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C Ronsmans

Publications and source records attributed to C Ronsmans.

At least 19 recordsLinked to original sources
PubMed2000

Deaths attributable to childbearing in Matlab, Bangladesh: indirect causes of maternal mortality questioned.

Little is known about the nature of diseases aggravated by pregnancy or the magnitude of mortality from causes indirectly related to pregnancy. This study aims at clarifying the contribution of indirect causes to maternal mortality by analyzing the problem from an epidemiologic perspective, using population-based data from Matlab, Bangladesh, for the period 1976-1993. The time spent during pregnancy and the puerperium was considered a transitory exposure period in women's lives, and death rates were calculated for women aged 15-44 years, while exposed and while not exposed. During or shortly after pregnancy, death rates from all causes are more than twice as high as outside this period. Once direct obstetric causes and injuries are excluded, the death rates among women while exposed are substantially lower than the death rates among women while not exposed. Several interpretations of this finding are discussed, particularly the role of selective factors ("healthy pregnant woman effect"?). This study highlights the complexity of the concept of indirect causes of maternal mortality and clearly illustrates the inherent difficulties in estimating the excess risk of death attached to pregnancy and the puerperium.

Adolescent↗
PubMed2000

Prenatal screening in rural Bangladesh: from prediction to care.

The role of antenatal care is being increasingly questioned, particularly in resource poor environments. The low predictability of antenatal markers for adverse maternal outcomes has led some to reject antenatal care as an efficient strategy in the fight against maternal and perinatal mortality. Few studies, however, have assessed the predictability of adverse outcomes other than dystocia or perinatal death, and most studies have been hospital based. This population-based cohort study was undertaken to assess whether prenatal screening can identify women at risk of severe labour or delivery complications in a rural area in Bangladesh. Antenatal risk markers, signs and symptoms were assessed for their association with severe maternal complications including dystocia, malpresentation, haemorrhage, hypertensive diseases, twin delivery and death. The results of the study suggest that antenatal screening by trained midwives fails to adequately distinguish women who will need special care during labour and delivery from those who will not need such care. The large majority of the women with dystocia or haemorrhage had no warning signs during pregnancy. A single blood pressure measurement and the assessment of fundal height, on the other hand, may detect a substantial number of women with hypertensive diseases and twin pregnancies. In addition, women who had an antenatal visit were four times more likely to deliver with a midwife than women who had no antenatal visit. Antenatal care may not be an efficient strategy to identify those most in need for obstetric service delivery, but if promoted in concurrence with effective emergency obstetric care, and delivered in skilled hands, it may become an effective instrument to facilitate better use of emergency obstetric care services.

Adult↗
PubMed1999

Use of hospital data for Safe Motherhood programmes in south Kalimantan, Indonesia.

The evaluation of Safe Motherhood programmes has been hampered by difficulties in measuring the preferred outcomes of maternal mortality and morbidity. The need for adequate indicators has led researchers and programme managers alike to resort to indicators of utilization and quality of health services. In this study we assess the magnitude of four indicators of use of essential obstetric care (EOC) and one indicator of quality of care in health facilities in three districts in South Kalimantan, Indonesia. The general picture which emerges for South Kalimantan is that the use of obstetric services is low. Even in the more urban district of Banjar where facility-based coverage is highest, fewer than 14% of all deliveries take place in an EOC facility, 2% of expected births are admitted to such a facility with a major obstetric intervention (MOI), and 1% of expected births have an MOI for an absolute maternal indication. The use of facility-based EOC is consistently lower in Barito Kuala compared to the other districts, and the differences persist regardless of the indicators used. In this setting with low utilization rates, general rates of utilization of EOC facilities seem to be as satisfactory an indicator of relative access to EOC as more elaborate indicators specifying the reasons for admission. The inequalities in access to care revealed by the various indicators of use of EOC services may prove to be a more powerful stimulus for change than the widely reported and highly inaccurate accounts of the high levels of maternal mortality.

Delivery, Obstetric↗
PubMed1998

A comparison of three verbal autopsy methods to ascertain levels and causes of maternal deaths in Matlab, Bangladesh.

