ABSTRACT
Maternal mortality ratio [MMR] is one of the main indicators of the millennium development goals and its accurate estimation is very important for the countries concerned. The objective of this study is to evaluate the applicability of capture-recapture [CRC] as an analytical method to estimate MMR in countries. We used the CRC method to estimate MMR in Iran for 2004 and 2005, using two data sources: The maternal mortality surveillance system and the National Death Registry [NDR]. Because the data registry contains errors, we defined three levels of matching criteria to enable matching of cases between the two systems. Increasing the matching level makes the matching criteria less conservative. Because NDR data were missing or incomplete for some provinces, we calculated estimates for two conditions: With and without missing/incomplete data. According to the CRC method, MMR in 2004 and 2005 were 33 and 25 in the best-case scenarios respectively and 86 and 59 in the worst-case scenarios respectively. These estimates are closer to the ones reported by United Nations Agencies published in 2010, 38 and Hogan's study, 30 in 100,000 live births in 2005. The MMR estimation by CRC method is slightly different from the international studies. CRC can be considered as a cost-effective method, in comparison with cross-sectional studies or improvement of vital registration systems, which are both costly and difficult. However, to achieve accurate estimates of MMR with CRC method and decrease the uncertainty we need to have valid databases and the absence of such capacities will limit the applicability of this method in developing countries with poor quality health databases
ABSTRACT
To determine the impact of a national intervention program on some pregnancy complications in Iran. This multicenter study was conducted in governmental sector in 14 provinces in Iran between 2003 and 2005. Intervention included education of all maternal health care providers including gynecologists, general physicians, and midwifes in the governmental sector. Time interval between the pre- [of 3,978 and 3,958 pregnancies] and post- [3,958 pregnancies] measurements were 18 months. Self reported data on pregnancy complications were registered. Interviews were conducted by trained personnel. Participants were interviewed when admitted for delivery or at the time attending for vaccination of their 2 month infants. The following pregnancy complications were reduced significantly as compared to before intervention: 1] bleeding or spotting, 2] urinary tract complications, 3] blurred vision and severe headache, 4] premature labor pain, 5] anemia, 6] severe vomiting, 7] inappropriate weight gain, 8] endometritis, 9] urinary incontinence, 10] breast abscess or mastitis, 11] wound infection, and 12] bleeding was significantly reduced after intervention, compared to before intervention. Premature rupture of membrane showed a significant increase. These complications did not show a significant change: 1] hypertension, 2] fever and chills, 3] convulsion, shock, and loss of consciousness, and 4] obstetric fistula. National programs may be proved to be largely effective by decreasing some of the pregnancy complications in developing countries
ABSTRACT
Maternal mortality [MM] is an avoidable death and there is national, international and political commitment to reduce it. The objective of this study is to examine the relation of MM to socioeconomic factors and its inequality in Iran's provinces at an ecologic level. The overall MM from each province was considered for 3 years from 2004 to 2006. The five independent variables whose relations were studied included the literacy rate among men and women in each province, mean annual household income per capita, Gini coefficients in each province, and Human Development Index [HDI]. The correlation of Maternal Mortality Ratio [MMR] to the above five variables was evaluated through Pearson's correlation coefficient [simple and weighted for each province's population] and linear regression-by considering MMR as the dependent variable and the Gini coefficient, HDI, and difference in literacy rate among men and women as the independent variables. The mean MMR in the years 2004-2006 was 24.7 in 100,000 live births. The correlation coefficients between MMR and literacy rate among women, literacy rate among men, the mean annual household income per capita, Gini coefficient and HDI were 0.82, 0.90, ?0.61, 0.52 and ?0.77, respectively. Based on multivariate regression, MMR was significantly associated with HDI [standardized B=?0.93] and difference in literacy rate among men and women [standardized B=?0.47]. However, MMR was not significantly associated with the Gini coefficient. This study shows the association between socioeconomic variables and their inequalities with MMR in Iran's provinces at an ecologic level. In addition to the other direct interventions performed to reduce MM, it seems essential to especially focus on more distal factors influencing MMR
ABSTRACT
Assessment of fetal lung maturity by a simple and rapid test has a pivotal role in obstetric managements. Lack of modern laboratory techniques in our country made us investigate whether lamellar body count [LBC] can be applied efficiently in the evaluation of fetal lung maturity. Lamellar body count was assessed in 104 unspun amniotic fluid samples taken from pregnant women admitted at Akbar Abadi Hospital, Tehran, Iran between May 2003 and November 2003 whose fetuses were at risk for respiratory distress syndrome [RDS]. Cut-off points for LBC were determined to evaluate the risk of RDS. Standard clinical and radiographic criteria were used to diagnose RDS. An LBC of less than 10,000 was 99.1% specific for lung immaturity [positive predictive value = 99.1%, negative predictive value = 83.5%]. The LBCs of greater than 45,000 eliminates RDS [negative predictive value = 98.9%]. Lamellar body count is an easy, rapid and cost-effective test to assess fetal lung maturity in high-risk fetuses. Using the cut-off points of 10,000 and 45,000, LBC can serve as the first screening test of fetal lung maturity