World health statistics quarterly. Rapport trimestriel de statistiques sanitaires mondiales
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With more than 40% of all female deaths attributable to pregnancy, delivery, and the puerperium period, the study established a maternal mortality ratio of 914 deaths per 100,000 live births. The principal risk factors for dying from pregnancy-related causes are: no attendance at antenatal care, too great a distance between the home and the nearest hospital facility, home delivery, belonging to specific ethnic/religious groups, and delivery assistance from family members and TBAs. The health policy implications to improve this situation are: increased coverage with appropriate services, increased numbers of rural midwives, in-service training of existing staff in maternity issues and problems, culture-specific educational approaches using the existing value system, educational campaigns to discourage harmful practices and behaviour, continued educational efforts to upgrade the knowledge of TBAs, and a culturally sensitive integration of TBAs into the government programmes.
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This article demonstrates the need for indicators in the policy-making process and presents some of the current work on developing environmental indicators at the international, national and local levels. The paucity of indicators to demonstrate relationships between environment and health is outlined and a causal chain for physical pollutants--from source activity to emission, concentration and exposure--is presented. ⋯ These were found to be only partially health-related and heavily weighted towards the source activity indicator category. Their utility as reliable indicators of human exposure is therefore seriously open to doubt and there is consequently a need to develop indicators specifically to assess environmental and health relationships.
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The Faisalabad Obstetric Flying Squad was established in 1988 and provides access to emergency obstetric services for the poor women of Faisalabad. The service is highly appreciated by both women and participating dais. The latter receive training from the Mother and Child Welfare Association of Faisalabad and form an integral part of the obstetric care team. ⋯ It would also permit an assessment of the operating costs of the service. One of the reasons the service functions effectively is that it is fully integrated into the general operations of the Allied Hospital. If similar institutional mechanisms can be established there is good reason to think that the Faisalabad Obstetric Flying Squad could be replicated in other developing country settings.
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The health and well-being of adolescents is closely intertwined with their physical, psychological and social development, but this is put at risk by sexual and reproductive health hazards which are increasing in much of the world. Changes in population growth and distribution, the rise of telecommunications, the increase in travel and a decline in the family, as well as a generally earlier start of menarche and later age of marriage are contributing to an increase in unprotected sexual relations before marriage. This, combined with risks from early marriage, result in too early or unwanted pregnancy and childbirth, induced abortion in hazardous circumstances and sexually transmitted diseases, including HIV infection leading to AIDS. ⋯ Young people generally lack adequate knowledge about their own development and information on how to get help. Those who could help are rarely trained for working with adolescents, and services which are generally designed for adults or children often deter young people from getting help when they most need it. Policy and legislation relating to sexual and reproductive health issues are often contradictory, and unclear or unenforced.(ABSTRACT TRUNCATED AT 250 WORDS)
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World Health Stat Q · Jan 1994
Population change, health planning and human resource development in the health sector.
As a result of the demographic and epidemiological transitions now occurring rapidly in many developed countries, a dramatic shift in the age structures of populations and the burden of disease towards the middle-aged and elderly is expected to take place over the next several decades. In the 1990s, however, there remains great diversity across countries in fertility levels and mortality patterns. The World Bank's 1993 World Development Report assessed the global burden of disease in order to define the minimum packages of public health measures and clinical interventions that would improve health conditions in low-income countries in a cost-effective and affordable way. ⋯ Such a population-based health strategy will require the development of a wide range of scientific, analytical and technical capacities, currently rare in most ministries of health. This will require the involvement of epidemiologists, demographers, sociologists, analysts, operations research specialists and environmental health scientists. Building up these capabilities in health ministries, universities or the private sector will be an essential ingredient of health system reform.