Abstract:
Objective:To analyse and improve the Namibian maternity care system by implementing maternal near-miss surveillance during 1 October 2018 and 31 March 2019, and identifying the challenges and benefits of such data collection. Methods:From the results of an initial feasibility study, we adapted the World Health Organization's criteria defining a maternal near miss to the Namibian health-care system. We visited most (27 out of 35) participating facilities before implementation and provided training on maternal near-miss identification and data collection. We visited all facilities at the end of the surveillance period to verify recorded data and to give staff the opportunity to provide feedback. Findings:During the 6-month period, we recorded 37 106 live births, 298 maternal near misses (8.0 per 1000 live births) and 23 maternal deaths (62.0 per 100 000 live births). We observed that obstetric haemorrhage and hypertensive disorders were the most common causes of maternal near misses (each 92/298; 30.9%). Of the 49 maternal near misses due to pregnancies with abortive outcomes, ectopic pregnancy was the most common cause (36/298; 12.1%). Fetal or neonatal outcomes were poor; only 50.3% (157/312) of the infants born to maternal near-miss mothers went home with their mother. Conclusion:Maternal near-miss surveillance is a useful intervention to identify within-country challenges, such as lack of access to caesarean section or hysterectomy. Knowledge of these challenges can be used by policy-makers and programme managers in the development of locally tailored targeted interventions to improve maternal outcome in their setting. Objectif:Analyser et améliorer le système de soins obstétricaux namibien en instaurant une surveillance des décès maternels évités de justesse durant la période comprise entre le 1er octobre 2018 et le 31 mars 2019. Cerner les défis et avantages que représente une telle collecte de données. Méthodes:En nous fondant sur les résultats d'une étude de faisabilité initiale, nous avons adapté les critères employés par l'Organisation mondiale de la Santé pour définir les décès maternels évités de justesse et les avons appliqués au système de santé namibien. Nous sommes allés dans la plupart (27 sur 35) des établissements participants avant la mise en œuvre, et avons organisé des formations consacrées à l'identification des décès maternels évités de justesse et à la collecte de données. Nous avons également rendu visite à l'ensemble des établissements à l'issue de la période de surveillance afin de vérifier les données recueillies et de donner au personnel soignant l'occasion d'exprimer son avis. Résultats:Durant cette période de 6 mois, nous avons enregistré 37 106 naissances vivantes, 298 décès maternels évités de justesse (8,0 pour 1000 naissances vivantes) et 23 décès maternels (62,0 pour 100 000 naissances vivantes). Nous avons constaté que les causes les plus fréquentes de décès maternels évités de justesse étaient les hémorragies obstétricales et les problèmes d'hypertension (92/298 pour l'une comme pour l'autre; 30,9%). Sur les 49 décès maternels évités de justesse liés à des grossesses infructueuses, la cause la plus répandue était la grossesse extra-utérine (36/298; 12,1%). Le nombre d'issues fœtales ou néonatales était faible; à peine 50,3% (157/312) des bébés nés de femmes ayant évité un décès de justesse sont rentrés avec leur mère à la sortie de l'hôpital. Conclusion:La surveillance des décès maternels