ABSTRACT
This retrospective study looked at the outcome of using 50-100 micrograms misoprostol once daily to induce labour compared to the outcome of the overall patient population delivered during the same period (1994-1996). During that period 11,255 patients were delivered and 1037 (9.2) were induced with misoprostol. Results showed a significantly lower mean Caesarean section rate: 9.3 for the misoprostol group versus 13.3 for the overall population (p = 0.002, Odds Ratio (OR) 0.67, 95 CI 0.53, 0.83). The abruption rates were not significantly different: 0.8 for misoprostol versus 0.4 (p = 0.09, OR 1.86, 95 CI 0.81, 4.09). There was more postpartum haemorrhage in the misoprostol group: 5.6 versus 3.5 (p = 0.0006, OR 1.63, 95 CI 1.22, 2.19); a higher incidence of Apgar scores less than 6 at one minute 10.2 versus 7.9 (p = 0.0093, OR 1.33, CI 1.06, 1.65) but not at five minutes 2.9 versus 2.4 (p = 0.674, OR 1.09, CI 0.73, 1.61) and a higher perinatal mortality rate 55/1000 versus 16.3/1000 (p = 0.00, OR 3.5, 95 CI 2.55, 4.80). The rate remained higher but not significantly so when a correction was made to eliminate the high number of intrauterine deaths induced with misoprostol 18/1000 versus 16.3/1000 (p = 0.69, OR 1.11, 95 CI 0.66, 1.84). There were no cases of uterine rupture in either group. In conclusion, there was a significantly lower Caesarean section rate among patients who had once daily misoprostol induction of labour. Close monitoring of the foetus, in patients with misoprostol induction, is needed to detect foetal distress and prophylaxis against postpartum haemorrhage is still mandatory.
Subject(s)
Humans , Male , Female , Pregnancy , Pregnancy Outcome , Misoprostol , Labor, Induced , Oxytocics/administration & dosage , Retrospective Studies , Misoprostol , Fetal Distress , Cesarean Section/statistics & numerical data , Apgar Score , Oxytocics/adverse effectsABSTRACT
We investigated the prevalence of the use of herbs among adults and children in Jamaica in 1996. Two concurrent surveys were conducted in randomly selected urban and rural areas: among adults and among caretakers of young children. From over 90 of the selected households, all caretakers of children under 6 years and one randomly selected adult (18 years or older) were interviewed using structured questionnaires. The 457 adults reportedly used 156 types of herbs: a mean of 6 +/- 3 (mean +/- standard deviation) by the urban adults, and 10 +/- 6 by the rural adults (t-test, p < 0.001). Almost 100 of respondents had at some time used herbs for teas or for treating illnesses. The most common method of preparation was by infusion or boiling in water, then adding sugar. Urban respondents, women and those who were employed were more likely to buy medicines than to use herbal remedies. One hundred and sixty-seven caretakers of 203 children under 6 years were interviewed. The mean number of herbs given to each child was between 2 and 3. The most common herbs were introduced within the first 6 months of life. Many caretaker factors were associated with herbal use. Public health implications include the potential toxicity of some herbs, the possibility that herbal teas given to young children may displace more nutritious foods and delay presentation to health care facilities. The findings will allow policy makers to target those most likely to use herbal preparations or to give them to young children, and target herbs to be analyzed for toxic or beneficial properties.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Beverages , Phytotherapy , Beverages , Prevalence , Data Collection , Caregivers , Jamaica , Random Allocation , Residence Characteristics , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
Three thousand, eight hundred and eighty-two (3,882) children in grades 2-5, attending 16 rural primary and all-age schools in central Jamaica were weighed and their weight-for-age standard deviation scores calculated using the World Health Organization/National Center for Health Statistics (WHO/NCHS) references. Heights were also measured in a random sample of the grade 5 children (n = 793) and height-for-age and body mass index (BMI-kg/m2) calculated. Sixty-nine per cent of the total sample were of normal weight-for-age, 2were moderately undernourished (weight-for-age > -3 Z-score, -2 Z-score, < or = -1 Z-score). Few children were overweight. The frequency distribution of weight-for-age was similar in girls and boys. In the subsample of children in whom heights were measured, 25.8were < or = -1 Z-score height-for-age, and of these 4.9were < -2 Z-score. Compared with a survey conducted in a similar rural area in the 1960s, the children's mean weights for age group categories were 1.1 to 3.7 kg heavier. Children who were older than appropriate for their grade were more likely to be undernourished (Odds ratio 3.94, 95CI 3.21, 4.83), which suggests that undernourished children may be more likely to repeat a grade or start school later.
Subject(s)
Humans , Male , Female , Child , Child Nutritional Physiological Phenomena , Rural Health , Body Constitution , JamaicaABSTRACT
This publication is a report of an international experts meeting held in 12-13 June 2003 at Washington (USA); which aims to explore and prioritise operations research questions about access to treatment for HIV/AIDS. Even if the discussions focused on treatment with ARVs; many of the issues raised and the research questions identified also pertain to treatment of opportunistic infections and the provision of palliative and end-of-life care