Health and survival of young children in southern Tanzania

Background

With a view to developing health systems strategies to improve reach to high-risk groups, we present information on health and survival from household and health facility perspectives in five districts of southern Tanzania.

Methods

We documented availability of health workers, vaccines, drugs, supplies and services essential for child health through a survey of all health facilities in the area. We did a representative cluster sample survey of 21,600 households using a modular questionnaire including household assets, birth histories, and antenatal care in currently pregnant women. In a subsample of households we asked about health of all children under two years, including breastfeeding, mosquito net use, vaccination, vitamin A, and care-seeking for recent illness, and measured haemoglobin and malaria parasitaemia.

Results

In the health facility survey, a prescriber or nurse was present on the day of the survey in about 40% of 114 dispensaries. Less than half of health facilities had all seven 'essential oral treatments', and water was available in only 22%. In the household survey, antenatal attendance (88%) and DPT-HepB3 vaccine coverage in children (81%) were high. Neonatal and infant mortality were 43.2 and 76.4 per 1000 live births respectively. Infant mortality was 40% higher for teenage mothers than older women (RR 1.4, 95% confidence interval (CI) 1.1 – 1.7), and 20% higher for mothers with no formal education than those who had been to school (RR 1.2, CI 1.0 – 1.4). The benefits of education on survival were apparently restricted to post-neonatal infants. There was no evidence of inequality in infant mortality by socio-economic status. Vaccine coverage, net use, anaemia and parasitaemia were inequitable: the least poor had a consistent advantage over children from the poorest families. Infant mortality was higher in families living over 5 km from their nearest health facility compared to those living closer (RR 1.25, CI 1.0 – 1.5): 75% of households live within this distance.

Conclusion

Relatively short distances to health facilities, high antenatal and vaccine coverage show that peripheral health facilities have huge potential to make a difference to health and survival at household level in rural Tanzania, even with current human resources.     

Management of the third stage of labour—focus group discussions with Swedish midwives

Objectiveto explore Swedish midwives’ experiences of management of third stage of labour.Designsix focus group discussions were performed and the analysis was based on content analysis.Settingthe midwives worked at six hospitals: three university hospitals and three provincial hospitals located from the south west to the north of Sweden.Participants32 midwives with extensive experience of assisting women in childbirth.Findingsthe analysis generated three categories: ‘bring the process under control’, ‘protect normality and women's birthing experiences’ and ‘maintain midwives’ autonomy’. This study demonstrates that management of the third stage of labour varies greatly. Not all midwives were convinced that administration of prophylactic oxytocin in the third stage of labour was always the best alternative for all women who had a normal birth.Key conclusions and implications for practicethe midwives exhibited self-confidence in evaluating the physiological process, and endeavoured to leave the physiological process undisturbed if no other risks were apparent. Their decisions concerning third stage management were based on a combination of previous experience, hospital guidelines, risk assessment and sensitivity to each woman's needs. This study demonstrates that management of the third stage of labour varies greatly. The findings show the importance of reaching a balance between treating birth as a normal process and as a biomedical event.     

A Meta‐analysis of the Efficacy of Ocular Prophylactic Agents Used for the Prevention of Gonococcal and Chlamydial Ophthalmia Neonatorum

Introduction : Neonatal eye prophylaxis has been routine in North America for more than a century. Contextual changes justify reexamining this practice, and prompted a systematic review of the efficacy of prophylactic agents. Methods : We searched MEDLINE (1966–2008), EMBASE (1980–2008), CINAHL (1982–2008), and the Cochrane library (the first quarter of 2008) for relevant clinical trials and hand‐searched the resulting reference lists. We independently evaluated eligibility and study quality. Meta‐analyses were performed using a random effects model. Results : Each of the eight included studies had substantial methodologic weaknesses. Data to estimate the efficacy of prophylaxis in the prevention of gonococcal ophthalmia neonatorum (GON) were not available. One study found no differences in rates of chlamydial ophthalmia neonatorum (CON) when three agents were compared to no prophylaxis: silver nitrate (relative risk [RR] = 1.06; 95% confidence interval [CI], 0.55–2.02; 2225 newborns), erythromycin (RR = 0.93; 95% CI, 0.48–1.79; 2306 newborns), and tetracycline (RR = 0.82; 95% CI, 0.42–1.63; 2299 newborns). No statistically significant differences were found between agents in the prevention of GON. Erythromycin and povidone‐iodine both decrease the risk of CON when compared to silver nitrate (RR = 0.71; 95% CI, 0.52–0.97; 4514 newborns, and RR = 0.52; 95% CI, 0.38–0.71; 2005 newborns, respectively). Discussion : Failure rates of universal eye prophylaxis support reexamination of this policy where the prevalence of maternal infection is low.     

Acupuncture treatment of pregnant women with low back and pelvic pain – an intervention study

Scand J Caring Sci; 2010; 24; 175–182
Acupuncture treatment of pregnant women with low back and pelvic pain – an intervention study
Objective:  To describe patients' experience of acupuncture treatment in low back and pelvic pain during pregnancy.
Design:  An intervention study carried out between September 2000 and December 2001, involving 40 pregnant women.
Participants:  The study population consisted of healthy pregnant women presenting with low back and pelvic pain at maternity health care centres within a defined area in southern Sweden.
Intervention:  Two groups of women received acupuncture treatment from gestational week 20 (group 1) or week 26 (group 2) respectively, for a period of 6 weeks divided into eight sessions of 30 minutes each.
Measurements:  Pain assessment was carried out using Pain-O-Meter and visual analogue scale (POM-VAS), Short-Form McGill Questionnaire (SF-MPQ), Short-Form-36: Health Survey Questionnaire (SF-36), followed by telephone interviews 2–3 months after delivery.
Findings:  The results of POM-VAS, SF-MPQ and SF-36 showed a relief of pain in both groups. In group 2, an improvement in several SF-36 variables was noted in spite of increased physical restrictions. Telephone interviews confirmed that expectations of treatment were fulfilled. Using content analysis the main category, limitations in daily life , was identified, with subcategories pain , and psychological well-being .
Conclusion:  It may be advantageous to begin acupuncture therapy later in pregnancy to maximise pain relief.