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Improving Birth Outcomes: Meeting the Challenge in the Developing World (2003)
Board on Global Health (BGH)
 Institute of Medicine (IOM)

Page
337
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Improving Birth Outcomes: Meeting the Challenge in the Developing World

Index

A

Abortion

access to, 246, 252

complications, 49, 51, 311

costs related to, 51

data on, 187

defined, 324, 333

female feticide, 145, 253, 328

illegal, 7, 34

legalization, 75, 171, 322-323

maternal mortality, 28, 44, 47, 49-51, 75, 191

misoprostol-induced, 244

prevalence, 49, 50, 75

spontaneous, 97, 240

unsafe, 7, 24, 28, 44, 47, 49-51, 75, 333

Access to care

antenatal, 278

and birth outcomes, 29-30

childbirth complications and, 29-30, 47, 58

communication barriers, 170

cultural barriers, 7, 26, 57, 96

economic barriers, 6, 10, 66, 176, 192

family planning services, 6-7, 23

geographic barriers, 10, 58, 73, 170, 176

HIV testing and treatment, 278-279

referral care for labor and delivery, 10, 42, 176-178, 191-192, 277, 295-296

Acute respiratory infections, 32, 92, 93, 95, 278.

See also Pneumonia

Adolescent pregnancy

contraceptive availability and, 24

domestic violence and, 26

fetal and neonatal mortality, 24, 25, 144

and IUGR, 208

maternal risks, 7

Adverse birth outcomes.

See also Fetal mortality;

Maternal morbidity and mortality;

Neonatal morbidity and mortality;

other specific outcomes

access to care and, 29-30

high-risk period, 8, 168

linking mother, fetus, and neonate in, 29

vital registration coverage, 8, 27-28, 192, 333

Africa.

See also individual countries

abortion, 49, 50

birth rate, 23

childbirth management practices, 76

low birth weight, 206

maternal deaths and causes, 3, 43, 44, 45, 49, 50, 51

neonatal mortality, 64, 91

smoking prevalence, 211

STD prevalence, 143

viral hepatitis, 49

 Page
337

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Improving Birth Outcomes: Meeting the Challenge in the Developing World Index A Abortion access to, 246, 252 complications, 49, 51, 311 costs related to, 51 data on, 187 defined, 324, 333 female feticide, 145, 253, 328 illegal, 7, 34 legalization, 75, 171, 322-323 maternal mortality, 28, 44, 47, 49-51, 75, 191 misoprostol-induced, 244 prevalence, 49, 50, 75 spontaneous, 97, 240 unsafe, 7, 24, 28, 44, 47, 49-51, 75, 333 Access to care antenatal, 278 and birth outcomes, 29-30 childbirth complications and, 29-30, 47, 58 communication barriers, 170 cultural barriers, 7, 26, 57, 96 economic barriers, 6, 10, 66, 176, 192 family planning services, 6-7, 23 geographic barriers, 10, 58, 73, 170, 176 HIV testing and treatment, 278-279 referral care for labor and delivery, 10, 42, 176-178, 191-192, 277, 295-296 Acute respiratory infections, 32, 92, 93, 95, 278. See also Pneumonia Adolescent pregnancy contraceptive availability and, 24 domestic violence and, 26 fetal and neonatal mortality, 24, 25, 144 and IUGR, 208 maternal risks, 7 Adverse birth outcomes. See also Fetal mortality; Maternal morbidity and mortality; Neonatal morbidity and mortality; other specific outcomes access to care and, 29-30 high-risk period, 8, 168 linking mother, fetus, and neonate in, 29 vital registration coverage, 8, 27-28, 192, 333 Africa. See also individual countries abortion, 49, 50 birth rate, 23 childbirth management practices, 76 low birth weight, 206 maternal deaths and causes, 3, 43, 44, 45, 49, 50, 51 neonatal mortality, 64, 91 smoking prevalence, 211 STD prevalence, 143 viral hepatitis, 49

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Improving Birth Outcomes: Meeting the Challenge in the Developing World AIDS. See HIV/AIDS; Prevention of perinatal HIV transmission AIDS Clinical Trials Group, 268, 270-271, 279 Alcohol-related neurodevelopmental disorder, 245 Alcohol use during pregnancy, 52, 103, 145-146, 211, 239, 244-245, 246, 249, 254 American College of Nurse Midwives, 181 Ampicillin, 220-221 Anemia causes and sequelae, 47, 48, 49, 55, 98, 147, 151, 211, 222, 241, 242 defined, 56, 324 prevalence, 56 prevention and treatment, 55, 56, 106, 151, 222 Anencephaly, 243, 246, 324 Antenatal care anemia prevention, 56, 151-152 in community facilities, 167 cost-effectiveness, 280-281, 282 counseling, 53, 57-58, 151 diabetes management, 152 education of women on, 151, 174, 176, 218 essential, 107, 119, 294, 295-296 and fetal mortality, 151-152 HIV/AIDS prevention and control, 31, 107, 262, 266, 279-284, 285 hypertensive disease management, 54-55, 78, 107, 151 infection detection and treatment, 55, 96, 103-105, 151, 152 international initiatives, 33 and IUGR and preterm birth, 222 and maternal mortality, 54-58, 60 maternal nutrition, 57, 147, 152, 217-219, 254 neonatal benefits of, 54, 90, 102-107 recommendations, 78, 80, 117, 167, 254, 285 screening for defects and disorders, 21, 31, 33, 54, 104, 107, 248, 253, 262, 266, 279-284 sickle cell disease management, 151-152 skilled birth attendant’s competencies, 312 Antepartum fetal mortality, 9, 28-29, 134, 141-148, 153-154, 324 Antibiotics, 55, 60, 71, 75, 79, 94, 98-99, 103-104, 108, 113, 143, 150, 172, 204, 220-221 Anticoagulant drugs, 224, 239, 244, 250 Anticonvulsant drugs, 71, 73-75, 172, 239, 244, 250 Antihypertensive drugs, 54-55, 73-74, 223 Antimalarial drugs, 55, 79, 147-148, 221 Antiretroviral drugs administration costs, 277 and breastfeeding, 278 clinical trials, 268, 270-275 combination therapy, 267-268, 269, 274-275, 276 costs of drugs, 268, 276-277, 278, 280-281 lamivudine, 267, 269 nevirapine, 268, 269, 274-275, 276, 279, 280-281, 284 resistance to, 276 toxicity and risks, 274-276 zidovudine, 267, 268-275, 279, 280-281, 284 Apgar scores, 99 Apnea, 99 Argentina, 107, 186, 207, 209, 216, 222 Armenia, 62-63 Asia. See also individual countries abortion, 50 birth rate, 23 cesarean sections, 76 low birth weight, 206 maternal deaths and causes, 45, 50, 51 neonatal mortality, 64 smoking prevalence, 211 TB cases, 95 viral hepatitis, 49 Asphyxia, 28, 29, 92, 99-100, 109-110, 118-119, 139, 140, 150, 153, 188, 191, 325 Aspirin, 223 Autopsies and death audits, 135, 152, 175, 188 Azerbaijan, 62-63 Azithromycin, 221 B Bacillus Calmette-Guérin (BCG) vaccine, 113-114 Bacterial vaginosis, 21-22, 204, 211, 220, 224

