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Biomedical subjects

B E Kwast

Publications and source records attributed to B E Kwast.

At least 19 recordsLinked to original sources
PubMed1995

Building a community-based maternity program.

The MotherCare Project has as its goal the reduction of maternal and neonatal mortality and related morbidities, and the promotion of the health of women and newborns. To achieve these goals, maternal and family planning programs were strengthened in both rural and urban settings through three intervention strategies--policy reform, affecting behaviors and improving services. The fundamental premise in each project was to strengthen the weakest part of the maternity care pyramid, ensuring linkages among all levels of service--from community through to the referral hospital level. In rural Andean populations of Bolivia, knowledge of danger signs and women's response to them improved, increasing in use of prenatal and family planning services through a participatory problem-solving and community-based strategy. In West Java, Indonesia, bringing professional midwifery services and facilities closer to women together has resulted in a positive response to their use. Augmenting this intervention with a transport and intercommunication system together with improved hospital practice through perinatal mortality meetings and in-service training for doctors and midwives has reduced the maternal and perinatal mortality over a four year period. Hospital practice has improved in Uganda and in two states of Nigeria, maternal mortality and morbidity have been reduced in the training facility where seminars for physicians, training of midwives in life saving midwifery and interpersonal communication skills have taken place, and equipment and supplies have been improved. Furthermore, in rural Guatemala, implementation of norms and protocols, expert supervision and sensitization of hospital staff to the needs of the community has increased referral by traditional birth attendants (TBAs) to the hospital and reduced perinatal mortality.

Community Health Services↗
PubMed1995

An integrated village maternity service to improve referral patterns in a rural area in West-Java.

The Regionalization of Perinatal Care, an intervention study carried out in Tanjungsari, a subdistrict in rural West Java, aimed to develop a comprehensive maternal health program to improve maternal and perinatal health outcomes. The main inputs included training at all levels of the health care system (informal and formal) and the establishment of birthing homes in villages to make services more accessible. Special attention was given to referral, transportation, communication and appropriate case management, A social marketing program was conducted to inform people of the accessible birthing homes for clean delivery, located near the women, and with better transportation and communications to referral facilities should complications arise. The study design was longitudinal, following all pregnant women from early pregnancy until 42 days postpartum in an intervention and a comparison area. The population was +/- 90,000 in the intervention area and 40,000 in the comparison area. Inclusion criteria were all mother and infant units delivered between June 1st, 1992 and May 31st, 1993. Analysis showed the following results: Most women sought antenatal care (> 95%). In Tanjungsari, nearly 90% sought such care from professional providers as versus 75% in the control area of Cisalak. Most women with bleeding or bleeding and edema during pregnancy sought professional assistance in both the study and control areas. However, fever for more than 3 days received more attention in the study area versus control area (93 vs. 69%). Greater than 85% of deliveries in both areas were conducted by TBAs. However, in the study area, nearly one-third of those with intrapartum complications (17%) delivered in a health facility compared to one-tenth in the control area. This meant a hospital delivery, primarily with assistance of a doctor or doctor/midwife combination. Overall referral rates by TBAs were low -13% of women with complications in Tanjungsari and 6% in Cisalak. More women with intrapartum complications were referred in the study area than in the control, and more complied when referred. Women who suffered intrapartum complications were more likely to have a perinatal death. Perinatal deaths declined in Tanjungsari, but not significantly. However, the trend over the period of the intervention shows an improvement in the deliveries managed by TBAs with more deaths resulting in the hands of professionals. Either women were arriving too late or the quality of care could not meet the needs. There was no change in the levels or place of perinatal deaths in Cisalak.

Adult↗
PubMed1993

Safe Motherhood--the first decade.

In 1987 an international project, the Safe Motherhood Initiative, was commenced with the aim of reducing, by half by the Year 2000, the 500,000 maternal deaths which occur each year throughout the world. In this paper the progress of the Initiative is described and reviewed. The crucial role of the midwife in reducing maternal mortality is recognised and the work to be done in the future is identified. This paper was given as a keynote address at the 23rd Congress of the International Confederation of Midwives in Vancouver in May, 1993.

Female↗
PubMed1992

Midwives: key rural health workers in maternity care.

The most acceptable and attainable rural health worker for maternity care is frequently the traditional birth attendant or other personnel lacking clinical skills to treat life-threatening emergencies. When first referral level facilities are also poorly staffed and ill-equipped to deal with these emergencies, this again points to the need for training of and delegation to the trained midwife in rural areas. Unfortunately, their number is declining in rural areas of some countries most in need, e.g., Tanzania. Elsewhere, midwifery skills and knowledge have been integrated into basic nursing education, but practical skills are only developed postbasically when midwife educators are expert clinicians. The graduates of such training could be delegated responsibility for many lifesaving procedures in obstetric care. Successful clinical experience in use of these responsibilities will earn the midwife's needed community reputation as a trusted health worker.

Clinical Competence↗
PubMed1992

Obstructed labour: its contribution to maternal mortality.

Every year 85,000 women die from obstructed labour and many many more lose their baby and have debilitating physical damage as a result. In this paper the extent of the problem is described. Methods by which obstructed labour can be prevented are given. Early detection and prompt referral for appropriate treatment are vital if damage is to be minimised. This requires particular attention in midwifery education which must include community experience which fosters dialogue and strengthens prevention. This paper is based on one originally given at the ICM/WHO/UNICEF pre-congress workshop in Kobe, Japan, October 1990.

