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

Fertility and reproductive history of sterilized and non-sterilized women in Campinas, São Paulo, Brazil

This article compares sterilized and non-sterilized women in relation to socio-demographic characteristics, reproductive history, and cohabitation status. Women from 30 to 49 years of age and residing in Campinas, São Paulo State, Brazil, were interviewed with a pre-tested and structured questionnaire: 236 women sterilized at least five years before the interview and 236 non-sterilized women. The sterilized women were significantly more likely to be married or cohabiting, to be younger when they began cohabiting, and to have been in the union longer than the non-sterilized women. They also began childbearing at an earlier age and had a history of more pregnancies and more live births than non-sterilized women. Factors associated with a history of 3 or more live births at the time of the interview were surgical sterilization, younger age at first childbirth, older age at the interview, recognition of fewer contraceptive methods, and lower per capita income. The article concludes that sterilization generally appears to be the consequence of higher fertility in a group of women who initiate childbearing early in life, although its role in preventing these women from having even larger families may also have a demographic impact

Obstetric complications: does training traditional birth attendants make a difference? / Las complicaciones obstétricas: ¿se produce alguna diferencia cuando se adiestra a las parteras tradicionales?

Objetivo. Evaluar el efecto que tuvo una intervención para adiestrar a las parteras tradicionales (PT) en Guatemala sobre la detección de complicaciones obstétricas, la remisión de las pacientes con complicaciones al sistema oficial de salud y, por último, la utilización de servicios de atención obstétrica esencial por estas pacientes. Métodos. Se puso en práctica, usando un diseño cuasi-experimental, un sistema de vigilancia para nacimientos a fin de obtener información poblacional de 3 518 mujeres entre 1990 y 1993. Todas las mujeres fueron entrevistadas después del parto. Fueron tres las variables independientes clave en nuestro estudio: 1) lugar (comunidad expuesta o no expuesta a la intervención), 2) momento en relación con la intervención educativa (antes o después) y 3) presencia o ausencia de una PT en el momento en que se presentó la complicación. Las variables dependientes clave en el caso de las mujeres entrevistadas fueron 1) aparición de una complicación obstétrica, 2) detección de la complicación por la PT, 3) remisión a un centro de salud, 4) cumplimiento de la remisión y 5) uso de servicios. Resultados. La incidencia de complicaciones después del parto disminuyó después de la intervención, una vez efectuado el ajuste según el tipo de comunidad (expuesta y no expuesta a la intervención). Por otra parte, después de la intervención fueron menores las probabilidades de que las PT detectaran la mayoría de las complicaciones maternas y no se observó ningún aumento significativo del número de remisiones. Las probabilidades de usar los servicios de salud aumentó seis veces en mujeres que no fueron atendidas por una PT, y no se observó ningún aumento entre las que sí fueron atendidas por una PT. Conclusión. El adiestramiento de las PT podría haber ejercido un efecto favorable en cuanto a la tasa y la detección de complicaciones después del parto y la remisión de las mujeres con este tipo de complicaciones. No obstante, hay menos datos a favor de un aumento general de la detección de complicaciones, de las remisiones al sistema de salud formal y del uso de servicios de atención obstétrica esencial entre las mujeres atendidas por PT

Objective. To assess the effect that a training intervention for traditional birth attendants (TBAs) in Guatemala had on the detection of obstetric complications, the referral of patients with complications to the formal health care system, and, ultimately, those patients' utilization of essential obstetric care services. Methods. Using a quasi-experimental design, a surveillance system of births was implemented to collect population-based information from 3 518 women between 1990 and 1993. All women were interviewed postpartum by physicians. There were three key independent variables in our study: 1) geographical area (intervention community and non-intervention community), 2) time in relation to the training intervention (before or after), and 3) presence or absence of a TBA at the time of the complication. The key dependent variables for women interviewed were 1) development of an obstetric complication, 2) detection of the problem by the TBA, 3) referral to a health facility, 4) compliance with referral, and 5) use of services. Results. The incidence of postpartum complications decreased after the intervention, controlling for intervention community. On the other hand, after the intervention TBAs were less likely to recognize most maternal complications, and referral rates did not increase significantly. The likelihood of using health care services increased six-fold among women who were not attended by TBAs, and no increase was observed among those who were attended by TBAs. Conclusion. Training TBAs may have had a positive effect on the rate, detection, and referral of postpartum complications. However, the evidence is less convincing for overall increases in the detection of complications, in referral to the formal health care system, and in the utilization of essential obstetric services among women attended by TBAs

Conseqüências do uso de métodos anticoncepcionais na vida das mulheres: o caso da laqueadura tubária / Impact of contraceptive methods on women's lives: the case of tubal ligation