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Improving Birth Outcomes: Meeting the Challenge in the Developing World Bacteriuria, asymptomatic, 54, 55, 98-99, 104, 107, 117, 204, 220, 223 Bangkok Trial, 268, 270-271 Bangladesh, 62-63, 97, 105, 106, 136, 213, 219 Bednets, insecticide-impregnated, 55 Behavioral change defined, 325 education interventions for, 52-53, 79, 102-103 Benin, 62-63, 151 Bilirubin encephalopathy, 101, 102 Bill and Melinda Gates Foundation, 34, 182 Birth defects. See also Complex birth defects; Environmental birth defects; Genetic birth defects; individual disorders causes and risk factors, 11, 31, 236, 238-247 defined, 237, 325 early diagnosis and treatment, 248, 250-251, 253 impact reduction strategy, 236, 248-254 IUGR and, 212 neonatal mortality, 28, 92 prevalence, 11, 30-31, 236, 237, 238, 241, 246 prevention, 248-250 recommendations, 254 registries, 238 research needs, 254-255 screening for, 236, 251-253 Birth injury, 92, 100, 139, 140-141, 150 Birth intervals, 6, 7, 23, 24, 25-26, 47, 212. See also Parity Birth order, 247 Birth outcomes. See Adverse birth outcomes; specific outcomes Birth rates, 23 Birthing position, 69, 70, 71 Blood safety, 151 Blood transfusions, 47-48, 60, 70, 73, 110, 149, 151, 172, 241 Bolivia, 51, 62-63, 105, 180, 182 Bosnia and Herzegovina, 27 Brazil, 62-63, 101, 136, 140, 141, 144, 169, 215, 216, 321, 322 Breastfeeding, 93, 95, 96, 101, 105, 110, 111-112, 113, 116, 204, 212, 223, 267, 268, 269, 270-271, 274-275, 277-278, 282-283, 284-285 Breech/transverse presentation, 51, 54, 100, 106, 107, 140, 150, 180, 188 Bronchopulmonary dysplasia, 216 Burkina Faso, 62-63, 179, 268, 270-271 C Calcium, 219, 224 Cambodia, 62-63 Cameroon, 62-63 Canada, 147, 213 Cannabis, 147 Carbamazepine, 244 CARE, 182 Caribbean HIV/AIDS, 264 maternal deaths and causes, 45, 51 neonatal mortality, 64 smoking prevalence, 211 STD prevalence, 143 Cefixime, 221 Centers for Disease Control and Prevention, 3-4, 18, 276 Central America, viral hepatitis, 49. See also individual countries Cephalopelvic disproportion, 140 Cephalosporin, 220 Cerclage, 222, 224, 326 Cerebral palsy, 74, 216, 245 Cervical incompetence, 222, 224 Cesarean section, 48, 60, 66, 69, 72, 75, 76, 109, 149, 150, 152, 174, 179, 191, 213, 214, 268, 277, 326 Chad, 62-63 Chancroid, 109 Child mortality and morbidity, 23, 25, 29, 31, 33, 57, 264, 266, 267 Child Survival Initiative, 31-32, 34, 52 Childbirth. See also Skilled birth attendants access to care, 29-30, 42, 47, 58, 176-178 anesthesia, 69, 172, 174 birthing position, 69, 70, 71 cesarean section, 48, 60, 66, 69, 72, 75, 76, 109, 149, 150, 152, 174, 179, 191, 213, 214, 268, 277, 326 clean delivery, 65, 97, 107-108, 109, 119, 180, 326 complications, 29-30, 47, 48, 51-52, 57, 58, 61, 69-70, 71-74, 90, 106, 107, 139-140, 143-144, 150, 312

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Improving Birth Outcomes: Meeting the Challenge in the Developing World cord complications, 94, 100, 140, 143 educational interventions, 174, 188 episiotomy, 69, 71, 76, 191 essential obstetric care, 11-12, 47, 71-74, 77-78, 80, 118, 149, 172, 173, 192, 223-224, 254, 294, 295-297, 324-325 essential package of interventions, 71 external cephalic version, 54, 106, 150 fetal monitoring, 76, 149, 153 and fetal mortality, 8, 28, 29, 51, 66, 138-139, 149-150, 153 first stage of labor, 65-69 forceps extraction, 66, 71, 75, 76 home delivery, 48, 58-59, 61, 94, 96, 97, 100, 101, 108, 110, 168, 170-172, 173 hospital/clinic delivery, 58, 60, 66-67, 72, 172-174 infections, 66, 71, 73, 75, 76, 108-109, 150, 178 malpresentation, 51, 54, 100, 106, 107, 140, 150, 180, 188 management, 29, 32, 42, 65-75, 76, 107-112, 138-139, 149-150, 153, 191, 193, 311, 312 neonatal care during, 90, 107-112 obstructed labor, 24, 28, 29, 44, 47, 51-52, 54, 72, 75, 106, 139-140, 150, 178, 191, 311, 330 oxytocin drug augmentation, 66, 69, 70-71, 76, 108, 149, 172 partograph monitoring, 65-69, 150, 180, 330 prolonged labor, 29, 51, 57, 66, 75, 100, 139-140, 150, 178, 311, 331 referral care for complications, 42, 149, 176-178, 191-192, 295-296 research needs, 174-175 second stage of labor, 69 social consequences of problems, 51-52 third stage of labor, 69-71 traditional beliefs and practices, 7, 26, 57, 96 trauma to neonate, 92, 100, 139, 140-141, 150 vaginal examinations, 76, 108, 149, 150 Chile, 62-63, 175 China, 46, 97, 136, 139, 169, 170, 171, 172, 188, 207, 209, 321, 322 Chinese Birth Defects Monitoring Program (CBDMP), 238 Chlamydia, 97, 98, 104, 204, 220 Chloriquine, 221 Chorioamnionitis, 108, 143, 148, 150 Chronic diseases, fetal origins of, 215-216, 224 Cleft lip and/or cleft palate, 239, 244, 245, 247, 251, 255 Clindamycin, 220 Clinical trials antiretroviral drugs, 268, 270-275 community health services, 166 nutrient supplementation, 218, 219 Clubfoot. See Talipes Cocaine, 147 Cochran Database of Systematic Reviews, 69, 76, 151, 217, 218, 219, 268-269, 274 Cochran Library, 55, 70 Collaborative Study of Maternal Anthropometry and Pregnancy Outcomes, 206, 207, 208, 209 Colombia, 207, 209, 210, 218 Communication capacity for referrals, 170, 177 Community health programs. See also Primary health care birthing homes/centers, 172, 178 capacity building, 167, 172, 298, 325 communication services, 170, 177 financing, 182-183, 321 home care for neonates and sick children, 32, 113, 114 maternity waiting homes, 172, 178, 210 randomized controlled trials, 166 recommendations, 192 support for referral services, 170, 177, 183 training of workers, 170, 171 village health workers, 113, 114-115, 116, 167, 168, 171, 172, 175 Complex birth defects, 238, 239, 246-247. See also specific disorders Congenital heart disease, 239, 240, 244, 245, 246-247, 251 Congenital infections, 96, 97, 98, 105, 239, 242, 246, 249-250, 255 Congenital malformations, 92, 97, 100, 142, 144, 152, 212, 238, 239, 240, 246-247

