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Cai X.,United Nations Population Fund | Wardlaw T.,United Nations Childrens Fund | Brown D.W.,United Nations Childrens Fund
International Breastfeeding Journal | Year: 2012

Background: Infant and young child feeding is critical for child health and survival. Proportion of infants 0-5 months who are fed exclusively with breast milk is a common indicator used for monitoring and evaluating infant and young child feeding in a given country and region. Despite progress made since 1990, a previous review in 2006 of global and regional trends found improvement to be modest. The current study provides an update in global and regional trends in exclusive breastfeeding from 1995 to 2010, taking advantage of the wealth of data from recent household surveys.Methods: Using the global database of infant and young child feeding maintained by the United Nations Children's Fund, the authors examined estimates from 440 household surveys in 140 countries over the period between 1995 and 2010 and calculated global and regional averages of the rate of exclusive breastfeeding among infants 0-5 months for the two time points to assess the trends.Results: Trend data suggest the prevalence of exclusive breastfeeding among infants younger than six months in developing countries increased from 33% in 1995 to 39% in 2010. The prevalence increased in almost all regions in the developing world, with the biggest improvement seen in West and Central Africa.Conclusions: In spite of the well-recognized importance of exclusive breastfeeding, the practice is not widespread in the developing world and increase on the global level is still very modest with much room for improvement. Child nutrition programmes worldwide continue to require investments and commitments to improve infant feeding practices in order to have maximum impact on children's lives. © 2012 Cai et al.; licensee BioMed Central Ltd. Source

Lusti-Narasimhan M.,World Health Organization | Collins L.,United Nations Population Fund | Hopkins J.,International Planned Parenthood Federation
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2014

Provision of comprehensive sexual and reproductive health (SRH) services that meet the complex and diverse needs of women, in particular, within resource-constrained settings, is often exacerbated by separate and uncoordinated reproductive health (RH) and HIV policies and programmes. A Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages was developed to assess bi-directional linkages between SRH and HIV at policy, systems and service delivery levels, as well as to identify gaps and contribute to the development of country-specific action plans. Findings from the implementation of this Assessment Tool are of particular relevance to the successful delivery and uptake of multipurpose prevention technologies (MPTs), which are products in the development pipeline addressing multiple SRH needs of women, including HIV. The findings highlight the need for better coordination between SRH and HIV programmes in countries; support and training for healthcare providers on SRH, HIV and human rights; supporting SRH and HIV integration at the service delivery level through relevant policies, strategic and operational plans; and strengthening logistics and supplies systems to provide a combination approach to prevention. These lessons learnt could help programme managers and service providers to better understand the strategies for positioning multipurpose prevention products in national policy and service contexts. © 2014 Royal College of Obstetricians and Gynaecologists. Source

Jat T.R.,United Nations Population Fund | Jat T.R.,Umea University | Ng N.,Umea University | San Sebastian M.,Umea University
International Journal for Equity in Health | Year: 2011

Background: Improving maternal health is one of the eight Millennium Development Goals. It is widely accepted that the use of maternal health services helps in reducing maternal morbidity and mortality. The utilization of maternal health services is a complex phenomenon and it is influenced by several factors. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The objective of this study was to estimate the effects of individual, community and district level characteristics on the utilisation of maternal health services with special reference to antenatal care (ANC), skilled attendance at delivery and postnatal care (PNC). Methods. This study was designed as a cross sectional study. Data from 15,782 ever married women aged 15-49 years residing in Madhya Pradesh state of India who participated in the District Level Household and Facility Survey (DLHS-3) 2007-08 were used for this study. Multilevel logistic regression analysis was performed accounting for individual, community and district level factors associated with the use of maternal health care services. Type of residence at community level and ratio of primary health center to population and percent of tribal population in the district were included as district level variables in this study. Results: The results of this study showed that 61.7% of the respondents used ANC at least once during their most recent pregnancy whereas only 37.4% women received PNC within two weeks of delivery. In the last delivery, 49.8% mothers were assisted by skilled personnel. There was considerable amount of variation in the use of maternal health services at community and district levels. About 40% and 14% of the total variance in the use of ANC, 29% and 8% of the total variance in the use of skilled attendance at delivery and 28% and 8.5% of the total variance in the use of PNC was attributable to differences across communities and districts, respectively. When controlled for individual, community and district level factors, the variances in the use of skilled attendance at delivery attributed to the differences across communities and districts were reduced to 15% and 4.3% respectively. There were only marginal reductions observed in the variance at community and district level for ANC and PNC use. The household socio-economic status and mother's education were the most important factors associated with the use of ANC and skilled attendance at delivery. The community level variable was only significant for ANC and skilled attendance at delivery but not for PNC. None of the district level variables used in this study were found to be influential factors for the use of maternal health services. Conclusions: We found sufficient amount of variations at community and district of residence on each of the three indicators of the use of maternal health services. For increasing the utilisation of these services in the state, in addition to individual-level, there is a strong need to identify and focus on community and district-level interventions. © 2011 Jat et al; licensee BioMed Central Ltd. Source