évités de justesse est une intervention utile pour identifier les défis auxquels est confronté le pays, comme le manque d'accès aux césariennes ou aux hystérectomies. S'ils sont conscients de ces défis, les législateurs et responsables de programmes peuvent développer des actions ciblées et adaptées aux spécificités locales afin d'améliorer la santé maternelle dans leur région. Objetivo:Analizar y mejorar el sistema de atención de maternidad de Namibia al implementar la vigilancia de la morbilidad materna extrema durante el 1 de octubre de 2018 y el 31 de marzo de 2019, e identificar los retos y los beneficios de esa recopilación de datos. Métodos:A partir de los resultados de un estudio inicial de viabilidad, se adaptaron los criterios de la Organización Mundial de la Salud que definen la morbilidad materna extrema al sistema de atención sanitaria de Namibia. Se visitaron la mayoría (27 de 35) de los centros participantes antes de la implementación y se impartió capacitación sobre la identificación de los casos de morbilidad materna extrema y la recopilación de datos. Se visitaron todos los centros al final del periodo de vigilancia para verificar los datos registrados y dar al personal la oportunidad de proporcionar información. Resultados:Durante el periodo de 6 meses, se registraron 37 106 nacimientos vivos, 298 casos de morbilidad materna extrema (8,0 por cada 1000 nacimientos vivos) y 23 muertes maternas (62,0 por cada 100 000 nacimientos vivos). Se observó que las hemorragias obstétricas y los trastornos hipertensivos fueron las causas más comunes de las morbilidades maternas extremas (cada una de ellas 92/298; 30,9 %). De los 49 casos de morbilidad materna extrema por embarazos cuyo resultado fue un aborto, el embarazo ectópico fue la causa más común (36/298; 12,1 %). Los resultados fetales o neonatales fueron deficientes; solo el 50,3 % (157/312) de los infantes nacidos de madres con morbilidad materna extrema regresaron a casa junto con sus madres quienes habían sido dadas de alta. Conclusión:La vigilancia de la morbilidad materna extrema es una intervención de gran utilidad para identificar las dificultades que existen dentro del país, como la falta de acceso a la intervención de cesárea o la histerectomía. Los responsables de formular las políticas y los gestores de los programas pueden utilizar el conocimiento de estas dificultades en la elaboración de iniciativas focalizadas y adaptadas a las necesidades locales para mejorar los resultados de la maternidad en su entorno. :الغرض تحليل وتحسين نظام رعاية الأمومة في ناميبيا عن طريق تنفيذ مراقبة حالات نجاة الأمهات من الوفاة المؤكدة، خلال الفترة من 1 أكتوبر/تشرين أول 2018 إلى 31 مارس/آذار 2019، وتحديد التحديات والفوائد تجميع هذه البيانات. الطريقة من نتائج دراسة الجدوى الأولية، قمنا بتكييف معايير منظمة الصحة العالمية التي تُعرّف حالة نجاة الأمهات من الوفاة شبه المؤكدة، في نظام الرعاية الصحية الناميبي. قمنا بزيارة معظم المنشآت المشاركة (27 من إجمالي 35) قبل التنفيذ، وقدمنا التدريب على تحديد حالات نجاة الأمهات من الموت شبه المؤكدة، وجمع البيانات. وقمنا بزيارة جميع المنشآت في نهاية فترة المراقبة للتحقق من البيانات المسجلة، ولإعطاء فريق العمل فرصة تقديم الملاحظات. النتائج خلال فترة 6 أشهر، قمنا بتسجيل 37106 حالة ولادة حية، و298 حالة نجاة للأمهات من الوفاة المؤكدة (8.0 لكل 1000 حالة ولادة حية)، و23 حالة وفاة للأمهات (62.0 لكل 100000 حالة ولادة حية). ولاحظنا أن النزيف أثناء الولادة، واضطرابات فرط ضغط الدم، كانت أكثر الأسباب شيوعاً لحالات قرب الأمهات من الوفاة (كل 92/298؛ 30.9%). من