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Improving Birth Outcomes: Meeting the Challenge in the Developing World Conjunctivitis, 98, 109 Consanguineous unions, 241, 242 Contraceptive prevalence, 23, 24 Coronary heart disease, 215, 216 Corticosteroids, 110-111 Cost-effectiveness of interventions antenatal screening programs, 251, 280-281, 282 DALY indicator, 191, 326 defined, 326 evidence base for, 5, 20 HIV/AIDS interventions, 278, 279, 280-281 immunization programs, 105 of maternal interventions, 52 nutrition-related programs, 57, 79 referral support, 177 reproductive health care, 190-191 research needs, 79, 119 STD diagnosis and treatment, 103, 151 Costs of abortion complications, 51 antiretroviral drugs, 268, 276-277, 280-281 instruments for estimating, 189, 190 of reproductive health services, 189-190 Coumarin, 244 Counseling antenatal, 53, 57-58, 151-152 of breastfeeding mothers, 111 on genetic risks, 152, 250, 253-254 HIV, 104, 278 for maternal behavioral change, 53, 90, 204, 224, 254 peer, 111 preconceptional, 250 to recognize childbirth complications, 57 smoking cessation, 224 to use skilled birth attendant, 52, 57-58, 90 Cretinism, 243, 244, 249 Cuba, 21, 107, 207, 209, 222, 253 Cultural barriers to data collection, 7, 8, 27 to obstetric and neonatal care, 7, 26, 27, 57, 96, 180, 247 traditional beliefs and birthing practices, 7, 26, 57, 96 Curaçao, 136 Cyprus, 252-253 Cytomegalovirus, 48, 118, 142-143 D Data on birth outcomes. See also Surveillance collection and analysis, 15, 16, 184, 187-188, 192-193, 298 cultural barriers to collection, 7, 8, 27 fetal deaths, 135, 138, 152, 153, 175, 188 inadequacy of, 8, 27-28, 212, 237, 238 and intervention development, 188 neonatal deaths, 8, 27, 187 recommendations, 15, 16, 192-193, 298 vital registration coverage, 8, 27-28, 185-186, 187, 192, 333 Denmark, 146-147 Developed countries abortion, 50 LBW, 30 maternal mortality, 17, 43, 50, 60, 64 neonatal mortality, 64 pediatric HIV/AIDS, 31 Developing countries. See also individual countries abortion in, 49, 50 birth defects, 30-31, 237 characteristics shared by, 305-306 classification by per capita income, 307-309 defined, 46 expenditures for health care, 10, 178-179, 182, 282 fertility rates, 25 fetal deaths, 3, 17, 134, 135-137 health personnel shortages in, 9-10, 178 health reforms, 183-184 infectious disease burden, 21-22, 92 LBW, 30 maternal deaths, 3, 17, 42, 44, 50, 59 neonatal deaths, 3, 17, 64, 90, 91, 92 Developmental dysplasia of the hip, 239, 245, 247, 251, 255 Diabetes mellitus, 48, 139, 142, 149, 152, 215, 216, 239, 243 Diagnostic tests, 79, 104. See also Screening for diseases and disorders Diarrheal disease, 32, 92, 93, 96, 111, 115, 278 Diazempam, 74 Dinoprostone, 73 Disability-adjusted years of life (DALY), 190-191, 279, 326

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Improving Birth Outcomes: Meeting the Challenge in the Developing World DITRAME ANRS trial, 270-271 Domestic violence, 6, 23, 26 Dominican Republic, 62-63 Down syndrome, 24, 150, 239, 240, 246, 249, 253, 254, 255 Dystocia, 140 E Echocardiography, 247 Eclampsia, 26, 28, 44, 47, 51, 73-75, 191, 326-327. See also Hypertensive disorders of pregnancy Economic factors. See also Cost-effectiveness of interventions; Costs; Poverty in access to care, 66, 176, 192 and fetal mortality, 141 in HIV/AIDS epidemic, 264, 283 in IUGR, 214 Ecuador, 186 Education of women. See Health education Educational status of women, 6, 22-23, 146 Egypt, 62-63, 182 El Salvador, 62-63 Encephalocele, 243, 327 Energy/protein requirements, 148, 209-210, 217-218, 224 Environmental birth defects. See also Complex birth defects; Teratogens alcohol consumption and, 239, 244-245, 249 and IUGR, 212 maternal illness and, 31, 96, 98, 238, 239, 242-243, 249-250 maternal nutrition and, 238, 239, 243-244 medications and, 238, 244, 250 Environmental pollutants, 245 Epilepsy, 244 Episiotomy, 69, 71, 76, 191 Ergometrine, 70-71 Erythromycin, 220 Escherichia coli, 94 Ethical considerations, 59, 282, 283, 284 Ethiopia, 93-94, 178, 210 Europe. See also individual countries maternal mortality, 44, 45, 57 neonatal mortality, 64, 91 smoking prevalence, 211 European Collaborative Study, 266 European Register of Congenital Abnormalities and Twins (EUROCAT), 238 External cephalic version, 54, 106, 150 F Family planning services, 6-7, 23, 24, 33, 75, 78, 80, 150-151, 167, 171, 181, 248, 249 Family size, 6, 23, 210. See also Parity Female infanticide, 145 Female literacy, 23 Fertility rates, 25 Fetal alcohol syndrome, 145, 146, 211, 239, 245, 255 Fetal interventions antenatal care, 151-152 childbirth management, 138-139, 150 detection and management of distress, 76, 149, 153 family planning, 150-151 infection management, 150 intrapartum care, 149-150, 153 recommendations, 153 research needs, 153 Fetal monitoring, 76, 149, 153 Fetal mortality, 9 antepartum, 9, 28-29, 134, 141-148, 153-154, 324 autopsy and fetal death audit, 135, 152, 175, 188 birth interval and, 25 causes of death, 188 childbirth complications and, 28, 29, 51, 66, 138-139, 149-150, 153 classification systems, 153 domestic violence and, 26 female feticide, 145 geographic distribution, 3, 17, 21, 134, 135-137, 139, 142 hypertensive disease of pregnancy and, 29, 100, 139, 141, 142, 143, 148, 151, 188 intrapartum, 8, 9, 28-29, 66, 134, 138-141, 148-149, 153, 328 maternal age and, 24, 25, 29, 144, 146 maternal infections and, 49, 96, 97, 139, 142-143, 147-148, 150, 204, 211, 221, 225 maternal nutrition and, 147, 148

