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At least 271 records · Page 15Linked to original sources
PubMed1992

Maternal mortality in the Thyolo District of southern Malawi.

The Sisterhood Method, a community-based survey technique, was used to estimate the Life Time Risk of a woman dying a maternal death in Southern Malawi. With this figure, the maternal mortality ratio for that area was calculated to be 409 deaths per 100,000 live births. The 4124 adults interviewed reported 150 maternal deaths in sisters. An in-depth questionnaire was then used to determine that 56% of these deaths occurred outside a health facility, largely due to lack of transportation or poor access to fixed health care facilities; 25% died from excessive hemorrhage; 20% from obstructed labour; 18% from abortion; 13% from sepsis; while eclampsia accounted for only 4% of the maternal deaths. This field experience with the Sisterhood Method technique combined with an in-depth questionnaire for determining causes of maternal deaths has provided useful information in a simple and cost-effective manner for use in planning intervention strategies designed to decrease maternal mortality.

Adolescent↗
PubMed1992

Intrauterine contraception.

Currently 85 million women use an intrauterine device (IUD), making it the most widely used, reliable, reversible contraceptive method worldwide. Although the exact mechanisms by which copper-bearing IUDs produce contraceptive action are not completely defined, recent evidence indicates that they act primarily to prevent sperm from fertilizing ova. The future of the IUD is brighter than it has been for the past 20 years. The latest generation of IUDs, such as the TCu 380A (Paragard, GynoPharma, Somerville, NJ), are safer and more effective than ever. In World Health Organization large, multicenter trials, pregnancy rates for the TCu 380A are 1.0, 1.4, 1.6, and 1.8 at 3, 5, 7, and 9 years of use, respectively. The ectopic pregnancy rates and removal for pelvic inflammatory disease are very low. The device may soon be the major IUD available in most countries. The acceptability of IUD use can be increased by good clinical management, sympathetic counseling, careful client selection, proper device selection, careful insertion, timing of insertion, and regular follow-up with quick access to medical care.

Aftercare↗
PubMed1992

[Myocardial infarct in motor transport drivers and the results of long-term observations].

As many as 283 drivers with a history of acute myocardial infarction were examined. In the long-term postinfarction period, the number of the able-bodied accounted for 22.8%, the number of persons with restricted work fitness was 43.3%, that of the disabled amounted to 33.9%. It should be noted that about 60% of the able-bodied and those with restricted work fitness returned to the driving-related work. However, in some cases, the type of the trucking was either changed of the work scope was to be minimized. Criteria forming the basis for predicting the recovery of work fitness of the drivers were as follows: non-transmural character of myocardial infarction for the most part, the effective staged rehabilitation program, positive dynamics and smoothing of the ECG signs of myocardial infarction, the lack of areas of regional hypo- and akinesia of the myocardium, normalization of the ejection fraction, high and mean indicators of physical work fitness, exercise tolerance, coronary reserves, functional class I and II angina pectoris of effort, either the lack or initial clinical signs of circulatory failure, psychological readaptation, high occupational class, and labour orientation.

Absenteeism↗
PubMed1992

Causes and consequences of increase in child survival rates: ethnoepidemiology among the Hmong of Thailand.

The Hmong "hill tribe" minority in Thailand has much higher exposure to factors usually associated with risk of child mortality (high fertility, low status of women, low education, less use of modern medical care for births, exposure to warfare, economic and physical disruption, and poor hygienic conditions) than the rural ethnic Thai population. Nonetheless, infant mortality has declined from over 120 per 1000 to under 50 per 1000 live births among both these populations in the past 30 years. The reason for the rapid increase in child survival among the Hmong appears to be better access to and more use of modern curative and preventive medical care associated with road construction rather than major changes in social or hygienic conditions. Conventional wisdom suggests that high fertility is both a cause and a consequence of high infant and child mortality and that parents will not reduce fertility until they see that mortality has declined. Most Hmong parents recognize the decline in child mortality and attribute it to better access to modern medical care. Most Hmong parents also say that, if they were starting to have children now, they would want to have fewer children. Fear of child death is infrequently mentioned as a motive for having more children, and the perceived decline in child mortality is rarely mentioned as a reason for reduced fertility. Most Hmong parents explain their desired family size in terms of economic conditions rather than perceived risk of child mortality. Results of this study suggest that fertility and child mortality can vary independently of one another and that major reductions in child mortality can be accomplished without waiting for major social changes (e.g., improved education or status of women) or major reductions in fertility.

Child Health Services↗
PubMedDate not supplied

Abortion in Europe, 1920-91: a public health perspective.

