Catherine Gourbin

Infant health and mortality indicators. Their accuracy for monitoring the socio-economic developement in the Europe of 1994

The ability of infant mortality and health indicators to monitor health conditions in early infancy, and their broader use as indicators of the general level of socio-economic development are discussed from three points of view. These are: (i) the increasing impact of differences in legal definitions of live and stillbirths on the comparability of the infant mortality figures produced by vital statistics; (ii) the validity of mortality measures to monitor health; (iii) the comparability of social inequalities in infant health and mortality over time and across countries.RésuméLa validité de la mesure de la mortalité infantile comme indicateur de développement économique et social est remise en question dans le contexte de la situation actuelle en Europe. Trois axes de réflexion sont envisagés: limpact croissant de différences dans les critères légaux de définition des naissances viràntes et des naissances denfants mort-nés sur les niveaux de mortalité infantile fournis par les statistiques détat civil; la pertinence de mesures de mortalité comme indicateurs de santé infantile; la comparabilité dans le temps et dans lespace des inégalités sociales de santé et mortalité infantile.

Complications of childbirth and maternal deaths in Kinshasa hospitals: testimonies from women and their families.

BackgroundMaternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications.MethodSemi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis.ResultsTestimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known) had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it.ConclusionOur findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing with health care staff