Maternal death surveillance efforts: notification and review coverage rates in 30 low-income and middle-income countries, 2015-2019.

OBJECTIVE: Performance of maternal death surveillance and response (MDSR) relies on the system's ability to identify and notify all maternal deaths and its ability to review all maternal deaths by a committee. Unified definitions for indicators to assess these functions are lacking. We aim to estimate notification and review coverage rates in 30 countries between 2015 and 2019 using standardised definitions. DESIGN: Repeat cross-sectional surveys provided the numerators for the coverage indicators; United Nations (UN)-modelled expected country maternal deaths provided the denominators. SETTING: 30 low-income and middle-income countries responding to the Maternal Health Thematic Fund annual surveys conducted by the UN Population Fund between 2015 and 2019. OUTCOME MEASURES: Notification coverage rate ([Formula: see text]) was calculated as the proportion of expected maternal deaths that were notified at the national level annually; review coverage rate ([Formula: see text]) was calculated as the proportion of expected maternal deaths that were reviewed annually. RESULTS: The average annual [Formula: see text] for all countries increased from 17% in 2015 to 28% in 2019; the average annual [Formula: see text] increased from 8% to 13%. Between 2015 and 2019, 22 countries (73%) reported increases in the [Formula: see text]-with an average increase of 20 (SD 18) percentage points-and 24 countries (80%) reported increases in [Formula: see text] by 7 (SD 11) percentage points. Low values of [Formula: see text] contrasts with country-published review rates, ranging from 46% to 51%. CONCLUSION: MDSR systems that count and review all maternal deaths can deliver real-time information that could prompt immediate actions and may improve maternal health. Consistent and systematic documentation of MDSR efforts may improve national and global monitoring. Assessing the notification and review functions using coverage indicators is feasible, not affected by fluctuations in data completeness and reporting, and can objectively capture progress.

Antenatal care service delivery and factors affecting effective tetanus vaccine coverage in low- and middle-income countries: Results of the Maternal Immunisation and Antenatal Care Situational analysis (MIACSA) project.

OBJECTIVES: To map the integration of existing maternal tetanus immunization programmes within antenatal care (ANC) services for pregnant women in low- and middle-income countries (LMICs) and to identify and understand the challenges, barriers and facilitators associated with high performance maternal vaccine service delivery. DESIGN: A mixed methods, cross sectional study with four data collection phases including a desk review, online survey, telephone and face-to-face interviews and in country visits was undertaken between 2016 and 2018. Associations of different service delivery process components with protection at birth (PAB) and with country groups were established. PAB was defined as the proportion of neonates protected at birth against neonatal tetanus. Regression analysis and structural equation modelling was used to assess associations of different variables with maternal tetanus immunization coverage. Latent class analysis (LCA), was used to group country performance for maternal immunization, and to address the problem of multicollinearity. SETTING: LMICs. RESULTS: The majority of LMICs had a policy on recommended number of ANC visits, however most were yet to implement the WHO guidelines recommending eight ANC contacts. Countries that recommended > 4 ANC contacts were more likely to have high PAB > 90%. Passive disease surveillance was the most common form of disease surveillance performed but the maternal and neonatal morbidity and mortality indicators recorded differed between countries. The presence of user fees for antenatal care and maternal immunization was significantly associated with lower PAB (<90%). CONCLUSIONS: Recommendations include implementing the current WHO ANC guideline to facilitate increased opportunities for vaccination during each pregnancy. Improved utilisation of ANC services by increasing the demand side by increasing the quality of services, reducing any associated costs and supporting user fee exemptions, or the supply side can also enhance utilisation of ANC services which are positioned as an ideal platform for delivery of maternal vaccines.

'What gets measured gets managed': revisiting the indicators for maternal and newborn health programmes.

BACKGROUND: The health of women and children are critical for global development. The Sustainable Development Goals (SDG) agenda and the Global Strategy for Women's, Children's, and Adolescent's Health 2016-2030 aim to reduce maternal and newborn deaths, disability, and enhancement of well-being. However, information and data on measuring countries' progress are limited given the variety of methodological challenges of measuring care around the time of birth, when most maternal and neonatal deaths and morbidities occur. MAIN BODY: In 2015, the World Health Organization launched Mother and Newborn Information for Tracking Outcomes and Results (MoNITOR), a technical advisory group to WHO. MoNITOR comprises 14 independent global experts from a variety of disciplines selected in a competitive process for their technical expertise and regional representation. MoNITOR will provide technical guidance to WHO to ensure harmonized guidance, messages, and tools so that countries can collect useful data to track progress toward achieving the Sustainable Development Goals. SHORT CONCLUSION: Ultimately, MoNITOR will provide technical guidance to WHO to ensure harmonized guidance, messages, and tools so that countries can collect useful data to track progress toward achieving the Sustainable Development Goals.

Oxytocin to augment labour during home births: an exploratory study in the urban slums of Dhaka, Bangladesh.

