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From page 257... ... 258 APPENDIX B natal deaths per 1,000 live births) reflect the isolation and poverty of these people (Howard-Grabman, Seoane, and Davenport, 1993) Read the entire page →
From page 258... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 259 Cochabamba Reproductive Health Project, Bolivia, 1990-1993 Just over one-half the population of Cochabamba, the third most populous department of Bolivia, is urban. Rapid growth of the urban population is due to the migration of Quechua and Aymara people from both rural parts of the department and the rest of the country. Read the entire page →
From page 259... ... 260 APPENDIX B Training was conducted with providers to upgrade their skills and to adapt case management procedures to the needs of clients. According to a household survey, in participating clinics prenatal care attendance rose by 17 percent to more than 100 percent, compared with a baseline period 2 years earlier, although there was no significant increase in the Cochabamba department as a whole (Bower and Perez, 1993) Read the entire page →
From page 260... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 261 pregnancy, labor, and delivery; preparation for delivery and the postpartum experiences; and what to do in case of emergencies. A third objective was to reinforce adequate health services utilization for the pregnant woman and her support person. Read the entire page →
From page 261... ... 262 APPENDIX B The program consisted of three interventions: • The first part was to train traditional birth attendants in the recognition and referral of maternal and newborn complications. • The second part was to establish community birthing homes (polindes) Read the entire page →
From page 262... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 263 were demonstrated, brought messages directly into villages. Promotional leaflets for pregnant women, husbands, and traditional birth attendants addressed several issues: • the importance of attending prenatal care, especially when feeling sick or experiencing one of the pictured conditions (bleeding, swollen face, feet, and hands, fever with chills, headache, and breech or transverse lie) Read the entire page →
From page 263... ... 264 APPENDIX B with only 14 complicated cases delivered in facilities in Cisalak. The traditional birth attendants' initial enthusiasm for making referrals dissipated over time. Read the entire page →
From page 264... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 265 familiarize women with formal health sector personnel and to provide the means to better access other health facilities during labor and delivery (Kwast, 1995) Read the entire page →
From page 265... ... 266 APPENDIX B changed significantly. Through interviews with a sample of recently delivered women in target communities, levels of complications and use of health services were determined retrospectively in both intervention and control areas (total population 165,000) Read the entire page →
From page 266... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 267 creased. Delays between admission and treatment decreased significantly. Read the entire page →
From page 267... ... 268 APPENDIX B complication: 52 percent of their referrals were diagnosed by hospital personnel as having a complication, but only 18 percent of the "walk-ins" actually had a medically diagnosed complication (Bailey et al., 1991) Read the entire page →
From page 268... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 269 a busy metropolis with 6 hospitals and 68 maternity homes. Yet 93 percent of deliveries in the project area were assisted by traditional birth attendants, even 15 years after the project began with an emphasis on recognition of complicated cases and referral. Read the entire page →
From page 269... ... 270 APPENDIX B workers. They offer a choice of contraceptive methods at the home of each woman, motivate and counsel mothers for family planning, monitor and manage adverse effects, administer vaccines, promote oral rehydration, distribute vitamin A capsules, provide nutritional education, detect and refer malnourished children, and distribute safe delivery kits and iron tablets to pregnant women. Read the entire page →
From page 270... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 271 eas in maternal mortality rates or ratios. During the 3 years after the expanded project was implemented (1987-1989) Read the entire page →
From page 271... ... 272 APPENDIX B and their wives. Yet often there is little communication with villagers about the new health worker's role. Read the entire page →
From page 272... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 273 women who used a maternity waiting home with women who were referred by a traditional birth attendant from home (control 1) or from home or clinic directly (control 2) Read the entire page →
From page 273... ... 274 APPENDIX B stetric complications (defined in Chapter 5) , plus risk assessment during prenatal care and resuscitation. Read the entire page →
From page 274... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 275 Implementing Standards of Care and Protocols, Quetzaltenango, Guatemala, 1989-1993 The Western General Hospital San Juan de Dios in Quetzaltenango, Guatemala, is a general hospital with an obstetric department that delivers approximately 3,000 newborns per year. Prior to the start of the maternal and neonatal health project described above, the sanitary conditions in the sick baby nursery were poor, overcrowding of incubators was a problem, adequate temperature control was difficult to maintain, resuscitation facilities were suboptimal, and equipment, including oxygen, was in short supply. Read the entire page →
From page 275... ... 276 APPENDIX B earlier) and in hospitals. Read the entire page →
From page 276... ... PROGRAMS TO PROMOTE SAFE PREGNANCY AND DELIVERY 277 Bailey, P.E., J.A. Szaszdi, and B Read the entire page →
From page 277... ... 278 APPENDIX B Kwast, B.E. 1995 Building a community-based maternity program. Read the entire page →

From page 257...

... 258 APPENDIX B natal deaths per 1,000 live births) reflect the isolation and poverty of these people (Howard-Grabman, Seoane, and Davenport, 1993)