Stakeholders' perceived achievements and challenges after the safe motherhood project in Northern Uganda

The Japanese Red Cross Society (JRCS) and the Uganda Red Cross Society (URCS) implemented the Safe Motherhood project topromote mother-friendly society in northern Uganda from 2010 to 2016. The follow-up study has not been conducted and the information on achievements and challenges after the project were limited. To review the safe motherhood project in northern Uganda, the purpose of the study was to explore the stakeholders' perceived achievements and challenges after the project. Study design was qualitative content analysis using interview guides. After the approval of Institutional Review Board Clearance, the study was started (Approval Number: 2017-034). The subjects were informed about the ethical considerations (informed consent, participation on free will, confidentiality, and anonymity) in participating in the research, and they participated after signing the consent form. Six volunteers, 2 health center staff, and 2 former Uganda Red Cross staff were interviewed. Achievements were the acquisition of knowledge, attitudes changes, behavioural changes, linkage of all stakeholders, and positive influence on Safe Motherhood in community. Challenges of sociocultural barriers, attitudes toward women, accessibility and human resources, incentives and facilities, and sustainability of the project were derived from the interview. The study revealed that the project linked all stakeholders to achieve Safe Motherhood in community and all the developed registration systems were taken over. Long-term support is necessary for Safe Motherhood to take root

Birth preparedness and complication readiness among pregnant and recently delivered women in villages of a block of Ganjam, Odisha, India: a community based cross-sectional study

Background: Globally approximately 830 women die from pregnancy and child birth every day. Most of deaths can be prevented by proper planning like birth preparedness and complication readiness (BPCR). The aim of study was to assess awareness and practice regarding BPCR among pregnant women and recently delivered women and to identify socio-demographic factors affecting it.Methods: A community based cross sectional study was conducted from September to December 2018 in villages of Chhatrapur block of Ganjam District among pregnant women (completed 24 weeks) and recently delivered women (12 months) regardless of newborn outcome. Sample size was calculated to be 96. Multi stage random sampling was adopted and PPS (Probability proportional to size) method was used. A questionnaire was used which contained socio-demographic information and set of 11 indicators to determine BPCR index. All data were analysed in SPSS.Results: BPCR index was 44.6% and it was higher (61%) in recently delivered women. 26% can be said to be well prepared and 45.8%, 27%, 32.3%, 37.5% knew at least one key danger sign in pregnancy, delivery, post partum and about new born respectively. A significant association was found between maternal education, age and pregnancy with awareness regarding BPCR.Conclusions: BPCR index in study area was low and a low proportion of participants were well prepared. Awareness about danger signs was quite low. So health workers at grassroots level should be encouraged to explain BPCR components to women and educational activities should be carried out to promote women to make plan a priori.

Promotion of safe motherhood in the nursing competency-based curriculum

Purpose@#Nurses play a significant role in maternal health. The nursing competency-based curriculum prepares students for this role. This study identified the competencies on safe motherhood expected of graduating nursing students, determined the degree of integration of these competencies in the curriculum, and described students' perceived levels of proficiency in performing said competencies. @*Design@#This is a descriptive cross-sectional study. The authors deduced concepts and principles of safe motherhood in nursing based on the 2006 standard competencies. A complete enumeration of 55 graduating students of a college of nursing in a state university in Manila participated in the study.@*Methods@#Students rated the competencies from A: “concepts were merely introduced” to D, “threaded through” in selected courses. The level of proficiency ranged from 1: “can perform well without supervision” to 4 “cannot perform despite supervision.” Ratings were analyzed using frequency counts, mode, and percentage distributions.@*Findings@#Seventy competencies on safe motherhood were derived. Cognitive and affective competencies on the basic nursing processes were threaded through in foundation, intervention, and intensive nursing process courses. Students could perform the cognitive and affective competencies without supervision but required assistance in performance of skills.@*Conclusion@#The nursing curriculum prepares students to promote safe motherhood; however, students need to improve their clinical skills to be fully competent.

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.

"Standardization training of obstetric residents based on ""safe motherhood project""" / 中华医学教育探索杂志

Combined with safe mothcrhood project,in order to completely promote teaching quality,we should explore establishing a uniform,standardized,scientific and perfect teaching model of obstetric residents' standard training by analyzing the status and the difficulties in standard training of obstetric residents,and by adopting scientific and reasonable evaluation measures.

Prevención de la hemorragia posparto / Post partum hemorrhage prevention

OBJETIVO: evaluar los cambios en la pérdida estimada de sangre y tasas de Hemorragia Posparto [HPP] derivados del entrenamiento en el Manejo Activo de la Tercera Etapa del Parto [MATED] en cinco Clínicas Materno Infantiles del departamento de Yoro, Honduras. METODOLOGÍA: durante nueve meses, el equipo de investigación enseña las habilidades sobre la pérdida estimada de sangre, establece una tasa base para la HPP y enseña el manejo activo de la tercera etapa del parto. En cada nacimiento se registran la pérdida estimada de sangre, los resultados para la madre y el neonato, así como el uso calculado de Oxitocina en el periodo posnatal. Los datos obtenidos se analizan estadísticamente con SPSS descriptivo, prueba-T y Chi-cuadrado. RESULTADOS: el periodo de estudio previo al entrenamiento en MATEP incluye 178 casos, el periodo posterior al entrenamiento incluye 392 casos. La pérdida estimada de sangre durante el periodo previo es de 109 ml en promedio, comparado con 81 ml en promedio que se obtiene durante el periodo posterior al entrenamiento (p=.004). En la fase previa y posterior a/ entrenamiento, el uso de Oxitocina en el periodo posparto es de 99.5%, aunque en el 17% de los casos reportados la administración de Oxitocina se realiza después de la expulsión de la placenta. Después del entrenamiento en MATER la tasa de hemorragia posparto disminuye del 7.3% al 3.8%, dato que no es estadísticamente significativo.

