Risk factors for maternal mortality: results of a case-control study conducted in Conakry (Guinea).

OBJECTIVE: To assess the risk factors of maternal mortality in an urban area of West Africa (Conakry, capital of Guinea). METHOD: A case-control study where 102 maternal deaths were compared with 338 control women who had given birth and survived, during 1 year (from July 1, 1989 to June 30, 1990). RESULT: Of all the socio-demographic variables studied, only a low family income (R = 2.6; 1.1-6.5) was found to be a risk factor for maternal death In the obstetrical part of the survey, neither parity nor the number or location of pre-natal consultations constituted risk factors. However, the presence during pregnancy or delivery of signs of infection (R = 3.7; 1.4-9.8), anemia (R = 2.1; 1.1-4.1), hypertension (R = 19.8; 5.8-67.8) and dystocia (R = 9.0; 3.7-21.5) were found to be the main predictive risk factors of maternal death. The maternal mortality risk was multiplied by 12 if the women had had a cesarean section, and by 4 in the case of complications in the post-partum period. CONCLUSION: To achieve substantial reductions in maternal mortality levels, work must be done on these specific risk factors, and future programs must urgently be concentrated on a higher standard of pre-natal monitoring, obstetrical emergency facilities and training of obstetrical staff.

Level and causes of maternal mortality in Guinea (West Africa).

In order to evaluate the level of maternal mortality at Conakry, capital of Guinea (West Africa), a descriptive epidemiological study was made of all maternal deaths occurring between July 1st, 1989 and June 30th, 1990. To ensure that cases of maternal death were recorded as exhaustively as possible, we conducted this study over 1 year in municipal and hospital maternity units, and 3 months in the urban community. One hundred thirty-nine maternal deaths were registered, representing an annual maternal mortality rate of 559/100,000 live births. The main causes of maternal death were abortion, complications linked with hypertension, and postpartum bleeding.

[Maternal mortality in Guinea: magnitude and perspectives]. / Mortalité maternelle en Guinée: mesure et perspectives.

In recent years maternal mortality in developing countries has become a public health priority for international organizations. However, measuring the true magnitude of this problem is the subject of much methodological debate. In less than a century, the rate of maternal mortality in most industrialized countries has decreased one hundred-fold. In contrast, the rate remains very high in most developing countries, particularly in Africa. In this article based on the studies conducted in Guinea we review various operational proposals which may contribute to improving maternal health and reducing maternal morbidity and mortality, with particular reference to the work of the French speaking organization "Santé Maternelle Internationale".

Family planning associations (FPAs) respond to the HIV / AIDS epidemic.

PIP: This paper presents several approaches used by the family planning associations in sub-Saharan Africa in response to the HIV/AIDS epidemic. These approaches include 1) participation in developing national policies and plans for HIV/AIDS and sexually transmitted diseases (STDs); 2) promotion of HIV/AIDS and STD prevention; 3) condom distribution through alternative service delivery approaches; 4) integration of HIV/AIDS- and STD-related services into family planning and sexual/reproductive health services; 5) networking with other nongovernmental organizations and key institutions; 6) male involvement and participation in family planning projects in Cameroon, Congo, Ghana, Kenya, Mauritius, Nigeria, Senegal, and Zaire; 7) integration of HIV/AIDS and STD prevention into adolescent health services; 8) home care services for HIV carriers and AIDS patients; and 9) promoting sexual health through community participation.^ieng

Reproductive choices for men.

PIP: The condom is a latex rubber sheath worn over the erect penis during sexual intercourse, designed to prevent conception and the transmission of sexually transmitted diseases (STDs). Any one condom is meant to be used for only one complete act of intercourse. This method is highly recommended for sexually active adolescents. Should a condom tear during intercourse, the woman should seek emergency contraception to avoid pregnancy. A spermicide should be applied immediately to help reduce the likelihood of STD and HIV transmission. Vasectomy involves excising the vas deferens, severing the route through which sperm passes from the testes and conferring a permanent method of male contraception. Withdrawal involves interrupting sexual intercourse prior to ejaculation, while periodic abstinence refers to not engaging in sexual intercourse during a woman's ovulation period. The calendar, temperature, Billings, and sympto-thermal methods may be used to determine a woman's fertile period.^ieng

Quality of care: from concept to action. A way ahead for sub-Saharan Africa FP and RH programmes.

PIP: This article describes the essential features and examples of family planning and reproductive health (FP/RH) program efforts in sub-Saharan Africa that increase access to and quality of care in FP/RH programs. The Bruce and Jain quality-of-care framework includes six interrelated elements: choice of FP methods, information exchanged between client and provider, interpersonal relations, technical competence of providers, ways to encourage continuity, and appropriate and acceptable services. Anglocentric countries define quality as the provision of standard services that are "safe, effective, accessible, acceptable, and affordable, in a sociophysical environment conducive to the improvement of the quality of life." The Francophone definition states that "quality is the provision of services which are available, accessible, offered by competent persons, in appropriate conditions within the norms and standards established for the satisfaction of clients." In Africa, FP services and supplies are not available to many people. Evidence from Demographic and Health Surveys (DHS) indicates a large unmet need for FP services for spacing births and limiting childbearing. Unmet need is over 50% among married women in Burundi, Kenya, Ghana, Mali, Togo, and Uganda. 12% of the nonuse of FP services in Kenya was due to availability factors during the late 1980s. More recent DHS data indicate specific problems with service delivery, such as poor facilities in rural areas and the lack of basic and essential equipment, supplies, and IEC. Medical barriers include a long waiting time, inadequate information given to clients, providers' biases, unnecessary medical procedures, and the use of eligibility criteria. Domestic barriers to use include traditional mores, low socioeconomic status, lack of communication between couples, contraception misconceptions, and the resistance of husbands.^ieng

Safety and environmental factors in accreditation of facilities.

The standards developed in 1972 by the Accreditation Council for Psychiatric Facilities of the Joint Commission on Accreditation of Hospitals cover 28 components of mental health programs, including the environment and patient safety. The author discusses the standards related to those two areas as they are set forth in the council's Accreditation Manual for Psychiatric Facilities, and he describes the difficulties psychiatric hospitals have faced in complying with them.