Publicaciones
Agradecemos a la Mtra. Erika Troncoso por compartir esta información.
Three-year study identifies key interventions to reduce maternal, newborn and child deaths
Agradecemos a la Dra. Raffaela Schiavon (Ipas) por compartir la siguiente información:
- Souza, JP et al., “Caesarean section without medical indications is associated with an increased risk of adverse short term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health”, BMC Medicine 2010, 8:71
- Schiavon, R, 2011, Mortalidad Materna: ¿Que necesitamos hacer? (Presentación)
Agradecemos a Sharon Bissell por compartir la siguiente publicación de la Secretaría General de la Organización de los Estados Americanos y la Comisión Interamericana De Derechos Humanos
REPORTE ACCESO A SERVICIOS DE SALUD MATERNA DESDE UNA PERSPECTIVA DE DERECHOS HUMANOS
Disminuyó el 34% de las muertes maternas a nivel mundial
- Full report Trends in Maternal Mortality 1990 to 2008
- PR2010 Maternal Deaths Drop new Maternal mortality estimates
Agradecemos a Karla Berdichevsky y Martha Murdock por hacernos llegar los siguientes documentos:
- Oportunidades y retos para la reducción de la muerte materna en América Latina y el Caribe. Grupo de Trabajo Regional para la Reducción de la Mortalidad Materna
- Apuntar al 5. La salud de las mujeres y los ODM. Women Deliver
La International Planned Parenthood Federation (IPPF) ha publicado recientemente dos documentos de interés que a continuación compartimos gracias a Esperanza Delgado de Mexfam:
- De la evidencia a la acción: Advocacy para la educación integral en sexualidad
- Datos sobre la salud sexual y reproductiva de mujeres adolescentes en el mundo en desarrollo
Women Deliver Conference 2010 se llevó a cabo del 7 al 9 de Junio en la ciudad de Washington D.C., a la que fue invitada y participó la Dra. Graciela Freyermuth, en dicha reunión se concluyó que:
- Los Objetivos del Milenio no se conseguirán si no se invierte en las mujeres.
- No hay suficiente tiempo, si el mundo compromete fondos ahora mismo para cumplir con el quinto objetivo del milenio conllevará la inversión de 10 mil millones de dólares en este 2010 y 20 mil millones de dólares en el 2015.
Se adjuntan los siguientes documentos:
- Women Deliver Conference Overview, que contiene el resumen de las 75 sesiones agrupadas en 9 áreas temáticas
- Closing Statement , contiene el discurso de clausura
- Ministers Forum Women Deliver, que incluye los acuerdos producto del foro de ministros
Karla Berdichevsky presenta los resultados obtenidos a la fecha sobre el proyecto del traje anti-choque no neumático (TAN) en México. El TAN es una herramienta de primeros auxilios que permite controlar la hemorragia y estabilizar los signos vitales hasta el momento en que se pueda acceder a un tratamiento definitivo que logre resolver la causa del sangrado. El estudio en México fue parte de un protocolo multicéntrico, realizado también en Egipto y Nigeria, para describir el uso del TAN en hospitales de bajos recursos y probarlo como una estrategia para reducir la morbi-mortalidad materna por hemorragia obstétrica. Ver presentación completa.
Francisco Javier Posadas presenta las acciones instrumentadas en San Luis Potosí para reducir la Razón de mortalidad materna de 8.3 en el 2003 a 5.1 (cifra preliminar) en 2005. Analiza detalladamente las cifras de mortalidad materna según causas, regiones y grupos de edad, así como la cobertura institucional de que dispone el estado. También describe las estrategias implementadas para el abatimiento de la mortalidad materna. Ver presentación completa.
Irma Salas presenta los resultados del Encuentro Estatal organizado por el Instituto de la Mujer Guanajuatense y la Secretaría de Salud de Guanajuato. El objetivo del Encuentro fue coadyuvar a la sensibilización y a la participación de sociedad civil y gobierno, en la atención de las mujeres durante el embarazo, parto y puerperio, que es parte de su Derecho a la Salud Reproductiva. Ver presentación completa.
Ignacio Bernal describe el plan de trabajo del Comité Estatal Oaxaca para el período 2006-2008. Inicialmente analiza el contexto presentando las fortalezas y debilidades del Comité Estatal y las amenazas y oportunidades que presenta su entorno. Asimismo, explica la misión, la visión y los objetivos tanto generales como específicos. Ver presentación completa.
