Assessing the Health System's Capacity to Conduct Neonatal Resuscitation in Ethiopia

Globally and nationally approximately a quarter of neonatal deaths and an unknown number of intrapartum stillbirths are attributed to intrapartum complications known as birth asphyxia. Simple stimulation and resuscitation can save many of these lives. To describe the capacity of the Ethiopian health system to provide neonatal resuscitation with bag and musk. Cross-sectional data were collected from 741 health facilities and one birth attendant at each facility was interviewed. This paper focuses on 711 nurses and midwives. Based on a guided interview; responses were converted into a knowledge index and we used multivariable linear regression to identify factors that predicted a high score. Nine out of 10 hospitals; but only 40of health centers; had performed neonatal resuscitation in the three months prior to the survey. Barriers to performing neonatal resuscitation included missing essential equipment and inadequately trained staff. Half of the midwives interviewed reported having performed neonatal resuscitation in the past three months compared to only 20of the nurses. After controlling for provider and facility characteristics; key predictors of a high knowledge score among providers were recent performance of neonatal resuscitation and geographic region. Whether the provider was a nurse or a midwife; was not associated with a higher knowledge score. Educators and program managers should insist on practical pre-service and in-service training; ensure the availability of equipment to perform neonatal resuscitation; and prioritize certain regions of the country for these interventions

Estudio hospitalario del aborto ilegal en Bolivia / A hospital study of illegal abortion in Bolivia

A causa del caracter ilegal del aborto provocado, es dificil determinar el grado en que este se practica en América Latina. En el caso de Bolivia, a la fecha no existen datos sobre el problema. Por este motivo, se decidio estudiar las caracteristicas sociodemograficas y obstétricas de una muestra de 4.371 mujeres bolivianas internadas por complicaciones del aborto en 11 hospitales urbanos en un período de un ano (1 de julio de 1983 a 30 de junio de 1984). Los datos se recogieron con ayuda de un calendario rellenado por los medicos tratantes y se interpretaron desde el punto de vista de la planificacion familiar. Una cuarta parte (22,7 por ciento) de los abortos fueron ilegalmente provocados. Las mujeres que deliberadamente pusieron fin a su embarazo se caracterizaron por ser en general jóvenes, nuliparas y solteras. En total, 65,0 por ciento de los abortos fueron provocados por personas con adiestramiento medico, la mayor parte de las veces mediante raspado uterino; en 30 por ciento fue provocado por personas sin adiestramiento medico y en 5 por ciento por la propia mujer, y en estos casos el medio mas comun fue la introduccion de un cuerpo extrano en el utero. Las mujeres con mayor escolaridad tendieron a recurrir a personas con adiestramiento medico. Ademas, cuando el aborto fue provocado por raspado uterino hubo menos probabilidades de sufrir fiebre y lesiones genitales, pero fue mas prolongada la estadia hospitalaria promedio...