Investigaram-se as conseqüências da laqueadura tubária, a longo prazo, na vida de mulheres residentes em Campinas, São Paulo. Aplicando-se um questionário estruturado e pré-testado, entrevistaram-se mulheres de trinta a 49 anos de idade, 236 laqueadas há pelo menos cinco anos e o mesmo número de não laqueadas. Os grupos foram comparados quanto à sua satisfação com o método anticoncepcional em uso, aos benefícios e prejuízos a ele atribuídos, ao possível arrependimento e à percepção de seus efeitos sobre a saúde, corpo, menstruações, vida sexual, afetiva e familiar, trabalho, estudos, situação econômica e autovaloração. Criaram-se escores para comparar os grupos quanto a conhecimento sobre métodos anticoncepcionais, amor próprio/auto-estima/competência, bem-estar/qualidade de vida, relacionamento com o parceiro, questões de gênero. A satisfação com o método em uso foi significativamente maior entre as mulheres laqueadas, embora tenham sido as que mais referiram arrependimento. Estas também atribuíram mais freqüentemente ao método melhora na vida sexual e na situação econômica; por outro lado, relataram um efeito negativo sobre suas menstruações. Não se verificaram diferenças significativas quanto aos escores avaliados

Calidad de los servicios de anticoncepción en El Alto, Bolivia / The quality of contraception services in El Alto, Bolivia

El presente estudio tuvo por objetivo evaluar la calidad de los servicios de anticoncepción en la ciudad de El Alto, Bolivia. En su diseño se han contemplado cuatro elementos: 1) las relaciones entre los proveedores de servicios y sus clientes, 2) la disponibilidad de métodos anticonceptivos, 3) las condiciones de los servicios, y 4) la satisfacción de las usuarias. También se han tenido en cuenta las opiniones de los proveedores y de las usuarias y no usuarias de estos servicios, quienes se clasificaron como gubernamentales o no gubernamentales, de acuerdo con la administración de la institución a la que pertenecían. Los datos provinieron de un análisis de la situación de dichos servicios y de testimonios obtenidos de las participantes durante 1995. En cuanto a las relaciones interpersonales, se encontró que los proveedores percibían el trato del médico más favorablemente que las clientas, en tanto que las no usuarias lo percibían desfavorablemente. La percepción de un trato igualitario se correlacionó positivamente con la vestimenta que usaban las clientas. En cuanto a la disponibilidad de los métodos anticonceptivos, 15 de las 36 instituciones encuestadas no disponían de métodos modernos, a pesar de la existencia de una política nacional para proveerlos a la población. La oferta de estos servicios a parejas y a adolescentes es escasa, principalmente en las instituciones gubernamentales. El análisis de las condiciones de los servicios demostró que en algunas instituciones había problemas graves en la provisión de una atención de mínima calidad. Finalmente, este trabajo describe cómo la mayoría de estas limitaciones en la prestación de servicios de anticoncepción en El Alto pueden subsanarse mediante estrategias de costo moderado

The objective of this study was to evaluate the quality of contraception services in the city of El Alto, Bolivia. In the study design, four components were considered: 1) interpersonal relations between service providers and users, 2) the availability of various contraceptive methods, 3) conditions in the service centers, and 4) user satisfaction. The opinions of three groups were taken into account: service providers, service users, and nonusers. The service centers were classified as either governmental or nongovernmental, depending on the management of the institution to which the service center belonged. The study data came from a situation analysis of the services and from comments gathered from study participants in 1995. The study found that providers held a more favorable view than did service users of the interpersonal relations and personal treatment that physicians provided. Nonusers had an unfavorable perception of physicians' treatment of users. Users' perceptions of receiving egalitarian treatment correlated with their style of dress. With regard to the availability of contraceptive methods, 15 of the 36 centers surveyed did not have modern methods, despite there being a national policy to provide them to the public. The supply of contraception services for couples and for adolescents is limited, especially in the governmental institutions. The analysis of the conditions in the service centers demonstrated that some institutions had serious difficulties providing services of at least a minimum quality. Finally, the study describes how most of the service limitations in El Alto can be corrected through moderate-cost strategies

Seminário gravidez na adolescência / Pregnancy in the adolescence seminar

Esta publicação reúne artigos apresentados no seminário Gravidez na Adolescência, realizado no Rio de Janeiro em 1998. Os autores apresentam importantes contribuições para um debate que extrapola o campo demográfico e assinala as transformações sócio-culturais sofridas pela sociedade brasileira. A introdução dos impactos diferenciados por gênero e classe social neste debate e as diferentes leituras culturais do significado da iniciação da vida reprodutiva permitem tornar a discussão mais complexa e menos ingênua

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...