This article grew out of a keynote address prepared for the conference, "From Abortion to Contraception: Public Health Approaches to Reducing Unwanted Pregnancy and Abortion Through Improved Family Planning Services," held in Tbilisi, Georgia, USSR in October 1990. The article reviews the legal, religious, and medical situation of induced abortion in Europe in historical perspective, and considers access to abortion services, attitudes of health professionals, abortion incidence, morbidity and mortality, the new antiprogestins, the characteristics of abortion seekers, late abortions, postabortion psychological reactions, effects of denied abortion, and repeat abortion. Special attention is focused on the changes occurring in Romania, Albania, and the former Soviet Union, plus the effects of the new conservatism elsewhere in the formerly socialist countries of central and eastern Europe, particularly Poland. Abortion is a social reality that can no more be legislated out of existence than the controversy surrounding it can be stilled. No matter how effective family planning services and practices become, there will always be a need for access to safe abortion services.

Abortion, Induced↗
PubMed1992

The quality assurance-risk management interface.

Involvement with both risk management and quality assurance programs has led many authors to the conclusion that the fundamental differences between these activities are, in fact, very small. "At the point of overlap, it is almost impossible to distinguish the purposes and methods of both functions from one another." "Good risk management includes real improvement in patient care through organized quality assurance activities." The interface between a proactive risk management program and a quality assurance program is dynamic and can serve the legitimate interests of both. There is little to be gained by thinking of them as separate entities and much to be gained by sharing the lessons of both. If one thinks of risk management in terms of "risk" to quality patient care, and that "assuring quality" is the most productive type of risk management, then there is no practical reason to separate one from the other.

Emergency Service, Hospital↗
PubMed1990

Community awareness and utilization of growth chart in a semi-urban Nigerian community.

Five hundred and eighteen mothers resident in Adeta, Sawmill and Baboko Communities of Ilorin Local Government Area of Kwara State, Nigeria, were interviewed to assess their knowledge, utilization, and understanding of the growth chart. Five health facilities in the communities studied were visited to assess the availability, utilization and understanding of growth charts by health workers. Over half (53.7%) of the mothers interviewed have heard about growth charts. The level of awareness was significantly influenced by maternal age, educational status and parity (PLO.OS). Of those who have heard about growth chart, only 155 (55.8%) have it, and 150 of these (96.8%) use it regularly. One hundred and seventy four (33.6%) of all mothers, but 62.6% of those who have heard about the chart demonstrated an understanding of the markings on it. One hundred and sixteen mothers found the growth chart useful for immunization record, nutrition advice, clinic appointment dates, and assessment of developmental milestones. Two of the five health facilities visited had, and used growth charts. The health workers, however, demonstrated a clear understanding of weighing, plotting, and interpretation of the chart, and gave appropriate advice to mothers. Ways of improving growth monitoring in the community using the growth chart are suggested.

Adult↗
PubMed1991

Utilization of village health workers within a primary health care programme in The Gambia.

The utilization of Village Health Workers (VHWs) was studied in a rural area of The Gambia 3 years after the introduction of a village-based Primary Health Care (PHC) programme. Of 23 children who died from conditions treatable at village level, only five were first seen by the VHW. Fourteen were seen elsewhere in the region by staff more qualified than the first tier workers. The implications of this pattern of utilization on the lack of impact of VHWs on mortality are discussed. Only half of the non-fatal illnesses were attended to by VHWs. Reasons for this included such factors as lack of knowledge of services available, shortages of money, absence of the VHW at critical periods and social or political disputes with VHWs. Attempts must be made to tackle these fundamental problems if VHWs are to be successfully incorporated into the health services.

Cause of Death↗
PubMed1991

Microcomputer applications for primary health care in developing countries.

This article explores some ways in which computer technology can be harnessed to strengthen primary health care planning and management, make more efficient use of scare health resources, and maximize the beneficial impact on health of local, district, and national health systems in both developing and developed countries.

Cost-Benefit Analysis↗
PubMedDate not supplied

The Guadeloupean perinatal mortality audit: process, results, and implications.

In 1983, we implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. We investigated all 320 perinatal deaths in Guadeloupe during 1984 and 1985. Nearly one-half of the perinatal deaths reviewed were determined to be related to maternal high blood pressure, maternal/fetal infection, and preterm delivery. Slightly more than one-half of the perinatal deaths were considered to be avoidable. Over the course of the audit, perinatal mortality rates exhibited a marked decline. The findings of this study support claims that perinatal audits with confidential inquiries may help effect change in perinatal health status in a population; the findings also call attention to the potential benefits of incorporating motivational incentives into these activities.

Cause of Death↗