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REACHING MATERNAL AND CHILD HEALTH MDG’S THROUGH A MULTI- SECTORAL APPROACH MODEL FOR HEALTH AND DEVELOPMENT IN RURAL INDIA
Somasundaram K. V.,Vidyadhar B Bangal,Ashok Patil,Prasanna Dhore
International Journal of Biomedical Research , 2012, DOI: 10.7439/ijbr.v3i3.215
Abstract: Introduction- Antenatal care is an essential component of health care delivery system in pregnant women.It is the most effective and proven strategy for optimum pregnancy outcome. Large disparities still exist in providing pregnant women with antenatal care and skilled assistance during delivery. The national Family Health Survey(2006) revealed that,only 52 percent of women receive 3 antenatal contacts and 42 percent receive any postnatal care.Largest number of births in the world are reported from India per year (27 millions).Poor women in rural and remote areas are least likely to receive adequate care due to various adversities. Methodology- Multisectoral health and developmental project was implemented in 235 underserved and tribal villages of Ahmednagar district of Maharashtra,India for the period of four years(2006-2009).Two hundred sixty five trained female health volunteers( FHVs) and TBA‘s received structured training and were equipped with disposable delivery kits(DDKs). The nine rural health centers(RHCs) and five mobile clinics(MCs) were established in the project area.A referal linkage was developed between villages and a tertiary care center. Results- Early ANC registration increased from 52% to 63% , full ANC coverage increased from 51 % to 78%, percentage of institutional deliveries increased from 40% to 74%,percentage of home deliveries attended by TBAs increased from 70% to 91% during the study period.MMR declined from 350 per 100,000 live births/650 in tribal areas to 117 per 100,000 live births/ in tribal areas).IMR declined from 80 per 1000 live births/110 in tribal areas) to 43 per 1000 live births/in tribal areas.
Responding to the maternal health care challenge: The Ethiopian Health Extension Program
M Koblinsky, F Tain, A Gaym, A Karim, M Carnell, S Tesfaye
Ethiopian Journal of Health Development , 2010,
Abstract: Background: Responding to challenges in achieving Millennium Development Goals (MDG), the Ethiopian government initiated the Health Extension Program in 2003 as part of the Health Sector Development Program (HSDP) to improve equitable access to preventive, promotive and select curative health interventions through paid community level health extension workers. Objective: To explore Ethiopia’s progress toward achieving MDG 5 that focuses on improved maternal health through the Health Extension Program. Methods: This paper reviews available survey data and literature to determine the feasibility of reaching the targets specified for MDG 5 and for HSDP. Important findings: Achieving the set targets is a daunting task despite reaching the physical targets of two health extension workers per kebele. The 2015 MDG target for the Maternal Mortality Ratio (MMR) is 218 while the 2005 MMR estimate is 673. The HSDP target is 32% skilled birth attendant use by 2010 but only about 12% use was found in the four most populated regions of the country in 2009. Conclusions: Accelerating progress towards these targets is possible through the Health Extension Program at the worker level through improved promotion of family planning and specific maternal interventions, such as misoprostol for active management of third stage of labor, immediate postpartum visits, and improved coordination from community to referral level. [Ethiop. J. Health Dev. 2010;24 Special Issue 1:105-109]
Inequities in utilization of maternal health interventions in Namibia: implications for progress towards MDG 5 targets
Eyob Zere, Prosper Tumusiime, Oladapo Walker, Joses Kirigia, Chris Mwikisa, Thomas Mbeeli
International Journal for Equity in Health , 2010, DOI: 10.1186/1475-9276-9-16
Abstract: Data from the Namibia Demographic and Health Survey 2006-07 are analyzed for inequities in the utilization of maternal health. In measuring the inequities, rate-ratios, concentration curves and concentration indices are used.Regions with relatively high human development index have the highest rates of delivery by skilled health service providers. The rate of caesarean section in women with post secondary education is about seven times that of women with no education. Women in urban areas are delivered by skilled providers 30% more than their rural counterparts. The rich use the public health facilities 30% more than the poor for child delivery.Most of the indicators such as delivery by trained health providers, delivery by caesarean section and postnatal care show inequities favoring the most educated, urban areas, regions with high human development indices and the wealthy. In the presence of inequities, it is difficult to achieve a significant reduction in the maternal mortality ratio needed to realize the MDG 5 targets so long as a large segment of society has inadequate access to essential maternal health services and other basic social services. Addressing inequities in access to maternal health services should not only be seen as a health systems issue. The social determinants of health have to be tackled through multi-sectoral approaches in line with the principles of Primary Health Care and the recommendations of the Commission on Social Determinants of Health.There has been a heightened concern for socio-economic inequalities in health and access to health care and the social determinants of health as countries progress towards the target date for achieving the Millennium Development Goals (MDGs) [1]. There is increasing evidence demonstrating that the poor and marginalized segments of society have the worst health status and access to health enhancing interventions [2-5]. Access to health care still follows the inverse care law, where the wealthiest that
Maternal health and human rights
YE Ratsma, J Malongo
Malawi Medical Journal , 2009,
Abstract: In Malawi the maternal mortality ratio is extremely high. Since almost all maternal deaths are avoidable, maternal mortality is also an issue of human rights. This paper examines the root causes of high maternal mortality in Malawi and applies a human rights-based approach to the reduction of maternal mortality. It recommends roles for the various duty-bearers. It describes indicators to monitor and evaluate the strategy and suggests how transparency and accountability should be ensured. In conclusion, full and effective implementation of the strategy is indispensable for achieving the fifth Millennium Development Goal that calls for the reduction of maternal mortality.
