Current and future availability of and need for human resources for sexual, reproductive, maternal and newborn health in 41 countries in Sub-Saharan Africa.

BACKGROUND: The WHO African region, covering the majority of Sub-Saharan Africa, faces the highest rates of maternal and neonatal mortality in the world. This study uses data from the State of the World's Midwifery 2014 survey to cast a spotlight on the WHO African region, highlight the specific characteristics of its sexual, reproductive, maternal and newborn health (SRMNH) workforce and describe and compare countries' different trajectories in terms of meeting the population need for services. METHODS: Using data from 41 African countries, this study used a mathematical model to estimate potential met need for SRMNH services, defined as "the percentage of a universal SRMNH package that could potentially be obtained by women and newborns given the composition, competencies and available working time of the SRMNH workforce." The model defined the 46 key interventions included in this universal SRMNH package and allocated them to the available health worker time and skill set in each country to estimate the potential met need. RESULTS: Based on the current and projected potential met need in the future, the countries were grouped into three categories: (1) 'making or maintaining progress' (expected to meet more, or the same level, of the need in the future than currently): 14 countries including Ghana, Senegal and South Africa, (2) 'at risk' (currently performing relatively well but expected to deteriorate due to the health workforce not keeping pace with population growth): 6 countries including Gabon, Rwanda and Zambia, and (3) 'low performing' (not performing well and not expected to improve): 21 countries including Burkina Faso, Eritrea and Sierra Leone. CONCLUSION: The three groups face different challenges, and policy solutions to increasing met need should be tailored to the specific context of the country. National health workforce accounts should be strengthened so that workforce planning can be evidence-informed.

A rapid review of the rate of attrition from the health workforce.

BACKGROUND: Attrition or losses from the health workforce exacerbate critical shortages of health workers and can be a barrier to countries reaching their universal health coverage and equity goals. Despite the importance of accurate estimates of the attrition rate (and in particular the voluntary attrition rate) to conduct effective workforce planning, there is a dearth of an agreed definition, information and studies on this topic. METHODS: We conducted a rapid review of studies published since 2005 on attrition rates of health workers from the workforce in different regions and settings; 1782 studies were identified, of which 51 were included in the study. In addition, we analysed data from the State of the World's Midwifery (SoWMy) 2014 survey and associated regional survey for the Arab states on the annual voluntary attrition rate for sexual, reproductive, maternal and newborn health workers (mainly midwives, doctors and nurses) in the 79 participating countries. RESULTS: There is a diversity of definitions of attrition and barely any studies distinguish between total and voluntary attrition (i.e. choosing to leave the workforce). Attrition rate estimates were provided for different periods of time, ranging from 3 months to 12 years, using different calculations and data collection systems. Overall, the total annual attrition rate varied between 3 and 44% while the voluntary annual attrition rate varied between 0.3 to 28%. In the SoWMy analysis, 49 countries provided some data on voluntary attrition rates of their SRMNH cadres. The average annual voluntary attrition rate was 6.8% across all cadres. CONCLUSION: Attrition, and particularly voluntary attrition, is under-recorded and understudied. The lack of internationally comparable definitions and guidelines for measuring attrition from the health workforce makes it very difficult for countries to identify the main causes of attrition and to develop and test strategies for reducing it. Standardized definitions and methods of measuring attrition are required.

The geography of maternal and newborn health: the state of the art.

As the deadline for the millennium development goals approaches, it has become clear that the goals linked to maternal and newborn health are the least likely to be achieved by 2015. It is therefore critical to ensure that all possible data, tools and methods are fully exploited to help address this gap. Among the methods that are under-used, mapping has always represented a powerful way to 'tell the story' of a health problem in an easily understood way. In addition to this, the advanced analytical methods and models now being embedded into Geographic Information Systems allow a more in-depth analysis of the causes behind adverse maternal and newborn health (MNH) outcomes. This paper examines the current state of the art in mapping the geography of MNH as a starting point to unleashing the potential of these under-used approaches. Using a rapid literature review and the description of the work currently in progress, this paper allows the identification of methods in use and describes a framework for methodological approaches to inform improved decision-making. The paper is aimed at health metrics and geography of health specialists, the MNH community, as well as policy-makers in developing countries and international donor agencies.

Mapping for maternal and newborn health: the distributions of women of childbearing age, pregnancies and births.

BACKGROUND: The health and survival of women and their new-born babies in low income countries has been a key priority in public health since the 1990s. However, basic planning data, such as numbers of pregnancies and births, remain difficult to obtain and information is also lacking on geographic access to key services, such as facilities with skilled health workers. For maternal and newborn health and survival, planning for safer births and healthier newborns could be improved by more accurate estimations of the distributions of women of childbearing age. Moreover, subnational estimates of projected future numbers of pregnancies are needed for more effective strategies on human resources and infrastructure, while there is a need to link information on pregnancies to better information on health facilities in districts and regions so that coverage of services can be assessed. METHODS: This paper outlines demographic mapping methods based on freely available data for the production of high resolution datasets depicting estimates of numbers of people, women of childbearing age, live births and pregnancies, and distribution of comprehensive EmONC facilities in four large high burden countries: Afghanistan, Bangladesh, Ethiopia and Tanzania. Satellite derived maps of settlements and land cover were constructed and used to redistribute areal census counts to produce detailed maps of the distributions of women of childbearing age. Household survey data, UN statistics and other sources on growth rates, age specific fertility rates, live births, stillbirths and abortions were then integrated to convert the population distribution datasets to gridded estimates of births and pregnancies. RESULTS AND CONCLUSIONS: These estimates, which can be produced for current, past or future years based on standard demographic projections, can provide the basis for strategic intelligence, planning services, and provide denominators for subnational indicators to track progress. The datasets produced are part of national midwifery workforce assessments conducted in collaboration with the respective Ministries of Health and the United Nations Population Fund (UNFPA) to identify disparities between population needs, health infrastructure and workforce supply. The datasets are available to the respective Ministries as part of the UNFPA programme to inform midwifery workforce planning and also publicly available through the WorldPop population mapping project.

