DOCSLIB.ORG

Maternal Health Training Priorities for Nursing and Allied Health Workers in Colombia, Honduras, and Nicaragua

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Maternal Health Training Priorities for Nursing and Allied Health Workers in Colombia, Honduras, and Nicaragua Pan American Journal Original research of Public Health Maternal health training priorities for nursing and allied health workers in Colombia, Honduras, and Nicaragua Amelia J. Brandt,1 Samantha Brown,1 Silvia Helena De Bortoli Cassiani,1 and Fernando Antonio Menezes da Silva1 Suggested citation Brandt AJ, Brown S, De Bortoli Cassiani SH, Menezes da Silva FA. Maternal health training priorities for nursing and allied health workers in Colombia, Honduras, and Nicaragua. Rev Panam Salud Publica. 2019;43:e7. https://doi.org/10.26633/RPSP.2019.7 ABSTRACT Objective. To assess maternal health training priorities for primary care human resources for health (HRH) in nursing and allied health workers in Colombia, Honduras, and Nicaragua, to inform maternal care HRH strategic planning efforts. Methods. This Washington, D.C.–based study utilized cross-sectional survey methodology to collect country-level data. From October 2016 to March 2017, a needs assessment tool was devel- oped by the Pan American Health Organization/World Health Organization (PAHO/WHO) and PAHO/WHO Collaborating Centers. Data collection was completed by PAHO/WHO country offices, in collaboration with national health authorities and other high-level government person- nel. The collected data included information on the composition, capacities, and training priorities of traditional birth attendants (TBAs), community health workers (CHWs), registered nurses (RNs), and auxiliary nurses in the three study countries; the findings were summarized in a report. Results. Data on the health workforce composition in the three countries indicated reliance on HRH with low levels of education and training, with limited integration of TBAs. In all three countries, management of obstetric emergencies was a training priority for RNs, and identification of danger signs was a priority for CHWs and TBAs. Training priorities for aux- iliary nurses varied widely across the three countries and included health promotion, precon- ception and prenatal care, and obstetric emergencies. There was also a wide range in the total number of HRH across the three countries. Conclusions. Reliance on health workers with low levels of training is concerning but can be mitigated through in-service training. Training priorities are consistent with the major causes of maternal mortality, and Latin America and Caribbean region training programs show promise for improving quality of care. In the long term, planning for maternal care HRH should seek to increase the concentration of health professionals that are more highly skilled. Keywords Human resources; maternal health services; primary health care; capacity building; strategic planning; Latin America; Caribbean region; Colombia; Honduras; Nicaragua. 1 Human Resources for Health Unit, Health Preventable pregnancy- or child- In addition, for each maternal death, Systems and Services Department, Pan American at least 30 women suffer complica- Health Organization, Washington, D.C., United birth-related complications kill 830 States of America. Send correspondence to: women daily, with 99% of these deaths tions with potential long-term conse- Amelia Brandt, [email protected] occurring in developing countries (1). quences (1). This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article’s original URL. Rev Panam Salud Publica 43, 2019 1 Original research Brandt et al. • Training priorities for maternal care in nursing/allied health: Colombia, Honduras, and Nicaragua Maternal mortality (MM) in the Amer- achieve sustained and equitable health Paulo. The development of the instru- icas region has dropped by more than in the Americas (17). PAHO/WHO Res- ment was informed by a literature re- 40% in the past 20 years, but these ad- olution CSP29.R15 (Strategy on Human view on maternal health in the Americas vances do not affect all women equally Resources for Universal Access to region and existing tools (19, 20). (2). For example, for 2015, the estimated Health and Health Coverage), approved The Spanish-language instrument maternal mortality ratio (MMR) for the in September 2017 at the 29th Pan Amer- consisted of a 24-page written survey Americas is 52 deaths per 100 000 live ican Sanitary Conference, reaffirms divided into three sections (health care births, but in Latin America and the Ca- PAHO/WHO’s role in providing techni- personnel, training needs, and country ribbean (LAC) it is more than 30% higher cal support to member states to improve resources). The target population in- (68) (3). The estimated MMRs of Colom- capacity for strategic HRH planning cluded four categories of health work- bia, Honduras, and Nicaragua are also (18). This type of strategic planning re- ers providing maternal health care at high