Community-based surveillance of maternal deaths in rural Ghana.

Objective: To examine the feasibility and effectiveness of community-based maternal mortality surveillance in rural Ghana, where most information on maternal deaths usually comes from retrospective surveys and hospital records.

Methods: In 2013, community-based surveillance volunteers used a modified reproductive age mortality survey (RAMOS 4+2) to interview family members of women of reproductive age (13-49 years) who died in Bosomtwe district in the previous five years. The survey comprised four yes-no questions and two supplementary questions.

The public health impact of training physicians to become obstetricians and gynecologists in Ghana.

Objectives: We assessed the public health effect of creating and sustaining obstetrics and gynecology postgraduate training in Ghana, established in 1989 to reverse low repatriation of physicians trained abroad.

Methods: All 85 certified graduates of 2 Ghanaian university-based postgraduate training programs from program initiation in 1989 through June 2010 were identified and eligible for this study. Of these, 7 were unable to be contacted, inaccessible, declined participation, or deceased.

Fistula awareness among sisters of women with fistula.

Objective: To determine whether sisters of women with obstetric fistula (OF) were aware of their sisters' condition, in order to inform the development of survey questions that adapt the sister-based method to fistula rate estimation.

Methods: Twelve women with OF and 20 of their sisters were interviewed using semi-structured questionnaires in rural Uganda in 2007. Topics included fistula awareness and perceptions of causality.

Traditional preparations used as uterotonics in Sub-Saharan Africa and their pharmacologic effects.

Background: Little is known about the use of traditional preparations for uterotonic effects at or near delivery in Sub-Saharan Africa.

Objective: To describe (1) use of traditional preparations in Sub-Saharan Africa intended to have uterotonic effects at or near birth; and (2) results of pharmacologic investigations of the uterotonic properties of such preparations.

Search Strategy: Structured review of 13 databases.

Improving maternal mortality reporting at the community level with a 4-question modified reproductive age mortality survey (RAMOS).

Objective: To investigate the identification of maternal deaths at the community level using the reproductive age mortality survey (RAMOS) in all households in which a women of reproductive age (WRA) died and to determine the most concise subset of questions for identifying a pregnancy-related death for further investigation.

Methods: A full RAMOS survey was conducted with the families of 46 deceased WRA who died between 2005 and July 2009 and was compared with the cause of death confirmed by the maternal mortality review committee to establish the number of maternal mortalities. The positive predictive value (PPV) of each RAMOS question for identifying a maternal death was determined.

Factors related to retention of postgraduate trainees in obstetrics-gynecology at the Korle-Bu Teaching Hospital in Ghana.

Purpose: The retention of health care workers in developing countries is a key component to reducing the current health care workforce crisis. The availability of postgraduate medical training in developing countries could be an appropriate adjunctive solution. The authors investigated factors that led obstetrics-gynecology (ob/gyn) residents at a university-based academic training program at the Korle-Bu Teaching Hospital (Accra, Ghana) to stay in Ghana for training and explored why the residents expect to stay in (or leave) Ghana after training.

Maternal mortality: an enduring epidemic.

Women continue to die from pregnancy-related causes at an alarming rate. Maternal mortality was first called a neglected epidemic in 1985, but to date, no significant improvements have been realized. Great disparity exists as lifetime risk of dying from pregnancy is 1 in 26 in Africa, 1 in 7300 in high-income areas.

Obstetric fistula in low-income countries.

Objective: To identify, survey, and systematically review the current knowledge regarding obstetric fistula as a public health problem in low-income countries from the peer-reviewed literature.

Methods: The Medline and Science Citation Index databases were searched to identify public health articles on obstetric fistula in low-income countries. Quantitative evidence-based papers were reviewed.

Perceptions of pregnancy complications in Haiti.

Objective: To determine the incidence of perceived pregnancy complications and associated factors.

Methods: During a census, 450 women identified themselves as pregnant and 388 were interviewed postpartum.

Results: Complications were reported by 58.

Who will be there when women deliver? Assuring retention of obstetric providers.

The Safe Motherhood Initiative has highlighted the need for improved health services with skilled attendants at delivery and the provision of emergency obstetric care. "Brain drain" has hampered this process and has been particularly prevalent in Ghana. Between 1993 and 2000, 68% of Ghanaian trained medical school graduates left the country.

Maternal mortality and the consequences on infant and child survival in rural Haiti.

Objective: To determine the odds of death of children when a woman of reproductive age dies from maternal or non maternal causes in rural Haiti.

Methods: Deaths among reproductive aged women between 1997 and 1999 in and around Jeremie, Haiti were classified as maternal or non maternal and matched to female, non-deceasesd controls based on village, age, and parity. Information regarding the health and survival of all of the offspring under 12 years old of the identified women was extracted from the Haitian Health Foundation (HHF) Health Information System (HIS).

Sudden death: ectopic pregnancy mortality.

Objective: To describe the trends in ectopic pregnancy mortality in Michigan from 1985 through 1999 and compare to those of previous time periods.

Methods: We reviewed all cases of maternal mortality from ectopic pregnancy in Michigan from 1985 through 1999. We extracted data from death certificates, hospital inpatient and emergency department records, medical examiner autopsy reports, and reviews by the Michigan Maternal Mortality Study.