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Obstetric care services in Saudi Arabia
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Three target groups: married women with under five children, adolescent schoolgirls and traditional birth attendants (TBAs) were interviewed. The interventions undertaken included immunization of preschool children, antenatal care of pregnant women, education in reproductive health and training of TBAs for early referral. Results: The results were encouraging. In five years, maternal mortality was reduced to zero from 460/100,000 live births and perinatal mortality to 21 from 62/1000 births. Contraceptive coverage increased from 32.3% to 44.6%. Prenatal care increased from 41% to 100% and preschool children’s immunization improved from 70% to 98%. Conclusions: Safe motherhood can be achieved even in an underserved area in a developing country by total reproductive health care with a holistic approach.
FC5.09.07 OBSTETRIC CARE SERVICES IN SAUDI ARABIA N. Dept. OB/GYN, Royal Commission Medical Center, Yanbu Sinaoyah, Saudi Arabia. Objectives: The aim of the review study was to assess the obstetric care services in Saudi Arabia. Study Methods: Available literature and study data from publications in journals relating to the concept, effectiveness and expansion of the care since its introduction with the Ministerial Decree in 1980 were reviewed. Results: There had been remarkable progress in the services and sixty to seventy percent of pregnant mothers receive satisfactory care. There were limitations and pitfalls. Conclusion: No health problem can be of greater importance and consequence to a nation than maternal and child health. The provision of comprehensive continuous care is an important strategy of Primary Health Care and Maternal and Child Health services. With the interacting and interrelating sociodemographic factors, the Health Services in Saudi Arabia were able to establish organized obstetric care system with a place for continuous improvement.
FC5.09.08 INTEGRATION OF REPRODUCTIVE HEALTH INTO FAMILY PLANNING Judith Fullerton, Kulmindar Johal, Alfred0 Fort, Donna Vivio Purpose and Objectives: The Ghana Ministry of Health adopted an integrated model for reproductive health services in the early 1990s. The Ministry of Health uses Regional Resource Teams of resource personnel to provide training. This investigation focused on outcome effects on family planning services, when selected additional RH services were also provided to clients in the setting. Design and Methodology: A case study was conducted in the Eastern Region of Ghana. Twenty-four case facilities (government hospitals and health clinics and private maternity homes) located in districts in which providers had received training in both Family Planning and either postabortion care or sexually transmitted disease prevention services were compared to 19 similar service delivery points in five districts that had not been the target of training interventions. Service statistics for the years 1996-98 were compared. Qualitative interviews were conducted with service providers and with clients to assess preparation for and satisfaction with new skills and services. Findings and Conclusion: Educating family planning practitioners to provide a broader mix of reproductive health services had a positive impact on the provision of FP services. Total numbers of clients, and number of new family planning clients served year to year were similar for both case and control. However, providers in case facilities who offered STD and/or PAC services demonstrated significantly greater numbers of continuing FP clients over three study years. Providers and managers in case facilities indicated strong support for receipt of training to provide these integrated services and a request for additional training in an even broader array of RH and adult/child services (e.g., immunization and treatment of minor illnesses). Providers and managers of services and clients receiving these additional RH services perceived positive benefits for their individual practices and for the community, and clients were well satisfied with the services that they received.
FRIDAY,
SEPTEMBER
8
FC5.09.09 ADDRESSING THE INCREASING RATES OF REPRODUCTIVE LOSS IN THE REPUBLIC OF GEORGIA TAsatiani (l), G.McIlwaine (2), (1) Medical Academy, Chavchsvadze Ave 33, Tbilisi, Georgia, 380030, (2) U mversity of Edinburgh, Edinburgh, Lothian, United Kingdom. Background: Since independence in 1991 the maternal mortality ratio in Georgia increased from 39.9 to 71.7/100,000 live births (1997). Perinatal mortality increased to 39.4/1000 total births. These increases are associated with the collapse of the health service. In 1995, with the assistance of the World Bank, health reforms were introduced, but many problems remain. Members of GOGR.4 (Georgian Obstetric, Gynecology and Reproductive Health Association) have formed the Georgian Perinatal Task Force and have established the Georgian Centre for Clinical Effectiveness in Reproductive Health with the aim of improving care and reducing reproductive loss. Objectives: To establish maternal and perinatal mortality enquiries; to develop evidence based obstetric guidelines; to provide training in evidence based obstetric care Methodology: By the end of 1999 the Task Force had obtained funds from UNICEF and Society for Open Learning to establish the Centre. This work is based on the Scottish Programme for Clinical Effectiveness in Reproductive Health (SPCERH). Presentation: The paper will describe the work to date including how clinicians anxieties about confidential enquiries were overcome and the clinical effectiveness in reproductive health training programme. Recommendation: East/west twinning programmes in the promotion of clinical effectiveness in reproductive health will hasten improvement in obstetric care and reduce reproductive loss.