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Improving Birth Outcomes: Meeting the Challenge in the Developing World poverty and, 145 rates, 3, 17, 21, 134, 135-137 recognition/record of deaths, 135, 138, 152, 153, 175, 188 risk factors, 9, 21, 22, 25, 134, 138-148 surveillance and analysis, 134, 152, 154, 187 Fiji, 136 Folate/folic acid, 47, 56, 107, 147, 152, 188, 219, 239, 243, 246, 248-249, 254 Forceps extraction, 66, 71, 75, 76 France, 213, 270-273, 276 G Gambia, 54, 55, 73, 93-94, 137, 148, 180, 207, 209, 210, 218 Gender inequalities, 22, 23. See also Women’s status Genetic birth defects. See also Complex birth defects; individual disorders chromosomal disorders, 7, 24, 150, 238, 239, 240 counseling about risk, 152, 249, 250, 253-254, 255 detection, 253 examples of, 240-242 maternal age and, 7, 24, 150, 249 risk factors and sequelae, 56 screening for, 21, 252-254, 255 single-gene disorders, 238, 239, 240-242, 253 Genital herpes, 98, 109 Ghana, 62-63, 76, 139, 140, 141, 142 Glucose-6-phosphate dehydrogenase (G6PD) deficiency, 239, 242, 252, 253 Goiter, 243 Gonorrhea, 97, 98 Greece, 252 Group B streptococcus, 94, 106, 108, 118 Guatemala, 178, 180, 207, 209, 210, 214, 217 Guinea, 62-63 H Haemophilus influenzae type B (HiB), 106, 118 Health care systems, 9-11. See also Primary health care; Reproductive health care capacity building, 9-10, 16, 30, 164, 165, 167, 172, 178-184, 284, 298, 325 essential elements, 9-10, 14-15, 164, 165, 184, 294, 295-296 evaluation of models of care, 164, 166, 168, 184-185, 193 expenditures in developing countries, 10, 178-179, 182 managing, 184-191 recommendations, 15-16, 191-193, 298 research needs, 164, 193 surveillance of pregnancy and birth outcomes, 15, 16, 152-153, 164, 181, 187-189, 192-193 Health education on antenatal services, 151, 174, 176 for behavioral change, 52-53, 79, 90, 102-103 on birth defects, 250, 252 breastfeeding promotion, 111-112 on childbirth safety concerns, 174, 188 on HIV/AIDS, 278 and LBW, 222 mass media approaches, 218 nutrition, 52, 111, 152, 218-219 research needs, 79 Health personnel, 23. See also Skilled birth attendants female literacy and, 6 paramedics, 113, 114, 167 professional development and training, 170, 171, 179, 181, 184, 188 shortages in developing countries, 9-10, 178 village health workers, 113, 114-115, 116, 167, 168, 171, 172, 175 Health services. See also Primary health care; Reproductive health care decision-making process, 184-185 donor contributions, 52, 182, 183-184 evaluation of, 184-185 evidence-based care, 185, 327-328 maternal, 52; see also Antenatal care; Postpartum care; Preconceptional care monitoring health care delivery and outcomes, 194 national policy and leadership, 192 neonatal care, 167-168

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Improving Birth Outcomes: Meeting the Challenge in the Developing World priority setting, 192, 293-294 public-private collaborations, 106, 178, 180-182 quality of care, 141, 168, 174, 194 traditional, 4, 19 Hemorrhage. See also Postpartum hemorrhage and anemia, 56 antepartum, 142, 178 and fetal asphyxia, 29, 100 intrapartum, 139, 141, 143, 147, 151 maternal mortality, 28, 44, 47, 51, 191 skilled attendant’s management competency, 310 Hepatitis. See Viral hepatitis Hepatosplenomegaly, 98, 241 Herpes simplex virus, 98 HIV/AIDS. See also Prevention of perinatal HIV transmission blood transfusions and, 47-48 burden globally, 21, 93, 262, 265 child mortality, 262, 264, 266, 267 cultural factors, 264, 266 epidemic, 11, 263-265 and fetal mortality, 143 maternal mortality, 28 nutritional interventions, 220, 267 opportunistic infections, 95, 96 orphans, 283 perinatal transmission, 11, 31, 96, 103, 266-267 prevalence in women of childbearing age, 11, 28, 264-266, 280-281 risk factors and sequelae, 6, 49, 56, 95, 103, 105, 267, 282-283 and stigma and discrimination, 262, 282, 284, 285 testing and counseling, 104, 278, 280-281 HIVNET, 274-275 Home-based care childbirth, 48, 58-59, 61, 94, 96, 97, 100, 101, 108, 110, 168, 169, 170-172, 173 neonatal, 32, 113, 114, 116, 119, 120, 213-214, 295, 321-322 transition to facility-based care, 172-174 Honduras, 62-63, 172, 178 Hookworm infections, 47, 56, 106, 107 Hospitals childbirth management in, 58, 60, 66-67, 72, 169, 172-174 nosocomial infections, 96, 118 public vs. private, 21, 141, 183 Hydrocephalus, 98, 246 Hyperbilirubinemia, 101-102, 110, 328 Hypertension, 215 Hypertensive disorders of pregnancy defined, 328 and fetal mortality, 29, 100, 139, 141, 142, 143, 148, 151, 188 management of, 54-55, 70-71, 73-75, 78, 107, 149, 151, 222-223, 311 maternal mortality, 51 and IUGR and preterm birth, 222-223, 225 and PPH, 70-71 referral services, 178 screening for, 54, 78, 151 Hyperthermia, 239, 243 Hypocalcemia, 214 Hypoglycemia, 111, 214 Hypothermia, 100-101, 110, 111, 116 Hypothyroidism, 243, 253 Hypoxia, 214 Hysterectomy, 72 I Immunization. See also Vaccines; individual diseases cost-effectiveness, 105 maternal, 90, 96, 97, 105-106, 108-109, 117, 118, 249-250, 254 neonatal, 34, 113-115 research needs, 118 India, 21, 22, 56, 58, 91, 97, 101, 113, 114-115, 116, 141, 144, 188, 206, 207, 209, 210, 213-214, 215-216, 241, 283, 295, 321, 322 Indonesia, 46, 62-63, 97, 101, 181, 207, 209, 218 Industrialized countries. See also Developed countries defined, 46 Infant mortality. See also Neonatal morbidity and mortality defined, 328 female literacy and, 23 IUGR and preterm birth and, 28, 30, 92, 191, 212-214 neonatal percentage of, 33, 61

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Improving Birth Outcomes: Meeting the Challenge in the Developing World poverty and, 21 skilled birth attendant and, 61, 63, 64 Infections and infectious diseases. See also HIV/AIDS; Malaria; other specific diseases antenatal detection and treatment, 55, 96, 103-105 antibiotic-resistant pathogens, 79, 94-95, 109 and birth defects, 31, 96, 98, 238, 239 congenital, 96, 97, 98, 105, 239 control package, 118 cultural practices and, 96 and fetal mortality, 49, 96, 97, 139, 142-143, 148, 150 global burden, 21-22, 92 intrapartum, 150 management in childbirth, 66, 71, 73, 75, 76, 108-109, 150 maternal, 29, 31, 48-52, 79, 90, 93, 96, 97, 98-99, 103, 139, 148, 191, 266-267 mother-to-child transmission, 31, 96, 97, 98, 103, 118, 266-267 neonatal, 28, 32, 79, 90, 92-99, 108-109, 112-113, 118, 191 nosocomial, 96, 118 poverty and, 6, 21-22 and preterm birth, 55, 204, 208, 211-212, 220-221 recognition and treatment in neonates, 112-113 research needs, 79, 118 risk factors, 21-22 Initiative for Maternal Mortality Programme Assessment, 59 Institute of Medicine, 283 Integrated Management of Childhood Illness, 32, 112-113 International Classifications of Diseases (ICD), 10, 43-44 International Clearinghouse for Birth Defects Monitoring System (ICBDMS), 238 International Clinical Epidemiology Network (INCLEN), 181 International Conference on Primary Health Care, 166-167 International Nutritional Anemia Consultative Group, 56 International Planned Parenthood Federation, 32 Interventions. See Fetal interventions; Maternal interventions; Neonatal care Intrapartum fetal care, 149-150, 153 fetal mortality, 8, 9, 28-29, 66, 134, 138-141, 148-149, 153, 328 hemorrhage, 139, 141, 143, 147, 151 HIV/AIDS therapy, 269, 274, 279, 284 infections, 150 Intrauterine growth restriction (IUGR) alcohol consumption and, 211 and birth defects, 212 birth interval and, 212 causes, risk factors, and sequelae, 6, 22, 28, 29, 30, 98, 99, 100, 140, 144, 204, 207-214, 222-223, 224 defined, 328 family size/parity and, 210 genetic associations, 212, 214, 218 geographic distribution, 206, 207, 213 and infant mortality, 28, 30, 191, 212-213 interventions to prevent, 204, 217-223 maternal infections and, 211, 220-221 maternal nutrition and, 22, 29, 204, 208-211, 217-220, 224-225 and morbidity, growth, and development, 28, 191, 214-216 physical activity and, 210-211 proportionality indices, 214-215 relative risk, 212-213 research needs, 224 smoking and, 146, 204, 211, 223 ultrasound measurement, 215 Iodine deficiency disorders, 219, 239, 243-244, 255 fortification of foods, 249, 254 Ionizing radiation, 239, 245 Iran, 186, 252-253 Iraq, 210 Ireland, 207, 209 Iron deficiency, 47, 56, 106, 147, 152, 219 overload, 241 Israel, 241, 247 Ivory Coast, 62-63, 268, 270-271

