Saad M. Gadalla

Reproductive mortality in two developing countries.

Reproductive mortality includes mortality attributable to pregnancy, termination of pregnancy, childbirth and its sequelae, and contraception. Reproductive mortality has been estimated for the United Kingdom, the United States, and for states of the US. However, it has not previously been measured for developing countries, where maternal mortality often remains distressingly high. This paper reports on data from one governorate of Egypt, where reproductive mortality was 46 per 100,000 married women ages 15-49 (2.2 per cent of this was attributable to contraception), and one province of Indonesia, where reproductive mortality was 70 per 100,000 (of which 1.4 per cent was due to contraception). In both locations, complications of pregnancy and childbirth were a leading cause of death in the age group studied (the first cause in Indonesia, second in Egypt). Contraceptive prevalence was 24 per cent of married women ages 15-49 in Egypt and 48 per cent of this age group in Indonesia.

Maternal mortality in Indonesia and Egypt

Twenty‐three percent of deaths to women of reproductive age (15–49 years) in Bali, Indonesia and Menoufia, Egypt were due to maternal causes. Among the younger women, the percentage was even higher. In both areas complications of pregnancy and childbirth were a leading cause of death (the first cause in Bali, the second in Menoufia). In both sites, postpartum hemorrhage was the most common cause of maternal death. Relative to the United States, the number of maternal deaths per 100 000 live births was 20 times higher in Menoufia and 78 times higher in Bali. Families of women of reproductive age who died were interviewed about the conditions leading to death and other characteristics of the deceased. Completed histories were reviewed by a Medical Panel who were able to assign a cause of death in more than 90% of cases. Two‐thirds of the maternal deaths occurred to women who were over 30 and/or who had 3 children — the usual targets of family planning programs. Other possible intervention strategies include antenatal outreach programs, training of traditional birth attendants, and better hospital management of obstetric emergencies.

How the number of living sons influences contraceptive use in Menoufia Governorate, Egypt.

Couples in rural areas of many Arab societies, including Egypt, have consistently reported strong preferences for having sons. However, these reported preferences are not always reflected in reproductive behavior. In 38 rural villages in Menoufia Governorate in Egypt, womens responses to a community-based contraceptive distribution program were examined, taking into consideration both the number of living children and the number of living sons each women reported having. Controlling for number of living children, women with more sons were more likely to be using contraception before the distribution program began. Among women not using contraception before the program, those with more sons were more likely to initiate contraceptive use and were more likely to continue use for a nine-month period following the distribution. These findings imply that in addition to obstacles related to contraceptive availability, there are several cultural, social, and economic factors that influence fertility behavior and exert considerable pressure on married couples to have large families, including several sons. Unless the pressure exerted by these factors is changed or reduced, the impact of family planning programs is likely to reach a plateau at a relatively low prevalence level.

Accidental burn deaths to Egyptian women of reproductive age.

Among women of reproductive age in Menoufia, Egypt, deaths from burns constitute a major public health problem. Burns account for 9 per cent of the deaths occurring to women aged 15-49, and were the third cause of death (after disease of the circulatory system and complications of pregnancy and childbirth). Nearly two-thirds of the burns were caused by kerosene cooking stoves. The data were obtained from a population-based survey of all deaths to women of reproductive age. There were 1691 deaths from all causes during the 3 years of the study, 152 of these were due to burns. Information on the cause of death was gathered from interviews with surviving family members; interviews were reviewed by physicians and a cause of death established. Although hospital-based studies provide valuable information for the management of burn injuries presenting for treatment, establishing rates of injury, comparing the incidence in one population group relative to another, or comparing the incidence of burns relative to other forms of injury requires a population-based study.

Obstetric deaths in Menoufia Governorate, Egypt

Summary. A survey of all registered deaths which occurred during 1981–1983 in women of reproductive age was carried out in Menoufia Governorate, Egypt. Surviving family members were interviewed by trained social workers, and Information was collected on Symptoms of the disease that led to death. The completed questionnaires were reviewed by a panel of local physicians and a cause of death was assigned by the panel. Maternal mortality was a leading cause of death, second only to heart disease. There were 190 maternal deaths per 100 000 livebirths and 45 maternal deaths per 100 000 married women aged between 15 and 49 years. Most of the maternal deaths (63%) were due to direct obstetric causes of which haemorrhage was the main cause. Another 27% of the maternal deaths were due to indirect obstetric causes of which rheumatic heart disease was the main cause.

Household distribution of contraceptives in rural Egypt.

Oral contraceptives were offered to all married, fecund women 15-44 years of age living in 38 Egyptian villages with a population of 200,000. Before the household distribution, contraceptive prevalence was 19.1 percent. Nine months after the distribution, the contraceptive prevalence increased to 27.7 percent, a relative increase of 45 percent. Based on this study, a modified delivery system is currently being tested on a governoratewide basis. The modified system will include a wider range of fertility regulation methods and will also have health and community development components.

Causes of Death to Women of Reproductive Age in Two Developing Countries

Data on cause of death are deficient for most developing countries. Nevertheless, it is important for policy makers to have access to such information to plan the use of resources and to evaluate health programs. In this study, deaths among women of reproductive age (15 to 49) in two areas in developing countries were located, and family members were interviewed. Local physicians reviewed the completed interviews and determined the cause of death.Complications of pregnancy and childbirth were the cause of 23% of the deaths in Menoufia, Egypt and Bali, Indonesia. In Egypt, the first cause of death was circulatory system disease (28%), followed by complications of pregnancy and childbirth (23%), and trauma (14%, primarily burns). In Indonesia, complications of pregnancy and childbirth was the first cause of death, followed by infectious disease (22%, primarily tuberculosis), and circulatory system disease (13%).Although the method of data collection was unorthodox, findings for Menoufia are comparable to data from other sources for the country as a whole. There are few data with which to compare our findings for Bali, but their similarity to the data from the Egyptian study lends credence to their quality.

The determinants of fertility in rural Egypt: a study of Menoufia and Beni-Suef governorates

High levels of fertility in rural areas of many developing societies are an issue of considerable concern to the scientific community and to those interested in public policy. This paper reports on the determinants of fertility in 2 rural areas in Egypt: Menoufia and Beni-Suef governorates. There are important differences in fertility between the 2 areas; the total fertility rate is 7.88 in Beni-Suef and 6.03 in Menoufia. These aggregate differences are the result of even larger differences between the 2 areas in the proximate determinants of fertility particularly age at marriage breastfeeding and contraceptive use. Much of the difference in breastfeeding behavior can be explained by differences in the educational composition of the 2 populations; the level of female education in Menoufia is considerably higher than in Beni-Suef. However differences in contraceptive use cannot be explained by differences in the socioeconomic composition of the 2 populations. The differences may be the result of greater institutional support for contraceptive use and lower fertility in Menoufia where intensive family planning and maternal health programs have been in operation for several years. (authors)