BACKGROUND: Verbal autopsies have been widely used to determine the levels and causes of maternal death but few studies have assessed the reliability of various methods. METHODS: We compared the levels and causes of maternal mortality in three data sources from Matlab, Bangladesh: (1) maternal deaths identified through a unique demographic surveillance system (DSS); (2) maternal deaths identified as a result of a previous detailed investigation into the levels and causes of maternal mortality; and (3) maternal deaths identified in the current special study. All studies used lay reporting, but differed in terms of the nature of the study, the sex of the interviewer, the format of the questionnaire and the procedure to derive the diagnosis. RESULTS: There were substantial disagreements between the routine reporting and the special studies. The DSS identified 67.2% of all deaths occurring during pregnancy or within 42 days postpartum (82.3% of direct obstetric deaths, 70.0% of deaths due to induced abortions and 42.4% of indirect obstetric deaths). Extending the definition of maternal deaths to 90 days postpartum increased the numbers of maternal deaths between 1987 and 1993 from 174 to 196. The two special studies also disagreed in the ascertainment of the causes of maternal deaths and yielded different cause of death distributions; the proportion of direct obstetric deaths (excluding abortion) was 50.4% in the current system compared to 44.5% previously (P = 0.001). CONCLUSIONS: This study confirms the known difficulties in the ascertainment of the levels and causes of maternal mortality. The large disparities in the levels and causes of maternal mortality using three different methods of lay reporting in a population with an almost complete vital registration system add to the growing concern about the inaccuracies in the measurement of maternal mortality.

Bangladesh↗
PubMed1998

Short birth intervals don't kill women: evidence from Matlab, Bangladesh.

No previously published study has provided evidence to support the frequently made assertion that closely spaced births increase the risk of maternal death. This study reviews the literature for evidence supporting an association between short birth intervals and maternal mortality and presents empirical evidence to address the question of whether short birth-to-conception intervals alter the risk of maternal death. In this nested case-controls study selected from a cohort of women under demographic surveillance in Matlab, Bangladesh, the length of the preceding birth-to-conception interval is found not to affect the risk of maternal mortality. These results do not support the claim that births that are too close increase the risk of maternal death.

Adolescent↗
PubMed1997

Women's recall of obstetric complications in south Kalimantan, Indonesia.

The search for indicators for monitoring progress toward safe motherhood has prompted research into population-based measures of obstetric morbidity. One possible such measure is based on women's reports of their past childbirth experiences. In this prospective study in three hospitals in South Kalimantan, Indonesia, the accuracy of women's reporting of severe birth-related complications was examined. The findings of this study suggest that poor agreement exists between the way women report their experience of childbirth and the way doctors diagnose obstetric problems, although the degree of agreement varies with the type of complication. Questionnaires relying on women's experience of childbirth will tend to overestimate the prevalence of medically diagnosed obstetric problems such as those associated with excessive vaginal bleeding or dysfunctional labor. Questions suggestive of eclampsia may be more promising, although the small number of eclamptic women in this study precludes firm conclusions.

Adult↗
PubMed1996

Demonstrating programme impact on maternal mortality.

Reducing maternal mortality if one of the primary goals of safe mother hood programmes in developing countries. Maternal mortality is not, however, a feasible outcome indicator with which to judge the success of these programmes. This is due to an unfortunate combination of obstacles to measurement--some general to assessing the mortality impact of health programmes and some peculiar to estimating maternal mortality. There is a need to promote alternative views and measures of programme success, and alternative uses for information on maternal deaths.

Developing Countries↗
PubMed1996

Birth spacing and child survival in rural Senegal.

BACKGROUND: Studies examining the associations between short birth spacing and child mortality have often concentrated on the strength of the associations whilst the public health importance of short spacing in specific communities has received less attention. This study re-examines the association between short birth intervals and child mortality in rural Senegal and discusses the potential direct effects of efforts to delay births on child mortality in this community. METHODS: The study uses longitudinal data in a cohort of 4852 children born between 1983 and 1989. The associations between birth spacing and child mortality are examined using logistic and Cox proportional hazards regression models. RESULTS: The probability of dying before age five is 224 per 1000 livebirths. The median interval between births is 33 months and only 12% of the birth intervals are less than 24 months in length. The odds of dying in the neonatal and post-neonatal period is 2.27 and 2.12 times higher respectively for children born after preceding birth intervals of one year or less compared to children born after longer intervals. Children born within two years of a subsequent birth are at 4.09 times higher risk of dying in the second year of life than children whose mother gave birth more than 2 years after the index birth. CONCLUSIONS: In this community where prolonged breastfeeding causes women to space their births at long intervals, short birth intervals are a consequence rather than a cause of child mortality and the potential direct effects of birth spacing efforts on child mortality are limited. To reduce the high levels of child mortality, efforts will have to be made to ensure effective preventive and curative health services, and to maintain the traditional pattern of breastfeeding.