at 64 (2014), 129 (2010), and 150 quires the identification of HRH train- the primary care level in LAC countries: (2016) respectively (3). ing priorities in maternal health. traditional birth attendants (TBAs), The MMR varies by ethnicity, socio- In 2016 and 2017, as part of the community health workers (CHWs), economic status, and geography (1, 2). IHSLAC project (Integrated Health Sys- registered nurses (RNs), and auxiliary For example, the 2001 pregnancy-related tems in Latin America and the Caribbe- nurses. These categories were selected mortality ratio in Honduras ranged from an), funded by Global Affairs Canada, a based on consultations with maternal 177 to 277 across different regions of the survey tool was developed to conduct health experts and country offices on country and was higher in those with an assessment of maternal health train- the key nursing and allied health work- high poverty and low development (4). ing priorities for nursing and allied ers providing maternal health services The leading direct cause of MM in the health workers working in the first level in the three countries studied. The four Americas is hemorrhage, closely fol- of care in Colombia, Honduras, and groups were defined as follows using lowed by hypertension (5). The esti- Nicaragua. These three countries were internationally recognized criteria: mated proportion of deaths caused by selected for the study based on the ac- 1) TBA—person without formal educa- hemorrhage is 23.1% (13.3% during post- cessibility of country information, the tion who assists mothers through child- partum, 5.8% during prepartum, and MMR, and the level of interest of the birth using skills learned through 4.1% during intrapartum) (5). PAHO/WHO country offices and na- delivering babies herself or through an Increased access to skilled birth atten- tional health authorities. apprenticeship with other TBAs; 2) dance in low- and middle-income coun- The objective of the study was to assess CHW—community member selected by tries has not led to expected reductions in maternal health training priorities for pri- peers who works in the community to preventable MM and morbidity, possibly mary care HRH in nursing and allied provide care to support health care de- due to a lack of good-quality maternity health workers in Colombia, Honduras, livery and has no formal professional care (6–8). Low-quality services and disre- and Nicaragua, to guide maternal care certificate or degree; 3) RN—individual spectful care can harm women’s health HRH strategic planning efforts. The study who has graduated from a nursing pro- and well-being (9). Quality must be im- was designed to contribute to LAC coun- gram typically lasting three to four proved at all levels of care to continue try efforts to achieve universal access to years and has legal authority to practice progress in reducing MM and morbidity health, universal health coverage, and the as a nurse in his/her country based on (10–12). Highly skilled care does not nec- Sustainable Development Goals (SDGs).2 national regulations and licensing; and essarily lead to improved outcomes, even The assessment was limited to nursing 4) auxiliary nurse—individual with ba- in high-income countries. A review of 13 and allied health workers to match the sic nursing knowledge and, usually, randomized control trials in Australia, scope of the training efforts that will be high school–level training, who may Canada, Ireland, New Zealand, and the informed by the study results. have some on-the-job training but has United Kingdom found that women who no training in nursing decision-making. had midwife-led continuity models of MATERIALS AND METHODS The health care personnel section of care were less likely to experience region- the survey instrument covered in this al analgesia, episiotomy, and intrapartum This study used a cross-sectional report was designed to collect informa- analgesia/anesthesia compared to vari- quantitative survey methodology to col- tion on the general characteristics and ous combinations of care models focused lect country-level data on national ma- scopes of practice for each type of health on highly skilled care (13). ternal HRH needs. worker. The three country-level survey Interventions targeting human re- The survey instrument was devel- respondents were asked to answer cir- sources for health (HRH) in the areas of oped by PAHO/WHO’s Department of cle-response questions and describe, in management, education, and policy Health Systems and Services/Human writing, key capacities for each type of have been shown to improve HRH ca- Resources for Health Unit (HSS/HR) in provider and the scope of their practice pacity and maternal health outcomes collaboration with the following in the country. Both multiple-choice and (14), especially when there is an empha- PAHO/WHO Collaborating Centers: open-ended questions were used to elic- sis on strengthening primary health care University of Chile, University of Mi- it general descriptions related to the (PHC) (15, 16).
