ABSTRACT
BACKGROUND: Shortage of skilled birth attendants (SBA) is one of the determinants of maternal mortality in India. To combat this shortage, innovative task-shifting strategies to engage providers of the Indian system of medicine (Ayurveda and Homeopathy), called AYUSH practitioners (AP), to provide SBA services is being implemented. METHODS: Engagement of APs for SBA service provision was assessed in 3 states of India (Maharashtra, Rajasthan and Odisha) through 73 in-depth interviews (37 with APs and 36 with programme managers). The interviews explored the providers' SBA training experience, barriers for SBA service provision, workplace and community acceptance, and the perspective of programme managers on the competence and quality of SBA services provided. RESULTS: SBA training led to skill enhancement with adoption of appropriate maternal and newborn care practices. A dedicated trainer, more hands-on practice, and strengthening training on newborn care practices and management of complications emerged as the training needs. Conditional involvement in SBA-related work, a discriminatory attitude at the workplace and lack of legal/regulatory authorisation were identified as barriers to the inclusion of APs in SBA service provision. CONCLUSIONS: Quality skill enhancement measures, an enabling work environment, a systematic task-shifting process, role definition, supportive supervision and credentialing could be key for the integration of APs and their acceptance in the health system.
Subject(s)
Health Personnel , Maternal Health Services , Midwifery , Work , Adult , Clinical Competence , Female , Homeopathy , Humans , India , Maternal Mortality , Medicine, Ayurvedic , Middle Aged , Pregnancy , Professional Role , Qualitative Research , WorkforceABSTRACT
PIP: Until the 20th century, women and families worldwide knew that it was always a possibility that women would die from childbearing (e.g., over 2000 maternal deaths/100,000 births in Europe). Increased knowledge about pregnancy and its complications and the application of that knowledge in maternal health care systems in developed countries reduced maternal mortality considerably (e.g., 20 in northern Europe). Improvements in delivery management helped greatly to reduce maternal deaths, which include aseptic techniques, appropriate use of forceps, safe blood transfusion, sulphonamides, and proper management of preeclampsia and eclampsia. Maternal mortality is still high in developing countries (e.g., 5% of women in some parts of Africa die from a pregnancy-related condition) where 99% of all maternal deaths occur. These pillars of family life die in the prime of their life and often leave other children. Their loss adversely affects social and economic development. Just 78 countries (35% of the world's population) have a vital registration system recording causes of death, thereby making it difficult to understand the extent of maternal mortality. The 1st cause of maternal death to fall in developed countries and now in developing countries is sepsis. Other causes of maternal death are obstetric hemorrhage, eclampsia, ectopic pregnancy, unsafe abortions, and obstructed labor. Lack of access to maternal health services keeps many women with pregnancy complications from receiving the care they need to survive. Trained persons help only about 50% of women worldwide with labor and delivery. Upgrading of local health centers and training midwives in recognizing complications and in aseptic delivery techniques are needed to improve the quality of maternal health care. Each health center must have the means to transport women to district hospitals. Health centers must offer contraception to prevent unwanted pregnancies. Countries need to reduce the social inequalities that women face.^ieng
Subject(s)
Developed Countries , Developing Countries , Evaluation Studies as Topic , Maternal Health Services , Maternal Mortality , Pregnancy Complications , Quality of Health Care , Delivery of Health Care , Demography , Disease , Health , Health Services , Health Services Research , Maternal-Child Health Centers , Mortality , Organization and Administration , Population , Population Dynamics , Primary Health Care , Program EvaluationABSTRACT
PIP: The 14th International Federation of Gynaecology and Obstetrics World Congress will be held in Montreal, Canada, in 1994, under the auspices of the Society of Obstetricians and Gynecologists of Canada. The World Congress will 1) promote and facilitate international cooperation in the field of obstetrics and gynecology, 2) develop and improve the exchange of information and ideas, and 3) encourage the adoption of an international perspective on issues of concern. The 1994 program will survey recent research advances and introduce new equipment, instruments, and pharmaceuticals. Issues addressed will include maternal mortality, reproductive technologies, continuing education, malignancy, family planning, and contraception. The Conference's symposia, industry-sponsored events, and cultural activities are being designed to increase speaker-audience interaction and to stimulate debate and the exchange of views. The continuing education goals are 1) to encourage appropriate research with valid and applicable results and 2) to extend the patient-counseling abilities of participating physicians. Canada's socialized health care system, which carefully scrutinizes new expensive technologies, will be highlighted for the international delegates. The scientific program will include 1) general topics 2) reproductive endocrinology, 3) maternal/fetal medicine, and 4) gynecological oncology. Poster sessions followed by open discourses and free communications sessions will facilitate the exchange of views and information. The overall goal of the conference is to improve reproductive health care for mothers and babies worldwide.^ieng
Subject(s)
Congresses as Topic , Health Education , International Cooperation , Maternal Mortality , Physicians , Reproductive Medicine , Research , Americas , Canada , Delivery of Health Care , Demography , Developed Countries , Economics , Education , Health , Health Personnel , Mortality , North America , Population , Population Dynamics , TechnologyABSTRACT
La investigación de nuevos anestésicos locales con un aumento de la liposolubilidad de sus moléculas ha permitido hallar drogas con mayor potencia y duración del efecto. Sin embargo, los mismos cambios moleculares que incrementan la duración de acción y la potencia también pueden aumentar la toxicidad local y sistémica. En el caso de una excesiva dosis utilizada, ya sea por una rápida absorción o por una inyección intravascular inadvertida, durante el procedimiento para el bloqueo se pueden producir efectos sistémicos de importancia. El primer sistema afectado es el nervioso central, donde produce una excitación, llegando luego a deprimir el sistema cardiovascular. Los estudios comparativos para numerosas indicaciones no han podido demostrar fehacientemente diferencias en cuanto a la toxicidad de la levobupivacaína, la ropivacaína y la bupivacaína.
Subject(s)
Humans , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Anesthetics, Local/pharmacokinetics , Anesthetics, Local/pharmacology , Anesthetics, Local/toxicity , Bupivacaine/pharmacokinetics , Bupivacaine/toxicity , Drug Overdose , Maximum Acceptable Dose , Pregnancy/drug effects , Acidosis , Central Nervous System/drug effects , Hypercapnia , Hypoxia , Kindling, Neurologic/drug effects , Maternal Mortality , Homeopathic DosageABSTRACT
Presenta Memoria del I Congreso Nacional de Atención Primaria en Salud sobre "Salud y Desarrollo Humano Sostenible: retos y desafíos, celebrado del 21 al 23 de septiembre del 2000, el Centro de Convenciones Olof Palme de la ciudad de Managua, Nicaragua. Resumen las intensas y ricas discusiones sostenidas y las que suscitaron en los diferentes grupos de trabajo. El material constituye un valioso aporte al debate por una salud para todos, una meta social válida y vigente hoy mas que nunca antes. Además el material es un documento que sirve de referencia para cualquier persona interesada en el presente y futuro de la salu pública en Nicaragua para contribuir a mejorar la situación de salud y la calidad de vida de los nicaragüenses