بين 49 حالة نجاة لأمهات من الوفاة شبه المؤكدة بسبب الحمل مع نتائج للإجهاض، كان الحمل خارج الرحم هو السبب الأكثر شيوعاً (36/298؛ 12.1%). كانت النتائج المتعلقة بالجنين أو الأطفال حديثي الولادة بسيطة؛ فقط 50.3% (157/312) من المواليد وُلدوا لأمهات كانت على وشك الوفاة المؤكدة، وعادوا إلى المنزل مع أمهاتهم بعد الولادة. الاستنتاج تعد مراقبة حالات نجاة الأمهات من الوفاة شبه المؤكدة، تدخلاً مفيداً لتحديد التحديات داخل البلد، مثل عدم توفر فرصة العملية القيصرية أو استئصال الرحم. إن معرفة هذه التحديات يمكن استغلالها من جانب صانعي السياسات ومديري البرامج في تطوير التدخلات المستهدفة المصممة محلياً، لتحسين نتائج الولادة في بيئاتهم. 目标:旨在通过于 2018 年 10 月 1 日和 2019 年 3 月 31 日期间实施危重孕产妇监测来分析和改善纳米比亚孕产妇护理系统,并确定收集此类数据的挑战和益处。. 方法:根据初步可行性研究的结果,我们调整了世界卫生组织定义危重孕产妇的标准,使之适用于纳米比亚的医疗保健系统。在实施之前,我们访问了大部分参与机构(35 家中的 27 家),并对其进行有关危重孕产妇的识别和数据收集培训。我们在监测期结束时访问了所有机构以核实记录的数据,并为工作人员提供分享反馈的机会。. 结果:在这 6 个月期间,我们记录了 37,106 例活产儿,298 例危重孕产妇(每 1000 例活产儿中有 8.0 例)和 23 例孕产妇死亡(每 100000 例活产儿中有 62.0 例)。我们发现,产科出血和高血压疾病是导致危重孕产妇最常见的原因(均为 92/298;30.9%)。在 49 例最终导致流产的危重孕产妇中,宫外孕是最常见的原因(36/298;12.1%)。胎儿或新生儿生命体征弱;危重孕产妇生下的婴儿中,只有 50.3% (157/312) 的婴儿可以和母亲一起出院回家。. 结论:危重孕产妇监测是一种有效识别国内挑战的干预手段,例如缺乏实施剖腹产或子宫切除术的机会。政策制定者和计划管理者可以利用对这些挑战的了解来针对当地状况制定干预措施,以改善纳米比亚医疗背景下的孕产妇结果。. Цель:Анализ и совершенствование действующей системы охраны материнства в Намибии посредством мониторинга осложнений при родах, представляющих угрозу для жизни, в период с 1 октября 2018 г. по 31 марта 2019 г., а также выявление проблем и преимуществ такого сбора данных. Методы:Ориентируясь на результаты предварительного анализа осуществимости, авторы адаптировали критерии Всемирной организации здравоохранения, определяющие понятие осложнений при родах, представляющих угрозу для жизни, к реалиям системы здравоохранения в Намибии. До начала мониторинга авторы посетили большую часть (27 из 35) учреждений, участвовавших в исследовании, и провели обучение по выявлению осложнений при родах, представляющих угрозу для жизни, и сбору данных. По окончании периода мониторинга авторы посетили все учреждения, чтобы проверить точность зарегистрированных данных и предоставить персоналу возможность высказать свое мнение. Результаты:На протяжении 6 месяцев наблюдений авторами было зарегистрировано 37 106 живорожденных, 298 случаев осложнений при родах, представлявших угрозу для жизни (8,0 на 1000 живорожденных), и 23 случая материнской смерти (62,0 случая на 100 000 живорожденных). Согласно наблюдениям, кровотечения в родах и гипертензивные расстройства были наиболее распространенными причинами осложнений при родах, представляющих угрозу для жизни (каждая из причин составляла 92 из 298 случаев, 30,9%). В 49 случаях осложнений, представлявших угрозу для жизни, в результате беременности, завершившейся выкидышем, наиболее распространенной причиной была внематочная беременность (36 случаев из 298, 12,1%). Показатели здоровья плода или новорожденного были низкими: только 50,3% (157 из 312) младенцев, рожденных матерями, имевшими осложнения при родах, представлявшими угрозу для жизни, были выписаны вместе с матерями. Вывод:Мониторинг осложнений во время родов, представляющих угрозу для жизни, является полезным вмешательством, позволяющим выявить проблемы внутри страны, такие как недостаточный доступ к кесареву сечению или гистерэктомии. Понимание этих проблем может помочь руководителям программ и лицам, принимающим решения, в разработке специализированных программ вмешательств на местах для улучшения состояния здоровья матерей в соответствующих условиях.