Load more

Recommended publications
  • MATERNAL MORTALITY in 2000: Estimates Developed by WHO, UNICEF and UNFPA
    MATERNAL MORTALITY IN 2000: Estimates Developed by WHO, UNICEF and UNFPA Acknowledgements This document was prepared by Carla AbouZahra of WHO and Tessa Wardlawb of UNICEF on the basis of a technical paper originally developed by Kenneth Hill and Yoonjoung Choi, Johns Hopkins University. Valuable inputs and assistance were provided by Colin Mathers, Kenji Shibuya, Nyein Nyein Lwin, Ana Betran and Elisabeth Aahman. Particular thanks to Gareth Jones, Paul Van Look and France Donnay for their guidance, advice and unfailing support. a Coordinator, Advocacy, Communications and Evaluation, Office of the Executive Director, Family and Community Health, WHO, Geneva Correspondence to C. AbouZahr, Family and Community Health, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland. b Senior Project Officer, Statistics and Monitoring, UNICEF, New York MATERNAL MORTALITY IN 2000: Estimates Developed by WHO, UNICEF and UNFPA Page 2 Executive Summary Reduction of maternal mortality is one of the major goals of several recent international conferences and has been included within the Millennium Development Goals (MDGs). However, because measuring maternal mortality is difficult and complex, reliable estimates of the dimensions of the problem are not generally available and assessing progress towards the goal is difficult. In recent years, new ways of measuring maternal mortality have been developed, with the needs and constraints of developing countries in particular in mind. As a result, there is considerably more information available today than was the case even a few years ago. Nonetheless, problems of underreporting and misclassification are endemic to all methods and estimates that are based on household surveys are subject to wide margins of uncertainty because of sample size issues.
    [Show full text]
  • Women's Health and Well-Being in the United Nations Sustainable
    International Journal of Environmental Research and Public Health Article Women’s Health and Well-Being in the United Nations Sustainable Development Goals: A Narrative Review of Achievements and Gaps in the Gulf States Suhad Daher-Nashif 1 and Hiba Bawadi 2,* 1 Population Medicine Department, College of Medicine, QU-health, Qatar University, Doha 2713, Qatar; [email protected] 2 Human Nutrition Department, College of Health Sciences, QU-health, Qatar University, Doha 2713, Qatar * Correspondence: [email protected] Received: 25 November 2019; Accepted: 24 January 2020; Published: 7 February 2020 Abstract: Background: In 2014, United Nations member states proposed a set of sustainable development goals (SDGs) to help further the millennium development goals that they had proposed in New York in 2000. Of these 13 SDGs, Goal 3 (i.e., SDG 3) was titled “Good Health and Well-Being.” This goal highlighted women’s health and well-being via two key objectives. The first, SDG 3.1, aimed to reduce maternal mortality rates (MMR) and the second, SDG 3.7, aimed to ensure access to sexual and reproductive health care services. Drawing on all the latest reports, which have been released by Gulf Cooperation Council states (GCC), this paper sheds light on GCC states’ work on women’s wellbeing through SDG 3. Aim: the paper aims to review GCC states’ work on women’s wellbeing in SDG3, which achievements they obtained, which tools they used and which gaps still exist. The paper aims to explain the socio-cultural background behind these achievements, tools, and gaps. Methodology: For the purpose of this study, we used narrative review approach through which we reviewed reports from 2017 and 2018 on SDGs published online by the Ministry of Development and Planning of each GCC state, and latest reports of the WHO on the same states.
    [Show full text]
  • Maternal Mortality: Evidence Brief
    Maternal mortality Evidence brief To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. Key facts ` Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth. ` 94% of all maternal deaths occur in in low and lower-middle income countries. ` Young adolescents (aged 10-14) face a higher risk of complications and death as a result of pregnancy than older women. ` Appropriate care provided by skilled health professionals competent in sexual and reproductive health care, before, during and after childbirth can save the lives of women and newborn babies. ` Between 2000 and 2017 maternal mortality* worldwide dropped by about 38%. Maternal mortality is unacceptably high. Estimates for global maternal mortality ratio of less than 70 deaths 2017 show that some 810 women die every day from per 100 000 live births. pregnancy- or childbirth-related complications around Meeting this target will require average reductions the world. In 2017, 295 000 women died during and of about three times the annual rate of reduction following pregnancy and childbirth. The vast majority achieved during the Millennium Development Goal occurred in low-resource settings, and most could era – an enormous challenge. At the current pace have been prevented. (1) of progress the world will fall short of meeting the SDG-3 at a cost of more than 1 million lives. (1) Progress towards achieving the Sustainable Development Goals Where do maternal deaths occur? Improving maternal health is one of the thirteen The high number of maternal deaths in some areas targets for the Sustainable Development Goal 3 of the world reflects inequities in access to health (SDG-3) on health adopted by the international services, and highlights the gap between rich and community in 2015.
