Search

The present review was intended to explore the effectiveness of perinatal services such as antenatal care (ANC) and post-natal care (PNC) on the health indicators such as maternal, child and neonatal mortality. Globally, indicators are considered very important in determining the health status and the overall performance of a country's healthcare system. A literature search was conducted using maternal mortality, child mortality, neonatal mortality, ANC and PNC in the PubMed, Google, Academia, The Lancet and Journal of the American Medical Association databases. Globally, implementing integrated perinatal care services has brought positive changes in the maternal, child and neonatal mortality indices. The United Nations (UN) is committed to improving the overall living conditions in all countries, significantly improving the population's health status. The UN came up with eight Millennium Development Goals in 2000, aiming to eliminate poverty and increase development in member states. The World Health Organization was a partner in implementing these goals. Later, the UN introduced 17-fold Sustainable Development Goals in 2015 as a blueprint for peace and prosperity for all citizens towards a better future by 2030. As a result, many countries have experienced positive changes in most indicator areas, including service utilisation, maternal mortality and child mortality. Some Sub-Saharan African and South Asian countries are progressing, however, slowly. [ABSTRACT FROM AUTHOR]

Under the loom of extreme climatic perturbations, human expansion and rising demand, world's freshwater reserves are expected to suffer severe setbacks in the coming years. A major task for the international authorities in this regard is to develop a reliable inventory of existing potable water sources and identify the challenges therein. The main objective of this study was to present a spatial summary of 'safe' water sources in India using the most 'authentic', cross-sectional, open-sourced census database for 2011 ranging from household to state level. Under the present circumstances, we urge the authorities to revisit potable water source classification scheme in India, acknowledging water quality issues and devise strategies for catchment-scale protection with special emphasis on real-time continuous monitoring and assessment of the peri-urban water resources. [ABSTRACT FROM AUTHOR]

Background: The Millennium Development Goals (MDG) provide targets for 2015. MDG 6 includes a target to reduce the tuberculosis (TB) death rate by 50% compared with 1990. We aimed to assess whether this target was reached by the European Union (EU) and European Economic Area countries.Methods: We used Eurostat causes of death data to assess whether the target was reached in the EU. We calculated the reduction in reported and adjusted death rates and the annual average percentage decline based on the available data.Results: Between 1999 and 2014, the TB death rate decreased by 50%, the adjusted death rate by 56% and the annual average percentage decline was 5.43% (95% confidence interval 4.94-6.74) for the EU. Twenty of 26 countries reporting >5 TB deaths in the first reporting year reached the target of 50% reduction in adjusted death rate.Conclusions: The EU reached the MDG target of a 50% reduction of the TB death rate and also the annual average percentage decline was larger than the 2.73% needed to reach the target. The World Health Organization 'End TB Strategy' requires a further reduction of the number of TB deaths of 35% by 2020 compared to 2015, which will challenge TB prevention and care services in the EU. [ABSTRACT FROM AUTHOR]

Objectives... To identify comparative study to see the impact on newborn body temperature after skin contact of mother and newborn v/s conventional method. Study Design: Cross sectional, analytical study. Place and Duration: Department of Obstetrics and Gynecology (Unit-III) Liaquat University Hospital, Hyderabad Sindh from May 2013 to April 2014. Methods: All the laboring women with no any antenatal complication and with cephalic presentation admitted at term pregnancy for normal vaginal delivery along with new born with Apgar score more than 6 were approached by duty doctors. Written as well as verbal consent was obtained and women have allocated numbers, 1 to 120. The women were divided in two groups. Group A (baby warmer group 60 patients) and Group B (Skin to skin contact 60 patients). Results: 120 patients were recruited and randomly equally divided into two groups. There over all mean age of these patients was 26.7+_ 5.0years. In group A the gravida was found as between 1 to 6 children in 60% (n=30), Compared with Group B, 64% (n=32). The overall mean hospital stay was as 6.6+- 1.6 hours. Personal health response like was found in 76% (n =38) patients with group A compared with Group B 86% (n=43). Mother response like was found in 76% (n=38 patient in group A) compared with group B 76% (n=38). There is statically significant mean difference in °F after one hour was observed (P=0.001) between group A and group B, no significant mean difference in temperature °F after 1 and 5 minutes were observed ( P > 0.05)compared with in group B 76% (n=38) patients. Conclusion: Skin to skin contact reduces the hypothermia, so it should be encourage and continue. Skin to skin contact is easy, cheap and helps in bonding of mother and baby. With this practice we will achieve the millennium development goal (MDG) that is to decrease neonatal mortality in Pakistan. [ABSTRACT FROM AUTHOR]

