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Biomedical subjects

O M Campbell

Publications and source records attributed to O M Campbell.

16 recordsLinked to original sources
PubMed2001

The Maternal and Neonatal Programme Effort Index (MNPI).

A new index is presented that measures the effort levels of national programmes to reduce maternal and neonatal mortality. These indices come from a questionnaire instrument composed of 14 major headings and 81 items. Forty-nine countries including most of the population in each geographical region are covered. Data were collected from 10 to 25 raters in each country, who rated the 81 items for both the current year and 3 years ago, using a 0-5 scale running from no adequacy to full adequacy. The raters were drawn from a variety of positions and backgrounds, and were identified by a consultant retained in each country for that purpose. On average, country programmes score at about half of the maximum score, but this varies considerably across the 14 components of effort, from very low scores for access to treatment by rural women, to high scores for neonatal care. Regional averages are not far apart for the overall score, although South Asia scores are especially low and East Asia's are especially high. To a considerable extent regions agree in the relative stress they give to each of the 14 components. Over the 3-year period, average scores rose by about 10%. When countries are divided into three groups by their maternal mortality levels, most of the 14 components distinguish the high from the medium mortality countries; and about half of the components distinguish the medium from the low mortality countries. This new Maternal and Neonatal Programme Effort Index (MNPI) appears to yield useful measures for various dimensions of programme effort, and it relates sensibly to the output measure of maternal mortality, at least as it is currently measured.

Developing Countries↗
PubMed2000

Menstrual dysfunction: a missed opportunity for improving reproductive health in developing countries.

The field of population has undergone a paradigm shift to a broader focus on reproductive health, which recognises women's self-perceived health needs. Investigations in various countries reveal that menstruation is a primary concern of women. Yet sparse attention has been paid to understanding or ameliorating women's menstrual complaints. We propose including the management of menstrual complaints as part of reproductive health programming. Next steps should include further quantitative and qualitative research to understand the prevalence, determinants and consequences of menstrual dysfunction; developing appropriate protocols and low-cost interventions for diagnosis and treatment of menstrual morbidity and training of health care workers in resource-scarce settings; and developing educational interventions to facilitate women's understanding of normal menstrual function and variability as well as of the types, causes and appropriate treatments for menstrual dysfunction.

Cost of Illness↗
PubMed1997

Women's hidden transcripts about abortion in Brazil.

Two folk medical conditions, "delayed" (atrasada) and "suspended" (suspendida) menstruation, are described as perceived by poor Brazilian women in Northeast Brazil. Culturally prescribed methods to "regulate" these conditions and provoke menstrual bleeding are also described, including ingesting herbal remedies, patent drugs, and modern pharmaceuticals. The ingestion of such self-administered remedies is facilitated by the cognitive ambiguity, euphemisms, folklore, etc., which surround conception and gestation. The authors argue that the ethnomedical conditions of "delayed" and "suspended" menstruation and subsequent menstrual regulation are part of the "hidden reproductive transcript" of poor and powerless Brazilian women. Through popular culture, they voice their collective dissent to the official, public opinion about the illegality and immorality of induced abortion and the chronic lack of family planning services in Northeast Brazil. While many health professionals consider women's explanations of menstrual regulation as a "cover-up" for self-induced abortions, such popular justifications may represent either an unconscious or artful manipulation of hegemonic, anti-abortion ideology expressed in prudent, unobtrusive and veiled ways. The development of safer abortion alternatives should consider women's hidden reproductive transcripts.

Abortion, Illegal↗
PubMed1994

Institutional maternal mortality in Mali.

OBJECTIVES: To measure the institutional maternal mortality ratio (MMR) in Mali and suggest ways to reduce it. METHODS: Routinely recorded data from 24 health institutions in three regions were reviewed for 1988 to 1992. RESULTS: The overall MMR in the institutions was 201 maternal deaths per 100,000 live births. Hemorrhage, toxemia and infections accounted for 80% of the 360 recorded maternal deaths, almost all of which were preventable. The main reasons why these conditions result in death lie in poor quality and maldistribution of health services, lack of transport and late use of allopathic services. CONCLUSIONS: Maternal mortality is still a major public health problem in Mali, even among the small proportion of women who reach health facilities. Substantial new initiatives are urgently needed to reduce this major cause of preventable adult female mortality.

Adolescent↗
PubMed1993

Characteristics and determinants of postpartum ovarian function in women in the United States.

OBJECTIVE: Our aim was to characterize the influence of breast-feeding on the postpartum return of ovarian activity for the purpose of assessing the relevance of the lactational amenorrhea method of contraception for women in the United States. STUDY DESIGN: Twenty-two non-breast-feeding and 60 breast-feeding women from Baltimore collected daily urine specimens that were assayed to determine ovulation and luteal phase adequacy. Vaginal bleeding was ascertained weekly, and breast-feeding women recorded infant feeding daily. Proportion-hazards models were used to relate measures of breast-feeding to the occurrence of ovulation. RESULTS: Two thirds of women ovulated before their first vaginal bleeding, but 47% of those cycles had decreased luteal-phase pregnanediol excretion. Breast-feeding frequency and suckling duration were significant predictors of the risk of ovulation (p < 0.001). Supplementation with bottle feeding was associated with a reduction in breast-feeding. CONCLUSION: A high degree of protection from pregnancy can be achieved using breast-feeding frequency and suckling duration, even with supplemented breast-feeding.

Adult↗
PubMed1992

Maternal health and the measurement trap.