Birth Intervals↗
PubMed1996

Clinical algorithms for the screening of Chlamydia trachomatis in Turkish women.

OBJECTIVE: To test the diagnostic validity of clinical algorithms for the detection of Chlamydia trachomatis in an urban population of married women in Turkey. DESIGN: Cross-sectional population-based survey. SUBJECTS: A systematic sample of 867 women who reported the use of contraceptive methods. MAIN OUTCOME MEASURES: Sensitivity, specificity and positive predictive value of clinical algorithms for the diagnosis of C trachomatis. RESULTS: C trachomatis was diagnosed in 4.89% of the women. The WHO algorithm for use in settings where no vaginal examination could be performed had a sensitivity of 9% and a specificity of 96%. The corresponding figures for the WHO algorithm incorporating the findings of a speculum examination were 47% and 56% respectively. Algorithms incorporating symptoms or signs other than those suggested by the WHO did not yield satisfactory standards of validity. CONCLUSIONS: The findings of this study do not support the widespread introduction of the use of clinical decision models for screening of women for chlamydia infection in primary health care settings such as family planning or antenatal clinics. The large number of false positive results with the use of the clinical algorithms tested in this study would cause unnecessary costs to the health system and unnecessary interventions to the women treated.

Adult↗
PubMed1993

Risk factors for mortality in the Bangladesh cyclone of 1991.

Cyclones continue to pose a dangerous threat to the coastal populations of Bangladesh, despite improvements in disaster control procedures. After 138,000 persons died in the April 1991 cyclone, we carried out a rapid epidemiological assessment to determine factors associated with cyclone-related mortality and to identify prevention strategies. A nonrandom survey of 45 housing clusters comprising 1123 persons showed that mortality was greatest among under-10-year-olds (26%) and women older than 40 years (31%). Nearly 22% of persons who did not reach a concrete or brick structure died, whereas all persons who sought refuge in such structures survived. Future cyclone-associated mortality in Bangladesh could be prevented by more effective warnings leading to an earlier response, better access to designated cyclone shelters, and improved preparedness in high-risk communities. In particular, deaths among women and under-10-year-olds could be reduced by ensuring that they are given special attention by families, neighbours, local authorities, and especially those in charge of early warnings and emergency evacuation.

Adult↗
PubMed1992

Antimicrobial resistance of Shigella isolates in Bangladesh, 1983-1990: increasing frequency of strains multiply resistant to ampicillin, trimethoprim-sulfamethoxazole, and nalidixic acid.

The susceptibility to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ) was determined for 15,824 isolates of Shigella obtained from patients attending a treatment center in Dhaka, Bangladesh, from 1983 through 1990 and for 520 isolates obtained during community surveys from 1988 through 1990. Susceptibility to nalidixic acid was determined for isolates obtained after 1985. In 1983 13% of isolates were resistant to ampicillin, 23.5% to TMP-SMZ, and 0.8% to both drugs. By 1990 51.2% of isolates obtained at the Diarrhea Treatment Centre were resistant to ampicillin, 47.7% to TMP-SMZ, and 40.5% to both drugs (for comparison with figures for 1983, P less than .001). Resistance to nalidixic acid increased from 0.8% in 1986 to 20.2% in 1990 (P less than .001). In 1990 71.5% of Shigella dysenteriae type 1 isolates were resistant to ampicillin, 68.5% to TMP-SMZ, 67.7% to both drugs, and 57.9% to nalidixic acid. The resistance pattern of isolates obtained during community surveillance was similar to that of Treatment Centre isolates. In Bangladesh ampicillin and TMP-SMZ are no longer useful for treatment of infection with any species of Shigella, and nalidixic acid is no longer useful for treatment of infections due to S. dysenteriae type 1.

Ampicillin Resistance↗