Monitoring maternal and newborn health outcomes globally: a brief history of key events and initiatives.

OBJECTIVE: Over time, we have seen a major evolution of measurement initiatives, indicators and methods, such that today a wide range of maternal and perinatal indicators are monitored and new indicators are under development. Monitoring global progress in maternal and newborn health outcomes and development has been dominated in recent decades by efforts to set, measure and achieve global goals and targets: the Millennium Development Goals followed by the Sustainable Development Goals. This paper aims to review, reflect and learn on accelerated progress towards global goals and events, including universal health coverage, and better tracking of maternal and newborn health outcomes. METHODS: We searched for literature of key events and global initiatives over recent decades related to maternal and newborn health. The searches were conducted using PubMed/MEDLINE and the World Health Organization Global Index Medicus. RESULTS: This paper describes global key events and initiatives over recent decades showing how maternal and neonatal mortality and morbidity, and stillbirths, have been viewed, when they have achieved higher priority on the global agenda, and how they have been measured, monitored and reported. Despite substantial improvements, the enormous maternal and newborn health disparities that persist within and between countries indicate the urgent need to renew the focus on reducing inequities. CONCLUSION: The review has featured the long story of the progress in monitoring improving maternal and newborn health outcomes, but has also underlined current gaps and significant inequities. The many global initiatives described in this paper have highlighted the magnitude of the problems and have built the political momentum over the years for effectively addressing maternal and newborn health and well-being, with particular focus on improved measurement and monitoring.

Chaque jour, environ 810 femmes meurent de causes évitables liées à la grossesse et à l'accouchement, près de 7.000 nouveau-nés décèdent et plus de 7.000 bébés sont mort-nés, selon les dernières estimations annuelles. Au fil du temps, nous avons assisté à une évolution majeure des initiatives, indicateurs et méthodes de mesure, de sorte qu'aujourd'hui un grand nombre d'indicateurs maternels et périnatals sont monitorés et de nouveaux indicateurs sont en cours d'élaboration. Le suivi des progrès mondiaux en matière de santé et de développement a été dominé au cours des dernières décennies par les efforts visant à définir, mesurer et atteindre les objectifs et cibles mondiaux: les Objectifs de Développement pour le Millénaire, suivis des Objectifs de Développement Durable. Le but de cette revue est d'encourager la réflexion et l'éducation en vue d'accélérer les progrès vers les objectifs mondiaux, y compris la couverture de santé universelle et un meilleur suivi des résultats pour la santé de la mère et du nouveau-né. Cet article décrit les événements et les initiatives clés des dernières décennies montrant comment la mortalité et la morbidité maternelles et néonatales, ainsi que les mortinaissances, ont été considérées lorsqu'elles ont atteint un rang de priorité plus élevé dans l'agenda mondial, et comment elles ont été mesurées, suivies et rapportées. En dépit des améliorations substantielles, les énormes disparités de santé maternelle et néonatale qui persistent dans et entre les pays indiquent qu'il est urgent de recentrer l'attention sur la réduction des inégalités. Nous devons intensifier les initiatives fondées sur des preuves et sur les droits de l'homme visant à améliorer la sécurité de la grossesse, de l'accouchement et des périodes néonatale et post-partum (en particulier l'amélioration de la couverture, de la qualité et de l'équité des soins pendant le travail et l'accouchement, ainsi que les soins pour les nouveau-nés petits et malades), ainsi que la qualité, et la rapidité des données de surveillance (notamment l'enregistrement précis des naissances et des décès).

The organization of STI/HIV risk-taking among long-line fishermen in Bali, Indonesia.

We report on selected findings of a qualitative social network study investigating STI/HIV-related risk among migrant fishermen based at one of Indonesia's major fishing ports in Bali. Their activities between fishing trips include drinking parties, watching pornographic videos, and visiting brothels, while condom use is rare. While on board, they plan and anticipate these activities and many insert penile implants. These fishermen run a high personal risk of contracting STI/HIV, and, with their circular migration patterns among Indonesian and foreign ports such as Thailand and South Africa, and with visits back to their rural hometowns and wives or girlfriends in Java, there is a serious risk of disease transmission to the general population. This paper argues that the role that social interactions play in HIV/AIDS-related risks should be considered as important as (if not more important than) individual knowledge, attitudes, and practices in the design of effective STI/HIV prevention programs.

Prevalence of sexually transmissible infections (STI) among male patients with STI in Denpasar and Makassar, Indonesia: are symptoms of urethritis sufficient to guide syndromic treatment?

BACKGROUND: There are few data on sexually transmissible infections in men in Indonesia. We conducted a prevalence study and compared symptoms alone with clinical signs to manage urethritis. METHODS: We recruited symptomatic male patients at public clinics, and used standardised questionnaires, examinations and laboratory tests. RESULTS: We recruited 273 men and the prevalences were Neisseria gonorrhoeae 18.2%, Chlamydia trachomatis 10.1%, and positive syphilis serology 5.2%. Four cases of HIV were detected. Urethral symptoms detected 91.7% of N. gonorrhoeae and/or C. trachomatis, and positive predictive value (PPV) was 41.8%, compared with clinical confirmation (sensitivity 86.1%, PPV 37.6%). CONCLUSIONS: Most cases of syphilis were asymptomatic, supporting routine screening for syphilis. Urethral symptoms predicted infection with N. gonorrhoeae/C. trachomatis better than clinical signs.