调查年报表、常住人口孕产妇死亡报告卡、孕产妇死亡调查表、孕产妇死亡评审资料进行统计分析。结果2008至2012年南宁市活产数520091例,孕产妇死亡149例,平均死亡率28.64/10万(其中户籍死亡17.49/10万),孕产妇死亡原因前5位依次为：羊水栓塞、妊娠合并心脏病、妊娠合并肝病、妊娠合并恶性肿瘤、产后出血。评审结果显示不可避免死亡125例(71.84%),可避免死亡49例(28.16%)。监测资料分析显示：虽然影响孕产妇死亡率是多因素的,但妊娠合并症在孕产妇死亡原因中排位上升,前5位死因中,间接产科死亡原因已超出直接产科原因。结论孕期三级保健网络管理的健全、医务人员对妊娠内科合并症的早期识别、高危孕产妇多学科联合监测管理、产科团队的应急救治反应能力对危重孕产妇的救治和降低孕产妇死亡率有重要作用。     

苏州市1999~2004年孕产妇死亡情况分析

目的:通过对孕产妇死亡相关资料的分析,总结孕产妇保健管理的经验教训,为进一步降低孕产妇死亡率,完善妇幼卫生工作制度制定对策提供科学依据。方法:采用回顾性调查,对苏州市1999~2004年的孕产妇死亡个案进行分析。结果:6年来苏州孕产妇死亡率平均为16.9/10万,并有所波动,在死亡的孕产妇中流动人口及未接受过孕产期保健的人员比例逐年上升,前3位死因分别为产科出血、羊水栓塞、妊高征及妊娠合并心脏病。死亡孕产妇中产时及产后死亡占71.1%,家中分娩者占28.1%。结论:苏州市的孕产妇死亡率已接近发达国家水平,要进一步降低孕产妇死亡率,必须加强基层产科的建设,加强对孕产妇中流动人口的孕产期保健管理,杜绝非法接生。     

The prevalence of diabetes mellitus in a rural community in Iraq.

A survey was undertaken to estimate the prevalence of diabetes mellitus in a rural community in Iraq. Blood-sugar estimations after glucose-loading were performed on a sample of a village population 15 + years. 4.8% had diabetes and a majority of them had symptoms referable to their diabetic state. Diabetes was totally unknown among this rural population before the survey.     

1991～2005年中国孕产妇死亡率变化趋势分析

目的描述1991—2005年中国孕产妇死亡率变化趋势和特征，为有关部门制定孕产妇保健对策提供依据。方法采用描述性分析和升降趋势检验法对1991～2005年我国孕产妇死亡情况进行分析。结果全国、城市和农村的孕产妇死亡率下降幅度明显。1991～2005年全国孕产妇死亡率由80．0／10万降为47．7／10万，下降幅度为40．4％；农村地区孕产妇死亡率由100．0／10万降为53．8／10万，下降幅度为46．2％；城市孕产妇死亡率由46．3／10万降为25．0／10万，下降幅度为46．0％。结论1991—2005年全国及城乡孕产妇死亡率均呈下降趋势，农村孕产妇死亡率显著高于城市，下降空间大，国家应加大农村孕产妇保健的力度。     

Socio-cultural factors in maternal morbidity and mortality: a study of a semi-urban community in southern Nigeria

STUDY OBJECTIVE: To understand community based or socio-cultural factors that determine maternal morbidity and mortality in a semi-urban setting. DESIGN: The study is an exploratory multidisciplinary operations research and the instruments were focus groups and interviews. SETTING: Ekpoma, a semi-urban community with a population of 70,000 in central part of Edo state in southern Nigeria. PARTICIPANTS: Thirteen groups of women, two groups of men, and two groups of traditional birth attendants. RESULTS: There is a fairly good knowledge of haemorrhage but this is circumscibed by attitudes, practices, and situations that keep women away from or delay the decision to seek modern obstetric care. CONCLUSIONS: For a fuller understanding of maternal morbidity and mortality, it is important to consider factors outside the hospital and formal medical practice. Furthermore, a change of existing knowledge, attitudes, practices, and situations can be enhanced through modelling on them.

 

     

(The shift to) online delivery of a rural faculty development program in research skills: lessons learned

Background

The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care.

Methods

A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care.

Results

Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions.

Conclusions

Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.