This paper focuses on the contribution of measurement-related factors to the neglect of maternal health in resource allocation for programmes and in public health research. As the recent interest in maternal health has now progressed beyond the need for information primarily for the purpose of advocacy, measurement-related factors have emerged as powerful constraints on programme action. Three outstanding needs for information can be identified: first, to establish the levels and trends of specific maternal health outcomes; secondly, to identify the characteristics and determinants of health outcomes; and thirdly, to monitor and evaluate the effectiveness of programmes designed to influence health outcomes. In order to meet these needs, the emphasis placed on operational research by the current major initiatives in maternal health must be complemented by an equivalent emphasis on methodological studies. The call for improved information by international and national agencies should be made in unison with the call for action. Inadequate information is a reality that has to be faced throughout the world, but particularly in developing countries. The quality, quantity and scope of health-related data are the elements of this inadequacy and may be discussed in terms of four factors: the indicators, the data sources, the measurement techniques, and the conceptual framework. In this paper, the neglect of maternal health and the lack of information are shown to be self-reinforcing and constitute a measurement trap sprung by these four factors. Dismantling this trap has revealed a weak conceptual framework to lie at the very centre. Maternal health has tended to be conceptualized as a discrete, negative state, characterized by physical rather than social or mental manifestations, and by a narrow time-perspective focusing on pregnancy, delivery and the puerperium. The need to broaden this perspective and to develop equally broad operational definitions represent important steps forward that must be taken.

Developing Countries↗
PubMed1990

Risk of ovulation during lactation.

60 breastfeeding mothers in Baltimore and 41 in Manila recorded their infant feeding patterns daily, and gave additional information at weekly interviews. Ovarian activity was monitored by assays for hormone metabolites in daily urine samples. On average, women in Baltimore breastfed less often but for longer at each feed than women in Manila, and the mean times until ovulation were 27 and 38 weeks post partum. 41% of first ovulations had luteal phase defects. Anovular first menses were common (45.1%) during the first 6 months post partum but the rate fell greatly thereafter. The risk of ovulation was reduced by a higher frequency of breastfeeds, longer duration of each feed, and less supplementary feeding. During the first 6 months post partum, amenorrhoeic women had low risks of ovulation (below 10%) with partial breastfeeding, and exclusive breastfeeding reduced the risk to 1-5% with either frequent short feeds or infrequent longer feeds. However, if the woman started menstruating before 6 months post partum, or if she continued breastfeeding beyond 6 months, the risk of ovulation rose, and contraception would be needed.

Amenorrhea↗
PubMed1990

Birth intervals and childhood mortality in rural Bangladesh.

This study investigates the relationship between birth intervals and childhood mortality, using longitudinal data from rural Bangladesh known to be of exceptional accuracy and completeness. Results demonstrate significant but very distinctive effects of the previous and subsequent birth intervals on mortality, with the former concentrated in the neonatal period and the latter during early childhood. The impact of short birth intervals on mortality, however, is substantially less than that found in many previous studies of this issue, particularly for the previous birth interval. The findings are discussed in terms of the potential for family planning programs to contribute to improved child survival in settings such as Bangladesh.

Bangladesh↗
PubMed1987

Postpartum return of ovarian activity in nonbreastfeeding women monitored by urinary assays.

Assays of first morning urine samples for pregnanediol-3 alpha-glucuronide (PdG), estradiol-17 beta-glucuronide (E2G), and LH were used to monitor endocrine function in 16 regularly cycling women and 22 postpartum nonbreastfeeding women. Twice weekly blood samples were also obtained from the postpartum group. Ovulation was inferred by a significant rise in LH and PdG, and reversal of the E2G to PdG ratio. Luteal phase PdG excretion was measured by the peak of smoothed PdG levels and the area under the smoothed luteal phase PdG curve. The lower limits of normal established in 16 cycling women were a peak luteal phase PdG of 4 micrograms/ml and an area under the PdG curve of 20 micrograms/ml. In the postpartum women, 32% of first cycles were anovulatory, and among ovulatory cycles, 73% had abnormally low luteal phase PdG excretion or short luteal phases. In second and subsequent cycles, 15% were anovulatory and 26% had luteal phase abnormalities. There was a progressive increase in luteal PdG excretion from the first to third cycles. The mean delay before first ovulation was 45.2 days, and no woman ovulated before 25 days after delivery. The correlations between blood and urinary hormone levels were 0.78 for PdG, 0.65 for E2G, and 0.55 for LH. We conclude that assays of daily early morning urine samples provide reliable information on ovulation and luteal phase adequacy, and that there is gradual recovery of pituitary ovarian function after parturition.

Adult↗
PubMedDate not supplied

Investigating induced abortion in developing countries: methods and problems.

Interest in abortion research is reemerging, partly as a result of political changes and partly due to evidence of the contribution of induced abortion to maternal mortality in developing countries. Information is lacking on all aspects of induced abortion, particularly methodological issues. This article reviews the methodological dilemmas encountered in previous studies, which provide useful lessons for future research on induced abortion and its complications, including related deaths. Adverse health outcomes of induced abortion are emphasized, because these are largely avoidable with access to safe abortion services. The main sources of information are examined, and their relevance for assessing rates of induced abortion, complications, and mortality is addressed. Two of the major topics are the problems of identifying cases of induced abortion, abortion complications, and related deaths, and the difficulties of selecting a valid and representative sample of women having the outcome of interest, with an appropriate comparison group. The article concludes with a discussion of approaches for improving the accuracy, completeness, and representativeness of information on induced abortion. Although the prospects for high-quality information seem daunting, it is essential that methodological advances accompany program efforts to alleviate this important public health problem.

Abortion, Induced↗