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Biomedical subjects

M A Koblinsky

Publications and source records attributed to M A Koblinsky.

10 recordsLinked to original sources
PubMed1999

Organizing delivery care: what works for safe motherhood?

The various means of delivering essential obstetric services are described for settings in which the maternal mortality ratio is relatively low. This review yields four basic models of care, which are best described by organizational characteristics relating to where women give birth and who performs deliveries. In Model 1, deliveries are conducted at home by a community member who has received brief training. In Model 2, delivery takes place at home but is performed by a professional. In Model 3, delivery is performed by a professional in a basic essential obstetric care facility, and in Model 4 all women give birth in a comprehensive essential obstetric care facility with the help of professionals. In each of these models it is assumed that providers do not increase the risk to women, either iatrogenically or through traditional practices. Although there have been some successes with Model 1, there is no evidence that it can provide a maternal mortality ratio under 100 per 100,000 live births. If strong referral mechanisms are in place the introduction of a professional attendant can lead to a marked reduction in the maternal mortality ratio. Countries using Models 2-4, involving the use of professional attendants at delivery, have reduced maternal mortality ratios to 50 or less per 100,000. However, Model 4, although arguably the most advanced, does not necessarily reduce the maternal mortality ratio to less than 100 per 100,000. It appears that not all countries are ready to adopt Model 4, and its affordability by many developing countries is doubtful. There are few data making it possible to determine which configuration with professional attendance is the most cost-effective, and what the constraints are with respect to training, skill maintenance, supervision, regulation, acceptability to women, and other criteria. A successful transition to Models 2-4 requires strong links with the community through either traditional providers or popular demand.

Delivery of Health Care↗
PubMed1995

Beyond maternal mortality--magnitude, interrelationship, and consequences of women's health, pregnancy-related complications and nutritional status on pregnancy outcomes.

The magnitude of maternal mortality in developing countries and its disparity with similar statistics from the developed world has touched a responsive chord among policy makers and health services program officials. What is not well appreciated, however, is that maternal mortality is only the tip of the iceberg--for every one maternal death, acute obstetrical complications cause suffering in nearly 100 women, 250 women contract a sexually transmitted disease, and 1000 women suffer stunting and/or anemia. All of these problems impact on the pregnancy outcome, both for the woman as well as for the newborn. Through a review of the literature, the magnitude, interrelationships and consequences of these various problems are described. The woman and the newborn are a dyad, a unit; what affects the woman typically affects the fetus and is manifest in the newborn. Safe motherhood programs need to pay attention to both, realizing that interventions aimed at the women can benefit the next generation.

Developing Countries↗
PubMed1994

Programming for safe motherhood: a guide to action.

The Safe Motherhood Initiative has successfully stimulated much interest in reducing maternal mortality. To accelerate programme implementation, this paper reviews lessons learned from the experience of industrial countries and from demonstration projects in developing countries, and proposes intervention strategies of policy dialogue, improved services and behavioural change. A typological approach with three hypothetical settings from resource poor to resource rich environments is used to address the variability in health behaviours and infrastructure encountered when programming for safe motherhood.

Delivery, Obstetric↗
PubMedDate not supplied

Helping managers to manage: work schedules of field-workers in rural Bangladesh.

The Maternal-Child Health/Family Planning (MCH/FP) Extension Project in Bangladesh identifies and examines barriers to implementation of the national MCH/FP program, and determines strategies to overcome them. This study analyzes field-workers' ability to carry out more tasks than they do presently, and how their performance might be improved when additional field-workers are hired. In two experimental subdistricts, researchers observed the work of family welfare assistants (FWAs), the female family planning field-workers, to determine the duration and frequency of their home visits with village women and the content of their exchanges. While many factors influence the FWA's work, researchers found that the preplanned monthly work schedules could be manipulated relatively easily to improve duration and frequency of program contact with village women. With more time available to spend with women, the potential to improve the quality of services is enhanced.

Bangladesh↗
PubMedDate not supplied

Client relations in South Asia: programmatic and societal determinants.

Client relations constitute a neglected area of research in family planning. Findings from studies in northern India and Bangladesh reveal considerable variation in both the quantity and quality of contacts in programs that function under roughly comparable socioeconomic conditions. Client relations are determined by a complex set of forces in which both programmatic factors and conditions pertaining to the societal environment play a key role. Worker-client exchanges have a net, incremental effect on contraceptive use.

Bangladesh↗
PubMedDate not supplied

Funding for reproductive research: the status and the needs.

Just to maintain the admittedly inadequate level of research in reproduction and contraceptive development attained in 1974 would require an investment of $143 million this year--a level that has not been reached. To take advantage of existing knowledge, at least $361 million would be required--increasing to $498 million by 1980. To achieve a high-priority research program--10 percent of health expenditures--would require $500 million this year--rising to $766 million by 1980.

Contraception↗