Delivering the evidence to improve the health of women and newborns: State of the World's Midwifery, report 2014.

The State of the World's Midwifery Report 2014: A universal pathway, a women's right to health (SoWMy2014) was published in June 2014 and joins the ranks of a number of publications which contribute to the growing body of evidence about a global midwifery workforce that can improve maternal and child health.This editorial provides an overview of these publications that have been supported by global movements in the area of sexual, reproductive, maternal, and newborn and child health over the last four years. Background information is given on the methodology and data collection of SoWMy2014, the main findings cover the area of the availability, accessibility, acceptability and quality of midwifery services and a 2 page country brief shows the SRMNH data and workforce projections for each of the 73 "Countdown countries" that participated.SoWMy 2014 report shows that midwives can provide 87% of the needed essential care for women and newborns, when educated and trained to international standards. Midwives however, are most effective when they work within a functional health system and enabling environment.Also, a supportive team of auxiliaries, physicians and specialists is essential in order to ensure coverage of SRMNH services to women and newborns across the whole continuum of care, from pre-pregnancy through to pregnancy, childbirth and the post-natal period and from household to hospital.Based on these findings, the report puts forward a vision of Midwifery2030, a pathway for women's health and for midwifery policy and planning through the end of 2030. It promotes women-centered and midwife-led care to achieve the goal of universal health coverage for all women.

Colecistitis aguda asociada con COVID-19 grave en el embarazo. Reporte de caso y revisión de la bibliografía / Acute cholecystitis associated with severe COVID-19 in pregnancy. Case report and bibliographic review

Resumen ANTECEDENTES: Las mujeres embarazadas e infectadas con SARS-CoV-2 tuvieron 2.9 veces más probabilidad de requerir ventilación invasiva. La colecistitis aguda es la segunda indicación quirúrgica más común en el embarazo. En la búsqueda bibliográfica no se encontraron reportes de concomitancia de ambas enfermedades durante el embarazo, por este motivo se publica el reporte de caso clínico y se revisa la bibliografía. CASO CLÍNICO: Paciente de 32 años, en curso de las 23 semanas de embarazo. Debido a síntomas de COVID-19, con prueba PCR positiva, se hospitalizó para inicio de ventilación mecánica invasiva. Al noveno día de internamiento tuvo elevación de transaminasas y reporte de TAC de colecistitis aguda alitiásica. Se le indicó la colecistostomía percutánea, con la que se alivió el cuadro hepatobiliar. En el segundo tiempo quirúrgico se procedió a la cesárea. Tres días después experimentó mejoría ventilatoria y bioquímica gradual. A los 32 días de hospitalización se logró la intubación y, después de 54 días, se dio de alta del hospital, sin requerimiento de oxígeno suplementario. CONCLUSIONES: Encontrar, en conjunto con el síndrome de insuficiencia respiratoria aguda por COVID-19 grave que requiere ventilación mecánica invasiva, embarazo previable y colecistitis alitiásica pone en grave peligro a la embarazada y al equipo médico en múltiples dilemas médicos, quirúrgicos y bioéticos. La colecistostomía percutánea en pacientes con inestabilidad hemodinámica y la finalización del embarazo en caso de deterioro ventilatorio ante síndrome de insuficiencia respiratoria aguda es una opción controvertida. Lo conducente, sin duda, son los procedimientos basados en evidencia y las sesiones multidisciplinarias, incluyendo a la familia.

Abstract BACKGROUND: Pregnant women infected with SARS-CoV-2 were 2.9 times more likely to require invasive ventilation. Acute cholecystitis is the second most common surgical indication in pregnancy. In the literature search, no reports of concomitance of both diseases during pregnancy were found, for this reason the clinical case report is published and the literature is reviewed. CASE REPORT: 32-year-old female patient, in the course of 23 weeks of pregnancy. Due to symptoms of COVID-19, with positive PCR test, she was hospitalized for initiation of invasive mechanical ventilation. On the ninth day of hospitalization, she had elevated transaminases and CT report of acute cholecystitis alliasis. Percutaneous cholecystostomy was indicated, which relieved the hepatobiliary symptoms. In the second surgical stage, a cesarean section was performed. Three days later she experienced gradual ventilatory and biochemical improvement. After 32 days of hospitalization, intubation was achieved and, after 54 days, she was discharged from the hospital, without requiring supplemental oxygen. CONCLUSIONS: Finding, in conjunction with severe COVID-19 acute respiratory failure syndrome requiring invasive mechanical ventilation, pre-viable pregnancy, alliasic cholecystitis, places the pregnant woman and the medical team in serious medical, surgical, and bioethical dilemmas. Percutaneous cholecystostomy in patients with hemodynamic instability and termination of pregnancy in case of ventilatory deterioration in the face of acute respiratory failure syndrome is a controversial option. Evidence-based procedures and multidisciplinary sessions, including the family, are undoubtedly conducive.