journal_name
Bull World Health Organjournal_title
Bulletin of the World Health Organizationauthors
Heemelaar S,Josef M,Diener Z,Chipeio M,Stekelenburg J,van den Akker T,Mackenzie Sdoi
10.2471/BLT.20.251371subject
Has Abstractpub_date
2020-08-01 00:00:00pages
548-557issue
8eissn
0042-9686issn
1564-0604pii
BLT.20.251371journal_volume
98pub_type
杂志文章abstract::Concentration of infected erythrocytes was achieved in cell suspensions derived from long-term culture of Plasmodium falciparum growing asynchronously in human erythrocytes. This new procedure involves the slow centrifugation (at 33 g) of erythrocyte suspensions through 5% Ficoll solutions. Mature asexual erythrocytic...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1979-01-01 00:00:00
abstract:OBJECTIVE:Rubella vaccine is not included in the immunization schedule in Myanmar. Although surveillance for outbreaks of measles and rubella is conducted nationwide, there is no routine surveillance for congenital rubella syndrome (CRS). Therefore, we organized a study to assess the burden of CRS. METHODS:From 1 Dece...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:10.2471/blt.05.022814
更新日期:2006-01-01 00:00:00
abstract::A simple technique for achieving high yields of Plasmodium falciparum parasites on a continuous basis is described. The technique is applicable in any laboratory. The culture apparatus is also simple and inexpensive and allows multiple cultures to be run simultaneously. A total of approximately 1-2 x 10(9) parasites c...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1979-01-01 00:00:00
abstract::Water velocity is an important physical factor in the conditioning of streams and canals as habitats for the intermediate snail host of bilharziasis. Ecologists in most of the bilharziasis endemic areas have studied the resistance of these molluscs to the disturbing action of water motion. However, the complex nature ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1962-01-01 00:00:00
abstract::The unacceptably high mortality related to acute respiratory infections (ARI) in children, recognition of the importance of bacteria in the causation of severe acute lower respiratory infection in developing countries, and the established effectiveness of antimicrobial and supportive treatment in averting death make a...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1984-01-01 00:00:00
abstract::A national cross-sectional survey of the heights and weights of Kuwaiti preschool-age children of 0-5 years was conducted on a stratified multistage sample of 2554 subjects from high and low socioeconomic levels. The collected data were used to compare the nutritional status of these children with their American count...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract::Previous investigations have shown that in the Lake Region of Sukumaland, Tanganyika, where Schistosoma haematobium is highly endemic, Bulinus (Physopsis) nasutus is responsible for the transmission of that schistosome in small, temporary rain pools. This area is one of low rainfall, and large artificial reservoirs ar...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1964-01-01 00:00:00
abstract::The feeding habits of 15 species of Glossina have been studied by the identification of their blood meals. Representative samples of the blood meals from each of these species of tsetse fly and from different habitats were collected and 22 640 blood meals were identified. The feeding patterns are characteristic for ea...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1963-01-01 00:00:00
abstract::Hospital- and community-based studies were conducted in central Sudan to investigate the association between pesticide exposure and perinatal mortality. The cases were 197 stillbirths in the hospital and 36 perinatal deaths in the community; the controls were 812 liveborn, normal-birth-weight infants in the hospital, ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract::A series of lectures on the tubercle bacillus by eminent authorities from various countries was organized at the Institut d'Hygiène et de Bactériologie of the University of Lausanne by Professor Paul Hauduroy, from 22 to 25 April 1949. Through the kindness of Professor Hauduroy it has been possible for the World Healt...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1949-01-01 00:00:00
abstract:OBJECTIVES:To implement and evaluate a public-private partnership to deliver the internationally recommended strategy DOTS for the control of tuberculosis (TB) in Lalitpur municipality, Nepal, where it is estimated that 50% of patients with TB are managed in the private sector. METHODS:A local working group developed ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:2004-02-01 00:00:00
abstract::Studies have recently been published of surveys of antibodies to common respiratory viruses in human sera from several parts of the world. The present article reports the findings of a survey of antibodies to two more viruses (adenovirus type 8 and coxsackievirus type A21) in human sera mainly collected from six widel...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1966-01-01 00:00:00
abstract::The frequency of radiological examinations in a country is an important indicator of the general scope of such services in that setting. Frequency data obtained from surveys provide health planners with valuable information that can form an objective basis for resource allocation. Also, from the point of view of radia...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract::This report from the Tuberculosis Chemotherapy Centre, Madras, summarizes the progress over a 5-year period of 193 patients with newly diagnosed, sputum-positive pulmonary tuberculosis who were admitted to a concurrent comparison of home and sanatorium treatment for one year with isoniazid plus PAS. Previous reports h...
