Suchergebnisse

Section 1. Current status of newborn infants and perinatal health in South Asia. ch. 1. Current state of the health of newborn infants in developing countries / Anthony Costello and Dharma Manandhar -- ch. 2. Recent trends in perinatal health in South Asia -- Section 2. Social, economic and cultural aspects of motherhood in South Asia. ch. 3. Social and developmental issues affecting the perinatal health of mothers and their infants / Hilary Standing and Anthony Costello -- ch. 4. Epidemiological trends in nutritional status of children and women in India / Harshpal Sachdev -- ch. 5. Women's work and maternal-child health: anthropological views on intervention / Catherine Panter-Brick -- ch. 6. Perinatal mortality in Nepal: implications for behaviour modification / Shyam Thapa -- ch. 7. Traditional and cultural aspects of neonatal care in developing countries / Shashi N.Vani -- Section 3. Cost-effective essential newborn care in poor communities: the evidence-base. ch. 8. Effective interventions in pregnancy to improve foetal growth / Amali Lokugamage and Charles H. Rodeck -- ch. 9. Hypothermia: epidemiology and prevention / Ragnar Tunell -- ch. 10. New methods for monitoring neonatal hypothermia and cold stress / Anthony Costello -- ch. 11. Birth asphyxia in developing countries: epidemiology, sequelae and prevention / Matthew Ellis -- ch. 12. Effective resuscitation / Siddarth Ramji -- ch. 13. Effective interventions to reduce neonatal mortality and morbidity from perinatal infection / Zulfiqar Ahmed Bhutta -- ch. 14. The importance of breastfeeding and strategies to sustain high breastfeeding rates / M. Q-K. Talukder -- ch. 15. Neonatal hypoglycaemia / Anthony Costello and Deb Pal -- ch. 16. Neonatal hyperbilirubinaemia in developing countries / Therese Hesketh -- ch. 17. Low birth weight newborns - the risks in infancy and beyond / Dipak K. Guha -- ch. 18. Does health education improve newborn care? / Alison Bolam, Dominique Tillen and Anthony Costello -- ch. 19. Community based strategies to improve newborn and infant care practices / Fehmida Jalil -- Section 4. Improving health service delivery. ch. 20. Special care of newborn at the district hospital / Dharma Manandhar -- ch. 21. Current controversies and recommendations for the care of high risk newborn infants / Meharban Singh -- ch. 22. Audit - a tool to improve the quality of perinatal care / Sophie Mancey-Jones -- ch. 23. Trained traditional birth attendants and essential newborn care in South Asia / Marta J. Levitt-Dayal -- ch. 24. TBA training: cost-effective? / Carole Presern -- ch. 25. What to do about referral and transfers of high risk mothers and newborns? / Daljit Singh -- ch. 26. Making perinatal services more user-friendly / Susan F. Murray -- ch. 27. How to improve information, education and communication for better newborn care -- Section 5. Challenges for future policy implementation and research. ch. 28. Challenges for future policy implementation and research / Anthony Costello and Sophie Mancey-Jones.

Abstract Background Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. Methods The analysis included a survey of 8798 women who reported a birth in the previous two years [of whom 3557 reported illness in their pregnancy], on 30 case studies of perinatal morbidity and mortality, and on 43 focus group discussions with mothers, other family members and health workers. Results Early pregnancy was often concealed, preparation for birth was minimal and trained attendance at birth was uncommon. Family members were favoured attendants, particularly mothers-in-law. The most common recalled maternal complications were prolonged labour, postpartum haemorrhage and retained placenta. Neonatal death, though less definable, was often associated with cessation of suckling and shortness of breath. Many home-based care practices for maternal and neonatal illness were described. Self-medication was common. There were delays in recognising and acting on danger signs, and in seeking care beyond the household, in which the cultural requirement for maternal seclusion, and the perceived expense of care, played a part. Of the 760 women who sought care at a government facility, 70% took more than 12 hours from the decision to seek help to actual consultation. Consultation was primarily with traditional healers, who were key actors in the ascription of causation. Use of the government primary health care system was limited: the most common source of allopathic care was the district hospital. Conclusions Major obstacles to seeking care were: a limited capacity to recognise danger signs; the need to watch and wait; and an overwhelming preference to treat illness within the community. Safer motherhood and newborn care programmes in rural communities, must address both community and health facility care to have an impact on morbidity and mortality. The roles of community actors such as mothers-in-law, husbands, local healers and pharmacies, and increased access to properly trained birth attendants need to be addressed if delays in reaching health facilities are to be shortened.