Suchergebnisse

Behavior change interventions focusing on birth preparedness for pregnant women, their husbands, and adults in the community are common components of community-oriented Safe Motherhood programs in developing countries. Few studies have examined the effectiveness of these interventions, and existing studies are flawed due to study and sample design. This article highlights methodological issues that are often overlooked when measuring indicators of birth preparedness among multiple audiences for program evaluation purposes in household-based surveys. Solutions are proposed to address each of these problems in an effort to improve future research.

Cesarean section surgery is the clinical response used to prevent several of the leading causes of maternal and perinatal mortality and morbidity. Given the deficient state of health‐information systems in most developing countries, nationally representative surveys are currently the most widely available source of population‐based cesarean birth data. The purpose of this study is to assess the quality and internal consistency of Demographic and Health Survey cesarean birth data across countries and time periods. Although these surveys are highly standardized, the formulation of the question on cesarean birth and the categories of women who are asked the question often differ across surveys. A skip pattern that restricts the cesarean question to women who delivered in a health‐care facility improves the internal consistency of the data, although in some countries cesarean deliveries are still reported at low‐level, presumably nonsurgical facilities. Recommendations are made for improving data analysis and the future collection of population‐based cesarean birth data.

Evidence suggests that cesarean birth rates are high and increasing in some developing countries. The objectives of this study are to compile the best current estimate of cesarean birth rates for developing countries, to estimate regional rates, and to document trends nationally and by urban/ rural residence where data permit. A database of cesarean birth rates was compiled representing 90 percent of births in the developing world, resulting in an estimated cesarean birth rate for the developing world of 12 percent, with regional rates ranging from 3 to 26 percent. Data representing 45 percent of births in the developing world show that a majority of countries experienced increases in cesarean birth rates during the 1990s, except in sub‐Saharan African countries, where little if any change occurred. Cesarean birth rates must be monitored routinely to call attention to rapidly changing practices. These data can, in turn, trigger investigation into the appropriateness of the rate in a given context.

Abstract Background Obstetric fistula continues to have devastating effects on the physical, social, and economic lives of thousands of women in many low-resource settings. Governments require credible estimates of the backlog of existing cases requiring care to effectively plan for the treatment of fistula cases. Our study aims to quantify the backlog of obstetric fistula cases within two states via community-based screenings and to assess the questions in the Demographic Health Survey (DHS) fistula module. Methods The screening sites, all lower level health facilities, were selected based on their geographic coverage, prior relationships with the communities and availability of fistula surgery facilities in the state. This cross-sectional study included women who presented for fistula screenings at study facilities based on their perceived fistula-like symptoms. Research assistants administered the pre-screening questionnaire. Nurse-midwives then conducted a medical exam. Univariate and bivariate analyses are presented. Results A total of 268 women attended the screenings. Based on the pre-screening interview, the backlog of fistula cases reported was 75 (28% of women screened). The backlog identified after the medical exam was 26 fistula cases (29.5% of women screened) in Kebbi State sites and 12 cases in Cross River State sites (6.7%). Verification assessment showed that the DHS questionnaire had 92% sensitivity, 83% specificity with 47% positive predictive value and 98% negative predictive value for identifying women afflicted by fistula among women who came for the screenings. Conclusions This methodology, involving effective, locally appropriate messaging and community outreach followed up with medical examination by nurse-midwives at lower level facilities, is challenging, but represents a promising approach to identify the backlog of women needing surgery and to link them with surgical facilities.