    [Show full text]
  • Republic of Botswana
    Republic of Botswana JULY 2019 0 Abbreviations AIDS Acquired Immune Deficiency Syndrome AMSTL Active Management of Third Stage of Labour ANC Antenatal Care BBA Born Before Arrival CBOs Community Based Organisations CMEs Continuous Medical Education C/S Cesarean Section DC District Commissioner DHMT District Health Management Team e-MMRI electronic Maternal Mortality Reduction Initiative EmONC Emergency Obstetric and Newborn Care FP Family Planning ICU Intensive Care Unit LIIMH Letsholathebe II Memorial Hospital MDGs Millennium Development Goals MMR Maternal Mortality Ratio MoHW Ministry of Health and Wellness MWH Maternal Waiting Home PE/E Pre-eclampsia/Eclampsia PMTCT Prevention of Mother to Child Transmission PPH Postpartum Haemorrhage QI Quality Improvement QIT Quality Improvement Team RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health SDGs Sustainable Development Goals SOPs Standard Operating Procedures TBAs Traditional Birth Attendants TFR Total Fertility Rate UNFPA United Nations Population Fund WRA Women of Reproductive Age 1 Table of Contents ABBREVIATIONS ..................................................................................................................................... 1 THE NGAMI HEALTH DISTRICT EXPERIENCES AT A GLANCE ......................................... 3 1.0. PUTTING THINGS IN CONTEXT; BOTSWANA AND NGAMI HEALTH DISTRICT LANDSCAPE ANALYSIS .................................................................................................. 4 2.0. WHY THE DOCUMENTATION AND HOW WAS IT DONE;
    [Show full text]
  • World Health Statistics 2019 Report Reviews, for the the Impact of Health Emergencies
    2019 2019 2019 World health statistics 2019: monitoring health for the SDGs, sustainable development goals ISBN 978-92-4-156570-7 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders.
    [Show full text]
  • Trends in Maternal Mortality: 2000 to 2017
    Public Disclosure Authorized Public Disclosure Authorized TRENDS IN Public Disclosure Authorized MATERNAL MORTALITY 2000 to 2017 Estimates by WHO, UNICEF, UNFPA, World Bank Group and For more information, please contact: Public Disclosure Authorized Department of Reproductive Health and Research the United Nations Population Division World Health Organization Avenue Appia 20 CH-1211 Geneva 27 LAUNCH VERSION Switzerland Email: [email protected] www.who.int/reproductivehealth WHO/RHR/19.23 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). TRENDS IN MATERNAL MORTALITY: 2000 TO 2017 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division ISBN 978-92-4-151648-8 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence.
    [Show full text]
  • Maternal Mortality Trends at the Princess Marina and Nyangabwe Referral Hospitals in Botswana
    Maternal mortality trends at the Princess Marina and Nyangabwe referral hospitals in Botswana Ludo Nkhwalume1, Yohana Mashalla2 1. Ministry of Health, Institute of Health Sciences, Francistown, Botswana. 2. Faculty of Health Sciences, University of Botswana, Gaborone, Botswana. Abstract: Despite the fact that about 94% of pregnant women attend ANC, 95% deliver at health facilities and 99% deliveries are assisted by skilled birth attendants in Botswana, the national Maternal Mortality Rate is still high. Objectives: To determine the trend of MMR at Princess Marina and Nyangabwe referral hospitals before and after EMOC training. Methods: Retrospective longitudinal quantitative study design was used to collect data on maternal deaths. Demographic char- acteristics, maternal death causes, gestation at ANC registration and pregnancy risks were collected for the period before EMOC training and after training, analysed and compared. Descriptive statistics and frequency tables were used. Findings: Maternal deaths were 33 and 41 before and after EMOC training respectively. Majority of the maternal deaths, 78.8% and 70.7% before and after EMOC training respectively occurred among young women in the reproductive ages. Eclampsia was the commonest cause of maternal death before EMOC between training & and 58% and 66% of maternal deaths before and after EMOC training respectively occurred among women who had attended ANC services four or more times. Conclusion: Maternal deaths at the hospitals remained similar during the two periods. Qualitative studies are needed to deter- mine why EMOC training has not resulted in significant reduction in MMR in Botswana. Keywords: Maternal mortality trends, princess Marina, Nyangabwe referral hospitals, Botswana. DOI: https://dx.doi.org/10.4314/ahs.v19i2.5 Cite as: Nkhwalume L, Mashalla Y.