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Improving Birth Outcomes: Meeting the Challenge in the Developing World J Jamaica, 62-63, 136, 139, 140, 141, 142, 144, 152, 153, 175 Jamaican Perinatal Mortality Survey, 140 Japan, 245 Jaundice, neonatal, 98, 101-102, 110, 253 Joint United Nations Programme on HIV/AIDS, 264 Jordan, 62-63 K Kangaroo care, 110, 116, 119, 204, 223, 328-329 Karyotyping, 253 Kazakhstan, 62-63, 101 Kenya, 55, 56, 62-63, 177, 220, 267 Kernicterus, 101, 102, 253, 329 Kick charts, 149 Klebsiella infections, 94 Kuwait, 62-63 Kyrqyz Republic, 62-63 L Labor and delivery. See Childbirth Lamivudine, 267, 269 Large for gestational age infants, 152 Latin America. See also individual countries abortion, 50 birth rate, 23 cesarean sections, 76 fetal mortality and risk factors, 21, 139, 142 low birth weight, 206 maternal deaths and causes, 45, 50, 51 neonatal mortality, 64, 91 smoking prevalence, 211 Latin American Center for Perinatalogy and Human Development, 25-26 Latin American Collaborative Study of Congenital Malformations (ECLAMC), 238 Least developed countries defined, 46 fertility rates, 25 tetanus, 97 Lebanon, 62-63 Leprosy, 244 Libya, 62-63, 137 Low birth weight. See also Intrauterine growth restriction; Preterm birth anthropometric measurement, 206-207 antibiotic treatment and, 220-221 birth interval and, 7, 25 causes and sequelae, 6, 7, 11, 30, 55, 74, 95, 96, 97, 99, 100, 103, 104, 188, 204, 205 defined, 329 neonatal care, 110, 116, 188, 204, 223 patterns of occurrence, 11, 30, 204, 205-207, 213 psychosocial support and, 222 recommendations, 223-224 and reporting of births and deaths, 187 research needs, 224 and thermal control, 110 M Macrosomia, 100, 140 Madagascar, 62-63 Magnesium, 219 Magnesium sulfate, 73, 75, 100 Magpie Trial, 75 Making Pregnancy Safer Initiative, 33 Malaria fetal effects, 147-148, 204, 211, 221, 225 and maternal mortality, 44, 47 neonatal effects, 29, 48, 99-100, 204, 221 prevention and treatment, 32, 52, 55, 56, 78, 79, 105, 107, 152, 204, 221, 224 research needs, 79 risk factors and sequelae, 6, 48-49, 56, 106 sickle cell disease and, 242 Malawi, 56, 143, 148, 179, 207, 209, 267 Malaysia, 169, 172, 173, 174 Mali, 62-63, 137, 177 Malnutrition, 214, 278. See also Maternal nutrition Marriage age, 6, 23, 51 Maternal age and birth defects, 7, 24, 150, 238, 240, 249, 255 and chronic medical disorders, 150-151

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Improving Birth Outcomes: Meeting the Challenge in the Developing World and fetal mortality, 24, 25, 29, 144, 146 and IUGR, 208 and neonatal morbidity and mortality, 24, 25, 144 and preterm birth, 213 and smoking, 146 Maternal and child health, 32. See also Child Survival Initiative; Safe Motherhood Initiative Maternal-Fetal Medicine Network, 220 Maternal interventions. See also Maternal nutrition antenatal care, 54-58, 60, 223 behavioral change, 52-53, 79, 90, 102-103 childbirth management, 29, 32, 42, 65-75, 76, 107-112, 138-139, 149-150, 153, 191, 193 deaths averted by, 43 education, see Health education effectiveness of, 52 essential package of, 71, 294, 295-296 evidence base on, 217 immunization, 90, 96, 97, 105-106, 108-109, 117, 118, 249-250 overused or inappropriate, 48, 76 recommendations, 77-78, 118, 223-224, 254 research needs, 52-53, 56, 78-79, 224 Maternal morbidity and mortality abortion and, 28, 44, 47, 49-51, 75, 191 and birth defects, 238, 242-243, 249-250 birth intervals and, 25-26 causes of death, 8, 28, 42, 43, 44-52, 75, 77, 191 and child survival probability, 29 critical period, 3, 28 deaths annually, 45 defined, 43-44, 329 epidemiological trends, 61 epilepsy, 244 geographic distribution of, 3, 17, 42, 43, 44, 45, 49, 50, 51, 59, 60, 64 historical trends, 59-60 infections, 29, 31, 44, 47, 48-52, 79, 90, 93, 96, 97, 98-99, 103, 139, 148, 191, 211, 220-221, 223-224, 238, 266-267 interventions. See Maternal interventions lifetime risk of dying, 3, 17, 42, 44, 45 measurement of, 44, 187, 329 and neonatal health, 29, 48, 90, 99-100, 204, 221 nutrition and, 43, 47, 48, 51, 56 ratios, 44, 45, 52, 62, 321, 329 research needs, 78-79 skilled birth attendants, 42, 58-65, 173 surveillance, 44, 187 women’s status and, 6, 22-23, 77, 80, 102-103 Maternal nutrition and anemia, 47, 106, 147 antenatal care, 57, 147, 152, 217-219 and birth defects, 31, 238, 239, 243-244, 248-249 calcium, 219, 224 causes of deficiencies, 56, 209 cost-effectiveness of interventions, 57, 79 “eating down,” 209 educational campaigns, 52, 111, 152, 218-219 energy/protein, 148, 209-210, 217-218, 224 and fetal mortality, 147, 148 folate, 47, 56, 107, 147, 152, 188, 219, 239, 243, 246, 248-249, 254 fortification of foods, 248-249 guidelines for pregnant women, 56 and HIV/AIDS, 220, 267 interventions, 57, 79, 217-220, 224 iodine, 219, 239, 243-244, 249, 254, 255 iron, 47, 56, 106, 147, 152, 219 and IUGR, 22, 29, 204, 208-211, 217-220, 224-225 magnesium, 219 and maternal morbidity and mortality, 43, 47, 48, 51, 56 micronutrients, 56, 106, 148, 218-219 n-3 polyunsaturated fatty acids, 219 poverty and, 6, 22 preconceptional, 217-218, 248-249 and preterm birth, 217-220 research needs, 56, 79, 148, 219, 224 supplements, 57, 147, 152, 188, 217-219, 224, 243, 249 vitamin A, 57, 267, 277 vitamin B12, 56 zinc, 148, 219

