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B Dujardin

Publications and source records attributed to B Dujardin.

15 recordsLinked to original sources
PubMed1992

Value of the alert and action lines on the partogram.

A partogram based on a World Health Organisation model has been used for many years in the peripheral maternity clinics of Pikine, Senegal, to monitor labour. We have assessed the value of the partogram and efficacy of the alert and action lines. 1022 pregnant women were monitored by partogram during 4 months. The alert line was crossed in 100 (9.8%) of these cases and the frequency of neonatal resuscitation was higher for this group (relative risk 4.0, 95% confidence interval 2.3-7.1; p less than 0.0001), as was the number of "fresh" stillbirths (5.3, 1.8-15.6; p less than 0.01) (recent death may have occurred during labour). Among the women who crossed the alert but not the action line, neonatal resuscitation was also four times more likely than for the normal labour group (4.0, 2.1-7.6; p less than 0.001), and the fresh stillbirth rate was higher but not significantly so. For women who crossed both lines, the fresh stillbirth rate was ten times higher than for women in the normal labour group (9.9, 2.8-34.7; p less than 0.001). Crossing the alert line had a sensitivity of 27%, a specificity of 93%, and a positive predictive value of 17% for neonatal resuscitation. If the action line was chosen as the decision level, the positive predictive value remained the same but the sensitivity was only 8%. Health workers intervened (eg, artificial rupture of the membranes, administration of oxytocics) in half the dystocic cases. Of the women who did not receive any such treatment 44% crossed the action line compared with only 26% of those who did receive treatment (p = 0.06). The results show the usefulness and efficacy of the partogram and underscore the value of medical intervention as soon as the alert line is crossed.

Bias↗
PubMed1992

Epidemiology's contribution to health service management and planning in developing countries: a missing link.

Two hypotheses are examined in the light of experience and the literature: (1) health service planning requires little epidemiological information, and (2) health services rarely get useful answers to relevant epidemiological questions. In the first hypothesis, the theoretical robustness of the concept of a minimum package of activities common to all facilities belonging to the same level of the system and the extent to which it is unaffected by variations in the frequencies of most diseases are examined. Semi-quantitative analyses and analysis of routine entries and participation suffice to adapt this package to the local context. Some of the methods which give a fundamental role to epidemiological information are criticized. With regard to the second hypothesis, the pertinent contributions epidemiology may make to health service organization are reviewed. These include identification of diseases that justify special activities (health maps and interepidemic surveillance), determination of the activities that should be added to the health centres, the political usefulness of rare impact assessments, and the relevant demographic elements. Finally an epidemiological agenda is proposed for specialized centres, districts, universities, and the central decision-making level of health ministries in developing countries.

Adult↗
PubMed1991

[The initiative for a risk-free motherhood: which perspectives?].

The "Safe Motherhood Initiative" started off with a first conference held in Nairobi in February 1987. In 1989, several conferences were organised throughout the world which led to a new current of opinion in favour of maternal health improvement. Governments, decision markers and aid agencies have been called upon to support such Initiative. In this paper, we review the main characteristics of the Safe Motherhood Initiative and analyse two main constraints which were insufficiently discussed during the conferences. The first one is the need to increase the efficiency of the existing health system. The second one is the problem which arises from poor acceptability by the populations of certain health activities promoted by the Initiative. By giving various examples, we describe how these factors may restrict its expected results. Proposals are made to increase the efficacy of the programmes and of activities promoted by the Initiative and to ensure its mid-range continuation. The authors suggest that specific attention and more resources have to be given to achieving specific operational researches, by taking into account the health behaviour of the populations, the characteristics of the existing health services and the resources available. Such research will lead to improved maternal health activities.

Cultural Characteristics↗
PubMed1989

Perinatal geography of Belgium.

The use of routinely collected perinatal data allows calculation of health indicators at regional levels. It helps the health managers in making decisions and provides etiological clues for epidemiology. The information is more easily assimilated with the use of maps. In Belgium, the rates of perinatal mortality, low-birthweight and preterm births vary widely between the districts. Southern districts maintain the highest rates of low-birthweight and preterm births. Even though these two factors account for most perinatal mortality cases, within 20 years, a disproportion of perinatal mortality rates between the north and the south of the country was progressively inversed to the disadvantage of the north. Advances in perinatology of some major services of the southern part may explain a good deal of this change. Discrepancies between low-birthweight and preterm rates in some districts may be explained by biomedical characteristics of ethnic groups concentrated in these areas.