OBJECTIVE: In Bangladesh, the majority of women give birth at home. There is anecdotal evidence that unqualified allopathic practitioners (UAPs) administer oxytocin at home births to augment labour pain. The objective is to explore the use of oxytocin to augment labour pain during home births in an urban slum in Dhaka, Bangladesh. DESIGN: Cross-sectional survey. SETTING: KamrangirChar slum, Dhaka, Bangladesh. POPULATION: Married women with a home birth or who experienced labour at home in the 6 months prior to the survey (n = 463) were interviewed. Twenty-seven UAPs were interviewed to validate women's responses. METHODS: Bivariate and multivariate logistic regressions were used to identify significant predictors of oxytocin use. MAIN OUTCOME MEASURES: Reported use of oxytocin to augment labour pain. RESULTS: Forty-six percent of women reported using medicine or other treatments to augment labour pain, 131 of whom reported using oxytocin (28% of total). Traditional birth attendants were the predominant decision-makers of when to use oxytocin. The medication was provided by a UAP who administered the drug via saline infusion or intramuscular injection. Higher education, lower parity, reported long labour (more than 12 hours), and knowledge of and positive attitudes towards oxytocin were significantly associated with oxytocin use after controlling for other factors. In the validation exercise, there was agreement about the use of oxytocin to augment labour in 22 of 27 cases (82%). CONCLUSIONS: About one-third of women used oxytocin to augment labour pain. This practice has implications for health education as well as future research to assess the impact on adverse maternal and neonatal outcomes.

Delivery practices of traditional birth attendants in Dhaka slums, Bangladesh.

This paper describes associations among delivery-location, training of birth attendants, birthing practices, and early postpartum morbidity in women in slum areas of Dhaka, Bangladesh. During November 1993-May 1995, data on delivery-location, training of birth attendants, birthing practices, delivery-related complications, and postpartum morbidity were collected through interviews with 1,506 women, 489 home-based birth attendants, and audits in 20 facilities where the women from this study gave birth. Associations among maternal characteristics, birth practices, delivery-location, and early postpartum morbidity were specifically explored. Self-reported postpartum morbidity was associated with maternal characteristics, delivery-related complications, and some birthing practices. Dais with more experience were more likely to use potentially-harmful birthing practices which increased the risk of postpartum morbidity among women with births at home. Postpartum morbidity did not differ by birth-location. Safe motherhood programmes must develop effective strategies to discourage potentially-harmful home-based delivery practices demonstrated to contribute to morbidity.

Simazine treatment history determines a significant herbicide degradation potential in soils that is not improved by bioaugmentation with Pseudomonas sp. ADP.

AIMS: To study biological removal of the herbicide simazine in soils with different history of herbicide treatment and to test bioaugmentation with a simazine-degrading bacterial strain. METHODS AND RESULTS: Simazine removal was studied in microcosms prepared with soils that had been differentially exposed to this herbicide. Simazine removal was much higher in previously exposed soils than in unexposed ones. Terminal restriction fragment length polymorphism analysis and multivariate analysis showed that soils previously exposed to simazine contained bacterial communities that were significantly impacted by simazine but also had an increased resilience. The biodegradation potential was also related to the presence of high levels of the atz-like gene sequences involved in simazine degradation. Bioaugmentation with Pseudomonas sp. ADP resulted in an increased initial rate of simazine removal, but this strain scarcely survived. After 28 days, residual simazine removals were the same in bioaugmented and not bioaugmented microcosms. CONCLUSIONS: In soils with a history of simazine treatment bacterial communities were able to overcome subsequent impacts with the herbicide. The success of bioaugmentation was limited by the low survival of the introduced strain. SIGNIFICANCE AND IMPACT OF THE STUDY: Conclusions from this work provided insights on simazine biodegradation potential of soils and the convenience of bioaugmentation.

Delivery-related complications and early postpartum morbidity in Dhaka, Bangladesh.

OBJECTIVE: To describe delivery-related complications and postpartum morbidity of women living in slum areas of Dhaka, Bangladesh. METHOD: From November 1993 to May 1995, 1506 women were interviewed regarding delivery-related complications and postpartum morbidities. Operational definitions were applied to maternal reports to categorize serious delivery-related complications and postpartum morbidity. Corroborating information was identified from medical records for facility-based deliveries and physical examinations by female physicians 14 to 22 days postpartum. RESULT: Thirty-six percent of women described serious delivery-related complications and 75% of women reported postpartum morbidity. There were two maternal deaths among 1471 live births. When maternal reports were related to corroborating information, the proportion of women's reports of serious complications and morbidity appears reasonably accurate for some conditions. CONCLUSION: A large proportion of urban slum women in Dhaka experience serious delivery-related complications and/or postpartum morbidity. Information on delivery practices that contribute to morbidity and factors that influence appropriate care seeking is needed.

Enhancement of hydrocarbon waste biodegradation by addition of a biosurfactant from Bacillus subtilis O9.

A non-sterile biosurfactant preparation (surfactin) was obtained from a 24-h culture of Bacillus subtilis O9 grown on sucrose and used to study its effect on the biodegradation of hydrocarbon wastes by an indigenous microbial community at the Erlenmeyer-flask scale. Crude biosurfactant was added to the cultures to obtain concentrations above and below the critical micelle concentration (CMC). Lower concentration affected neither biodegradation nor microbial growth. Higher concentration gave higher cell concentrations. Biodegradation of aliphatic hydrocarbons increased from 20.9 to 35.5% and in the case of aromatic hydrocarbons from nil to 41%, compared to the culture without biosurfactant. The enhancement effect of biosurfactant addition was more noticeable in the case of long chain alkanes. Pristane and phytane isoprenoids were degraded to the same extent as n-C17 and n-C18 alkanes and, consequently, no decrease in the ratios n-C17/pri and n-C18/phy was observed. Rapid production of surfactin crude preparation could make it practical for bioremediation of ship bilge wastes.