Tropical medicine & international health : TM & IH
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Trop. Med. Int. Health · May 2014
Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG-5.
To understand changes in epidemiology of maternal mortality in rural India in the context of increasing institutional deliveries and implementation of community-based interventions that can inform policies to reach MDG-5. ⋯ Gains in institutional deliveries and community-based interventions resulting in fewer maternal deaths due to direct causes should be maintained. However, it would be essential to now prioritize management of indirect causes of maternal mortality during pregnancy at community and hospitals for further reduction in maternal deaths to achieve MDG-5.
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Trop. Med. Int. Health · May 2014
Oxygen and pulse oximetry in childhood pneumonia: surveys of clinicians and student clinicians in Cambodia.
To better understand the availability of oxygen and pulse oximetry, barriers to use, clinician perceptions and practices regarding their role in the management of childhood pneumonia, and the formal education and training regarding these technologies received by student clinicians in Cambodia. ⋯ Data from both surveys indicate that despite their utility, oxygen and pulse oximetry may be underused in Cambodia. The reported barriers and perceptions of the tools indicate a clear role for improved training for clinicians and students on the use of oxygen and pulse oximetry, the value of oxygen and pulse oximetry for managing childhood pneumonia, and the need for improved policies and guidelines governing their use.
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Trop. Med. Int. Health · Apr 2014
Review Meta AnalysisSystematic review and meta-analysis: association between water and sanitation environment and maternal mortality.
To assess whether the lack of water or the lack of sanitation facilities in either the home or in health facilities is associated with an increased risk of maternal mortality and to quantify the effect sizes. ⋯ There is evidence of association between sanitation and maternal mortality and between water and maternal mortality. Both associations are of substantial magnitude and are maintained after adjusting for confounders. However, these conclusions are based on a very small number of studies, few of which set out to examine sanitation or water as risk factors, and only some of which adjusted for potential confounders. Nevertheless, there are plausible pathways through which such associations may operate.
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Trop. Med. Int. Health · Apr 2014
Validating a verbal autopsy tool to assess pre-hospital trauma mortality burden in a resource-poor setting.
To present the validation of a verbal autopsy (VA) tool using inpatient deaths in order to ultimately assess the burden of adult pre-hospital trauma mortality in Lilongwe, Malawi. ⋯ This VA tool can accurately ascertain trauma-related mortality with almost perfect agreement. The next step is to assess pre-hospital trauma mortality burden using the VA tool to determine whether hospital records underestimate the burden of trauma in the community.
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Trop. Med. Int. Health · Mar 2014
Randomized Controlled TrialGoodstart: a cluster randomised effectiveness trial of an integrated, community-based package for maternal and newborn care, with prevention of mother-to-child transmission of HIV in a South African township.
Progress towards MDG4 for child survival in South Africa requires effective prevention of mother-to-child transmission (PMTCT) of HIV including increasing exclusive breastfeeding, as well as a new focus on reducing neonatal deaths. This necessitates increased focus on the pregnancy and early post-natal periods, developing and scaling up appropriate models of community-based care, especially to reach the peri-urban poor. ⋯ The trial coincided with national scale up of ARVs for PMTCT, and this could have diluted the effect of the intervention on HIV-free survival. We have demonstrated that implementation of a pro-poor integrated PMTCT and maternal, neonatal and child health home visiting model is feasible and effective. This trial could inform national primary healthcare reengineering strategies in favour of home visits. The dose effect on exclusive breastfeeding is notable as improving exclusive breastfeeding has been resistant to change in other studies targeting urban poor families.