Maternal and Infant Deaths: Chasing Millennium Development Goals 4 and 5

Front cover
......Page 1
Title page
......Page 4
Contents......Page 6
Participants......Page 8
Additional contributors......Page 9
Declarations of personal interest
......Page 11
Preface......Page 12
The Millennium Development Goals......Page 14
Section 1 The size of the
problem......Page 16
Introduction......Page 18
How are maternal deaths identified in developing countries?......Page 19
Finding deaths......Page 20
Identifying maternal deaths......Page 21
Global distribution of maternal deaths......Page 22
Patterns of maternal mortality at subnational levels......Page 24
What are the key differentials of place of maternal death?......Page 27
Types of place of maternal death......Page 28
Co-variates of place of maternal death......Page 29
Conclusion......Page 35
References......Page 38
Progress for neonatal and child survival......Page 44
Where do newborns die?......Page 46
When do newborns die?......Page 50
Delivering solutions for the main causes of neonatal death......Page 51
Tetanus – 72 000 newborn deaths globally......Page 52
Preterm birth complications – 1 044 000 newborn deaths globally......Page 54
Addressing deadly delays in care-seeking......Page 55
Coverage of care and current trends......Page 57
Addressing research gaps......Page 58
Conclusion......Page 59
References......Page 61
Background......Page 64
Beyond the Numbers......Page 66
A continual audit cycle......Page 67
Self-reflective learning......Page 68
Community-based death reviews (verbal autopsies)......Page 69
Facility-based maternal death review......Page 70
Confidential enquiries into maternal deaths......Page 71
Experience to date......Page 72
Conclusion......Page 73
References......Page 74
Introduction......Page 76
Nature of the skilled birth attendant......Page 78
Location of practice......Page 79
Community acceptability......Page 80
Education, training and updating (including upskilling and task shifting)......Page 81
Sufficient employment and sustainable retention, particularly in rural and remote areas......Page 83
Supervision, management and policy infrastructure......Page 85
The Mobile Obstetric Maternal Health Worker and the Midwives and Others with Midwifery Skills initiatives......Page 86
Medical officer of health units in Sri Lanka......Page 88
The 104 Advice hotline in India......Page 89
The need for whole-system thinking......Page 90
Conclusion: learning from what works well......Page 91
Acknowledgement......Page 93
References
......Page 94
Section 2 Clinical problems and solutions –
maternal......Page 98
Aetiology......Page 100
Strategies for preventing postpartum haemorrhage deaths......Page 101
Active management of the third stage of labour......Page 102
Oxytocin and carbetocin......Page 103
Misoprostol......Page 104
Tranexamic acid......Page 105
Umbilical cord injection with oxytocin or prostaglandin......Page 106
Misoprostol......Page 107
Physical treatment......Page 109
Compression anti-shock garments for transfer......Page 110
References......Page 111
Introduction......Page 114
Summary of the impact of HDP on maternal and perinatal deaths......Page 116
Reduction in unplanned pregnancies at the extremes of reproductive age......Page 117
Rest at home......Page 118
Magnesium sulphate......Page 121
Early induction of labour......Page 122
Summary of effective interventions......Page 123
Treatment (delivery)......Page 124
Impact of introducing interventions......Page 125
References......Page 126
Definition......Page 130
Causes of obstructed labour......Page 131
Reducing the risks of obstructed labour......Page 132
Quality of routine care of labour in developing countries......Page 135
The partogram......Page 136
Management options for obstructed labour......Page 137
Maternal morbidity and mortality from obstructed labour......Page 139
Summary......Page 140
References......Page 141
Introduction......Page 146
Definition of puerperal sepsis......Page 147
Epidemiology......Page 148
Aetiology of infection......Page 149
Hand hygiene......Page 151
Surgical asepsis......Page 153
Antibiotics......Page 154
Behavioural and organisational change......Page 155
Understanding organisational and behavioural factors......Page 156
Build a stronger knowledge base on puerperal sepsis and infection control in childbirth......Page 157
References......Page 158
Introduction......Page 164
Mortality and morbidity......Page 165
Unwanted pregnancy, the necessary (but insufficient) step......Page 166
Legal environment......Page 167
Health system constraints......Page 168
Economic and geographic barriers......Page 169
Stigma......Page 170
Scale up the availability of safe and appropriate services......Page 171
Medical abortion service alternatives......Page 172
Designing effective service-based interventions where abortion is legally restricted......Page 173
References......Page 174