The millennium development goals (MDGs) adopted during the millennium summit in 2000 gave an opportunity to improve the health and overall development. The MDG framework had 8 goals, 21 targets, and 60 indicators. Of these, three are directly related to health and have other interrelated goals and targets that influence health. The year 1990 is baseline, and the targets are to be reached by 2015. India's progress towards health related MDGs is lagging in some areas, and more attention is needed to states and districts where the indicators are poor. The proportion of underweight children <3 years is around 40%. The under-five and infant mortality rate is 49 and 40/1000 live births in 2013, respectively. The country lags behind the maternal mortality ratio target of 109/100,000 live births. Regarding HIV, malaria, and tuberculosis, trend reversal had been achieved while providing basic sanitation facilities remains a big challenge. [ABSTRACT FROM AUTHOR]

Background Maternal and neonatal mortality remains a serious challenge in Tanzania. Progress is tracked through maternal mortality ratios (MMR) and neonatal mortality rates (NMR), yet robust national data on these outcomes is difficult and expensive to ascertain, and mask wide variation. Search strategy We searched EMBASE, MEDLINE, Popline, and EBSCO online databases, basing search terms on (“maternal” OR “neonatal”) AND (“mortality” OR “cause of death”) AND “Tanzania.” Selection criteria Nationally representative or population representative from the subnational context were eligible, providing NMR, MMR, or numbers of maternal deaths or early neonatal deaths or neonatal deaths and live births. Data collection and analysis Data were extracted on study context, time period, number of deaths and live births, definition of maternal and neonatal death, study design, and completeness and representativeness of data. NMR and MMR were extracted or calculated and study quality was assessed. Nationally representative data were compared with modelled national data from international agencies. Main results 2107 records were screened yielding 21 maternal mortality and 15 neonatal mortality datasets. There were high mortality levels with wide subnational MMR and NMR variation. National survey data differed from the modelled estimates, with wide uncertainty ranges. Conclusion Subnational data quality was generally poor with no observable trends and geographical clustering across several regions. Combined MMR and NMR reporting is uncommon. Modelled national estimates lack precision and are complex to interpret. Results suggest that aggregate national data are inadequate for policy generation and progress monitoring. We recommend strengthening of vital registration and Health Management Information Systems with complementary use of process indicators, for improved monitoring of, and accountability for maternal and newborn health. [ABSTRACT FROM AUTHOR]

Health and illness were interpreted in a cosmological and anthropological prospective. Medicine was dominated by magical and religious beliefs which were an integral part of ancient cultural and civilization. Over the years development planning in India has focused on reducing the burden of illness and mortality among women and children. A large number of development and public health programmes such as the Integrated Child Development Services (ICDS) have been geared towards this, since a long time. India is committed to achieve the Millennium Development Goals, particularly with respect to maternal and child health. Awareness generation is a major responsibility and fundamental importance, to ensure utilization of various healthcare programmes implemented by Government. The Indian healthcare sector can be viewed as a glass half empty or a glass half full. In this research paper author focuses on The Status of health care services in India. [ABSTRACT FROM AUTHOR]

The MDGs incentivised a focus on education access over quality. For post-2015, a compelling goal on learning for all will be critical to address the global ‘learning crisis’. This poses challenges both with respect to getting global agreement on learning metrics and finding ways to reliably measure learning over time. Furthermore, in order to accelerate progress on learning, robust evidence of what works will need to be generated and more effectively used in programming and policy making. The paper concludes with some reflections on the difficult politics for donors of engaging on a learning agenda post-2015. [ABSTRACT FROM AUTHOR]

