published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

Background: Since the launch of the Safe Motherhood Initiative in 1987, the global community has called for reductions in maternal mortality in the developing world. However, reliable methods for assessing levels and trends in maternal deaths, particularly at a district level, are lacking. In increasingly-diverse countries like Indonesia, it is essential for national and local decision-makers to have timely figures to inform programmatic efforts. Aims: The aim of this PhD is to develop and pilot a community-based surveillance system (‘Surveillance by Key Informants’/SKI). The objective is a proof of principle of SKI’s reliability and feasibility, and to verify the potential for routine use at a district level in Indonesia. Methods: This PhD is comprised of two methodological studies, both designed and implemented in Serang and Pandeglang Districts of Banten Province, Indonesia, between 2004 and 2008. The Maternal Death from Informant/the Maternal Death Follow on Review (MADE-IN/MADE-FOR) method comprises retrospective, community-based surveillance of maternal deaths, involving two local informant networks. The experience from MADE-IN/MADE-FOR was used to create a prospective surveillance system (SKI), using the same networks but re-designed for routine use by district authorities. Results: MADE-IN/MADE-FOR found a high level both of maternal mortality (435 deaths per 100,000 live births) and of indirect causes (43%). The SKI findings show the considerable potential of this new approach. The two informant networks together captured about 91% of births and 92% of deaths. In general, the local stakeholders accepted SKI as a useful and realistic system for them to continuously capture local vital events. Conclusions: In a country like Indonesia where civil registration is lacking, SKI could be used to capture deaths and births in the immediate term, with MADE-IN/MADE-FOR used as a periodic census of all maternal deaths. Both approaches can provide the basis for more detailed follow-up of deaths, and so ultimately help to inform reductions in maternal mortality.

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

No description available.

The objectives of the present study in rural Nepali pregnant women living in the terai were: 1) to identify the risk factors of severe anemia and investigate whether risk factors for anemia without iron deficiency, iron deficiency without anemia and iron deficiency anemia (IDA) were different; 2) to examine the effect of vitamin A supplementation, alone or combined with iron, on hemoglobin (Hb) and soluble transferrin receptor (sTfR); and 3) to identify the risk factors of low birth weight (LBW) and preterm delivery, focusing on maternal Hb concentrations. The prevalence of severe anemia (Hb < 8.0 g/dl) in this population (n = 3531) was 4.2% and that of iron deficiency was 31%. Logistic regression analyses indicated that risk factors of severe anemia included hookworm infestation, impaired dark adaptation, lack of iron supplement intake, a diet low in heme iron and malnutrition manifested by thinness and short stature. These same factors differed among non-iron-deficient anemic, iron deficient non-anemic, and iron-deficient anemic pregnant women. We found a significant positive correlation between Hb and retinol concentrations (Pearson r = 0.212, P < 0.0001) and one fourth of our anemic subjects were also vitamin A deficient. There was no evidence that vitamin A alone significantly increased Hb and decreased the prevalence of anemia (n = 498). However, vitamin A, when given together with iron, had an added beneficial effect on Hb but not sTfR. In addition, women with initially compromised iron status benefited more from iron and vitamin A supplementation. The prevalence of LBW and preterm delivery was 22% and 20%, respectively (n = 915). There was an increased risk of LBW associated with short stature, thinness and impaired dark adaptation. The association between Hb measured during the second trimester and risk of LBW had a U-shaped distribution, with risk increasing significantly with Hb < 8.0 g/dl. Based on our findings, we recommend that Hb is evaluated during the second trimester as an indicator of increased LBW risk. While vitamin A supplementation to all pregnant women is recommended, routine supplementation of iron and deworming during pregnancy are essential.

Approximately 10% of women use cocaine and 20% smoke cigarettes during pregnancy. Animal studies indicate that both cocaine and nicotine are neuroteratogenic agents, although findings with humans are inconsistent. Studies with human infants have been plagued by unreliable subject identification procedures, poor control over confounding factors, and invalid measures of CNS integrity. The literature on prenatal cocaine and nicotine use is reviewed and two studies are presented along with an intriguing case report. The effects of maternal prenatal cocaine use (Study 1) and two levels of cigarette smoking (Study 2) on newborn information processing ability were examined using an auditory habituation-recovery paradigm. Case-control designs were employed in which subjects were individually matched on a number of maternal and infant factors. Cocaine exposure was determined by newborn meconium analysis, urine analysis, and maternal self-report. Maternal smoking was determined by self-report and a variation of the bogus pipeline method. Fetal cocaine- and nicotine-exposure were associated with differential impairments in neonatal information processing. Cocaine-exposed newborns exhibited deficits on measures of habituation and recovery to novelty. Dose-response effects of nicotine-exposure were evident on measures of orientation and habituation, but recovery to novelty was not consistently affected. The results imply that fetal cocaine-exposure severely impairs neonatal auditory information processing ability, whereas fetal tobacco-exposure is associated with deficits in information-processing which may be secondary to impairments in arousal regulation. These auditory processing deficits may be related to the later language impairments reported in follow-up studies with cocaine-and tobacco-exposed infants. Following the two studies, a case is presented of an infant born to a woman who reported using large amounts of cocaine throughout pregnancy, although the infant's meco

Thesis (M.S.)--Case Western Reserve University, 2008. / [School of Medicine] Department of Genetics. Includes bibliographical references.

Thesis (M.Nurs. (Hons.)) -- University of Western Sydney, 2002. / "A thesis submitted in fulfillment of the Master of Nursing (Honours) degree, 2002" Bibliography : leaves 215-223.

Thesis (Ph. D.)--University of Sydney, 2001. / Includes tables. Title from title screen (viewed Apr. 22, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Physiotherapy, Faculty of Health Science. Includes bibliography. Also available in print form.