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Improving Birth Outcomes: Meeting the Challenge in the Developing World Maternity waiting homes, 172, 178, 210 Mauritania, 62-63 Measles, 32 Mebendazole, 222 Medications. See also Antiretroviral drugs abortifacients, 49 analgesia, 69, 172 antibiotics, 55, 60, 71, 75, 79, 94, 98-99, 103-104, 108, 113, 143, 150, 172, 204, 220-221 anticoagulant drugs, 224, 239, 244 anticonvulsant drugs, 71, 73-75, 172, 239, 244 antihypertensive drugs, 54-55, 73-74 antimalarial drugs, 55, 79, 147-148 oxytocic drugs, 66, 69, 70-71, 76, 108, 149 postpartum hemorrhage control, 73 teratogenic, 239, 244, 250 MEDLINE, 217 Meningitis, 93, 94, 242 Mental retardation, 74, 98, 216, 240, 243, 245 15-Methyl PGF, 73 Methylergonovine, 73 Methylmercury, 239, 245 Metronidazol, 220-221 Mexico, 56, 144, 169 Micronutrients, 56, 106, 148, 218-219 Middle East. See also individual countries birth defects, 241 consanguineous marriages, 241 smoking prevalence, 211 viral hepatitis, 49 Midwives and midwifery, 9, 60, 61, 65, 167, 168, 170, 171, 173, 175, 178, 180, 181, 184, 329-330. See also Health personnel; Skilled birth attendants Misoprostol (RU-486), 71, 73, 149, 239, 244, 250 Mortality. See Fetal morbidity and mortality; Maternal morbidity and mortality; Neonatal morbidity and mortality Mother-Baby Package, 33, 189, 191 Mozambique, 62-63, 75, 101, 137, 139, 179, 186 Myanmar, 62-63, 207, 209 Mycobacterium bovis, 113 N National Institute for Child Health and Human Development, 4, 18 National Institutes of Health, 4, 18, 220 Natural disasters, 26-27 Nausea and vomiting, 57, 70 Necrotizing fascitis, 94 Neonatal care. See also Breastfeeding birth defects, 248, 250-251, 253 during childbirth, 90, 107-112 cord care practices, 108-109, 119 corticosteroids, 110-111 disease recognition and treatment, 112-113 essential, 117, 172, 192, 294, 295-296, 327 home-based, 32, 113, 114, 116, 119, 120, 213-214, 295, 321-322 immunization, 34, 113-115 infection control package, 118 integrated approach to, 112-113 Kangaroo care, 110, 116, 119, 204, 223, 328-329 for low-birth-weight infants, 110, 116, 188, 204, 223 nutrition, 110, 111-112 postpartum, 117, 119 preterm birth and, 213-214 providers, 167-168, 311-312 recommendations, 90, 116-117, 321 research needs, 117-119 resuscitation, 99, 109-110, 116, 118-119, 153, 172, 180 skilled birth attendant’s competencies, 311-312, 321 thermal control, 101, 110, 116, 172 traditional practices, 247 Neonatal interventions. See Neonatal care Neonatal morbidity and mortality antenatal care and, 54, 90, 102-107 birth defects, 28, 92, 238-240 birth injury, 100 birth interval and, 25 breastfeeding and, 111-112 burden of mortality, 91 causes of death, 9, 28, 51, 64, 76, 90, 91-102, 188, 191 challenges to health, see Birth defects; Low birth weight

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Improving Birth Outcomes: Meeting the Challenge in the Developing World childbirth management and, 100, 107-112 cultural context, 27 definitional issues, 27, 187, 330 geographic distribution, 3, 17, 64, 90, 91, 92 hypothermia, 100-101, 110, 111, 116 infectious diseases, 28, 32, 79, 90, 92-99, 108-109, 112-113, 118, 191 interventions, 9, 90, 102-116, 253; See also Neonatal care IUGR and, 28, 191, 214-216 jaundice/hyperbilirubinemia, 98, 101-102, 110 maternal age and, 24, 25, 144 maternal health and nutrition and, 29, 48, 90, 99-100, 204, 221 noninfectious conditions, 99-102 perinatal asphyxia, 28, 29, 92, 99-100, 109-110, 118-119, 139, 140, 150, 153, 188, 191 preterm delivery and, 28, 92, 191, 216 rates, 3, 17, 18, 33, 61, 90, 321-322, 330 risk of death, 9, 91 vital registration coverage, 8, 27, 187, 333 Nepal, 57, 62-63, 76, 101, 136, 141, 207, 209 Netherlands, 169, 209 Neural tube defects, 188, 239, 243, 244, 245, 246, 248, 253, 255 Neurodevelopmental disability, 100 Nevirapine, 268, 269, 274, 276, 279, 280-281, 284 Nicaragua, 62-63 Niger, 62-63 Nigeria, 56, 69, 137, 177, 242 Night blindness, 57 Nongovernmental organizations, 178, 181 North America maternal deaths, 45 neonatal mortality, 91 Norway, 60 Nurses, 9, 10, 167, 168, 171, 178. See also Health personnel; Skilled birth attendants Nutrition. See also Breastfeeding; Maternal nutrition neonatal, 110, 111-112 O Obesity, maternal, 145, 152, 216 Obstructed labor, 24, 28, 29, 44, 47, 51-52, 54, 72, 75, 106, 139-140, 150, 178, 330 Oceania, maternal deaths, 45 Oligohydramnios, 143 Omphalitis, 94 Operation Smile, 251 Ophthalmia, 103, 109 Oxytocin, 66, 69, 70-71, 73, 76, 149, 172 P Pakistan, 51, 97 Papua New Guinea, 62-63, 93-94, 98, 106, 108, 141, 143, 210, 241 Paraguay, 62-63 Paramedics, 113, 114, 167 Parasites and parasitic infections, 47, 56, 106, 107, 147 Parity, 7, 23, 24-26, 144-145, 330 Partograph monitoring, 65-69, 150, 180, 330 Perinatal HIV Prevention trial, 268, 270-271 Perinatal mortality rates, 21, 330-331 Peru, 62-63, 219 PETRA Trial, 269, 272-273 Phenobarbital, 244 Phenylketonuria, 253 Phenytoin, 74, 244 Philippines, 62-63, 93-94, 136, 214 Phototherapy, 110 Physicians, 9, 175, 178, 179, 181. See also Health personnel; Skilled birth attendants Placental abruption, 139, 141, 143, 147, 151, 324 Placental infarction, 141 Plasmodium falciparum, 55, 152 Plasmodium vivax, 55 Pneumonia, 92, 95, 98, 104, 106, 108, 113, 242 Political conflicts, 26-27 n-3 Polyunsaturated fatty acids, 219 Population Council, 32 Portugal, 62-63 Postpartum care, 33, 77-78, 80, 117, 119, 269, 274, 331

