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      An Assessment of Maternal Health Issues in Two Villages in the Eastern Cape Province of South Africa

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          Abstract

          The fifth Millennium Development Goal of improving maternal health was placed on the international agenda and endorsed by global leaders at the Millennium Summit held in 2000. The aim of this baseline study was to conduct a situational analysis of key maternal health issues in two rural Eastern Cape villages in South Africa: Glenmore and Ndwayana. Ten focus group discussions were conducted with village leaders, community health workers and three different women self-help groups from Glenmore and Ndwayana, with five to eight voluntary participants in each focus group discussion. One of the themes highlighted was inadequate service delivery of ambulance services, which frequently failed to timeously reach expectant mothers in urgent need of transportation to a referral hospital. Adolescent pregnancy was highlighted as the maternal health issue of most concern to the community participants. In this context, a consensus was reached to design and implement an educational intervention to address adolescent pregnancy, which will form the focus of the next phase of this project.

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          Focus groups as qualitative research

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            Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data.

            Maternal mortality, as a largely avoidable cause of death, is an important focus of international development efforts, and a target for Millennium Development Goal (MDG) 5. However, data weaknesses have made monitoring progress problematic. In 2006, a new maternal mortality working group was established to develop improved estimation methods and make new estimates of maternal mortality for 2005, and to analyse trends in maternal mortality since 1990. We developed and used a range of methods, depending on the type of data available, to produce comparable country, regional, and global estimates of maternal mortality ratios for 2005 and to assess trends between 1990 and 2005. We estimate that there were 535,900 maternal deaths in 2005, corresponding to a maternal mortality ratio of 402 (uncertainty bounds 216-654) deaths per 100,000 livebirths. Most maternal deaths in 2005 were concentrated in sub-Saharan Africa (270,500, 50%) and Asia (240,600, 45%). For all countries with data, there was a decrease of 2.5% per year in the maternal mortality ratio between 1990 and 2005 (p<0.0001); however, there was no evidence of a significant reduction in maternal mortality ratios in sub-Saharan Africa in the same period. Although some regions have shown some progress since 1990 in reducing maternal deaths, maternal mortality ratios in sub-Saharan Africa have remained very high, with little evidence of improvement in the past 15 years. To achieve MDG5 targets by 2015 will require sustained and urgent emphasis on improved pregnancy and delivery care throughout the developing world.
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              Access to care and medicines, burden of health care expenditures, and risk protection: results from the World Health Survey.

              We assessed the contribution of health insurance and a functioning public sector to access to care and medicines and household economic burden. We used descriptive and logistic regression analyses on 2002/3 World Health Survey data in 70 countries. Across countries, 286,803 households and 276,362 respondents contributed data. More than 90% of households had access to acute care. However, less than half of respondents with a chronic condition reported access. In 51 low and middle income countries (LMIC), health care expenditures accounted for 13-32% of total 4-week household expenditures. One in four poor households in low income countries incurred potentially catastrophic health care expenses and more than 40% used savings, borrowed money, or sold assets to pay for care. Between 41% and 56% of households in LMIC spent 100% of health care expenditures on medicines. Health insurance and a functioning public sector were both associated with better access to care and lower risk of economic burden. To improve access, policy makers should improve public sector provision of care, increase health insurance coverage, and expand medicines benefit policies in health insurance systems. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                22 September 2014
                September 2014
                : 11
                : 9
                : 9871-9884
                Affiliations
                [1 ]Division of Pharmacy Practice, Faculty of Pharmacy, Rhodes University, Grahamstown 6140, South Africa; E-Mail: tafmanda@ 123456gmail.com
                [2 ]Community Engagement Office, Rhodes University, Grahamstown 6140, South Africa; E-Mail: d.hornby@ 123456ru.ac.za
                Author notes
                [* ]Author to whom correspondence should be addressed: E-Mail: s.srinivas@ 123456ru.ac.za ; Tel: +27-(0)46-603-8496; Fax: +27-(0)46-603-7506.
                Article
                ijerph-11-09871
                10.3390/ijerph110909871
                4199055
                25247428
                9d13b752-c6d5-40cb-947b-f13fb7fbcf64
                © 2014 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                : 24 April 2014
                : 13 August 2014
                : 27 August 2014
                Categories
                Article

                Public health
                maternal health,south africa,service delivery,antenatal care,adolescent pregnancy
                Public health
                maternal health, south africa, service delivery, antenatal care, adolescent pregnancy

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