Abas M.,Kings College London | Ostrovschi N.V.,Moldova State University | Prince M.,Kings College London | Gorceag V.I.,United Nations Population Fund | And 2 more authors.
BMC Psychiatry | Year: 2013

Background: Previous studies have found high levels of symptoms of depression, anxiety, and post-traumatic stress disorder among women survivors of human trafficking. No previous research has described risk factors for diagnosed mental disorders in this population.Methods: A historical cohort study of women survivors of trafficked women aged 18 and over who returned to Moldova and registered for assistance with the International Organisation for Migration (IOM). Women were approached by IOM social workers and, if they gave informed consented to participate in the study, interviewed by the research team. At 2-12 months post-return to Moldova, a psychiatrist assessed DSM-IV mental disorders blind to information about women's pre-trafficking and post-trafficking experiences using the Structured Clinical Interview for DSM-IV (SCID). A backwards stepwise selection procedure was used to create a multivariable regression model of risk factors for DSM-IV mental disorder measured at an average of 6 months post-return.Results: 120/176 (68%) eligible women participated. At an average of 6 months post-return, 54% met criteria for any DSM-IV mental disorder: 35.8% of women had PTSD (alone or co-morbid), 12.5% had depression without PTSD and 5.8% had another anxiety disorder. Multivariable regression analysis found that childhood sexual abuse (Adjusted Odds Ratio [AOR] 4.68, 95% CI 1.04-20.92), increased number of post-trafficking unmet needs (AOR 1.80; 95% CI 1.28-2.52) and post-trafficking social support (AOR 0.64; 95% CI 0.52-0.79) were independent risk factors for mental disorder, and that duration of trafficking showed a borderline association with mental disorder (AOR 1.12, 95% CI 0.98-1.29).Conclusions: Assessment for mental disorders should be part of re-integration follow-up care for women survivors of human trafficking. Mental disorders at that time, most commonly PTSD and depression, are likely to be influenced by a range of predisposing, precipitating and maintaining factors. Care plans for survivors of trafficking must be based on individual needs, and must apply clinical guidelines for the treatment of PTSD and of depression. Evidence is needed on the effectiveness of therapy for PTSD in survivors of human trafficking. © 2013 Abas et al.; licensee BioMed Central Ltd. Source

Nove A.,Evidence for Action | Matthews Z.,University of Southampton | Neal S.,University of Southampton | Camacho A.V.,United Nations Population Fund
The Lancet Global Health | Year: 2014

Background: Adolescents are often noted to have an increased risk of death during pregnancy or childbirth compared with older women, but the existing evidence is inconsistent and in many cases contradictory. We aimed to quantify the risk of maternal death in adolescents by estimating maternal mortality ratios for women aged 15-19 years by country, region, and worldwide, and to compare these ratios with those for women in other 5-year age groups. Methods: We used data from 144 countries and territories (65 with vital registration data and 79 with nationally representative survey data) to calculate the proportion of maternal deaths among deaths of females of reproductive age (PMDF) for each 5-year age group from 15-19 to 45-49 years. We adjusted these estimates to take into account under-reporting of maternal deaths, and deaths during pregnancy from non-maternal causes. We then applied the adjusted PMDFs to the most reliable age-specific estimates of deaths and livebirths to derive age-specific maternal mortality ratios. Findings: The aggregated data show a J-shaped curve for the age distribution of maternal mortality, with a slightly increased risk of mortality in adolescents compared with women aged 20-24 years (maternal mortality ratio 260 [uncertainty 100-410] vs 190 [120-260] maternal deaths per 100000 livebirths for all 144 countries combined), and the highest risk in women older than 30 years. Analysis for individual countries showed substantial heterogeneity; some showed a clear J-shaped curve, whereas in others adolescents had a slightly lower maternal mortality ratio than women in their early 20s. No obvious groupings were apparent in terms of economic development, demographic characteristics, or geographical region for countries with these different age patterns. Interpretation: Our findings suggest that the excess mortality risk to adolescent mothers might be less than previously believed, and in most countries the adolescent maternal mortality ratio is low compared with women older than 30 years. However, these findings should not divert focus away from efforts to reduce adolescent pregnancy, which are central to the promotion of women's educational, social, and economic development. Funding: WHO, UN Population Fund. © 2014 World Health Organization. Source

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