¿Qué pasa con los derechos de las mujeres afectadas por VIH/SIDA?. En nuestro país se incrementa el número de mujeres afectadas por el VIH/SIDA, sin que existan políticas claramente definidas para su atención. A pesar de la discriminación existente, hay mujeres que han decidido sacar a la luz su enfermedad, y luchar por sus derechos. Así lo hicieron en el Encuentro de Mujeres Afectadas por VIH/SIDA, organizado por SIPAM, en marzo del 2006.
Bajo el título de Mortalidad Materna y VIH/SIDA , Pilar Muriedas presentó, en la Reunión Plenaria del CPMSR (6 de abril, 2006) los principales aprendizajes del Encuentro, donde se evidenció, una vez más, la indignante situación en que viven esas mujeres estigmatizadas socialmente y sin apoyos oficiales. Nadie, incluyendo al CPMSR, puede permanecer al margen ante tan profunda injusticia y las vinculaciones existentes entre el VIH/SIDA y la mortalidad materna. Ver presentación completa.
mortalidad_materna_y_vih-sipam
¿Cuánto vale la vida de una mujer?. El valor de la vida de todos los seres humanos es incalculable. No todas las muertes se pueden evitar, pero sí la mayoría de las muertes maternas. Una de las estrategias es la Atención Obstétrica de Emergencia (AOE), pues el 15% de los partos constituyen una emergencia obstétrica, aún cuando no hayan presentado, durante los respectivos embarazos, señales de alarma.
En la misma Reunión Plenaria del CPMSR Daniela Díaz compartió los resultados de la investigación Mortalidad Materna y presupuesto público: costeo de la Atención Obstétrica de Emergencia en los niveles nacional, y en Chiapas, Guerrero y Oaxaca , realizada por FUNDAR. Los datos muestran que el costo de los medicamentos necesarios para estabilizar, en el primer nivel de atención, las complicaciones que derivan en las 5 principales causas de muertes maternas, sería mucho menor que el asignado a otros rubros de programas públicos, no tan urgentes. Ver presentación completa.
RAISE Literature Review
Dear Colleagues,
We were unable to send out a review last week.
Please find below this week’s RAISE Initiative literature review. If you have trouble accessing any of the articles or would like to receive them in an alternative format, please feel free to contact us at litreview@raiseinitiative.org
This week features articles on an evaluation of the accuracy of blood pressure measurement during pregnancy to predict pre-eclampsia, empirical evidence on how CBHI impacts access to health care, and particularly maternal health services in 3 West African countries, an exploration of health providers’ perceptions of adolescent sexual and reproductive healthcare services in Swaziland, provider perceptions of reproductive health service quality in Jordan and measures to aid in primary prevention and recognition of obstetric infections to facilitate early diagnosis and treatment. Also included is PATHfinder International’s pocket guide for healthy timing and spacing of pregnancies
Thank you and enjoy!
The RAISE Initiative Literature Review Team
Juliana Bol, Jennifer Kim and Claire Tebbets
Graduate Research Assistants
Mailman School of Public Health
Program Articles
Cnossen, J. S., et al (2008). “Accuracy of mean arterial pressure and blood pressure measurements in predicting pre-eclampsia: systematic review and meta-analysis.” BMJ 336: 1117-1120.
Abstract: To determine the accuracy of using systolic and diastolic blood pressure, mean arterial pressure, and increase of blood pressure to predict pre-eclampsia. Results: 34 studies, testing 60 599 women (3341 cases of pre-eclampsia), were included. In women at low risk for pre-eclampsia, the areas under the summary receiver operating characteristic curves for blood pressure measurement in the second trimester were 0.68 (95% confidence interval 0.64 to 0.72) for systolic blood pressure, 0.66 (0.59 to 0.72) for diastolic blood pressure, and 0.76 (0.70 to 0.82) for mean arterial pressure. Findings for the first trimester showed a similar pattern. Second trimester mean arterial pressure of 90 mm Hg or more showed a positive likelihood ratio of 3.5 (95% confidence interval 2.0 to 5.0) and a negative likelihood ratio of 0.46 (0.16 to 0.75). In women deemed to be at high risk, a diastolic blood pressure of 75 mm Hg or more at 13 to 20 weeks’ gestation best predicted pre-eclampsia: positive likelihood ratio 2.8 (1.8 to 3.6), negative likelihood ratio 0.39 (0.18 to 0.71). Additional subgroup analyses did not show improved predictive accuracy. Conclusion: When blood pressure is measured in the first or second trimester of pregnancy, the mean arterial pressure is a better predictor for pre-eclampsia than systolic blood pressure, diastolic blood pressure, or an increase of blood pressure.
