Utilization of medically-trained birth attendants in rural Bangladesh.

Using case-control methodology, this study compared the characteristics of women who requested medically-trained birth attendants at home with those who did not, in order to identify constraints to service delivery and suggest program changes to increase service utilization in a rural area of Bangladesh. By several different measures, prior contact with medical professionals were much more common among cases than controls, with the greatest differences observed in the frequency of antenatal visits. At least one antenatal visit was the strongest predictor that a woman would call a medically-trained birth attendant, though primiparity, proximity to the provider, previous contact with the clinic, and education (both of the mother and her spouse) were also predictive. Recommendations include increasing contact through antenatal visits, and extending midwife coverage through training and supervision of traditional birth attendants. This study demonstrates the usefulness of case-control methodology in evaluating health care utilization.

The Lao People's Democratic Republic: maternal mortality and female mortality: determining causes of deaths.

A sample of 380 female deaths in the age group 15-49 years from 16 provinces of the Lao People's Democratic Republic were analyzed to determine the most likely cause of death. 127 deaths were classified as maternal, 28% occurred during pregnancy and the remaining 72% within six weeks of the termination of pregnancy. Almost three quarters of all maternal deaths were directly related to obstetrical complications during pregnancy or childbirth. Many of these deaths could probably have been avoided, if appropriate obstetric care had been available. The level of attention to problems related to maternity and childbirth needs to be raised at all responsible levels of the health service system. This must start at the health facility where attending nurses and midwives should be oriented towards pregnancy-related problems and early detection of high-risk women, with appropriate supervisory support. District and national administrations should also focus more on maternity services within their Primary Health Care programme.

PIP: During April-August 1993 a study was conducted with the aim of ascertaining the causes and determinants of maternal deaths in Laos. The findings are based on 380 cases identified among women 15-49 years old for 16 out of 17 provinces. 33.4% of deaths (127 cases) were identified by verbal autopsy as pregnancy related. 72% of deaths occurred postnatally, and almost 40% were due to postpartum hemorrhage. The majority of deaths were to poor women and occurred in rural areas. Almost 75% of deaths were related to obstetrical complications during pregnancy or childbirth. 26.0% of deaths were due to a retained placenta and postpartum hemorrhage, 11.0% were due to induced abortion, and 7.1% were due to uterine inertia and postpartum hemorrhage. 5.5% had hemorrhage during the pregnancy, and 5.5% had a uterine rupture. 6.3% died of complications from spontaneous abortion. 7.1% died of infection. Among deaths at home and home deliveries, 71% were poor, 55% well-off, 70% rural, and 50% urban. Deaths at home after a hospital delivery were to 10% of poor women, 10% of well-off women, 10% of rural women, and 14% of urban women. 14% of poor women, 28% of well-off women, 16% of rural women, and 29% of urban women died in a hospital. Deaths on the way to the hospital involved 3% of poor women and 3% of rural women.