There is time bond succession from Millennium Development Goals to Sustainable Development Goals from 2015 as a defined point of demarcation. This is an ultra short sociopolitical intervention in order to transform society into a healthier state. This is an unnatural process that depends on will and resources. As the country is in political transition, it would be an opportunity to assure to implement programs and plans early ahead. [ABSTRACT FROM AUTHOR]

Background Under-five mortality has been declining rapidly in a number of sub-Saharan African settings. Malaria-related mortality is known to be a major component of childhood causes of death and malaria remains a major focus of health interventions. The paper explored the contribution of malaria relative to other specific causes of under-five deaths to these trends. Methods This paper uses longitudinal demographic surveillance data to examine trends and causes of death of under-five mortality in Rufiji, whose population has been followed for over nine years (1999-2007). Causes of death, determined by the verbal autopsy technique, are analysed with Arriaga's decomposition method to assess the contribution of declining malaria-related mortality relative to other causes of death as explaining a rapid decline in overall childhood mortality. Results Over the 1999-2007 period, under-five mortality rate in Rufiji declined by 54.3%, from 33.3 to 15.2 per 1,000 person-years. If this trend is sustained, Rufiji will be a locality that achieves MDG4 target. Although hypotrophy at birth remained the leading cause of death for neonates, malaria remains as the leading cause of death for post-neonates followed by pneumonia. However, declines in malaria death rates accounted for 49.9% of the observed under-five mortality decline while all perinatal causes accounted for only 19.9%. Conclusion To achieve MDG 4 in malaria endemic settings, health programmes should continue efforts to reduce malaria mortality and more efforts are also needed to improve newborn survival. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the prevalence of female genital mutilation (FGM), the common forms of FGM, reasons for the practice, associated obstetric outcomes, and how these have affected efforts to achieve Millennium Development Goals (MDGs) 3, 4, and 5 in southeast Nigeria. Methods: A prospective descriptive study of parturients in southeast Nigeria was conducted from January to December 2012. All primigravid women attending delivery services at 2 health institutions during the study period were recruited, examined, and classified using the 2008 WHO classification for FGM. Results: The mean age of the 516 participants was 27.24±4.80years and most (66.3%) had undergone FGM. Type II FGM was the most common form, accounting for 59.6% of cases. Most FGM procedures were performed in infancy (97.1%) and for cultural reasons (60.8%). Women who had undergone FGM had significantly higher risk for episiotomy, perineal tear, hemorrhage, cesarean delivery, neonatal resuscitation, fresh stillbirth/early neonatal death, and longer hospitalization, with higher risk ratios associated with higher degrees of FGM. Conclusion: FGM is still a common practice in southeast Nigeria, where its association with adverse reproductive outcomes militates against efforts to achieve MDGs 3, 4, and 5. [Copyright &y& Elsevier]

Under National TB/HIV framework, all TB patients are referred by Revised National Tuberculosis Programme (RNTCP) service providers to Integrated Counseling and Testing Centers (ICTCs) for voluntary counseling and testing (C&T) and ICTC “TB-suspects” are referred to RNTCP facilities for TB diagnosis and treatment. HIV–TB coinfected patients are then referred to Anti Retroviral Treatment (ART) center for initiation of ART between two weeks and two months of initiating TB treatment. During the third phase of National AIDS Control Programme (NACP-III, April 2007–April 2012), 30749/130503 (23.6%) TB/HIV cross-referrals were lost to follow up (LTFU) and there was missed opportunity for 940/1884 (49.9%) HIV–TB coinfected patients for initiation of ART during TB treatment. This motivated Delhi State AIDS Control Society (DSACS) and State TB Cell (STC) to revise existing cross-referral strategy. The new strategy was launched in May 2012, wherein HIV–TB coinfected and HIV-positive “TB-suspects” were referred to nearest ART center for HIV care and investigations of TB at Chest Clinic/Designated Microscopy Centre (DMC) located within the same hospital instead of referral to area RNTCP facility. Outcome of the strategy was evaluated in March 2013. The new HIV–TB cross-referral strategy in Delhi has shown advantage over national strategy: first, improved retention of coinfected clients in HIV care; second, ensured timely initiation of TB-treatment and ART; and third, significantly improved survival of HIV–TB coinfected patients. [ABSTRACT FROM PUBLISHER]

