Multicountry research on comprehensive abortion policy implementation in Latin America: a mixed-methods study protocol.

INTRODUCTION: Access to comprehensive abortion care could prevent the death of between 13 865 and 38 940 women and the associated morbidity of 5 million women worldwide. There have been some important improvements in Latin America in terms of laws and policies on abortion. However, the predominant environment is still restrictive, and many women, adolescents and girls still face multiple barriers to exercise their reproductive rights. This research will systematically assess comprehensive abortion policies in five Latin American countries (Argentina, Colombia, Honduras, Mexico and Uruguay). The aim is to identify barriers, facilitators and strategies to the implementation of abortion policies, looking at four key dimensions-regulatory framework, abortion policy dynamics, abortion service delivery and health system and health outcomes indicators-to draw cross-cutting lessons learnt to improve current implementation and inform future safe abortion policy development. METHODS AND ANALYSIS: A mixed-method design will be used in the five countries to address the four dimensions through the Availability, Accessibility, Acceptability and Quality of Care model. The data collection tools include desk reviews and semi-structured interviews with key actors. Analysis will be performed using thematic analysis and stakeholder analysis. A regional synthesis exercise will be conducted to draw lessons on barriers, facilitators and the strategies. ETHICS AND DISSEMINATION: The project has been approved by the WHO Research Ethics Review Committee (ID: A66023) and by the local research ethics committees. Informed consent will be obtained from participants. Data will be treated with careful attention to protecting privacy and confidentiality. Findings from the study will be disseminated through a multipurpose strategy to target diverse audiences to foster the use of the study findings to inform the public debate agenda and policy implementation at national level. The strategy will include academic, advocacy and policy arenas and actors, including peer-reviewed publication and national and regional dissemination workshops.

Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion (MCS-A).

INTRODUCTION: Abortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication severity, describe the management of these complications and report women's experiences with abortion care in selected countries of the Americas region. METHODS: This is a cross-sectional study of 70 health facilities across six countries in the region. We collected data on women's characteristics including socio-demographics, obstetric history, clinical information, management procedures and using Audio Computer-Assisted Self-Interviewing (ACASI) survey the experience of abortion care. Descriptive bivariate analysis was performed for women's characteristics, management of complications and reported experiences of abortion care by severity of complications, organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Generalised linear estimation models were used to assess the association between women's characteristics and severity of complications. RESULTS: We collected data on 7983 women with abortion-related complications. Complications were classified as mild (46.3%), moderate (49.5%), potentially life-threatening (3.1%), near-miss cases (1.1%) and deaths (0.2%). Being single, having a gestational age of ≥13 weeks and having expelled products of conception before arrival at the facility were significantly associated with experiencing severe maternal outcomes compared with mild complications.Management of abortion-related complications included both uterotonics and uterine evacuation for two-thirds of the women while one-third received uterine evacuation only. Surgical uterine evacuation was performed in 93.2% (7437/7983) of women, being vacuum aspiration the most common one (5007/7437, 67.4%).Of the 327 women who completed the ACASI survey, 16.5% reported having an induced abortion, 12.5% of the women stated that they were not given explanations regarding their care nor were able to ask questions during their examination and treatment with percentages increasing with the severity of morbidity. CONCLUSIONS: This is one of the first studies using a standardised methodology to measure severity of abortion-related complications and women's experiences with abortion care in LAC. Results aim to inform policies and programmes addressing sexual and reproductive rights and health in the region.

Does route matter? Impact of route of oxytocin administration on postpartum bleeding: A double-blind, randomized controlled trial.

OBJECTIVE: We assessed the impact of intravenous (IV) infusion versus intramuscular (IM) oxytocin on postpartum blood loss and rates of postpartum hemorrhage (PPH) when administered during the third stage of labor. While oxytocin is recommended for prevention of PPH, few double-blind studies have compared outcomes by routes of administration. METHODS: A double-blind, placebo-controlled randomized trial was conducted at a hospital in Argentina. Participants were assigned to receive 10 IU oxytocin via IV infusion or IM injection and a matching saline ampoule for the other route after vaginal birth. Blood loss was measured using a calibrated receptacle for a 1-hour minimum. Shock index (SI) was also calculated, based on vital signs measurements, and additional interventions were recorded. Primary outcomes included: the frequency of blood loss ≥500ml and mean blood loss. RESULTS: 239 (IV infusion) and 241 (IM) women were enrolled with comparable baseline characteristics. Mean blood loss was 43ml less in the IV infusion group (p = 0.161). Rates of blood loss ≥500ml were similar (IV infusion = 21%; IM = 24%, p = 0.362). Women in the IV infusion group received significantly fewer additional uterotonics (5%), than women in the IM group (12%, p = 0.007). Women with PPH in the IM group experienced a larger increase in SI after delivery, which may have influenced recourse to additional interventions. CONCLUSIONS: The route of oxytocin administration for PPH prevention did not significantly impact measured blood loss after vaginal birth. However, differences were observed in recourse to additional uterotonics, favoring IV infusion over IM. In settings where IV lines are routinely placed, oxytocin infusion may be preferable to IM injection.