Belgium↗
PubMed1989

[Follow-up of a cohort of premature infants: identification of factors associated with hospital death].

A cohort of premature babies (i.e. under 2.000 g and/or less than 32 weeks of gestation) born in Brussels in 1987, was followed-up during and after their stay at the neonatal unit. Among the 181 babies, 27 hospital deaths were recorded (a rate of 14.9%). Some of the variables significantly associated with hospital deaths (p less than 0.005) are well known, i.e.: birthweight, gestational age, respiratory distress, intraventricular hemorrhage. The strength of the link is measured by the relative risk (RR). For each factor with a significant RR, the positive predictive value (PPV) was also calculated. Not surprisingly, respiratory distress and intraventricular hemorrhage have the highest RR and PPV. More interesting, however, is the relatively high RR of Apgar score at five minutes (the value of which is determined at an early stage). Furthermore, the positive predictive value reaches a level of 35% and may therefore be used for the early detection of babies with a high risk of hospital death.

Birth Weight↗
PubMed1989

A versatile approach to health system evaluation.

Although problems in the relationships between different levels of health care systems in developing countries have a significant influence on efficiency, they have not been clearly defined. In the present article a simple method is described for assessing certain aspects of these problems. It is shown that data collected in a hospital can be used not only to highlight inadequate management of patients at the community level, but also to identify deficiencies at the community/hospital interface. The method is inexpensive and easy to understand, and could easily be adapted for every interface in a system and for all stages of health service development.

Chad↗
PubMed1986

[Neonatal mortality and birth weight. Which strategy for the future?].

In this study the authors analysed the neonatal mortality rates in Belgium in 1981 and 1982. Newborns were grouped into four categories according to their birth weight: 500-1,499 gr (Cat. A), 1,500-2,499 gr (Cat B), 2,500-3,499 gr (Cat C), 3,500 gr or more (Cat D). The distribution of neonatal deaths in those four categories was 33.2% in category A, 29% in category B, 27.3% in category C and 10% in category D. A specific strategy to lower neonatal mortality in each category could be worked out. The authors analysed what priority should be given to each category according to the data found in the literature concerning the following criteria: effectiveness, cost and doing the least damages. They concluded that the present focus on category A, is over done and should not be the strategy to be used at present. The higher neonatal mortality of newborns of category C (2,500-3,499 gr) as compared with the neonatal mortality in category D (3,500 gr and more) is generally underestimated and underanalysed. Reducing this extra mortality could result in lowering Belgium neonatal mortality by 12%. The organisation and accessibility of obstetric care seem to be linked to this higher mortality. In their conclusions the authors suggest other studies and short-term objectives that should be considered in order to lead to a continued lowering in neonatal mortality.

Belgium↗
PubMed1986

[Recent trends in infant mortality. The case of Belgium].

In this study concerning the whole of Belgium, the trends in infant mortality and of its two main components, neonatal mortality (NNM) and post-neonatal mortality (PNNM) from 1960 to 1981 were studied. NNM and PNNM followed similar trends until 1975 when PNNM became steady at a rate of 4-4.5%. On the other hand, an acceleration was observed in the rate of decrease for NNM, from -52% before 1975 to -71% between 1975-1981.

Age Factors↗
PubMed1977

[Human celosomias].

Definition and nomenclature of celosomia are based on a historical review which provides a system of classification. Morphology and organogenesis of celosomia were studied on 64 embryonic and foetal bodies. The anatomical study of 6 cases of human celosomia provided a definition of the characteristics of major celosomia, by showing the constant elements of the syndrome (particularly the parietal malformation) and the anomalies frequently found in each of the different types:--anterior (or superior) celosomia;--middle celosomia, including laparoschisis;--posterior (or inferior) celosomia, among which exstrophy of the bladder may be either one of the constant elements of the syndrome, or a limited form of the inferior celosomia;--total celosomia, of which one case was studied for this report, and of which the major forms, the schistosomia, chelinosomia and strophosomia types, seem to constitute forms of transition with other types of monstruosity. With improved knowledge of anatomy and organogenesis the possibilities of treatment have improved over the past few years, but still remain limited in the more monstrous forms of celosomia.

Abdomen↗