Rising Maternal Mortality in Mumbai Metropolitan Region: Need for Action.

Data from the past suggest that maternal deaths mostly occurred due to obstetric complications, like postpartum hemorrhage, sepsis or maternal morbidities, like eclampsia and cardiac diseases. This trend, however, has changed over a period of time in developing countries, like India where increasing number of maternal deaths have been attributed in recent years to preventable infectious causes, such as hepatitis, tuberculosis and malaria. Rising maternal mortality ratio (MMR) due to infections indicates there are several loop holes in the basic healthcare system at various levels in their prevention and control. Although maternal mortality worldwide is decreasing progressively, curbing maternal deaths in certain developing regions of the World including few parts of India and Mumbai Metropolitan Region at a faster rate is essential in order to achieve the United Nations Fifth Millennium Development Goal of 2015.

Inequality in maternal health-care services and safe delivery in eastern India.

Background: The target for Millennium Development Goal 5 (MDG-5) is to reduce the maternal mortality ratio by three quarters between 1990 and 2015. The United Nations 2014 report on MDG-5 concluded that little progress had been made in the South Asian countries, including India, which accounts for 17% of all maternal deaths globally. In resource-poor economies with widespread disparities even within the same country, it is very important to explore inequalities in safe delivery during childbirth by key socioeconomic factors in order to provide insights for future programming and policy actions. Methods: Data from the Indian District Level Household and Facility Survey 3 were analysed to examine inequalities in safe delivery in eastern India. Univariate and multivariate logistic regression models were used. Results: There were substantial inequalities in safe delivery by asset quintile, education of the woman and her husband, area of residence (rural or urban), religion and age at marriage (<18 years or ≥18 years); however, not all inequalities were the same. After adjusting for education levels of both parents, area of residence, religion and mother’s age at marriage, the odds of having a safe delivery were almost eightfold higher for those in the highest asset quintiles compared with those in the lowest quintiles. The odds for a safe pregnancy were three times higher for educated women compared with a base case of no education. The chances of having a safe delivery were twofold higher for women living in urban areas compared with those in rural areas (odds ratio 2.04, 95% confidence interval 1.91–2.17). Conclusion: Addressing inequalities in maternal health should be viewed as a central policy goal together with the achievement of MDG-5 targets. In addition to following the indirect route of improving maternal health via poverty alleviation, direct interventions are needed urgently. Women’s education has a strong potential to improve access for poor pregnant women to safe delivery services and to reduce disparities in maternal health outcomes in resource-poor economies.

Visceral Leishmaniasis Elimination Program in Bangladesh and Achieving Millennium Development Goal.

Aims: The aim of this review is to present the status of Visceral Leishmaniasis (VL) in Bangladesh and various steps taken to achieve the Millennium Development Goal (MDG). Additionally, the review covers the related challenges and opportunities to achieve this goal. Main Body: Currently, 45 out of 64 districts of the country are endemic for VL and 20 million people, around 18% of the total population, are considered to be at risk for VL. However, there is a concern about the total number of VL reported cases. It has been mentioned that the number of cases reported in surveillance data is likely to be at least five times underestimated. The current burden of VL disease is 23.4 times higher compare to the MDG of 1 case per 10,000 populations by 2015. In order to achieve the MDG various national strategies have been taken so far to eliminate VL from Bangladesh. Government of Bangladesh constituted a national steering committee and formed a technical working group to provide support to VL elimination program. Lack of trained and efficient labour force, along with lack of knowledge among the people are big challenges for VL elimination in Bangladesh. In addition, drug unavailability, unfriendly behaviour of health worker and existence of unofficial payment to the heath provider in public hospital work as barriers to achieve MDG. A major challenge towards VL elimination is the rising incidence of Post kalaazar dermal Leishmaniasis. Recent introduction of oral therapy with miltefosine and rapid diagnostic with rk39 as cost effective case management have the potentiality to work against all the barriers. Conclusion: From the public health view and guided by research evidence it seems the elimination of VL from Bangladesh is technically feasible and operationally possible. Ensuring sufficient health worker with adequate training remains the major challenges. Strengthening referral services, adapting active case detection strategies, and creating public awareness are also important for achieving MDG.