journal_title:Bulletin of the World Health Organization
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1966-01-01 00:00:00
abstract::A strain of Aëdes aegypti was recently found in Puerto Rico which proved to be resistant to both DDT and dieldrin. This paper reports on genetical studies of this strain to determine whether a single entity is involved or two distinct resistances. Tests carried out by repeated back-crossing combined with selection pre...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1961-01-01 00:00:00
abstract::Separation and concentration of parasitized erythrocytes from infected blood was achieved by centrifugation of a sample placed in a layer on top of a cushion of a Ficoll solution with a critical density. Pure suspensions of parasitized erythrocytes were obtained from Plasmodium berghei infected rodent blood, whereas r...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1977-01-01 00:00:00
abstract::In order to contribute to knowledge of the sporogonic cycle of malaria parasites, 3 batches of Anopheles labranchiae atroparvus were infected with the VS Romanian strain of Plasmodium malariae by feeding them on 2 patients undergoing malariotherapy in Romania. Of the 310 infected mosquitos 59 were dissected for ookine...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1968-01-01 00:00:00
abstract::About 30 million people in Africa are estimated to be living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), yet data about the natural history of infection on the continent are sparse. We reviewed the literature on the natural history of HIV-1 and HIV-2 infections among African adult...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章,评审
doi:
更新日期:2004-06-01 00:00:00
abstract::The author sees the task of industrial psychiatry as one of preventing emotional maladjustment and the more serious mental disorders in the industrial population, and of treating early cases of emotional disorders. He classifies the preventive functions as: giving "emotional" first-aid, holding psychiatric consultatio...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1955-01-01 00:00:00
abstract::The presence of non-specific inhibitors in immune influenza sera may falsify the antibody pattern as shown by the haemagglutination-inhibition test, and it is consequently often necessary to pre-treat sera in order to inactivate these inhibitors. A number of different methods are in use for this purpose. It was theref...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1960-01-01 00:00:00
abstract::Catalina Devandas Aguilar talks to Stephanie Cheng about the impact of the 2008 Convention on the Rights of Persons with Disabilities, the importance of listening to people living with disabilities and what United Nations agencies can do to support their further empowerment. ...
journal_title:Bulletin of the World Health Organization
pub_type: 面试,新闻
doi:10.2471/BLT.19.030119
更新日期:2019-01-01 00:00:00
abstract::Studies were conducted each month for one year to determine the cercarial-incubation periods of Schistosoma haematobium and Schistosoma bovis in Bulinus truncatus for different months of infection. The snails were kept in outdoor aquaria in order to simulate the natural temperature conditions in the endemic bilharzias...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1966-01-01 00:00:00
abstract::Stigma, discrimination and lack of legal recognition remain major barriers for transgender people to access the health services they need. Vijay Shankar Balakrishnan reports. ...
journal_title:Bulletin of the World Health Organization
pub_type: 新闻
doi:10.2471/BLT.16.021116
更新日期:2016-11-01 00:00:00
abstract::Monovalent acetone-inactivated typhoid vaccine and heat-killed TAB caused local reactions in 82-88% of volunteers vaccinated by jet injection, whereas they caused local reactions in only 24% of volunteers injected by means of a conventional syringe. Both vaccines induced a high seroconversion rate to typhoid H antigen...
journal_title:Bulletin of the World Health Organization
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1974-01-01 00:00:00
abstract::The minimal inhibitory concentration (MIC) values of penicillin, ampicillin, tetracycline, chloramphenicol, and streptomycin for 500 gonococcal strains were studied for product-moment coefficient correlations. The strains were isolated from male patients with acute gonococcal urethritis attending the Venereal Disease ...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1980-01-01 00:00:00
abstract::Neurocysticercosis is an infection of the nervous system caused by Taenia solium. It is the most important human parasitic neurological disease and a common cause of epilepsy in Africa, Asia, and Latin America, representing enormous costs for anticonvulsants, medical resources and lost production. Neurocysticercosis i...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract:OBJECTIVE:To estimate the proportion of participants in clinical trials who understand different components of informed consent. METHODS:Relevant studies were identified by a systematic review of PubMed, Scopus and Google Scholar and by manually reviewing reference lists for publications up to October 2013. A meta-ana...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章,meta分析,评审
doi:10.2471/BLT.14.141390
更新日期:2015-03-01 00:00:00
abstract::A dengue type 1 epidemic occurred in Fiji between July 1989 and July 1990. Virus isolation in C6/36 cell cultures and Toxorhynchites mosquitos yielded 36 strains. Of the 3686 cases recorded by the Ministry of Health, 60% involved indigenous Fijians and 37%, Indians. A house-to-house survey revealed that a large majori...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1995-01-01 00:00:00
abstract::Vaccination of pre-school children in the 1-7-years age-group for the specific prophylaxis of mumps and rubella is often difficult to arrange because of the already large number of inoculations given to these children. Combined vaccines to protect against measles, mumps and rubella should therefore be a valuable devel...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1970-01-01 00:00:00
abstract::The effects of measles immunization on diarrhea morbidity and mortality are reviewed using data from field studies and theoretical calculations. 2 types of measles-associated diarrhea are distinguished: with-measles diarrhea, which starts between 1 week prerash-onset and 4 weeks postrash-onset, and postmeasles diarr...
journal_title:Bulletin of the World Health Organization
pub_type: 杂志文章
doi:
更新日期:1983-01-01 00:00:00