Rostral growth of commissural axons requires the cell adhesion molecule MDGA2
Pascal Joset, Andrin Wacker, Régis Babey, Esther A Ingold, Irwin Andermatt, Esther T Stoeckli, Matthias Gesemann
Neural Development , 2011, DOI: 10.1186/1749-8104-6-22
Abstract: MDGA2, a recently discovered cell adhesion molecule of the IgCAM superfamily, is highly expressed in dorsolaterally located (dI1) spinal interneurons. Functional studies inactivating MDGA2 by RNA interference (RNAi) or function-blocking antibodies demonstrate that either treatment results in a lack of commissural axon growth along the longitudinal axis. Moreover, results from RNAi experiments targeting the contralateral side together with binding studies suggest that homophilic MDGA2 interactions between ipsilaterally projecting axons and post-crossing commissural axons may be the basis of axonal growth along the longitudinal axis.Directed axonal growth of dorsal commissural interneurons requires an elaborate mixture of instructive (guidance) and permissive (outgrowth supporting) molecules. While Wnt and Sonic hedgehog (Shh) signalling pathways have been shown to specify the growth direction of post-crossing commissural axons, our study now provides evidence that homophilic MDGA2 interactions are essential for axonal extension along the longitudinal axis. Interestingly, so far each part of the complex axonal trajectory of commissural axons uses its own set of guidance and growth-promoting molecules, possibly explaining why such a high number of molecules influencing the growth pattern of commissural interneurons has been identified.For its function the mammalian central nervous system depends on precisely organized neuronal circuits. Synaptic connections between the cells of a circuit are established during development when axonal growth cones grow along specific pathways, reaching even very distant targets with exceptionally high precision. A combination of cell adhesion molecules, surface receptors and axon guidance molecules enables the growth cone to invade permissive areas and grow along specific molecular gradients [1,2]. Long distances are covered by splitting the entire trajectory into smaller segments with intermediate targets [3]. Such intermediate targets
Situation of Maternal Health Care Services in Bangladesh
Prosannajid Sarkar,K.M. Mustafizur Rahman
The Social Sciences , 2013,
Abstract: Improvement of the reproductive health status of women in the third world is being considered as one of the most important goals of human and social development. Bangladesh has achieved health gains over the last decade of the 20th century. However, equivalent program has not been realized in the area of maternal health. Despite the presence of an impressive establishment of the health infrastructure in the country to date the maternal health situation remains poor. Even through, the most maternal deaths are avoidable if adequate preventive observed are taken. Increasing the proportion of maternal health care services is being advocated as an important step in preventing maternal death.
An Exploratory Evaluation on Sectoral Funds of Health Uma avalia o exploratória do Fundo Setorial da Saúde
Thiago Caliari Silva,Ricardo Machado Ruiz
Revista Brasileira de Inova??o , 2011,
Abstract: The Sectoral Funds (SF), included in the context of National Fund of Technological and Scientific Development, meant a important change to Brazilian technological funding, treating industrial sectors within its peculiarities. The aim of this work is to study the sectoral fund of Health (CT-Saúde), using unpublished base data provided by Ministry of Science and Technology and Financier of Studies and Projects. The main results shows (i) small participation of the sectoral fund of health in the Health system of innovation; (ii) closer aims to health public politics (specifically SUS necessities); (iii) small relevance of industrial firms and little interaction among these firms and universities and research institutes and (iv) fragmentation of funding strategies. Resumo A institui o dos Fundos Setoriais (FS), no contexto do Fundo Nacional de Desenvolvimento Científico e Tecnológico (FNDCT), significou uma mudan a importante no financiamento tecnológico brasileiro, por tratar setores industriais dentro de suas particularidades e por garantir estabilidade ao financiamento. O objetivo do presente artigo é estudar o Fundo Setorial da Saúde (CT-Saúde), valendo-se de base de dados inédita disponibilizada pelo Ministério da Ciência e Tecnologia e pela Financiadora de Estudos e Projetos. Entre os principais resultados, podem ser destacados: participa o modesta do CT-Saúde nos financiamentos ao Sistema Setorial de Inova o da Saúde; objetivos próximos às políticas de saúde pública (especificamente em rela o às necessidades do SUS); baixa relevancia das empresas industriais, bem como pouca intera o entre estas e universidades e institutos de pesquisa; e fragmenta o das estratégias de financiamento.