Modeling and forecasting of the under-five mortality rate in Kermanshah province in Iran: a time series analysis / 한국역학회지

OBJECTIVES: The target of the Fourth Millennium Development Goal (MDG-4) is to reduce the rate of under-five mortality by two-thirds between 1990 and 2015. Despite substantial progress towards achieving the target of the MDG-4 in Iran at the national level, differences at the sub-national levels should be taken into consideration. METHODS: The under-five mortality data available from the Deputy of Public Health, Kermanshah University of Medical Sciences, was used in order to perform a time series analysis of the monthly under-five mortality rate (U5MR) from 2005 to 2012 in Kermanshah province in the west of Iran. After primary analysis, a seasonal auto-regressive integrated moving average model was chosen as the best fitting model based on model selection criteria. RESULTS: The model was assessed and proved to be adequate in describing variations in the data. However, the unexpected presence of a stochastic increasing trend and a seasonal component with a periodicity of six months in the fitted model are very likely to be consequences of poor quality of data collection and reporting systems. CONCLUSIONS: The present work is the first attempt at time series modeling of the U5MR in Iran, and reveals that improvement of under-five mortality data collection in health facilities and their corresponding systems is a major challenge to fully achieving the MGD-4 in Iran. Studies similar to the present work can enhance the understanding of the invisible patterns in U5MR, monitor progress towards the MGD-4, and predict the impact of future variations on the U5MR.

Why women do not utilize maternity services in Nepal: a literature review.

The structure and provision mechanism of maternity services in Nepal appears to be good, with adequate coverage and availability. Utilization of maternity services has also improved in the past decade. However, this progress may not be adequate to achieve the Millennium Development Goal to improve maternal health (MDG 5) in Nepal. This paper reviews the factors that impede women from utilizing maternity services and those that encourage such use. Twenty-one articles were examined in-depth with results presented under four headings: (i) sociocultural factors; (ii) perceived need/benefit of skilled attendance; (iii) physical accessibility; and (iv) economic accessibility. The majority of the studies on determinants of service use were cross-sectional focusing on sociocultural, economic and physical accessibility factors. In general, the education of couples, their economic status and antenatal check-ups appeared to have positive influences. On the other hand, traditional beliefs and customs, low status of women, long distance to facilities, low level of health awareness and women’s occupation tended to impact negatively on service uptake. More analytical studies are needed to assess the effectiveness of the Safer Mother Programme, expansion of rural birth centres and birth-preparedness packages on delivery-service use. Moreover, it is important to investigate women’s awareness of the need of facility delivery and their perception of the quality of health facilities in relation to actual usage.

The determinants of official development assistance for healthcare in Korea

This paper aims to examine the factors that affect the amount of official development assistance (ODA) a developing country receives for healthcare by the Korean government. We empirically tested to what extent the amount of Korea's ODA in health care services, infrastructure, HIV/AIDS, and tuberculosis are affected by the relevant demand factors in the recipient countries. To do so, we carried out country-level multivariate regression analyses by setting the amount of ODA for four health care sectors as dependent variables and the relevant demand factors and economic factors as independent variables. A panel dataset was constructed by combining ODA data from the Organisation for Economic Cooperation and Development and World Development Indicators. The analyses showed that the ODA for health care in Korea is partly meeting the recipient's health care needs. In particular, the recipients with a smaller number of physicians are likely to receive more ODA for medical services. Meanwhile, the amount of international trade with Korea is likely to affect the amount of ODA for medical services. However, disease factors, such as prevalence of HIV/AIDS and tuberculosis, did not positively affect the amount of ODA for those diseases. These results indicate that Korea's ODA system for health care needs to be improved to meet the demand of the recipients in order to achieve the humanitarian objectives set by the international community. We hope that the medical community and the government of Korea can cooperate in setting the global policy agenda for health care ODA based on concrete evidence-based healthcare policy research.

