Articles: health.
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Major public health resources are devoted to the prevention of sexually transmitted diseases (STDs) through public STD clinics. However, little is known about where people actually receive treatment for STDs. ⋯ The health care utilization patterns for STD treatment in the United States are complex. Specific disease diagnosis, gender, race and income status all affect where people will seek treatment. These factors need to be taken into account when STD prevention strategies are being developed.
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Comparative Study
The validity of verbal autopsies for assessing the causes of institutional maternal death.
This report presents data from a study carried out in three African countries to assess the validity of verbal autopsies--based on information about symptoms and signs observed antemortem by relatives or associates of deceased individuals--for determining the causes of institutional maternal death. The validity of the verbal autopsy was assessed for each cause of death; and for groups of "direct" and "indirect" maternal causes, by comparing the verbal autopsy diagnoses with the reference diagnoses and calculating their sensitivity, specificity, and positive predictive value. ⋯ Verbal autopsy estimates of cause-specific mortality were comparable to expected values for most of the causes. The study shows that certain direct causes of hospital-based maternal mortality can be determined by means of verbal autopsies with a reasonable level of confidence.
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Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.
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Review
Quality of care in reproductive health programmes: monitoring and evaluation of quality improvement.
As 200 million women become pregnant every year, at least 30 million will develop life-threatening complications requiring emergency treatment at any level of society where they live. But it is a basic human right that pregnancy be made safe for all women as complications are mostly unpredictable. This requires reproductive health programmes which are responsive to women's and their families' needs and expectations on the one hand and enhancement of community participation, high quality obstetric services, and both provider collaboration and satisfaction on the other. ⋯ This is the third, and last, article in a series on quality of care in reproductive health programmes. The first (Kwast 1998a) contains an overview of concepts, assessments, barriers and improvements of quality of care. The second (Kwast 1998b) addresses education issues for quality improvement.