Perceptions and viewpoints on proceedings of the Fifteenth Assembly of Heads of State and Government of the African Union Debate on Maternal, Newborn and Child Health and Development, 25–27 July 2010, Kampala, Uganda  [cached]
Sambo Luis,Kirigia Joses,Ki-Zerbo Georges
BMC Proceedings , 2011, DOI: 10.1186/1753-6561-5-s5-s1
Abstract: Background Out of 358000 maternal deaths that occurred globally in 2008, 57.8% occurred in continental Africa. Africa had a maternal mortality ratio of 590 compared to 14 in developed regions, 68 in Latin America and Caribbean, and 190 in Asia. This article reflects on the discussions held during the Fifteenth Assembly of the Heads of State and Government of the African Union on the reasons why the maternal mortality ratio is so high in Africa and what can be done to reduce it. Methods Methods employed included panel and open public discussions among the Heads of State and Government of the African Union. The article uses the WHO health systems strengthening framework, which consists of six pillars (information systems, leadership and governance, health workforce, financing, and medical products, vaccines and technologies, and health services) to describe the proceedings of the discussions. Discussion The high maternal mortality ratios in countries were attributed to weak national health information systems; leadership and governance challenges related to poverty, health illiteracy, poor transport networks and communications infrastructure, risky cultural practices, armed conflicts and domestic violence, dearth of women empowerment; inadequate levels of skilled birth attendants; inadequate domestic and external funding; stock-outs of consumable inputs; and limited coverage of maternal and child health interventions. In order to accelerate progress towards MDGs 4 and 5, the Heads of State and Government recommended that countries should make maternal deaths notifiable and institutionalize maternal death audits; develop, fund and implement policies and strategies geared at improving maternal, newborn and child health; accelerate inter-sectoral action to address the broad health determinants; increase the number of skilled birth attendants; fulfil commitment to allocate at least 15% of the national budget to the health sector and allocate adequate resources to prevent stock-outs of essential medicines and reproductive health commodities; leverage health promotion approaches to raise national awareness; and ensure that there is a health centre within a radius of four kilometres equipped to provide good quality integrated maternal, newborn and child health services. Conclusions There was consensus among the discussants that there was urgent need to speed up actions for strengthening health systems to improve coverage of maternal, newborn and child health services; and to address broad determinants of women, newborn and children’s health for sustaine
Towards the Elimination of Pediatric HIV: Enhancing Maternal, Sexual, and Reproductive Health Services  [cached]
Alana F. Hairston, MSc,Emily A. Bobrow, PhD, MPH,Christian S. Pitter, MD, MPH
International Journal of MCH and AIDS , 2012,
Abstract: Almost 10 years ago, the United Nations adopted a comprehensive, four-pronged approach for the prevention of mother-to-child transmission of HIV (PMTCT). Despite all four prongs being central to the elimination of pediatric HIV, and the health of the mother being critical to reaching this goal, PMTCT programs have historically focused more attention on preventing HIV transmission from mother to child (prong 3) than on preventing HIV in women of reproductive age (prong 1) and preventing unintended pregnancies in women living with HIV (prong 2). In this commentary, experts from the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) argue that within the context of efforts to eliminate pediatric HIV, there are many ways to keep women living with HIV alive and at the center of the response to the global epidemic. One of the ways to do this is to enhance maternal and sexual and reproductive health (SRH) services. Within the elimination agenda, integration and linkages between PMTCT and comprehensive SRH services can keep mothers alive and at the center of the response. The commentary highlights some of the foundation’s global health work supporting, evaluating and enhancing maternal and SRH services provided to women living with HIV and proposes concrete actions for donors, researchers, policy makers and program implementers to further enhance maternal and SRH services within the context of PMTCT. If keeping women living with HIV is an integral component of the elimination of pediatric HIV agenda, maternal and SRH research, policies and programs need to be strengthened within the context of PMTCT. Donor funding and priorities for PMTCT also need to be more supportive of primary prevention of HIV infection among women of childbearing age and preventing unintended pregnancies among women living with HIV.
Care seeking for maternal health: challenges remain for poor women
C Warren
Ethiopian Journal of Health Development , 2010,
Abstract: Background: In 2005 a Safe Motherhood Community-Based Survey was carried out on behalf of the Family Health Department to explore community values and practices surrounding pregnancy, childbirth and the postpartum period. Objective: To explore the knowledge, attitudes and beliefs which influence maternal care seeking behaviour and practices in pregnancy and childbirth. Methods: Qualitative data - focus group discussions and in depth interviews with women, men and adolescents- were gathered from communities distributed across Ethiopia’s 11 regions. Data were analysed using Nudist software. Important findings: The location of childbirth involves retaining control of the process and outcome, and securing a safe delivery. The pregnant woman is influenced by her attendants; families only seek care for complications if local or herbal, remedies and prayer are defeated. Timely care seeking is reliant on the knowledge, understanding and financial means of the husband. Distance, cost and lack of support for the cultural practices around birth are impeding factors. Conclusions: Communities are aware of the dangers of giving birth at home. Women are constrained by the distance and cost in reaching and receiving care. Important traditions around birth are not recognised by health providers. Socio-cultural aspects must be addressed and incorporated into the care provided at the health facilities. [Ethiop. J. Health Dev. 2010;24 Special Issue 1:100-104]
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