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Latest Update On preganacy

Submitted by: Nikko M. Razal 3BSN1 Submitted to: Mrs. Enrile Oxina Professor

Improving Maternal And Neonatal Care In Africa Saves Lives

A large regional hospital in Ghana saw a reduction in maternal and infant deaths after continuous quality improvement (QI) initiatives were put into place through a collaborative partnership. New research from lead author Medge Owen, M.D., a professor of obstetrical anesthesiology at Wake Forest Baptist Medical Center, outlines how QI initiatives that demonstrate best practices and care can increase overall survival rates for mothers and their children. The study appears in this month's issue of the International Journal of Gynecology and Obstetrics. Owen is the founder of Kybele, a non-profit 501(c)3 humanitarian organization dedicated to improving childbirth safety worldwide through educational partnerships. Kybele brings professional medical teams into host countries, to work alongside doctors and nurses in their home hospitals, to improve health care standards. Kybele partnered in 2007 with the Ghana Health Service to analyze systems and patient care processes at a regional hospital in Accra, Ghana, and to establish "obstetric centers of excellence" to reduce maternal and neonatal deaths. Owen said that childbirth claims more than 350,000 lives per year, many of which occur in Africa and Asia. "Maternal mortality is a major global health problem and reducing it is one of the United Nation's eight millennium development goals." Owen, who also serves as the director of Maternal and Infant Global Health Program at Wake Forest Baptist, said, "Maternal and infant mortality are basic health indicators that reflect the adequacy of a health care system and remains an unrelenting challenge in Africa. A recent mortality survey found that 60 percent of maternal deaths in Accra, Ghana, occurred within hospitals. An improvement model that focused on key areas such as leadership, low staff morale and motivation, staff knowledge and training levels, patient flow and ineffective triage, and lack of basic equipment and supplies was put into place. Owen said that a foundational element of the KybeleGHS system is frequent, brief, and intensive visits by an interdisciplinary team for immersive coaching and mentoring. As a result of the partnership, a 34 percent reduction in maternal mortality and a 36 percent reduction in stillbirth occurred between 2007 and 2009. Owen said these reductions occurred despite a 36 percent increase in patient volume and an increased prevalence of obstetric complications, without an increase in staff. "Although significant progress has been made, many challenges remain," Owen said. "There is no single intervention that can markedly improve maternal and perinatal care in Africa." Owen said that sustainable improvements are possible but must be comprehensive and result from a "unified vision" shared by the local hospitals and the intervention teams.

Connection Between Birth Weights And Armed Conflict

A new study shows pregnant women exposed to armed conflict have a higher risk of giving birth to underweight babies, a result that could change the way aid is delivered to developing countries. "From a development side we need to ask, `Who is the population we should be focusing on?'" said Hani Mansour, Ph.D., assistant professor of economics at the University of Colorado Denver who conducted the study with Daniel Rees, Ph.D., a CU Denver professor of economics. "Our results provide another reason why pregnant women deserve special attention when armed conflict breaks out." The study, the first to examine the relationship between prenatal exposure to armed conflict and birth weight, will be published in an upcoming edition of the Journal of Development Economics. The manuscript is available here*. The research focused on a major uprising in the Israeli-occupied territories. The Second Intifada, which began in September 2000, had claimed the lives of more than 4,000 Palestinians by 2005. Mansour and Rees drew on data from the Palestinian Demographic and Health Survey, which was collected by the Palestinian Central Bureau of Statistics approximately four years after the start of the uprising. These data were matched with data on Palestinian fatalities in the West Bank collected by B'Tselem, an Israeli human rights organization. "We find that an additional conflict-related fatality nine to six months before birth is associated with an increase in the probability of having a low-birth weight child," Mansour said. "Psychological stress is a plausible explanation for this relationship, although we cannot rule out malnutrition." The professors examined a sample of 1,224 births to women living in the West Bank. Conflict exposure in utero was measured by the number of Palestinians killed by Israeli security forces in the district where the mother lived. The authors controlled for a variety of potentially confounding variables including education of the mother and father, mother's age when she gave birth, father's occupation, birth order, gender of the baby, number of prenatal care visits, whether a curfew was in place, and self-reported anemia. Because they control for anemia, the professors believe that psychological stress, as opposed to malnutrition, is the likely mechanism behind low birth weight. In addition, they note that previous studies have shown that exposure to earthquakes and terrorist attacks in the early stages of pregnancy can lead to low birth weight. Rees and Mansour said they had no political agenda going into their research. They chose to study the impact of the Second Intifada "because of the quality of the data and the fact that mobility was very low in the West Bank during this period."

The authors noted that, "armed conflict is often associated with migration, which would complicate this type of analysis." According to Mansour, who was born in Haifa, Israel, "fully 94 percent of the mothers in our sample had not moved to a new community since the start of the Intifada." Rees and Mansour plan to follow up by examining whether intrauterine exposure to armed conflict affects longer-term outcomes in educational attainment and test scores. The authors said their findings had implications well beyond the West Bank and should be considered by policymakers around the world. "At a minimum our results are consistent with those of medical studies showing a positive association between self-reported stress and low birth weight, and suggest a heretofore unexplored rationale for intervention when armed conflict occurs," they said.