FC5.10 PREECLAMPSIA
INVESTIGATION
FC5.10.01 UPREGULATION OF ENDOTHELIAL ICAIv-1 EXPRESSION BY PLASMA FROM SEVERE PREECLAMPTIC WOMEN IS INHIBITED BY ANTIOXIDANTS VITAMIN E AND N-ACETYL-CYSTEINE. P. S. Kauma, M. Sholley, S. Walsh, Medical College of Virginia, Commonwealth University, Box 980034, Richmond, VA, United States, VA 23298. Objectives: To determine if increased lipid peroxides in plasma from preeclamptic women activate endothelial cells resulting in up-regulation of intercellular adhesion molecule-l (10&-l) expression, and whether this process can be prevented by treatment with antioxidants. Study Methods: Malondialdehyde (MDA) assay was performed on the plasma samples to measure lipid peroxidation. Vascular endothelial cells were incubated with media containing 5% plasma from normal term pregnant patients (n = 5) or from severe preeclamptic patients (n = 5) with or without the addition of vitamin E or N-acetyl-cysteine for 48 hours. ICAIv-1 expression was then determined by flow cytometry. Results: Plasma from severe preeclamptic patients had ten-fold higher MDA levels than controls (p
Three target groups: married women with under five children, adolescent schoolgirls and traditional birth attendants (TBAs) were interviewed. The interventions undertaken included immunization of preschool children, antenatal care of pregnant women, education in reproductive health and training of TBAs for early referral. Results: The results were encouraging. In five years, maternal mortality was reduced to zero from 460/100,000 live births and perinatal mortality to 21 from 62/1000 births. Contraceptive coverage increased from 32.3% to 44.6%. Prenatal care increased from 41% to 100% and preschool children’s immunization improved from 70% to 98%. Conclusions: Safe motherhood can be achieved even in an underserved area in a developing country by total reproductive health care with a holistic approach.
FC5.09.07 OBSTETRIC CARE SERVICES IN SAUDI ARABIA N. Dept. OB/GYN, Royal Commission Medical Center, Yanbu Sinaoyah, Saudi Arabia. Objectives: The aim of the review study was to assess the obstetric care services in Saudi Arabia. Study Methods: Available literature and study data from publications in journals relating to the concept, effectiveness and expansion of the care since its introduction with the Ministerial Decree in 1980 were reviewed. Results: There had been remarkable progress in the services and sixty to seventy percent of pregnant mothers receive satisfactory care. There were limitations and pitfalls. Conclusion: No health problem can be of greater importance and consequence to a nation than maternal and child health. The provision of comprehensive continuous care is an important strategy of Primary Health Care and Maternal and Child Health services. With the interacting and interrelating sociodemographic factors, the Health Services in Saudi Arabia were able to establish organized obstetric care system with a place for continuous improvement.
