Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India.

Evidence to support that antenatal screenings and interventions are effective in reducing maternal mortality has been scanty and studies have presented contradictory findings. In addition, antenatal care utilization is poorly characterized in studies. As an exposure under investigation, antenatal care should be well defined. However, measures typically only account for the frequency and timing of visits and not for care content. We introduce a new measure for antenatal care utilization, comprised of 20 input components covering care content and visit frequency. Weights for each component reflect its relative importance to better maternal and child health, and were derived from a survey of international researchers. This composite measure for antenatal care utilization was studied in a probability sample of 300 low to middle income women who had given birth within the last three years in Varanasi, Uttar Pradesh, India. Results showed that demarcating women's antenatal care status based on a simple indicator--two or more visits versus less--masked a large amount of variation in care received. Logistic regression analyses were conducted to examine the effect of antenatal care utilization on the likelihood of using safe delivery care, a factor known to decrease maternal mortality. After controlling for relevant socio-demographic and maternity history factors, women with a relatively high level of care (at the 75th percentile of the score) had an estimated odds of using trained assistance at delivery that was almost four times higher than women with a low level of care (at the 25th percentile of the score) (OR = 3.97, 95% CI = 1.96, 8.10). Similar results were obtained for women delivering in a health facility versus at home. This strong positive association between level of care obtained during pregnancy and the use of safe delivery care may help explain why antenatal care could also be associated with reduced maternal mortality.

PIP: A new measure for antenatal care utilization is introduced, comprised of 20 input components on care content and visit frequency. Weights for each component reflect the component's relative importance to better maternal and child health, and were derived from a survey of international researchers. The measure was studied in a probability sample of 300 low- to middle-income women who had given birth within the past 3 years in Varanasi, Uttar Pradesh, India. After controlling for relevant sociodemographic and maternity history factors, analysis of the data found that the use of antenatal care among low- to middle-income women in Varanasi positively influences the likelihood of using trained assistance at the birth of the child. Women with a relatively high level of care had an estimated odds of using trained assistance at delivery that was almost 4 times higher than women with a low level of care. Similar results were obtained for women delivering in a health facility rather than at home. This strong positive association between level of care during pregnancy and the use of safe delivery care may help explain why antenatal care could also be associated with reduced maternal mortality.

Health information systems--making them work.

A health services model based on different concentration levels between the centre and the periphery, each with particular resources, responsibilities and management functions, provides a framework on which health information systems can be built or rebuilt so as to accelerate progress towards the health-for-all goals.

[Effect of 2 vaccination strategies on developments during the epidemic of meningococcal A meningitis in N'Djamena (Chad) in 1988]. / Effet de deux stratégies de vaccination sur l'évolution de l'épidémie de ménigite à méningocoque A survenue à N'Djamena (Tchad) en 1988.

From February till May 1988, during an epidemic of group-A meningococcal disease, 4542 cases of meningitis were reported in N'Djamena, the capital of Chad (550,000 inhabitants). A first selective vaccination campaign was carried out between 5 and 14 March; 156,500 vaccine doses (polyvalent: group A and C: Institut Mérieux) were given using jet injectors. The target population for this first campaign consisted of groups such as school-children and the armed forces. As the epidemic continued, a mass vaccination campaign was implemented one month later between 8 and 14 April 1988; this was targeted at the whole population above 1 year of age, not previously immunized, and 266,738 doses of vaccine were injected. One week after the start of the second campaign, the number of reported cases fell sharply and, within four weeks, the epidemic was halted. The vaccination coverage rate, evaluated by a WHO cluster survey method in people above one year of age, was 95.5%. These results show (i) the failure of selective vaccination, restricted to only at-risk groups, to halt the epidemic; (ii) the efficacy of the mass vaccination campaign aimed at the whole population; and (iii) the feasibility in tropical Africa of such a mass campaign which must be carried out in a few days.

Respiratory viruses and mycoplasma as cofactors for epidemic group A meningococcal meningitis.

To investigate the role of coincident respiratory viral and mycoplasmal agents in the pathogenesis of meningococcal meningitis, we performed a matched case-control study of 62 patients with group A meningococcal meningitis during an epidemic in Chad. Case patients were more likely than controls to have nasal colonization or infection with respiratory viruses and Mycoplasma species (matched odds ratio, 23; 95% confidence interval, 3.1 to 170). Respiratory pathogens were found more commonly in older patients with meningitis (odds ratios were 2.9 for children under age 5 years and 46.5 in those over age 15 years), consistent with the increasing risk of meningitis with age during epidemics. In controls, the presence of respiratory pathogens increased the risk of upper-respiratory-tract symptoms but did not significantly increase meningococcal carriage.