AIM: evaluate the changes in estimated blood loss and Post Partum Hemorrhage [PPH] rates with dissemination of Active Management of Third Stage of Labor [AMTSL] training to five Clinicas Materno Infantiles in the state of Yoro, Honduras. METHODS: over a nine month period, the research team utilized a two part training module to first teach the skills of estimated blood loss to establish a baseline rate for PPH and then in the second phase teach skills of active management of third stage labor. Estimated blood loss, outcomes for mother and neonate as well as the use and timing of Oxytocin in the postpartum period were recorded for each birth for the research team. The collected data were analyzed with SPSS for descriptive, t-test and chi-square statistics. RESULTS: pre-AMTSL training period N= 178, post AMTSL training N=392. Estimated blood loss pre-AMTSL training was a mean of 109 ml compared with post-training period of 81ml (p=.004). The use of Oxytocin in the postpartum period was 99.5% in both pre and post AMTSL training, though 17% of the cases reported Oxytocin administration after delivery of the placenta. The postpartum hemorrhage rate decreased from 7.3% to 3.8% after the AMTSL training, but was not statistically significant. CONCLUSION: AMTSL training reduced estimated blood loss though did not significantly change PPH rates in this study. Use of Oxytocin postpartum has become a regular component of care provided.

Maternal Mortality-reduction Programme in Andhra Pradesh.

Andhra Pradesh, a large state in southern India, has a high maternal mortality ratio of 195 per 100,000 livebirths despite the improvements in social, demographic and health indicators over the last two decades. This contrary situation has been analyzed using findings of different studies on maternal mortality, and four factors have been presented for consistently-high maternal mortality in the state. First, the disproportionately-high focus on family planning towards population stabilization reduced the emphasis on maternal health in the peripheral hospitals, resulting in low use of these facilities for childbirths. Second, the growth of services in Primary Health Centres was not given adequate emphasis, resulting in the weakening of the peripheral health system. Third, there was little emphasis on developing a cadre of midwives who would have primarily focused on maternal health. Lastly, the low status of women in the state has hampered timely referral and access to services.

Control prenatal y su impacto en la mortalidad materna: Análisis de una tendencia, 1994-2004: Cali, Colombia / Prenatal control and its impact on reducing maternal deaths: Trend analysis, 1994-2004: Cali, Colombia

Objetivo: analizar el comportamiento de las razones de mortalidad materna en la ciudad de Cali (Colombia) durante dos décadas, 1985 a 2004, a la luz de indicadores de desarrollo social y organización de los servicios de atención a la gestante. Metodología: se utiliza como marco conceptual el modelo canadiense propuesto por Laframboise y Lalonde en 1974, para explicar la contribución de los servicios de salud en la disminución de las tasas de mortalidad materna. Resultados: a partir de 1994 se inició un descenso sostenido de la mortalidad materna, que se ha mantenido hasta el 2004. Durante este período no se evidenció un mejoramiento cuantitativo significativo de los indicadores de desarrollo social y económico de la ciudad de Cali. Las altas coberturas de atención prenatal (97%) y del parto institucional (98%), junto con un sistema eficiente de referencia y contrareferencia, se mantuvieron estables. El control de los procesos de mejoramiento de la calidad de la atención prenatal, con evaluaciones y ajustes periódicos, y la participación permanente de ginecobstetras en el nivel primario de atención, constituyeron los hitos primordiales de las intervenciones realizadas en la red de servicios públicos de atención. Discusión: los factores de riesgo intervenidos en la atención prenatal, la alta cobertura institucional de atención del parto y una red de referencia y contrareferencia de pacientes, oportuna y eficiente, parecen ser responsables de la disminución del 80% de las muertes, según el cálculo de Guzmán en 1986.

Objective: analysing the statistical data regarding maternal deaths in Cali (Colombia) during two consecutive decades (1985-2004) and correlating outcomes with environmental and social indicators. Methodology: the Canadian Laframboise conceptual model was used for explaining how health service organisation and other aspects of medical care play a part in decreasing maternal mortality rates. Results: maternal deaths in Cali have been decreasing since 1994. No significant quantitative variations in environmental and/or social indicators for Cali were detected from 1994-2004. High prenatal control (97%) and institutional delivery coverage (98%) remained stable, together with an efficient referral and counter-referral system. Improving prenatal attention quality through periodic evaluation and adjustment and obstetrician/gynaecologists’ ongoing participation in first-level attention were the highlights of public attention service network intervention. Discussion: prenatal risk factors, broad institutional coverage for a quality motherhood care programme and an efficient referral system have all contributed towards reducing maternal deaths by nearly 80 (taking Guzmán’s 1986 calculation as reference point).