The role of the village midwives in antenatal care services in the Sudan.

A study was conducted to assess the obstetric care coverage provided by the Sudanese village midwives. Mothers and village midwives, from four villages were interviewed using structured questionnaires. A total of 130 mothers who had delivered within 6 months were included in the study. Seventy per cent of these mothers contacted the village midwives at least once during their pregnancy. The average attendance was 3.8 antenatal contacts per mother. Seventy-one per cent of those who contacted the village midwives did so during the first half of pregnancy. Half of these mothers were seen in the village midwife's own home and only 20 per cent were in the mothers' homes. The village midwife attended 76 per cent of the deliveries, 11 per cent were attended by the traditional birth attendants, and the remainder delivered in hospital. The village midwives demonstrated reasonable standard of knowledge and competence in various aspects of antenatal care, history taking, examination, and selection of cases for referral. They lack adequate support and supervision, and supplies of drugs such as iron, folic acid, and chloroquine tablets.

Plasma zinc concentration and catch up growth in preterm infants.

Changes in plasma zinc concentration during the period of catch up growth were examined in 44 preterm infants. Blood samples were collected at birth, 6, 12 and 24 weeks. Plasma zinc concentration showed a mean of 13.6 mumol/l at birth and dropped to 9.8 mumol/l at 6 weeks and rose to 11.3 and 15.4 mumol/l at 12 and 24 weeks respectively. Plasma zinc concentrations showed significant correlation with weight velocity at 12 weeks. Male infants had significantly lower plasma zinc concentrations than females at 12 weeks. Infants of gestational age more than 32 weeks had lower plasma zinc concentrations at 12 and 24 weeks than those of earlier gestations. At the same time males were growing faster than females and also infants of gestational ages more than 32 weeks were growing faster than those born at earlier gestations. These observations, together with the finding that the decline in zinc occurred during the phase of rapid growth, suggest that growth is the predominant modulator of plasma zinc concentration.

Catch up growth in preterm infants.

Seventy-one surviving infants were followed up from birth to 24 weeks of postnatal age. Their mean gestational age was 32 weeks with a range of 26-36 weeks and a standard deviation of 2.1 weeks. Their mean birth weight was 1,805 kg with a range of 0.675-2.5 kg and a standard deviation of 0.408 kg. Their weights, lengths and head circumferences were measured at birth, 6, 12 and 24 weeks. Curves for the mean weight, length and head circumference were produced and superimposed on the available intrauterine and extrauterine growth charts. The growth curves of the preterm infants did not show the flattening noted in the intrauterine curves towards term. The curve of the mean weight of the preterm infants started at the 50th centile for Gairdner & Pearson (1971) at birth to drop below that shortly after birth. At 40 weeks of postconceptional age the mean weight curve of preterm infants crossed the 50th centile and continued above it to reach the 90th centile at 60 weeks. The curves of mean length and head circumference started below the 50th centile at birth and crossed it at 40 weeks and continued above it to approach the 90th centile at 60 weeks. Growth velocity was calculated as a relative gradient using the straight line equation (y = a + bx), where y is the weight, length or head circumference, and x is the independent variable and here it is the group mean of the parameter at the corresponding ages. Catch up growth is taken as a relative gradient significantly greater than one. The first 24 weeks of postnatal life are defined as a period of catch up growth with the first 8 weeks as an interval of maximum head velocity.