Background Achieving the Millennium Development Goal (MDG) of improving maternal health has become a focus in recent times for the majority of countries in sub-Saharan Africa. Ghana's maternal mortality is still high indicating that there are challenges in the provision of quality maternal health care at the facility level. This study examined the implementation challenges of maternal health care services in the Tamale Metropolis of Ghana. Methods Purposive sampling was used to select study participants and qualitative strategies, including in-depth interviews, focus group discussions and review of documents employed for data collection. The study participants included midwives (24) and health managers (4) at the facility level. Results The study revealed inadequate in-service training, limited knowledge of health policies by midwives, increased workload, risks of infection, low motivation, inadequate labour wards, problems with transportation, and difficulties in following the procurement act, among others as some of the challenges confronting the successful implementation of the MDGs targeting maternal and child health in the Tamale Metropolis. Conclusions Implementation of maternal health interventions should take into consideration the environment or the context under which the interventions are implemented by health care providers to ensure they are successful. The study recommends involving midwives in the health policy development process to secure their support and commitment towards successful implementation of maternal health interventions. [ABSTRACT FROM AUTHOR]

Objectives Few developing countries have the accurate civil registration systems needed to track progress in child survival. However, the health information systems in most of these countries do record facility births and deaths, at least in principle. We used data from two districts of Malawi to test a method for monitoring child mortality based on adjusting health facility records for incomplete coverage. Methods Trained researchers collected reports of monthly births and deaths among children younger than 5 years from all health facilities in Balaka and Salima districts of Malawi in 2010-2011. We estimated the proportion of births and deaths occurring in health facilities, respectively, from the 2010 Demographic and Health Survey and a household mortality survey conducted between October 2011 and February 2012. We used these proportions to adjust the health facility data to estimate the actual numbers of births and deaths. The survey also provided 'gold-standard' measures of under-five mortality. Results Annual under-five mortality rates generated by adjusting health facility data were between 35% and 65% of those estimated by the gold-standard survey in Balaka, and 46% and 50% in Salima for four overlapping 12-month periods in 2010-2011. The ratios of adjusted health facility rates to gold-standard rates increased sharply over the four periods in Balaka, but remained relatively stable in Salima. Conclusions Even in Malawi, where high proportions of births and deaths occur in health facilities compared with other countries in sub- Saharan Africa, routine Health Management Information Systems data on births and deaths cannot be used at present to estimate annual trends in under-five mortality. [ABSTRACT FROM AUTHOR]

Background: At the 1994 International Conference on Population and Development (ICPD), held in Cairo, the global community agreed to the goal of achieving universal access to sexual and reproductive health (SRH) and rights by 2015. This research explores the accelerators and decelerators of achieving universal access to the sexual and reproductive health targets and accordingly makes some suggestions.Method: We have critically reviewed the latest national reports and extracted the background data on each SRH indicator. The key stakeholders, both national and international, were visited and interviewed at two sites. A total of 55 in-depth interviews were conducted with religious leaders, policy-makers, senior managers, senior academics, and health care managers. Six focus-group discussions were also held among health care providers. The study was qualitative in nature.Results: Obstacles on the road to achieving universal access to SRH can be viewed from two perspectives. One gap exists between current achievements and the targets. The other gap arises due to age, marital status, and residency status. The most recently observed trends in the indicators of the universal access to SRH shows that the achievements in the "unmet need for family planning" have been poor. Unmet need for family planning could directly be translated to unwanted pregnancies and unwanted childbirths; the former calls for sexual education to underserved people, including adolescents; and the latter calls for access to safe abortion. Local religious leaders have not actively attended international goal-setting programs. Therefore, they usually do not presume a positive attitude towards these goals. Such negative attitudes seem to be the most important factors hindering the progress towards universal access to SRH. Lack of international donors to fund for SRH programs is also another barrier. In national levels both state and the society are interactively playing their roles. We have used a cascade model for presenting the barriers at the state levels from the strategic planning to implementation. Social factors are to be considered as a background for other factors at all stages.Conclusion: Accelerating universal access to SRH requires adequate funding, firm political commitment, creative programming, and the involvement of diverse actors, including faith-based, civil society, and private sector partners. [ABSTRACT FROM AUTHOR]