Field test results of the motherhood method to measure maternal mortality.

Background & objectives: Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital registration is extremely deficient. Currently available methods to measure maternal mortality, such as the sisterhood method, pose problems with respect to validity, precision, cost and time. We conducted this field study to test a community-based method (the motherhood method), to measure maternal and child mortality in a developing country setting. Methods: Motherhood method was field tested to derive measures of maternal and child mortality at the district and sub-regional levels in Bara district, Nepal. Information on birth, death, risk factors and health outcomes was collected within a geographic area as in an unbiased census, but without visiting every household. The sources of information were a vaccination registry, focus group discussions with local health workers, and most importantly, interview in group setting with women who share social bonds formed by motherhood and aided by their peer memory. Such groups included all women who have given birth, including those whose babies died during the measurement period. Results: A total of 15161 births were elicited in the study period of two years. In the same period 49 maternal deaths, 713 infant deaths, 493 neonatal deaths and 679 perinatal deaths were also recorded. The maternal mortality ratio was 329 (95%CI:243-434)/100000 live birth, infant mortality rate was 48(44-51)/1000LB, neonatal mortality rate was 33(30-36)/1000LB, and perinatal mortality rate was 45(42-48)/1000 total birth. Interpretation & conclusions: The motherhood method estimated maternal, perinatal, neonatal and infant mortality rates and ratios. It has been field tested and validated against census data, and found to be efficient in terms of time and cost. Motherhood method can be applied in a time and cost-efficient manner to measure and monitor the progress in the reduction of maternal and child deaths. It can give current estimates of mortalities as well as averages over the past few years. It appears to be particularly well-suited to measuring and monitoring programmes in community and districts levels.

Burden, Differentials, and Causes of Child Deaths in India.

Objective To review the current information on trends, burden, differentials, causes, and timing of under five (U5) child deaths in India. Methods We reviewed and analyzed data on child deaths in India from official government sources, reports, surveys, and from the published literature. The secondary analyses were carried out to provide additional insight. Results An estimated 1.84 million under 5 child deaths, including approx 1.44 million infant and 940,000 neonatal deaths occurred in India during 2007. More than 60% of these Under 5 child deaths occurred in 5 states: Uttar Pradesh (27.0%), Bihar (11.3%), Madhya Pradesh (9.9%), Rajasthan (8.0%) and Andhra Pradesh (5.7%). Approximately 41% of all Under 5 child deaths happen in the first week of life and the risk of deaths during neonatal period was at least 68 times higher than the rest of childhood. The children living in rural areas, in the central Indian states, in the lowest 20% of wealth index have the highest risk of death in India. The mortality rates in under 5, infant, neonates and early neonatal period in India declined by 43.5%, 31.2%, 32.1%, and 21.6%, respectively, between 1990 to 2007. However, the rate of reduction has slowed in last 4 years (2003–2007), with negative trend in the early neonatal mortality rate. Neonatal conditions (33%), pneumonia (22%) and diarrhea (14%) are the leading causes of under 5 deaths in India. Sepsis, pneumonia (30.4%), birth asphyxia (19.5%), and pre-maturity (16.8%) are the 3 commonest causes of neonatal deaths (0–27 days). Conclusions The reduction in under 5 child mortality in India during 1990–2007 has been insufficient to attain Millennium Development Goal 4 (MDG4). However, there have been variable declines in early neonatal, neonatal, infant and child mortality. Despite the well known importance of neonatal survival to attain MDG4, our data suggest the early neonatal mortality rate in India may be increasing in the recent years, which is a cause for serious concern. Achievement of MDG4 in India will require further acceleration in the reduction of the under 5 mortality rate, particularly, in the 5 highest burden states: Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan and Andhra Pradesh.