FC5.09.08 INTEGRATION OF REPRODUCTIVE HEALTH INTO FAMILY PLANNING Judith Fullerton, Kulmindar Johal, Alfred0 Fort, Donna Vivio Purpose and Objectives: The Ghana Ministry of Health adopted an integrated model for reproductive health services in the early 1990s. The Ministry of Health uses Regional Resource Teams of resource personnel to provide training. This investigation focused on outcome effects on family planning services, when selected additional RH services were also provided to clients in the setting. Design and Methodology: A case study was conducted in the Eastern Region of Ghana. Twenty-four case facilities (government hospitals and health clinics and private maternity homes) located in districts in which providers had received training in both Family Planning and either postabortion care or sexually transmitted disease prevention services were compared to 19 similar service delivery points in five districts that had not been the target of training interventions. Service statistics for the years 1996-98 were compared. Qualitative interviews were conducted with service providers and with clients to assess preparation for and satisfaction with new skills and services. Findings and Conclusion: Educating family planning practitioners to provide a broader mix of reproductive health services had a positive impact on the provision of FP services. Total numbers of clients, and number of new family planning clients served year to year were similar for both case and control. However, providers in case facilities who offered STD and/or PAC services demonstrated significantly greater numbers of continuing FP clients over three study years. Providers and managers in case facilities indicated strong support for receipt of training to provide these integrated services and a request for additional training in an even broader array of RH and adult/child services (e.g., immunization and treatment of minor illnesses). Providers and managers of services and clients receiving these additional RH services perceived positive benefits for their individual practices and for the community, and clients were well satisfied with the services that they received.
FRIDAY,
SEPTEMBER
8
FC5.09.09 ADDRESSING THE INCREASING RATES OF REPRODUCTIVE LOSS IN THE REPUBLIC OF GEORGIA TAsatiani (l), G.McIlwaine (2), (1) Medical Academy, Chavchsvadze Ave 33, Tbilisi, Georgia, 380030, (2) U mversity of Edinburgh, Edinburgh, Lothian, United Kingdom. Background: Since independence in 1991 the maternal mortality ratio in Georgia increased from 39.9 to 71.7/100,000 live births (1997). Perinatal mortality increased to 39.4/1000 total births. These increases are associated with the collapse of the health service. In 1995, with the assistance of the World Bank, health reforms were introduced, but many problems remain. Members of GOGR.4 (Georgian Obstetric, Gynecology and Reproductive Health Association) have formed the Georgian Perinatal Task Force and have established the Georgian Centre for Clinical Effectiveness in Reproductive Health with the aim of improving care and reducing reproductive loss. Objectives: To establish maternal and perinatal mortality enquiries; to develop evidence based obstetric guidelines; to provide training in evidence based obstetric care Methodology: By the end of 1999 the Task Force had obtained funds from UNICEF and Society for Open Learning to establish the Centre. This work is based on the Scottish Programme for Clinical Effectiveness in Reproductive Health (SPCERH). Presentation: The paper will describe the work to date including how clinicians anxieties about confidential enquiries were overcome and the clinical effectiveness in reproductive health training programme. Recommendation: East/west twinning programmes in the promotion of clinical effectiveness in reproductive health will hasten improvement in obstetric care and reduce reproductive loss.
FC5.10 PREECLAMPSIA
INVESTIGATION
FC5.10.01 UPREGULATION OF ENDOTHELIAL ICAIv-1 EXPRESSION BY PLASMA FROM SEVERE PREECLAMPTIC WOMEN IS INHIBITED BY ANTIOXIDANTS VITAMIN E AND N-ACETYL-CYSTEINE. P. S. Kauma, M. Sholley, S. Walsh, Medical College of Virginia, Commonwealth University, Box 980034, Richmond, VA, United States, VA 23298. Objectives: To determine if increased lipid peroxides in plasma from preeclamptic women activate endothelial cells resulting in up-regulation of intercellular adhesion molecule-l (10&-l) expression, and whether this process can be prevented by treatment with antioxidants. Study Methods: Malondialdehyde (MDA) assay was performed on the plasma samples to measure lipid peroxidation. Vascular endothelial cells were incubated with media containing 5% plasma from normal term pregnant patients (n = 5) or from severe preeclamptic patients (n = 5) with or without the addition of vitamin E or N-acetyl-cysteine for 48 hours. ICAIv-1 expression was then determined by flow cytometry. Results: Plasma from severe preeclamptic patients had ten-fold higher MDA levels than controls (p