Background: Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods: A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". Results: The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion: The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. [ABSTRACT FROM AUTHOR]

Objectives To estimate the reduction in maternal mortality associated with the emergency obstetric care provided by Médecins Sans Frontières ( MSF) and to compare this to the fifth Millennium Development Goal of reducing maternal mortality. Methods The impact of MSF's intervention was approximated by estimating how many deaths were averted among women transferred to and treated at MSF's emergency obstetric care facility in Kabezi, Burundi, with a severe acute maternal morbidity. Using this estimate, the resulting theoretical maternal mortality ratio in Kabezi was calculated and compared to the Millennium Development Goal for Burundi. Results In 2011, 1385 women from Kabezi were transferred to the MSF facility, of whom 55% had a severe acute maternal morbidity. We estimated that the MSF intervention averted 74% (range 55-99%) of maternal deaths in Kabezi district, equating to a district maternal mortality rate of 208 (range 8-360) deaths/100 000 live births. This lies very near to the 2015 MDG 5 target for Burundi (285 deaths/100 000 live births). Conclusion Provision of quality emergency obstetric care combined with a functional patient transfer system can be associated with a rapid and substantial reduction in maternal mortality, and may thus be a possible way to achieve Millennium Development Goal 5 in rural Africa. [ABSTRACT FROM AUTHOR]

In Tunisia, the contribution of the microentreprises sector, in the fight against poverty, has appeared so that, every increasing in the number of the microentreprises involves a reduction of the poverty rate. In addition, it proved that the participation of these small unities in the fight against poverty varies from one area to another, according to the activity sectors. The detection of such sectoral specialization on the level of the fight against poverty, allows the adoption of targeted regional policies, intended to encourage the creation of microentreprises, in the most relevant activity sectors. [ABSTRACT FROM AUTHOR]

Biotechnological intervention in the development of crops has opened new vistas in agriculture. Central to the accomplishment of the Millennium Development Goals (MDGs), biotechagriculture is essential in meeting these targets. Biotech crops have already made modest contributions toward ensuring food and nutrition security by reducing losses and increasing productivity, with less pesticide input. These crops could help address some of the major challenges in agriculture-based economies created by climate change. Projections of global climate change expect the concentration of greenhouse gases to increase, aridization of the environment to increase, temperature fluctuations to occur sharply and frequently, and spatial and temporal distribution of rainfall to be disturbed-- all of which will increase abiotic stressrelated challenges to crops. Countering these challenges and to meet the food requirement of the ever-increasing world population (expected to reach 9 billion by 2030) we need to (1) develop and use biotech crops for mitigating adverse climatic changes; (2) develop biotech crops resilient to adverse environmental conditions; and (3) address the issues/ non-issues raised by NGO's and educate the masses about the benefits of biotech crops. [ABSTRACT FROM AUTHOR]

The first part of this article examines the global progress towards target A of the fourth Millennium Development Goal. This target is to reduce by two thirds the under-five mortality rate between 1990 and 2015. Accepting such a target implies de facto that most child deaths could be avoided. Recent sources are examined and the UN-IGME data set is used for the comparison as being the one favoured by the United Nations. Child deaths are falling but not quickly enough, particularly in Southern Asia and sub-Saharan Africa. In this part, a search of the literature for Algeria, Libya, Mauritania, Morocco and Tunisia, the five countries composing the Maghreb is performed, and shows that four of these countries are in good progress and possibly on track. The main concern, both globally and for four Maghreb countries is that the share of neonatal death is rising. This brings on new challenges, because the means for addressing this issue differ from, validated policies such as vaccination, or diarrhea control. Scaling up low-cost interventions will be a priority. In the second part an in depth description of the process in Algeria is made. This has included successive steps, starting from independence. Through a combination of interventions at community level and at health care points regular, sustainable progress has been achieved. These have included vaccination, family planning, skilled attendance at birth, infrastructure development, human resources, free access to care and prevention, and improved statistics of birth and death. The new challenges related to the growing share of neonatal mortality are discussed. It is acknowledged that neonatal survival requires, at population level, modern medical care. This means the problem is fundamentally different from post neonatal mortality where socio-economic development is the main determinant. A perinatal programme has been established in Algeria. Kangaroo Mother Care has been introduced in Algeria more than a decade ago and has been a success story. [ABSTRACT FROM AUTHOR]

