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Abstract Background Maternal mortality is high in Mali. Nevertheless, there are few studies on this topic from rural areas, and current estimates are mostly based on studies from urban settings. Our objective was to estimate the maternal mortality ratio in Kita, rural Mali. Methods Using the "sisterhood method", we interviewed participants aged 15-50 years from 20 villages in Kita, Mali, and thereby created a retrospective cohort of their sisters in reproductive age. Based on population and fertility estimates, we calculated the lifetime risk of maternal death, and from that the estimated approximate maternal mortality ratio. Results The 2,039 respondents reported 4,628 sisters who had reached reproductive age. Of these 4,628 sisters, almost a third (1,233; 27%) had died, and 429 (9%) had died during pregnancy or childbirth. This corresponded to a lifetime risk of maternal death of 20% and a maternal mortality ratio of 3,131 per 100,000 live births (95% confidence interval 2,967-3,296), with a time reference around 1999. Conclusions We found a very high maternal mortality in rural Mali and this highlights the urgent need for obstetric services in the remote rural areas.

Objective: Determining interventions to address food insecurity and poverty, as well as setting targets to be achieved in a specific time period have been a persistent challenge for development practitioners and decision makers. The present study aimed to assess the changes in food access and consumption at the household level after one-year implementation of an integrated food security intervention in three rural districts of Rwanda.Design: A before-and-after intervention study comparing Household Food Insecurity Access Scale (HFIAS) scores and household Food Consumption Scores (FCS) at baseline and after one year of programme implementation.Setting: Three rural districts of Rwanda (Kayonza, Kirehe and Burera) where the Partners In Health Food Security and Livelihoods Program (FSLP) has been implemented since July 2013.Subjects: All 600 households enrolled in the FSLP were included in the study.Results: There were significant improvements (P<0·001) in HFIAS and FCS. The median decrease in HFIAS was 8 units (interquartile range (IQR) -13·0, -3·0) and the median increase for FCS was 4·5 units (IQR -6·0, 18·0). Severe food insecurity decreased from 78% to 49%, while acceptable food consumption improved from 48% to 64%. The change in HFIAS was significantly higher (P=0·019) for the poorest households.Conclusions: Our study demonstrated that an integrated programme, implemented in a setting of extreme poverty, was associated with considerable improvements towards household food security. Other government and non-government organizations' projects should consider a similar holistic approach when designing structural interventions to address food insecurity and extreme poverty. [ABSTRACT FROM AUTHOR]

Objective: To determine the causes of stillbirths and neonatal deaths in the community in rural Tanzania and to evaluate whether the deaths were avoidable under the prevailing circumstances., Design: Review of stillbirths and neonatal deaths., Setting: Rural northern Tanzania, Mbulu and Hanang districts., Sample: One hundred and nineteen stillbirth and neonatal deaths identified in a prospective cohort of antenatal attendees and 21 stillbirths and neonatal deaths identified retrospectively in a household survey in seven rural communities., Methods: Verbal autopsy was done to reach a diagnosis, in many cases supplemented with information from antenatal records and hospital records. The avoidability of deaths under the prevailing circumstances was assessed for each case. An account of risk factors detectable at antenatal clinic was done and compared with the woman's recall of the risk assessment and recall of being referred., Main Outcome Measures: Avoidability of stillbirths and neonatal deaths., Results: There were 60 stillbirths, 49 early neonatal deaths and 27 late neonatal deaths. Infection-related deaths were most common (n = 53), followed by asphyxia-related deaths (n = 32) and immaturity-related deaths (n = 20). Malaria was the most common infectious agent observed (21 children and 20 mothers). Twenty-one deaths (15%) were probably avoidable and 13 (10%) were possibly avoidable. A patient-oriented avoidable factor was identified in 17 (51%) and a provider-oriented avoidable factor was identified in 22 cases (65%). Twenty-six of the 34 avoidable deaths had risk factors, but only two of the women were aware of it and only one recalled being referred to a hospital for the risk factor. There were eight deaths among the 133 mothers who experienced a perinatal death., Conclusion: Our data indicate that prevention and adequate treatment of infections and asphyxia in the newborn should have high priority in low-income settings. The relatively low proportion of avoidable stillbirths and neonatal deaths may be partly due to accessible emergency obstetric care in the area. Future efforts should emphasise improving the communication between midwife and women at the antenatal clinics, preparing the women-and their families-for the delivery and to be ready for complications.