Causality↗
PubMed1992

Abortion: its contribution to maternal mortality.

Every year between 100,000 and 200,000 women die from illicit abortion. In this paper the magnitude of the problem is described, those most at risk are identified and methods of preventing unwanted pregnancy are suggested. It is argued that midwives have a major role to play in family planning counselling and the provision of contraceptive services. Midwives can also reduce maternal mortality by resuscitating women when emergencies arise from incomplete abortion. This paper is based on one originally given at the ICM/WHO/UNICEF pre-congress workshop is Kobe, Japan, October 1990.

Abortion, Illegal↗
PubMed1991

Puerperal sepsis: its contribution to maternal mortality.

Puerperal sepsis is the second most common cause of maternal mortality in the developing world. In this paper the extent of the problem is described and factors affecting puerperal sepsis are identified. Methods of reducing the incidence of puerperal sepsis are suggested. This paper is based on one originally given at the ICM/WHO/UNICEF pre-congress workshop in Kobe, Japan, October, 1990.

Female↗
PubMed1991

Maternal mortality: the magnitude and the causes.

Half a million women die during childbirth in the world every year. This paper describes the magnitude and the causes and suggests ways in which this tragic loss might be reduced. This paper was the introductory presentation at the ICM Pre-Congress Workshop on Midwifery Education--Action for Safe Motherhood.

Cause of Death↗
PubMed1991

Introducing confident midwives: Midwifery Education--Action for Safe Motherhood.

The present crisis in midwifery and the seriousness of maternal mortality and morbidity demands a rethink about the background and training requirements of each level of midwifery worker. This paper describes the background of the present shortage and mal-distribution of midwives. The reduction of maternal mortality by 50% at the turn of this century requires the development of a maternal health care team in which the midwife functions as the linchpin. In order to equip the midwife for the leadership functions in this team, the present educational system needs to be fundamentally improved. The rationale for the acquisition of epidemiological, managerial specialised technical and teaching skills by midwives is discussed. Implications for further education are high-lighted. Collaborative actions taken by the WHO, ICM, UNICEF and other governmental and non-governmental agencies to address the issue of midwifery are outlined. This paper was given at the 1990 ICM, WHO, UNICEF Pre-Congress Workshop on Midwifery Education--Action for Safe Motherhood in Kobe, Japan.

Clinical Competence↗
PubMed1991

The hypertensive disorders of pregnancy: their contribution to maternal mortality.

The hypertensive disorders of pregnancy and their complications are the major cause of maternal mortality in the developed world and the third most common cause of maternal mortality in the world. In this paper the extent of the problem is described and factors affecting pre-eclampsia and eclampsia are described. Ways of reducing deaths from these causes are suggested.

Adult↗
PubMed1991

Postpartum haemorrhage: its contribution to maternal mortality.

Postpartum haemorrhage is the major cause of maternal mortality in the developing world. This paper presents the incidences and discusses the causes and strategies for its prevention. The paper is based on one originally given at the ICM/WHO/UNICEF pre-congress workshop in Kobe, Japan, Oct, 1990.

Developing Countries↗
PubMed1991

Safe motherhood: a challenge to midwifery practice.

The principal way of achieving maternal health and safe motherhood is to expand the specific functions and/or categories of midwifery personnel. This includes strengthening knowledge and skills to improve the quality and quantity of care. Success would ensure that for millions of women the prospect of childbirth would be one of joy rather than misery.

Delivery of Health Care↗
PubMed1988

Factors associated with maternal mortality in Addis Ababa, Ethiopia.

A housing probability survey in which 9315 women were interviewed was conducted in 1983 to detect the incidence and aetiology of maternal mortality in Addis Ababa, Ethiopia. Maternal mortality for the two-year period from 11 September 1981 was 350/100,000 livebirths (excluding abortions). A logistic regression analysis selected antenatal care, occupation and income as risk factors for maternal mortality, after adjusting for age, parity, education and marital status. Odds ratios were 2.5 for unbooked women compared to those receiving antenatal care, about 3 for students, and maids/janitresses compared to housewives, and between 3 and 5 for those earning less than US$25 monthly, compared to those earning US$150 or more.

Adolescent↗
PubMed1987

Viral hepatitis as a major cause of maternal mortality in Addis Ababa, Ethiopia.

Causes of maternal mortality were investigated in Addis Ababa, Ethiopia, from September 1981 to September 1983. Viral hepatitis ranked third among the leading causes of maternal mortality behind septic abortion and puerperal sepsis. There were 26 deaths from viral hepatitis during the 2-year study period for a hospital maternal mortality rate of 91.0 per 100,000 live births. Although 30% of women who died of all maternal causes received antenatal care in Addis Ababa, only 13% of women who died from viral hepatitis in our hospital study received antenatal care. Low socio-economic status (SES) has been shown to be associated with low antenatal care utilization and with an increased risk of protein malnutrition. Malnutrition is considered a predisposing factor for liver damage. Suggestions for reducing hepatitis transmission and maternal mortality through education, better hygiene, and improved sanitation are discussed.

Adolescent↗