The study examines the impact of religion on women empowerment. Three religions, indigenous African, Islam and Christianity, comprising Africa's triple heritage, are considered. The hypothesized relationships are confirmed. Christianity correlates with each of the four Development Targets specified for women empowerment under the third of the Millennium Development Goals (MDGs), including raising the: (1) percentage of school-aged girls in school, (2) female adult literacy rates, (3) female share of non-agricultural employment, and (4) female representation in government. African indigenous religion correlates with Target #3. Islam is inversely linked to each of the four Targets. A composite index incorporating values on these Targets was developed and employed as the dependent variable in a multiple regression model. The model is statistically significant, and confirms the hypothesis of a link between women empowerment and religion. Therefore, any meaningful effort to promote women empowerment in Africa must account for the continent's three main religions. [ABSTRACT FROM AUTHOR]

Objective For measurement of progress towards the Millennium Development Goal (MDG) 1, reliable data on nutrition indicators of specific countries are essential. Malnutrition is also the main determinant for childhood mortality, which is addressed in MDG 4. Methods In the health and demographic surveillance area of Kossi Province in north-western Burkina Faso, nutritional parameters were compared in two cohorts of young children of the same age range from eight villages. Surveys took place in June and December of the year 1999 and 2009. A multivariate model was used to control for confounding variables. Results For the 1999 study, data were analysed for 179 and 197 children who took part in the June and December survey respectively. In 2009, corresponding data were analysed for 460 and 409 children. Prevalence of underweight was highest in December 1999 (42.6%) and lowest in December 2009 (34.1%). After adjustment for age, sex and village, there was a slight but not always significant improvement in the z-scores of weight-for-age, weight-for-length, length-for-age, and mid-arm circumference over time. Conclusions The findings from this study confirm the still unacceptable high prevalence of malnutrition in young children of rural sub-Saharan Africa (SSA). Progress in the reduction of malnutrition remains slow on this continent making it rather unlikely that the corresponding MDGs will be achieved. Large-scale multi-sectoral community-based interventions are urgently needed for a sustainable improvement of child health in SSA. [ABSTRACT FROM AUTHOR]

Background & objectives: Measuring maternal mortality in developing countries poses a major challenge. In Nepal, vital registration is extremely deficient. Currently available methods to measure maternal mortality, such as the sisterhood method, pose problems with respect to validity, precision, cost and time. We conducted this field study to test a community-based method (the motherhood method), to measure maternal and child mortality in a developing country setting. Methods: Motherhood method was field tested to derive measures of maternal and child mortality at the district and sub-regional levels in Bara district, Nepal. Information on birth, death, risk factors and health outcomes was collected within a geographic area as in an unbiased census, but without visiting every household. The sources of information were a vaccination registry, focus group discussions with local health workers, and most importantly, interview in group setting with women who share social bonds formed by motherhood and aided by their peer memory. Such groups included all women who have given birth, including those whose babies died during the measurement period. Results: A total of 15161 births were elicited in the study period of two years. In the same period 49 maternal deaths, 713 infant deaths, 493 neonatal deaths and 679 perinatal deaths were also recorded. The maternal mortality ratio was 329 (95%CI:243-434)/100000 live birth, infant mortality rate was 48(44-51)/1000LB, neonatal mortality rate was 33(30-36)/1000LB, and perinatal mortality rate was 45(42-48)/1000 total birth. Interpretation & conclusions: The motherhood method estimated maternal, perinatal, neonatal and infant mortality rates and ratios. It has been field tested and validated against census data, and found to be efficient in terms of time and cost. Motherhood method can be applied in a time and cost-efficient manner to measure and monitor the progress in the reduction of maternal and child deaths, it can give current estimates of mortalities as well as averages over the past few years. It appears to be particularly well-suited to measuring and monitoring programmes in community and districts levels. [ABSTRACT FROM AUTHOR]

