Impact of a quality improvement programme on family planning services in Egypt.

The Egyptian government's national Gold Star programme to improve the quality and usage of family planning was conducted from 1995 to 2000. Data from the 2004 Egypt Service Provision Assessment survey were used to assess whether the certified Gold Star facilities had sustained higher quality services than non-Gold Star facilities 4 years after conclusion of the programme. A nationally representative sample of 637 facilities providing family planning services were compared using several quality indicators. Gold Star facilities had significantly better availability of family planning methods, counselling and examination services than non-Gold Starfacilities, independent of type, size and geographical location. Providers in Gold Star facilities were also more likely to adhere to higher quality practices in counselling and examination than in non-Gold Star facilities. The Gold Star programme was effective and could be implemented elsewhere in the region and globally.

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.

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.

Nutrition and immunization survey of Bosnian women and children during 1993.

BACKGROUND: As a result of the war in Bosnia, millions of displaced people and refugees have come to depend upon international donations of food aid. METHODS: We conducted a survey of 120 randomly selected 'clusters' of households in the Bosnian regions of Sarajevo, Tuzla, Zenica and Bihac (30 'clusters' in each region). Children from 6 to 59 months and their mothers were selected and their nutritional status was examined. Children aged 13-25 months and infants under 16 weeks were also assessed for their immunization status and infant feeding practices respectively. RESULTS: There were no clinical signs of protein-energy undernutrition or micronutrient deficiency in children. Similarly, there were no clinical signs of undernutrition in adults, although 10.8% of the resident women in Sarajevo and 11.9% in Zenica had a Body Mass Index (BMI) below 18.5. Total BCG coverage was 94% while the coverage for DPT/polio was only 55% in Sarajevo and 49% in Zenica. Only 5% of mothers were exclusively breastfeeding babies under 16 weeks. CONCLUSION: While the coverage of the survey was not nationwide and was limited to the first year of the war, the results indicate that in this period serious hunger and undernutrition were prevented in Bosnia, though they suggest that appreciable loss of weight is likely to have occurred. Immunization coverage, except for BCG, and exclusive breastfeeding levels were poor.

PIP: The war in Bosnia has displaced millions of people. These individuals and refugees now depend upon international food aid. The authors surveyed 120 randomly selected clusters of households in the Bosnian regions of Sarajevo, Tuzla, Zenica, and Bihac to assess nutritional status, immunization status, and infant feeding practices. Children aged 6-59 months and their mothers were selected and their nutritional status examined. Children aged 13-25 months and infants younger than 16 weeks were also assessed for their immunization status and infant feeding practices, respectively. Research found no clinical signs of protein-energy undernutrition or micronutrient deficiency in children. Furthermore, there were no clinical signs of undernutrition in adults, although 10.8% of the resident women in Sarajevo and 11.9% in Zenica had a body mass index (BMI) under 18.5. Total BCG coverage was 94%, while the coverage for DPT/polio was 55% in Sarajevo and 49% in Zenica. Only 5% of mothers were exclusively breastfeeding babies younger than 16 weeks.

Nutrition and infant feeding survey of women and children in Sarajevo during July 1993.

OBJECTIVE: To collect baseline information on nutritional status and infant feeding practices in besieged Sarajevo and to identify areas for action. DESIGN: Thirty communities (clusters) were randomly selected from 84 local communities within besieged Sarajevo. A starting point within a community was randomly selected and subsequent houses visited until the required sample size was reached. 19 collective centres were included in a separate sample. SETTING: The survey was carried out in besieged Sarajevo during July 1993. SUBJECTS: Subjects included residents and refugees. The nutritional status of 524 children aged from six to 59 months and 494 women of child-bearing age was assessed. Information on feeding practices was obtained from a subsample of 64 mothers with babies less than 16 weeks old. MEASUREMENTS: Children and the women who accompanied them were weighed and measured. Weight for height Z scores were calculated for children and body mass index (BMI) was calculated for women. A structured questionnaire on infant feeding practices was administered to mothers of babies. RESULTS: There were no indications of undernutrition in children above the 2.5% which would normally be expected in a population. Among resident women, 10.8% had a BMI < 18.5, compared to 4.4% among refugee women in private accommodation and 8.6% in collective centres. The weights of refugee women in collective centres were significantly higher than the weights of resident women (ANOVA, p = 0.03). Only 6% of mothers with babies less than 16 weeks old were exclusively breast feeding. CONCLUSION: Nutritional monitoring proved to be possible and useful in assessing breast feeding practices and nutritional status. The level of exclusive breast feeding was extremely low, probably due to lack of relevant education of health workers.

A cross-national study of differences in length of stay of patients with cardiac diagnoses.

To determine the reason for large regional differences in average hospital length of stay shown in federal discharge abstract data, the medical records of 482 cardiac patients from hospitals belonging to two metropolitan area PSROs of Baltimore, Maryland, and 438 cardiac patients from hospitals in the Metropolitan area PSRO from Portland, Oregon, were reviewed, stratified by diagnosis and complications, and compared for length of stay. Cardiac patients were hospitalized between 2.5 and 7 days longer in Baltimore than in Portland. Federal data on length of hospital stay were basically correct for the diagnostic categories studied. Length-of-stay differences could not be explained by patient differences and appeared to be due to differences in physician practice patterns.

Why treatment centres failed to prevent cholera deaths among Rwandan refugees in Goma, Zaire.

In July, 1994, in one of the worst cholera outbreaks in recent times, an estimated 12,000 Rwandan refugees died in Goma in eastern Zaire. The Vibrio cholerae strains were resistant to tetracycline and doxycycline, the commonly used drugs for cholera treatment. Despite the efforts of international organisations, which provided medical relief by establishing treatment centres in Goma, mortality from the disease was much higher than expected. In the area of Muganga camp, which had the largest concentration of refugees and where most of the medical aid organisations were active, the highest reported case-fatality ratio for a single day was 48%. The slow rate of rehydration, inadequate use of oral rehydration therapy, use of inappropriate intravenous fluids, and inadequate experience of health workers in management of severe cholera are thought to be some of the factors associated with the failure to prevent so many deaths during the epidemic. In one of the temporary treatment centres with the worst case-fatality record, our team showed that improvement of these factors could increase the odds of survival of cholera patients even in a disaster setting.

Impact of a quality improvement programme on family planning services in Egypt

The Egyptian government's to improve the quality and usage of family planning was conducted from 1995 to 2000. Service Provision Assessment survey were used to assess whether the certified Gold Star facilities had sustained higher quality services than non-Gold Star facilities 4 years after conclusion of the programme. A nationally representative sample of 637 facilities providing family planning services were compared using several quality indicators. Gold Star facilities had significantly better availability of family planning methods, counselling and examination services than non-Gold Star facilities, independent of type, size and geographical location. Providers in Gold Star facilities were also more likely to adhere to higher quality practices in counselling and examination than in non-Gold Star facilities. The Gold Star programme was effective and could be implemented elsewhere in the region and globally