    [Show full text]
  • 2000 to 2017
    Executive summary TRENDS IN MATERNAL MORTALITY 2000 to 2017 Estimates by WHO, UNICEF, UNFPA, World Bank Group and For more information, please contact: Department of Reproductive Health and Research the United Nations Population Division World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Switzerland Email: [email protected] www.who.int/reproductivehealth WHO/RHR/19.23 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Cover.indd 1 22.11.19 13:06 EXECUTIVE SUMMARY Background Bank Group and the United Nations Population Division The Sustainable Development Goals (SDGs) were (UNPD) of the Department of Economic and Social launched on 25 September 2015 and came into force Affairs – has collaborated with external technical experts on 1 January 2016 for the 15-year period until 31 on a new round of estimates for 2000–2017. To provide December 2030. Among the 17 SDGs, the direct health- increasingly accurate MMR estimates, the previous related targets come under SDG 3: Ensure healthy estimation methods have been refined to optimize use lives and promote well-being for all at all ages. With of country-level data. Consultations with countries were the adoption of the SDGs, the United Nations Member carried out during May and June 2019. This process States extended the global commitments they had generated additional data for inclusion in the maternal made in 2000 to the Millennium Development Goals mortality estimation model, demonstrating widespread (MDGs), which covered the period until 2015.
    [Show full text]
  • Maternal Mortality Ratio to Less Than 70 Per 100,000 Live Births Indicator 3.1.1: Maternal Mortality Ratio
    Last updated: 12February 2020 Goal 3: Ensure healthy lives and promote well-being for all at all ages Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births Indicator 3.1.1: Maternal mortality ratio Institutional information Organization(s): World Health Organization (WHO). Department of Sexual and Reproductive Health and Research. Concepts and definitions Definition: The maternal mortality ratio (MMR) is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period. It depicts the risk of maternal death relative to the number of live births and essentially captures the risk of death in a single pregnancy or a single live birth. Maternal deaths: The annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, expressed per 100,000 live births, for a specified time period. Rationale: All maternal mortality indicators derived from the 2019 estimation round include a point-estimate and an 80% uncertainty interval (UI). Data are available and can be downloaded from the webpage “maternal mortality – levels and trends 2000-2017: http://mmr2017.srhr.org. Both point-estimates and 80% UIs should be taken into account when assessing estimates. For example: The estimated 2017 global MMR is 211 (UI 199 to 243) This means: • The point-estimate is 211 and the 80% uncertainty interval ranges 199 to 243.