Background: Water is a fundamental human need. This is the basis for target 10, goal 7 of the Millennium Development Goals which sets to reduce the proportion of people without access to safe water by half by 2015. This study assessed the access to safe water supply in 22 riverine communities in the Niger delta region of Nigeria. Materials and Method: The study was carried out using a descriptive cross-sectional study design, with the data collected using a structured interviewer-administered questionnaire, field observations and focused group discussions. The questionnaire was administered to female heads of household, and used to collect information on the main source of drinking water, the time it took for the round trip to the main water sources, and methods used for the treatment of water of suspicious quality. An inventory of all the community water facilities in the communities was also taken, and information collected on the functionality of the facilities, and how they were constructed, operated and maintained. A sample of the water from each of the facilities was also collected in a sterile container for microbiological analysis. Results: A total of 456 questionnaires were administered and retrieved. The most common source of drinking water was surface water (37.9%), and most (61.2%) of the water drawers spent less than 15 minutes to complete the round trip to the water sources. There were an average of 17 community water supply facilities, but only 23.8% of the facilities were functional during the study. Most of the functional facilities were being managed by community members. More than two third (67.9%) of the samples tested were found to contain significant numbers of Escherichia coli. Conclusion: The communities had easy access to water supply, but most of the facilities were either contaminated or nonfunctional. The management of the facilities by members of the communities, and the promotion of point-of-use purification systems are hereby advocated. [ABSTRACT FROM AUTHOR]

Abstract: In Swaziland, access to safe water supply and sanitation has improved significantly and was expected to result in improved health and, in particular, reduced infant mortality rates. On the contrary, mortality rates in the under 5years age group are high and have doubled from 60 in 1996, to 120 deaths per 1000 in 2006. The main objective of the study was to assess whether the water projects permit, and are accompanied by, changes in hygienic behaviour to prevent transmission of diseases. The study area was Phonjwane, located in the dry Lowveld of Swaziland, where water projects play a significant role in meeting domestic water demands. Hygienic behaviour and sanitation facilities were analysed and compared before and after project. The results of the study show that domestic water supply projects have significantly reduced distances travelled and time taken to collect water, and that increased quantities of water are collected and used. While the majority of respondents (95.6%) used the domestic water project source, the quantities allowed per household (125l which translates to an average of 20.8l per person) were insufficient and therefore were supplemented with harvested rainwater (57.8%), water from a polluted river (17.8%), and water from a dam (2.2%). Increased water quantities have permitted more baths and washing of clothes and hands, but significant proportions of the population still skip hygienic practices such as keeping water for washing hands inside or near toilet facilities (40%) and washing hands (20%). The study concludes that the water supply project has permitted and improved hygienic practices but not sufficiently. The health benefits of safe domestic water supplies are hampered by insufficient quantities of water availed through the projects, possible contamination of the water in the house, poor hygienic behaviours and lack of appropriate sanitation measures by some households. There is a need to provide sufficient quantities of safe water to meet all domestic demands. Domestic water supply must be accompanied by appropriate sanitation and hygienic education. [Copyright &y& Elsevier]

Objective In the absence of an adequate vital registration system in Ghana, the Navrongo demographic surveillance system (NDSS) established in 1993 presents a viable alternative to monitor, in a poor rural district, the UN Millennium Development Goal on maternal health (MDG) of reducing maternal mortality by 75% between 1990 and 2015. Methods Of the 518 women aged 12–49 years identified in the NDSS database to have died in the Kassena-Nankana district in the period January 2002–December 2004, spouses or family members completed verbal autopsy interviews for 516 female deaths. Results Of the 516 female deaths, 45 were identified as maternal deaths. 71% of the maternal deaths were attributed to direct maternal causes while 29% were due to indirect maternal causes. Abortion-related deaths were the most frequent cause of maternal deaths. The maternal mortality ratio for the period 2002–2004 was 373 maternal deaths per 100,000 live births indicating a 40% reduction of maternal mortality from the 1995–1996 level of 637 maternal deaths per 100,000 live births. However, the health-facility based maternal mortality ratio in the district (which excludes maternal deaths outside health facilities) was 141 maternal deaths per 100,000 live births for the period 2002–2004. Conclusion This district may be on track to achieve the MDG on maternal health. Ultimately, strengthening vital registration systems to provide timely information to policymakers should supersede the other methods of measuring maternal mortality. [ABSTRACT FROM AUTHOR]