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Improving Birth Outcomes: Meeting the Challenge in the Developing World Postpartum hemorrhage causes and sequelae, 47, 48 defined, 47, 331 hypertensive disease of pregnancy and, 70-71 management of, 47-48, 69-70, 71, 72, 73, 180 and maternal mortality, 46-48 Poverty and access to health services, 6, 10, 66, 176, 192 and fetal mortality, 145 and infant mortality, 21 and infectious disease, 6, 21-22 and nutrition, 6, 22 Preconceptional care counseling, 250 genetic screening, 248, 252-253 neonatal benefits of, 90 nutrition, 217-218, 248-249 recommendations, 13-14, 78, 117, 167, 223, 254, 285, 297 rubella testing, 250 Pregnancy. See also Adolescent pregnancy; Childbirth; Hypertensive disorders of pregnancy; Maternal age; Unintended pregnancy alcohol use during, 52, 103, 145-146, 244-245, 249 ectopic, 187 integrated management of childbirth and, 32 multiple gestation, 100, 140, 144, 213 prolonged, 144, 221, 331 Premature rupture of membranes, 48, 75, 108, 143, 211-212, 220, 331 Prenatal care. See Antenatal care Preterm birth antibiotic treatment and, 220-221 birth interval and, 25, 212 causes and risk factors, 96, 97, 99, 204, 207-208, 211-212, 213, 222-223 cervical incompetence, 222, 224, 326 consequences, 95, 101, 102, 140, 212-217 defined, 331 domestic violence and, 26 genetic associations, 212 and infant/neonatal mortality, 28, 30, 92, 191, 213-214 interventions, 55, 110, 204, 216, 217-223 maternal infections and, 55, 204, 208, 211-212, 220-221 maternal nutrition and, 217-220 and morbidity, growth, and development, 28, 92, 216 and neonatal care, 213-214 relative risk, 212-213 research needs, 224 smoking and, 204, 211, 223 Prevention of perinatal HIV transmission antenatal screening, 31, 107, 262, 266, 279-284 antiretroviral strategies, 11, 31, 244, 262, 263, 266, 267-277, 279, 284 breast milk substitutes, 111, 277-278, 279, 284-285 cesarean section, 268, 277 comparison of interventions, 278-279 ethical issues, 282, 283, 284 minimum standard of care, 268 recommendations, 284-285 research needs, 277, 285-286 vaginal lavage, 277 vitamin A therapy, 277 Primary health care. See also Reproductive health care; Skilled birth attendants Alma-Ata Declaration, 166-167 childbirth models of care, 10, 168-175, 322 “close-to-client” model, 167, 168 defined, 167 home birth models, 170-172 hospital/clinic birth models, 172-174 referral care for labor and delivery, 10, 33, 42, 52, 58, 65, 149, 164, 167, 171, 175, 176-178, 295-296, 321 Primidone, 244 Private sector, reproductive health care role, 180-182 Private voluntary organizations, 182 Products of conception, retention, 48, 71, 140 Professional organizations, 178 Prolonged labor, 29, 51, 57, 66, 75, 100, 139-140, 150, 178, 331 Proteinuria, 54, 107, 151 Psychosocial support for mothers, 222 Public-private partnerships, 106, 178, 180-182 Pyelonephritis, 55, 99

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Improving Birth Outcomes: Meeting the Challenge in the Developing World R Radiation. See Ionizing radiation Radiography, diagnostic, 105, 245 Recommendations antenatal care, 13-14, 78, 80, 117, 223, 254, 284-285, 297-298 birth defect reduction, 254 concerns about implementation, 320-323 data collection, 15, 16, 192-193, 298 essential obstetric care, 11-12, 77-78, 118, 223-224, 254, 296-297, 324-325 fetal interventions, 153 future priorities, 14-16, 298 health care systems, 15, 191-193, 298 HIV/AIDS prevention and control, 284-285 immediate priorities, 11-14, 296-298 LBW prevention, 223-224 neonatal interventions, 90, 116-117 postpartum care, 13, 297 preconceptional care, 13-14, 78, 117, 167, 223, 254, 285, 297 skilled birth attendants, 12, 64-65, 77, 80, 107-108, 116-117, 168, 191-192, 296-297 Recreational drug use, 143, 147, 239 Recto-vaginal fistulae, 51 Refugees, 26-27 Reproductive health, defined, 20 Reproductive health care. See also Antenatal care; Postpartum care barriers to, 6-7, 24, 26, 29-30, 72-73, 75 basic, 248 cost-effectiveness, 190-191 cost of services, 30, 189-190 donor contributions, 182, 183-184 essential obstetric care, 10, 47, 71-74, 77, 80, 149, 294, 295-296, 324-325 evaluation of interventions, 164, 189-191, 193 expenditures, 182 family planning services, 6-7, 23, 24, 33, 75, 78, 80, 167, 171, 181, 248, 249 financing, 179, 182-183, 193, 321 health care reforms, 183-184 priorities, 293-294 private-sector role, 180-182 quality of, 183, 194 recommendations, 77-78, 193 referral care for obstetric complications, 10, 33, 42, 52, 58, 65, 149, 164, 175, 176-178, 295-296, 321 rural sources of, 114 staff development and training, 179-180 Research needs autopsy studies, 153 behavioral change strategies, 52-53 birth defects, 254-255 educational strategies, 79 emphasis of recommendations, 20 ethical issues, 59 evaluation of interventions, 59, 78, 79, 119, 164, 168, 193, 254 fetal monitoring, 153 health care systems, 193 HIV/AIDS prevention and control, 277, 285-286 infectious disease control, 79, 118, 224, 277 IUGR, 224 low birth weight, 224 maternal interventions, 52-53, 56, 78-79, 224 neonatal, 104, 106, 117-119 nutrition interventions, 56, 79, 148, 219, 224 preterm birth, 224 priority setting, 78 STD treatment, 104, 118 surveillance, 254 Respiratory distress syndrome, 95, 110-111, 216 Resuscitation, 99, 109-110, 116, 118-119, 153, 172, 180 Retinopathy of prematurity, 216 RETROCI trial, 270-273 Rh hemolytic disease, 101-102 Rohrer’s ponderal index, 214-215 Rotavirus, 96, 115 Rubella, 6, 105, 142, 239, 242-243, 246, 249, 250, 255 Russian Federation, 62-63 S Safe Motherhood Initiative, 17, 32-33, 34, 52 SAINT trial, 269, 274-275 Sardinia, 252