HIV, tuberculosis and the Millennium Development Goals......Page 178
Saving children......Page 179
Saving mothers......Page 181
Reducing HIV-related maternal mortality......Page 183
HIV, TB and pregnancy......Page 184
Reducing the impact of HIV......Page 185
References......Page 186
The impact and importance of safe anaesthesia in obstetric care......Page 192
Non-doctor anaesthesia – a possible solution?......Page 193
Continuing professional development......Page 194
Monitoring equipment and drugs......Page 195
Training of non-doctor anaesthetists......Page 196
Summary......Page 197
References......Page 199
Section 3 Clinical problems
and solutions – neonatal......Page 200
Introduction......Page 202
Why integrate in primary care settings?......Page 203
Integrating maternal and newborn health in primary care settings......Page 204
Promotion of early and exclusive breastfeeding......Page 207
Cord care in newborn infants......Page 208
Kangaroo mother care......Page 209
Emollient use in newborns......Page 210
Community treatment of infection in newborns (including antibiotics for pneumonia and sepsis)......Page 211
Community support groups and packages of care......Page 213
References......Page 216
Progress towards maternal and child survival......Page 220
Evidence for community health worker interventions to reduce newborn mortality......Page 221
Community mobilisation through women’s groups for newborn survival......Page 222
Fertility reduction......Page 224
Financial incentives to seek care......Page 225
Improving access to life-saving drugs in the community......Page 226
Investment in maternal and newborn health programmes......Page 227
Acknowledgements......Page 228
References......Page 229
Section 4
Training and development......Page 232
Introduction: capacity development challenges and complexities......Page 234
What does capacity development mean?......Page 235
Gender inequities and capacity development......Page 236
The place of education in capacity development......Page 237
Sustainable solutions – is any attendance better than no attendance?......Page 238
Scaling up......Page 239
Strengthening in-country professional associations......Page 240
References......Page 241
Introduction......Page 244
Essential obstetric and newborn care......Page 245
Measuring availability of essential obstetric and newborn care......Page 246
Training for essential obstetric and newborn care......Page 249
Monitoring and evaluation of training in essential obstetric and newborn care......Page 251
References......Page 253
MRCOG......Page 256
Multiprofessional learning......Page 257
The AAGBI......Page 258
Potential future roles......Page 259
Introduction......Page 260
International networks......Page 261
WHO Collaborating Centre for Midwifery......Page 262
Background......Page 263
RCPCH International Strategy......Page 264
Africa......Page 265
South Asia......Page 266
Middle East......Page 267
References......Page 268
Section 5 Specific challenges
in specific countries......Page 270
Introduction......Page 272
Mortality and morbidity......Page 273
Other reproductive and maternal health indicators......Page 276
Skilled attendance at delivery......Page 278
Access to and quality of maternal health services......Page 279
Politics, religion and culture......Page 280
Education – general and medical......Page 282
Government policies regarding maternal health and other agency involvement......Page 283
Conclusion......Page 284
References......Page 285
Maternal mortality......Page 288
Child mortality......Page 291
HIV/AIDS......Page 293
Policy-level challenges......Page 294
Challenges at the health-system level......Page 295
Challenges at the population level......Page 296
Implementation of the recommendations of the maternal and perinatal mortality study......Page 297
References......Page 298
Maternal mortality levels......Page 302
Stillbirth and neonatal mortality levels......Page 303
Availability of normal delivery services and emergency care......Page 305
Use of delivery care: where women deliver and who delivers them......Page 307
Use of emergency care and referral......Page 308
Barriers to use of normal delivery services and emergency care......Page 309
Availability of antenatal care tetanus toxoid and postnatal care......Page 310
Antenatal care quality......Page 311
Fertility patterns, contraceptive use and abortion......Page 312
Dayas......Page 314
Quality of care......Page 315
Fertility and abortion......Page 316
Conclusion......Page 317
References......Page 318
Introduction......Page 322
Key interventions......Page 324
Trends towards achieving MDGs 4 and 5 in Sri Lanka......Page 325
Health interventions......Page 327
Newborn and child care......Page 328
Conclusion......Page 329
References......Page 330
Section 6
Consensus views......Page 332
Treatment of postpartum haemorrhage......Page 334
Symphysiotomy......Page 335
Family medicine practitioners......Page 336
Index......Page 338