Health care services in developing countries are being challenged by high childhood mortality rates. Although there have been tremendous strides made in reducing infant mortality rates largely due to vaccinations and improved standards of living, a lot remains to be done to reduce neonatal mortality. Achievement of the Millennium Development Goal (MDG) number 4 on childhood mortality will remain unattainable in most developing countries unless purpose based interventions targeted at reducing neonatal mortality are instituted. This viewpoint is based on the experiences gained in Eritrea, a country that gained independence less than twenty years ago following a protracted war that left a trail of destruction of infrastructure in general and health facilities in particular. War that broke out with Ethiopia less than 10 years into its independence and border conflicts followed by a no peace no war stalemate situation aggravated by frequent droughts have continued to throttle economic recovery, reconstruction and rehabilitative efforts. The population is estimated at 3.5 million comprising of nine ethnic groups who speak different languages. The country has a surface area of 124 000 km2 which shares borders with Sudan, Ethiopia, Djibouti and the Red Sea. Conclusion: Attainment of the MDG number 4 on reduction of childhood mortality can be achieved by addressing morbidities of the neonate where the bottle neck currently appears to be sited. [ABSTRACT FROM AUTHOR]

The overall picture of health in sub-Saharan Africa can easily be painted in dark colours. The aim of this viewpoint is to discuss epidemiological data from Tanzania on overall health indicators and the burden of malaria and HIV. Is the situation in Tanzania improving or deteriorating? Are the health-related millennium development goals (MDG) on reducing under-five mortality, reducing maternal mortality and halting HIV and malaria within reach? Conclusion: Child mortality and infant mortality rates are decreasing quite dramatically. Malaria prevention strategies and new effective treatment are being launched. The MDG 4 on child mortality is clearly within reach, and the same optimism may apply to MDG 6 on combating malaria. [ABSTRACT FROM AUTHOR]

Three types of privatisation are identified—involving demand‐side financing, reforms to the educational supply‐side and de facto privatisation, where responsibilities are transferred to the private sector, through the rapid growth of private schools, rather than through reform or legislation. Although de facto privatisation may arise because of parental dissatisfaction with state education, it is perceived as undesirable in the literature. Findings from a recent study on private schools in Ghana, Nigeria and India are outlined to explore this issue. The results show a majority of enrolment is in private schools in poor urban and peri‐urban areas, and a significant minority in rural areas. Regarding teacher activity, private schools appear superior to government schools, while private school children outperform government children on maths and English, even though expenditure on teacher salaries is much lower in private than government schools. In the context of this evidence, three major objections to the place of de facto privatisation in meeting the educational needs of the poor are explored and challenged. [ABSTRACT FROM AUTHOR]

There is increasing concern regarding adverse effects of prenatal arsenic exposure on the neurodevelopment of children. We analyzed mortality data for children, who were born to 11,414 pregnant women between 2002 and 2004, with an average age of 5 years of follow-up. Individual drinking-water arsenic exposure during pregnancy was calculated using tubewell water arsenic concentration between last menstrual period and date of birth. There were 84 drowning deaths registered, with cause of death ascertained using verbal autopsy (International Classification of Diseases, 10th revision, codes X65-X70). The prenatal water arsenic exposure distribution was tertiled, and the risk of drowning mortality was estimated by Cox proportional hazard models, adjusted for potential confounders. We observed a significant association between prenatal arsenic exposure and drowning in children aged 1-5 years in the highest exposure tertile (HR=1.74, 95% CI: 1.03-2.94). This study showed that in utero arsenic exposure might be associated with excess mortality among children aged 1-5 years due to drowning. [ABSTRACT FROM AUTHOR]