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Improving Birth Outcomes: Meeting the Challenge in the Developing World Saudi Arabia, 62-63, 107, 222, 241 Save the Children, 182 Saving Newborn Lives Initiative, 34 Scotland, 25 Screening for diseases and disorders antenatal, 33, 54, 104, 253, 279-284 barriers to, 279-283 for birth defects, 236, 248, 251-253 cost-effectiveness, 280-281, 282 counseling on risks, 253-254 genetic, 21, 248, 252-254 guidelines, 283-284 for HIV/AIDS, 279-284 for hypertensive disease of pregnancy, 54, 78, 151 neonatal, 253 preconceptional, 248, 252-253 research needs, 79 social, cultural, and ethical concerns, 282-283 for STDs, 104 for TB, 104-105 WHO guidelines, 283-284 Seizures, 73-74, 98, 216 Senegal, 62-63, 183 Sepsis causes, risk factors, and sequelae, 6, 48, 49, 51, 93-94 defined, 332 fatality rate, 93 management, 114, 115, 310-311 maternal, 28, 44, 47, 48, 49, 51, 66, 332 neonatal, 92, 93-95, 108, 111, 114, 115, 178, 278 prevention, 66, 111, 278 Sexual differentiation disorders, 240 Sexually transmitted diseases, 109. See also individual diseases adverse pregnancy outcomes, 97-98, 142 and childbirth complications, 48 cost-effectiveness of interventions, 103, 151 diagnosis and treatment, 103-104, 107, 109, 117, 118 domestic violence and, 26 intrapartum interventions, 109 mother-to-child transmission, 93, 97-98, 109, 118, 143 poverty and, 21-22 prevalence, 143 research needs, 118 screening for, 104, 151 women’s status and, 266 Sickle cell disease, 56, 142, 149, 151-152, 239, 241-242, 252, 332 Singapore, 62-63, 247 Skilled birth attendants attitudinal and cognitive skills, 312-313 clinical strategies during childbirth, 61-65, 72, 149, 312 competencies, 109-110, 119-120, 149, 167, 180, 310-313 counseling women to use, 52, 54, 57-58, 90 defined, 58, 294, 332-333 epidemiological trends, 61 evidence of effectiveness of, 42, 59, 61, 320, 321 historical trends, 59-60 and infant mortality, 61, 63, 64 and maternal mortality, 42, 58-65, 173 monitoring performance of, 180 neonatal care, 109-110, 116 and neonatal mortality, 90, 170 recommendations, 12, 64-65, 77, 80, 107-108, 116-117, 168, 191-192, 296-297 research needs, 59 training, 179-180, 295 transportation needs, 177 Small for gestational age, 206, 333. See also Intrauterine growth restriction Smoking, 52, 103, 139, 143, 146-147, 204, 211, 221, 223, 224, 225 Socioeconomic status of women, 6, 22-23 South Africa, 62-63, 97, 115, 170, 216, 220-221, 269, 272-273, 281 South Asia, neonatal morbidity and mortality, 91 Southeast Asia HIV/AIDS, 264 partograph monitoring trial, 66 Spina bifida, 243, 246, 247, 333 Sri Lanka, 21, 62-63, 136, 141, 169, 170, 172, 175, 182, 207, 209, 222, 321 Staphylococcus aureus, 94 Stillbirths, 21, 25, 138, 333. See also Fetal mortality Streptococcus pneumoniae, 95, 106, 114-115, 118 Study purpose and approach, 3-5, 18-20

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Improving Birth Outcomes: Meeting the Challenge in the Developing World Sub-Saharan Africa expenditures for health care, 282 genetic birth defects, 241, 242 HIV/AIDS in, 31, 263-264, 280-281 malaria, 48 smoking prevalence, 211 Sulfadoxine-pyrimethamine, 55, 221 Surveillance of antibiotic use and antibiotic-resistant microorganisms, 94-95, 119 defined, 333 of fetal deaths, 134, 152, 154, 187 of nosocomial infections, 118 of pregnancy and birth outcomes, 44, 152-153, 164, 181, 187-189, 192-193 prospective system, 188-189, 193 public-private partnerships, 181 recommendations, 192-193, 298 registration of births and deaths, 44, 185-187 research needs, 255 sentinel districts, 187, 192 Sweden, 25, 60, 146, 320 Swedish International Development Authority, 182 Syndromic treatment, 103 Syntometrine, 70-71 Syphilis, 48, 93, 97-98, 103, 104, 107, 109, 117, 142-143, 148, 151 T Taiwan, 217, 218 Talipes or clubfoot, 239, 245, 247, 250-251, 255 Tanzania, 27, 62-63, 103, 137, 179, 210, 220, 269, 272-273 Teratogens. See also Environmental birth defects ionizing radiation, 239, 245 medications, 239, 244, 250 pathogens, 96, 97, 98, 105, 239, 242-243 pollutants, 239, 245 Tetanus, 34, 49, 90, 92, 93, 94, 96-97, 105-106, 107, 108-109 Thailand, 107, 152, 186, 207, 209, 210, 222, 268, 270-271 Thalassemias, 56, 239, 241, 252-253 Thalidomide, 239, 244, 250 Thalidomide embryopathy, 244 Thermal control, 101, 110, 116, 172 Thrombocytopenia, 98 Togo, 62-63, 137 Toxoplasma, 142-143 Traditional birth attendants, 7, 26, 33, 65, 105, 113, 115, 170-171, 172, 173, 175, 180, 188, 294-295, 321, 322, 333 Transplacental congenital infections, 96 Transportation to referral facilities, 10, 58, 73, 170, 176, 177, 183 Trichonomiasis, 97, 204, 220 Trinidad and Tobago, 62-63 Tuberculosis, 95-96, 104-105, 107, 113-114, 117 Tunisia, 62-63 Turkey, 62-63 U Uganda, 103, 221, 269, 272-275 Ultrasound, 213, 215 Umbilical cord care practices, 108-109, 119 complications, 94, 100, 140, 143 infections, 108 UNAIDS, 278 Unintended pregnancy, 6-7, 23-24, 33 United Arab Emirates, 70, 241 United Kingdom, 10, 60, 70, 74-75, 169, 207, 209, 215 United Nations Children’s Fund (UNICEF), 30, 32, 34, 56, 58, 182, 187, 278 United Nations Convention on the Rights of the Child, 186 United Nations Development Program (UNDP), 32, 182 United Nations Fund for Population Activities, 32, 58, 182, 187 United States, 10, 60, 62-63, 146, 169, 186, 207, 209, 213, 263, 267, 268, 283, 322 Urinary tract infections, maternal, 54, 55, 98-99, 104, 107, 117, 142, 208, 220-221 U.S. Agency for International Development, 4, 18, 32, 182 Uterine dysfunction, 24 Uterine perforation, 49 Uterine rupture, 51, 140

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Improving Birth Outcomes: Meeting the Challenge in the Developing World Uterotonic drugs, 70 Uzbekistan, 62-63 V Vaccines, 106, 113-114, 118. See also Immunization Vaginal examinations, 76, 108, 149, 150 Vaginal infections, 21-22 Vaginal lavage, 277 Valproate, 244 Vesico-vaginal fistulae, 51 Vietnam, 62-63, 207, 209 Village health workers, 113, 114-115, 116, 167, 168, 171, 172, 175, 295 Violence. See Domestic violence; Political conflicts Viral hepatitis, 28, 44, 48, 49, 107, 114, 143 Vitamin A, 57, 267, 277 Vitamin B12, 56 W Wales, 147 War. See Political conflicts Women’s status, 145 childbirth complications and, 51-52 and HIV transmission, 266 and maternal and neonatal health, 6, 22-23, 77, 80, 102-103 World Bank, 32, 58, 182, 191, 283, 322 World Health Organization, 30, 32, 33, 56, 58, 93-94, 103, 111, 114, 182, 187, 206, 278, 283-284 partograph, 66-69, 330 Y Yemen, 62-63 Young Infants Study, 93-94 Yugoslavia, 62-63 Z Zaire, 75, 179, 210 Zambia, 62-63, 97-98, 183 Zidovudine, 267, 268-275, 279, 280-281, 284 Zimbabwe, 62-63, 69-70, 101, 137, 140, 144, 148, 153, 178, 186 Zinc, 148, 219

Representative terms from entire chapter:

fetal mortality