[Field testing of new WHO growth standards: assessment of anthropometric outcomes of children from 0 to 5 years from Rosario city, Argentina]. / Validación clínica de los nuevos estándares de crecimiento de la OMS: análisis de los resultados antropométricos en niños de 0 a 5 años de la ciudad de Rosario, Argentina.

INTRODUCTION: The field testing of the preliminary WHO child growth standards was conducted in Rosario, Argentina. The objective of the article is to analyze the anthropometrical outcomes based on the national and international growth references. POPULATION, MATERIALS AND METHODS: Descriptive, cross-sectional study. Healthy children born at term, aged 0 to 5 years, and users of the health care network of the municipality from January to May 2005 were included. A data collection form was designed for the study. The weight (kg) was measured with an electronic scale. The length/height (cm) was taken with instruments constructed locally. The measurements techniques were based on national guidelines. The NUTRI 1.3: 5 and ANTHRO 2005 software were used. RESULTS: A sample of 1.804 boys and girls was analyzed. The prevalence of underweight was 1,7 times higher in children less than 6 months with the application of the new standards compared to the national reference. For the rest of the age groups, the situation was the opposite. A major prevalence of stunting was observed after 6 months of age based on the new standards compared to the national reference. The prevalence of overweight, in comparison with the old growth international reference, increased with the use of the new standards. CONCLUSIONS: Differences in underweight, stunting and overweight were found based on the tool used. The prevalence of stunting and overweight may increase with the application of the new growth standard.

Validación clínica de los nuevos estándares de crecimiento de la OMS: análisis de los resultados antropométricos en niños de 0 a 5 años de la ciudad de Rosario, Argentina / Field testing of new WHO growth standards: assessment of anthropometric outcomes of children from 0 to 5 years from Rosario city, Argentina

Introducción. En Rosario, Argentina, se realizó un estudio para validar la utilidad clínica de los estándares de crecimiento preliminares de la Organización Mundial de la Salud. El objetivo del artículo es analizar los resultados antropométricos según las referencias nacional e internacional. Población, material y métodos. Estudio transversal, descriptivo. Se incluyeron niños y niñas nacidos de término, sanos, de 0 a 5 años, usuarios de la red de salud municipal entre enero y mayo del 2005. Se utilizó un formulario de recolección de datos diseñado para el estudio. El peso (kg) se midió con una balanza electrónica. La medición de la longitud corporal/talla (cm) se realizó con instrumentos construidos localmente. Las técnicas de medición se basaron en guías nacionales. Se utilizaron los programas NUTRI 1.3: 5 y ANTHRO 2005. Resultados. La muestra analizada fue de 1.804 niños/as. La prevalencia de bajo peso fue 1,7 veces mayor en los menores de 6 meses al utilizar los nuevos estándares comparados con la referencia nacional. Para los restantes grupos de edad, el comportamiento fue inverso. Se observó una mayor prevalencia de baja talla sobre la base de los nuevos estándares a partir de los 6 meses de edad comparada con la referencia nacional. La prevalencia de sobrepeso, en comparación con la anterior referencia internacional, aumentó al utilizar los nuevos estandares. Conclusiones. Según el instrumento utilizado, se observaron diferencias en la prevalencia de bajo peso, baja talla y sobrepeso. Las prevalencias debaja talla y sobrepeso aumentarían con el uso de losnuevos estándares de crecimiento

Introduction. The field testing of the preliminary WHO child growth standards was conducted inRosario, Argentina. The objective of the article is to analyze the anthropometrical outcomes based onthe national and international growth references. Population, materials and methods. Descriptive cross-sectional study. Healthy children born at term,aged 0 to 5 years, and users of the health care network of the municipality from January to May 2005 were included. A data collection form wasdesigned for the study. The weight (kg) was measured with an electronic scale. The length/height (cm) was taken with instruments constructed locally. The measurements techniques were based onnational guidelines. The NUTRI 1.3: 5 and ANTHRO 2005 software were used.Results. A sample of 1.804 boys and girls was analyzed. The prevalence of underweight was 1,7 times higher in children less than 6 months with theapplication of the new standards compared to the national reference. For the rest of the age groups, the situation was the opposite. A major prevalence ofstunting was observed after 6 months of age based on the new standards compared to the national reference. The prevalence of overweight, in comparisonwith the old growth international reference, increased with the use of the new standards. Conclusions. Differences in underweight, stunting and overweight were found based on the tool used. The prevalence of stunting and overweight may increase with the application of the new growth standard.

