Suchergebnisse

The data from the Demographic and Health Survey conducted in Ghana in 1988 are used to identify determinants of immunisation uptake for children under 5 years. The logistic binomial analysis shows that socioeconomic factors are significant, especially women's education and region, and that the type of prenatal care received by the mother is also important. There is a strong familial correlation of vaccination behaviours, and there is also clustering of data within enumeration areas.

Nepal. Information was drawn from a sample survey of 997 young women 499 young men, and data from the Nepal Demographic Health Survey 2001 (NDHS). A new definition of unintended pregnancy was developed. Using bivariate and multivariate analyses, the results show that the conventional NDHS definition of unintended pregnancy provides a substantial under–estimate of prevalence. Unintended pregnancy was more likely to be reported by both men and women who were younger, with a higher number of living children, a smaller desired family size, higher exposure to mass media, a higher level of education and low household well-being. The results suggest the 'transition phenomena in pregnancy intention' in developing countries like Nepal where total fertility is still high and the desired fertility is falling rapidly. The paper recommends that services should focus on helping those groups of couples who were identified in the analysis as being at increased risk of unintended pregnancy.

This paper examines the impact of rural–urban migration on under-two mortality in India, using data from the 1992/93 Indian National Family Health Survey. Multilevel logistic models are fitted for mortality in three age groups: neonatal, early post-neonatal, and late post-neonatal and toddler. Migration status was not a significant determinant of mortality in any of the three age groups. Further analysis shows that a relationship between migration status and mortality exists when socioeconomic and health utilization variables are omitted from the models. The relationship between migration and mortality is thus explained by differences in socioeconomic status and use of health services between rural–urban migrant and non-migrant groups. The selectivity of rural–urban migrants on socioeconomic characteristics creates mortality differentials between rural–urban migrants and rural non-migrants. Problems faced by migrants in assimilating into urban societies create mortality differentials between rural–urban migrants and urban non-migrants. These results highlight the need to target migrants in the provision of health services, and demonstrate that rural areas continue to have the highest levels of infant–child mortality. Further research is needed to understand the health care needs of rural–urban migrants in order to inform the provision of appropriate health care.

Over the past decades, governments have taken steps towards improving women's health in line with commitments made in key international summits. Progress has been made in reducing maternal mortality, which accelerated with the launch of the United Nations secretary general's Global Strategy for Women's and Children's Health in 2010. Use of maternal healthcare and family planning has increased in some countries. Progress has also been seen on two determinants of women's health—school enrolment rates for girls and political participation of women—but not for others such as gender based violence. However, societies are still failing women in relation to health, especially in low resource settings. Discrimination on the basis of their sex leads to health disadvantages for women. Structural determinants of women's health, along with legal and policy restrictions, often restrict women's access to health services. This paper elaborates the health problems women face, and priority interventions to overcome them, as a background for and informing the updating of the Global Strategy for Women's, Children's and Adolescents' Health.

BACKGROUND: The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas. METHODS AND FINDINGS: Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km. CONCLUSION: Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

This correspondence argues and offers recommendations for how Geographic Information System (GIS) applied to maternal and newborn health data could potentially be used as part of the broader efforts for ending preventable maternal and newborn mortality. These recommendations were generated from a technical consultation on reporting and mapping maternal deaths that was held in Washington, DC from January 12 to 13, 2015 and hosted by the United States Agency for International Development's (USAID) global Maternal and Child Survival Program (MCSP). Approximately 72 participants from over 25 global health organizations, government agencies, donors, universities, and other groups participated in the meeting. The meeting placed emphases on how improved use of mapping could contribute to the post-2015 United Nation's Sustainable Development Goals (SDGs), agenda in general and to contribute to better maternal and neonatal health outcomes in particular. Researchers and policy makers have been calling for more equitable improvement in Maternal and Newborn Health (MNH), specifically addressing hard-to-reach populations at sub-national levels. Data visualization using mapping and geospatial analyses play a significant role in addressing the emerging need for improved spatial investigation at subnational scale. This correspondence identifies key challenges and recommendations so GIS may be better applied to maternal health programs in resource poor settings. The challenges and recommendations are broadly grouped into three categories: ancillary geospatial and MNH data sources, technical and human resources needs and community participation.

To improve maternal health requires action to ensure quality maternal health care for all women and girls, and to guarantee access to care for those outside the system. In this paper, we highlight some of the most pressing issues in maternal health and ask: what steps can be taken in the next 5 years to catalyse action toward achieving the Sustainable Development Goal target of less than 70 maternal deaths per 100 000 livebirths by 2030, with no single country exceeding 140? What steps can be taken to ensure that high-quality maternal health care is prioritised for every woman and girl everywhere? We call on all stakeholders to work together in securing a healthy, prosperous future for all women. National and local governments must be supported by development partners, civil society, and the private sector in leading efforts to improve maternal-perinatal health. This effort means dedicating needed policies and resources, and sustaining implementation to address the many factors influencing maternal health-care provision and use. Five priority actions emerge for all partners: prioritise quality maternal health services that respond to the local specificities of need, and meet emerging challenges; promote equity through universal coverage of quality maternal health services, including for the most vulnerable women; increase the resilience and strength of health systems by optimising the health workforce, and improve facility capability; guarantee sustainable finances for maternal-perinatal health; and accelerate progress through evidence, advocacy, and accountability.

Recent years have seen many changes in human reproduction resulting from state and medical interventions in childbearing processes. Based on empirical work in a variety of societies and countries, this volume considers the relationship between reproductive processes (of fertility, pregnancy, childbirth and the postpartum period) on the one hand and attitudes, medical technologies and state health policies in diverse cultural contexts on the other