Click here for article:
Arterial pressure and blood pressure measurements in predicting pre-eclampsia
Smith, K. V. and S. Sulzbach (2008). “Community-based health insurance and access to maternal health services: Evidence from three West African countries.” Social Science & Medicine 66(12): 2460-2473.
Abstract: Community-based health insurance (CBHI) has been incorporated into the health financing strategies of governments and communities in several Sub-Saharan African countries. Despite the support for and proliferation of CBHI schemes in this region, empirical evidence on how CBHI impacts access to health care, particularly maternal health services, is very limited. We use recent household surveys in three West African countries -Senegal, Mali, and Ghana- to examine the relationship between CBHI membership and access to formal sector maternal health care. We find that membership in a CBHI scheme is positively associated with the use of maternal health services, particularly in areas where utilization rates are very low and for more expensive delivery-related care. Our findings suggest, however, that membership in a CBHI scheme is not sufficient to influence maternal health behaviors - it is the inclusion of maternal health care in the benefits package that makes a difference. While many questions remain about CBHI, this study provides preliminary evidence suggesting that CBHI is a potential demand-side mechanism to increase maternal health care access. However, complementary supply-side interventions to improve quality of and geographic access to health care are also critical for improving health outcomes in this region.
Click here for article:
Community-based health insurance and access to maternal health services
Mngadi, P. T., E. Faxelid, et al. (2008). Health providers’ perceptions of adolescent sexual and reproductive health care in Swaziland. 55: 148-155.
Abstract: To explore health providers’ perceptions of adolescent sexual and reproductive healthcare services in Swaziland. Methods: Fifty-six healthcare providers, working in 11 health clinics in in 2005, were surveyed using a semi-structured questionnaire. The data were analysed by descriptive statistics and content analysis to identify key themes. Findings: Most participants were women with a mean age of 36 years and a mean number of 6 years in the profession. Services provided included STIs/HIV/AIDS advice, pre- and post-test counselling and testing on HIV, contraceptives and condom use. Half of the nurses/midwives had no continued education and lacked supervision on adolescent sexual and reproductive health care. The majority had unresolved moral doubts, negative attitudes, values and ethical dilemmas towards abortion care between the law, which is against abortion, and the reality of the adolescents’ situation. Forty-four wanted to be trained on post-abortion care while eight on how to perform abortions. Twenty-six wanted the government to support adolescent-friendly services and to train healthcare providers in adolescent sexual and reproductive health services. Conclusion: The curricula within nursing and midwifery preservice education need to be reviewed to incorporate comprehensive services for adolescents. There is need for provision of comprehensive services for adolescents in and appropriate youth-friendly services at all levels. There is need for nurse/midwifery participation, advocacy and leadership in policy development.
Click here for article:
Health providers’ perceptions of adolescent sexual and reproductive health care in Swaziland
Raeda, A., Nasir, A. Laeth S. (2008). “Provider Perceptions of Reproductive Health Service Quality in Jordanian Public Community Health Centers.” Health Care for Women International 29(N 5).
Abstract: Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in , which is a requirement for public sector reform.
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http://www.informaworld.com/10.1080/07399330801949657
Tharpe, N. (2008). “Postpregnancy Genital Tract and Wound Infections.” Journal of Midwifery & Women’s Health 53(3): 236-246.
Abstract: Despite the widespread application of standard aseptic techniques during vaginal birth, cesarean birth, and/or termination of pregnancy, postpregnancy infections remain a significant source of maternal morbidity and mortality. Obstetric infection accounts for more than 12% of maternal deaths. Infection occurs most frequently in women who have cesarean births, and following spontaneous or elective termination of pregnancy. Infection is estimated to be the second highest cause of under-reported maternal death in the . This article identifies measures to aid in primary prevention and recognition of obstetric infections in order to facilitate early diagnosis and treatment.
Click here for article:
Postpregnancy Genital Tract and Wound Infections
Pathfinder International. Extending Service Delivery Project:
Healthy timing and spacing of pregnancies: a pocket guide for health practitioners, program managers, and community leaders.
http://www.esdproj.org/site/DocServer/ESD_PG_updated_Feb07.pdf?docID=181
Salvando Vidas: Una Guía de Programas y Políticas como argumento de intervenciones exitosas en planificación familiar, maternidad segura y ITS/VIH/SIDA.
Jill Gay, MA. Karen Hardee, PhD. Nicole Judice, MA. Kokila Agarwal, MD, PhD. Katerine Fleming, MA. Alana Hairston. Brettania Walker. Martha Wood. Enero 2003.
http://maternidadsinriesgos.org/web/wp-content/uploads/2008/10/whatworksspanishfinal1.pdf