Validación clínica de los nuevos estándares de crecimiento de la OMS: análisis de los resultados antropométricos en niños de 0 a 5 años de la ciudad de Rosario, Argentina / Field testing of new WHO growth standards: assessment of anthropometric outcomes of children from 0 to 5 years from Rosario city, Argentina

Introducción. En Rosario, Argentina, se realizó un estudio para validar la utilidad clínica de los estándares de crecimiento preliminares de la Organización Mundial de la Salud. El objetivo del artículo es analizar los resultados antropométricos según las referencias nacional e internacional. Población, material y métodos. Estudio transversal, descriptivo. Se incluyeron niños y niñas nacidos de término, sanos, de 0 a 5 años, usuarios de la red de salud municipal entre enero y mayo del 2005. Se utilizó un formulario de recolección de datos diseñado para el estudio. El peso (kg) se midió con una balanza electrónica. La medición de la longitud corporal/talla (cm) se realizó con instrumentos construidos localmente. Las técnicas de medición se basaron en guías nacionales. Se utilizaron los programas NUTRI 1.3: 5 y ANTHRO 2005. Resultados. La muestra analizada fue de 1.804 niños/as. La prevalencia de bajo peso fue 1,7 veces mayor en los menores de 6 meses al utilizar los nuevos estándares comparados con la referencia nacional. Para los restantes grupos de edad, el comportamiento fue inverso. Se observó una mayor prevalencia de baja talla sobre la base de los nuevos estándares a partir de los 6 meses de edad comparada con la referencia nacional. La prevalencia de sobrepeso, en comparación con la anterior referencia internacional, aumentó al utilizar los nuevos estandares. Conclusiones. Según el instrumento utilizado, se observaron diferencias en la prevalencia de bajo peso, baja talla y sobrepeso. Las prevalencias debaja talla y sobrepeso aumentarían con el uso de losnuevos estándares de crecimiento (AU)

Introduction. The field testing of the preliminary WHO child growth standards was conducted inRosario, Argentina. The objective of the article is to analyze the anthropometrical outcomes based onthe national and international growth references. Population, materials and methods. Descriptive cross-sectional study. Healthy children born at term,aged 0 to 5 years, and users of the health care network of the municipality from January to May 2005 were included. A data collection form wasdesigned for the study. The weight (kg) was measured with an electronic scale. The length/height (cm) was taken with instruments constructed locally. The measurements techniques were based onnational guidelines. The NUTRI 1.3: 5 and ANTHRO 2005 software were used.Results. A sample of 1.804 boys and girls was analyzed. The prevalence of underweight was 1,7 times higher in children less than 6 months with theapplication of the new standards compared to the national reference. For the rest of the age groups, the situation was the opposite. A major prevalence ofstunting was observed after 6 months of age based on the new standards compared to the national reference. The prevalence of overweight, in comparisonwith the old growth international reference, increased with the use of the new standards. Conclusions. Differences in underweight, stunting and overweight were found based on the tool used. The prevalence of stunting and overweight may increase with the application of the new growth standard.(AU)

Field-testing the WHO child growth standards in four countries.

In April 2006 the WHO released a set of growth standards for children from birth to the age of 5 y. Prior to their release, the standards were field-tested in 4 countries. The main objective was to compare children's length/height-for-age and weight-for-length/height based on the new standards with clinician assessments of the same children. The study sampled children <5-y-old attending well-child clinics in 2 affluent populations (Argentina and Italy) and 2 less-affluent ones (Maldives and Pakistan). Length/height and weight were measured by doctors and epidemiologists who also recorded a clinical assessment of each child's length/height in relation to age and weight relative to length/height. Anthropometric indicators of nutritional status were generated based on the WHO standards. As expected, Pakistan and the Maldives had higher rates of stunting, wasting, and underweight than Italy and Argentina, and the reverse was true for overweight and obesity. Where stunting was prevalent, the children classified as short were a mean <-2 SD for height-for-age. In all sites, the children classified as thin were indeed wasted (<-2 SD for weight-for-height) and a positive association in trend was evident between weight-for-height and the line-up of groups from thin to obese. The overall concordance between clinical assessments and the WHO standards-based indicators attested to the clinical soundness of the standards.