Maternal Health

Maternal mortality in developing countries: challenges in scaling-up priority interventions

Ndola Prata
Paige Passano
Amita Sreenivas
Caitlin Elisabeth Gerdts
2010

Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as Sri Lanka, Malaysia and Honduras, demonstrate that maternal mortality will decline when...

Prevention of postpartum hemorrhage at home birth in Afghanistan

Harshadkumar Sanghvi
Nasratullah Ansari
Ndola Prata
Hannah Gibson
Aftab T. Ehsan
Jeffrey M. Smith
2010

Objective To test the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan. Methods A nonrandomized experimental control design in rural Afghanistan. Results A total of 3187 women participated: 2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were unexpectedly lower in the...

A Woman Cannot Die from a Pregnancy She Does Not Have

Malcolm Potts
Nadia Diamond-Smith
2011

The fifth Millennium Development Goal has brought critical attention to the unacceptably high burden of maternal mortality and the need to improve antenatal health care. However, many of the approaches to reducing maternal mortality (e.g., increasing the number of deliveries at health facilities with skilled attendants or improving access to emergency obstetric care) are complex and will take time to implement. In the meantime, maternal mortality can be reduced relatively inexpensively by preventing unwanted pregnancy through family planning. The decision to practice family planning is...

Health education for microcredit clients in Peru: a randomized controlled trial

Rita Hamad1
Lia CH Fernald
Dean S Karlan
2011

Background: Poverty, lack of female empowerment, and lack of education are major risk factors for childhood illness worldwide. Microcredit programs, by offering small loans to poor individuals, attempt to address the first two of these risk factors, poverty and gender disparity. They provide clients, usually women, with a means to invest in their businesses and support their families. This study investigates the health effects of also addressing the remaining risk factor, lack of knowledge about important health issues, through randomization of members of a microcredit organization to...

Where There Are (Few) Skilled Birth Attendants

Ndola Prata
Paige Passano
Tami Rowen
Suzanne Bell
Julia Walsh
Malcolm Potts
2011

Recent efforts to reduce maternal mortality in developing countries have focused primarily on two long-term aims: training and deploying skilled birth attendants and upgrading emergency obstetric care facilities. Given the future population-level benefits, strengthening of health systems makes excellent strategic sense but it does not address the immediate safe-delivery needs of the estimated 45 million women who are likely to deliver at home, without a skilled birth attendant. There are currently 28 countries from four major regions in which fewer than half of all births are attended by...

Task shifting and sharing in Tigray, Ethiopia, to achieve comprehensive emergency obstetric care

Amanuel Gessessew
Gebre Ab Barnabas
Ab Barnabas
Ndola Prata
Karen Weidert
2011

Objective: To assess the contribution of nonphysician clinicians (NPCs) to comprehensive emergency obstetric care (CEmOC) in Tigray, Ethiopia. Methods: We conducted a retrospective review of the obstetric records of all women treated from January 1, 2006, to December 31, 2008, at the 11 hospitals and 2 health centers with CEmOC status in Tigray. Data were collected using 2 questionnaires, one concerning the facility and the other concerning the patient. Results: During the studied period 25,629 deliveries and 11,059 obstetric procedures (3369 of which were major surgical interventions)...

Microcredit participation and nutrition outcomes among women in Peru

Lia Fernald
Rita Hamad
2010

Microcredit services-the awarding of small loans to individuals who are too poor to take advantage of traditional financial services-are an increasingly popular scheme for poverty alleviation. Several studies have examined the ability of microcredit programmes to influence the financial standing of borrowers, but only a few studies have examined whether the added household income improves health and nutritional outcomes among household members. This study examined the hypothesis that longer participation in microcredit services would be associated with better nutritional status in women....

Criticism of misguided Chu et al. article

Malcolm Potts
Caitlin Gerdts
Ndola Prata
Friday Okonofua
Nuriye Hodoglugil
Nap Hosang
Karen Weidert
Ashley Fraser
Suzanne Bell
2012

Chu, Brhlikova and Pollock’s article suggests the WHO rethink its decision to include misoprostol on the Essential Medi- cines List. Their paper is a sad example of workers in an elite setting advocating policies with the potential to endanger the lives of thousands of vulnerable women in low-resource settings.

Published in Journal of the Royal Society of Medicine 2012: 105(11), 454.

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Evaluation of a traditional birth attendant training programme in Bangladesh

Ndola Prata
Paige Passano
Tami Rowen
2011

Background and context: the 1997 Safe Motherhood Initiative effectively eliminated support for training traditional birth attendants (TBAs) in safe childbirth. Despite this, TBAs are still active in many countries such as Bangladesh, where 88% of deliveries occur at home. Renewed interest in community-based approaches and the urgent need to improve birth care has necessitated a re-examination of how provider training should be conducted and evaluated.

Objective: to demonstrate how a simple evaluation tool can provide a quantitative measure of knowledge...

Do Economists Have Frequent Sex?

Malcolm Potts
Martha Campbell
2012

Last year a member of the World Bank professional staff gave a lecture on development in Africa on the UC Berkeley campus. His audience asked him about rapid population growth in that continent. He immediately dismissed the question, saying that population growth did not need any special attention. It would look after itself. He was voicing an uncritical interpretation of the demographic transition, a “theory” which has as much evidence to support it as the fictitious Da Vinci Code, and like the Da Vinci Code it remains perennially popular.

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