    [Show full text]
  • American Journal of Public Health
    American Journal of Public Health May 1 2007, Volume 97, Issue 5 , pp. 780-957 LETTERS: Gregory Todd Jones AGENT-BASED MODELING: USE WITH NECESSARY CAUTION Am J Public Health 2007 97: 780-781, 10.2105/AJPH.2006.109058. Igor Mezic, Paul J. Gruenewald, Dennis M. Gorman, and Jadranka Mezic MEZIC ET AL. RESPOND Am J Public Health 2007 97: 781-782, 10.2105/AJPH.2007.109710. ERRATUM: ERRATA Am J Public Health 2007 97: 782, 10.2105/AJPH.2005.078121e. EDITOR'S CHOICE: Farzana Kapadia Closing the Gaps Am J Public Health 2007 97: 783, 10.2105/AJPH.2007.112607. PUBLIC HEALTH THEN AND NOW: Naomi Rogers Race and the Politics of Polio: Warm Springs, Tuskegee, and the March of Dimes Am J Public Health 2007 97: 784-795, 10.2105/AJPH.2006.095406. FRAMING HEALTH MATTERS: Jeremy Shiffman Generating Political Priority for Maternal Mortality Reduction in 5 Developing Countries Am J Public Health 2007 97: 796-803, 10.2105/AJPH.2006.095455. RESEARCH AND PRACTICE: Jennifer Prah Ruger and Hak-Ju Kim Out-of-Pocket Healthcare Spending by the Poor and Chronically Ill in the Republic of Korea Am J Public Health 2007 97: 804-811, 10.2105/AJPH.2005.080184. Amanda Sacker, Richard D. Wiggins, Mel Bartley, and Peggy McDonough Self-Rated Health Trajectories in the United States and the United Kingdom: A Comparative Study Am J Public Health 2007 97: 812-818, 10.2105/AJPH.2006.092320. Richard T. Enander, Ronald N. Gagnon, R. Choudary Hanumara, Eugene Park, Thomas Armstrong, and David M. Gute Environmental Health Practice: Statistically Based Performance Measurement Am J Public Health 2007 97: 819-824, 10.2105/AJPH.2006.088021.
    [Show full text]
  • United States of America Country Profile for Demographic and Health Surveys, the Years Refer to When the Surveys Were Conducted
    WHO Director-General Roundtable with Women Leaders on Millennium Development Goal 5 United States of America Country profile For Demographic and Health Surveys, the years refer to when the Surveys were conducted. Estimates from the Surveys refer to three or five years before the Surveys. United States of America and the world 1. Maternal mortality ratio: global, regional and 2. Lifetime risk of maternal death (1 in N), 2005 country data, 2005 Maternal death is defined as the death of a woman while pregnant or The lifetime risk of maternal death is the estimated risk of an individual within 42 days of termination of pregnancy, from any cause related to woman dying from pregnancy or childbirth during her adult lifetime, the pregnancy or its management but not from accidental or incidental based on maternal mortality and the fertility rate in the country. The causes. The maternal mortality ratio is the number of maternal deaths lifetime risk of dying from pregnancy-related causes in the United States per 100 000 live births per year. The ratio in the United States of America of America is very low (1 in 4800), similar to the overall figure for is 11 per 100 000 live births versus the average of 9 per 100 000 live developed regions of the world (1/7300). This is lower than the rest of the births in developed regions of the world, and much lower than the world: the global average lifetime risk is 1 in 92 and 1 in 22 in sub-Saharan global average of 400 per 100 000 live births.
    [Show full text]
  • Botswana Maternal Mortality Reduction Initiative
    TECHNICAL REPORT Botswana Maternal Mortality Reduction Initiative DECEMBER 2015 This report was prepared by University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID) and authored by Dr. Morrison Sinvula and Dr. Maria Insua of URC under the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. The work of the USAID ASSIST Project is made possible by the generous support of the American people through USAID. FINAL REPORT Botswana Maternal Mortality Reduction Initiative DECEMBER 2015 Morrison Sinvula, University Research Co., LLC Maria Insua, University Research Co., LLC DISCLAIMER The contents of this report are the sole responsibility of University Research Co., LLC (URC) and do not necessarily reflect the views of the United States Agency for International Development or the United States Government. Acknowledgements This technical report was prepared by Dr. Morrison Sinvula and Dr. Maria Insua from the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, managed by University Research Co., LLC (URC), for the Ministry of Health (MOH) in Botswana. It reflects USAID ASSIST technical report for the Ministry’s Maternal Mortality Reduction Initiative (MMRI). The MMRI quality improvement activities supported by USAID ASSIST could not have been possible without the dedication of the MOH district midwife coordinators (Eva Lephirimile, Kebonye Tangane, Dolly Oitsile, Tlhabologo Autilia Johannes, Margaret Buzwane, Chiani Thomas, Keolebogile Keolebale, Thapelo Gaselesego, Kefilwe Matlhare, Kefilwe Kgopana, Veronica Hange, Susan Pono, Emma Lucky and Ms. Hiri) and numerous individuals who formed the quality improvement teams within the various hospitals and districts. The initiative was managed by both ASSIST and the Ministry of Health in Botswana.
    [Show full text]