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The purpose of this paper is to provide a situational overview of the facility-based maternal and perinatal morbidity and mortality audits (MPMMAs) in SSA, their current efficacy at reducing mortality and morbidity rates related to childbirth.

This is a scoping literature review based on the synthesis of secondary literature.

Not all countries in SSA conduct MPMMAs. Countries where MPMMAs are conducted have not instituted standard practice, MPMMAs are not done on a national scale, and there is no clear best practice for MPMMAs. In addition, auditing process of pediatrics and maternal deaths is flawed by human and organizational barriers. Thus, the aggregated data collected from MPMMAs are not adequate enough to identify and correct systemic flaws in SSA childbirth-related health care.

There are a few published literature on the topic in sub-Saharan Africa.

This review exposes serious gaps in literature and practice. It provides a platform upon which practitioners and policy makers must begin to discuss ways of embedding mortality audits in SSA in their health systems as well as health strategies.

The findings of this paper can inform policy in sub-Saharan Africa that could lead toward better outcomes in health and well-being.

The paper is original.

Twenty-first century has dawned with substantial achievements in population health outcome indicators in India. However, very little is known on patterns in causes of death in India. The paper aims to discuss this issue.

In this paper, data was drawn from two sources namely, National Family Health Survey (NFHS-1, 1992-1993 and NFHS-2, 1998-1999) and published reports of Survey of Cause of Death (Rural). Three-years moving average causes-of-death estimates were calculated based on World Health Organization classification of causes of death. Negative binomial regression models were fitted to capture the effect of socio-demographic and behavioural determinants of patterns in causes of death.

The leading causes of death were heart diseases, tuberculosis, asthma, paralysis, prematurity and cancer. Three-fifth of the deaths to children under the age of ten was from communicable, maternal, perinatal and nutritional conditions. On the other hand, about two-third persons aged 45 years and above were dying from non-communicable diseases. Female were at greater risk of dying from non-communicable diseases (IRR: 1.22, 95 per cent CI: 1.11-1.34, p < 0.001).

The epidemiologic transition in India has produced a shift in mortality from communicable, maternal, perinatal and nutritional conditions to non-communicable diseases, with little or no role played by injuries regardless of the level of all-cause mortality. Coupled with the effects of population age structures, other factors were also responsible for the bulk of the inter-regional disparities. These factors include differences in the populations’ health risks associated with the natural or built environments, prevalence of behavioural risk factors, or gaps in the capacities of health systems to respond to specific disease challenges, social stratification and others.

This paper described the trends, patterns and geographic variability in India’s causes-of-death profile in terms of communicable diseases, non-communicable diseases and injuries, and socio-economic and demographic determinants of patterns in the profile.

The purpose of this paper is to assess congestion as the simultaneous occurrence of desirable health output (e.g. maternal admissions) along with undesirable output (e.g. still births (SB)), in emergency obstetric care settings of public hospitals in Tamil Nadu.

The study is based on a cross-sectional data set of 97 public hospitals collected by the statistical cell of Tamil Nadu Health Systems Project for the year 2013–2014. The study uses three inputs – beds, doctors and nurses; three desirable outputs – maternal admissions, neonatal admission and live births; and four undesirable outputs – SB, intra-uterine deaths, neonatal deaths and maternal deaths. Congestion analysis, a variant of the data envelopment analysis (DEA) method and slack analysis, has been applied to detect an excessive use of some inputs or a shortfall in some outputs across these hospitals. Furthermore, the association between congestion and some contextual factors has been examined.

On an average, the hospitals in our sample can increase the total amount of outputs by 62.8 percent by improving overall efficiency, and about 34.2 percent of this inefficiency can be attributed to congestion. Analysis of sub-samples showed that government hospitals at the taluk level have higher congestion than district headquarter hospitals. Congestion seems to decrease with greater hospital volume up to a limit; beyond that, it increases in obstetric care settings.

Hospital-based efficiency studies in the Indian context, so far, have estimated relative efficiency among hospitals using the classical DEA method, but ignoring adverse health outcomes. Congestion analysis, an advance in the DEA method, considers how much the desirable outputs can be increased as also how much undesirable outputs affect efficiency.

This paper is concerned with strategic planning in the public services, in particular that sector where no market price exists and where the community expresses some demands. The National Health Service, the Social Services, Education Authorities or Local Authorities are examples. Because the consumer does not directly pay for the service at the point of consumption, demand cannot be expressed in monetary terms. The supply of services is some reflection of community need tempered by its willingness to provide the resources of people, equipment, facilities and money to satisfy that need. Strategic planning or policy making is a complex not to say emotive process, because no obvious measure of success or of community satisfaction exists. It is often difficult to measure satisfaction of a single need, let alone define a policy which “best” satisfies the conglomerate of often conflicting community needs. Nevertheless, this is the task confronting policy makers in the public sector services. The quantity and allocation of these services are not usually directly determined by the community itself but by some section of the community; commonly politicians, economists, planners and occasionally representatives of the community. Within these planning bodies each individual conception of the “best” policy is in conflict with all others. It is not possible to resolve this conflict by deriving a policy which maximises the satisfaction and, hence, minimising the regret of the policy making body. Yet a compromise, or at least a single, policy must be reached. The aim of this paper is to suggest a method of arriving at the most acceptable single policy without making assumptions or deriving definitions of where that compromise ought to lie given the initial postures of the policy makers. The paper is in two sections. The first describes the method in general terms. The second demonstrates, through a small model of the maternity services, its use in practice. The community or surrogate of the community is referred to throughout as the decision makers, policy makers or planning body.

Children are the most vulnerable group owing to long lasting impact of the violation of human rights in term of proper nutrition and their right to live. The purpose of this paper is to assess the risk of child mortality associated with size of child at birth and mother’s anemia level in northern India.

The data were used from 2015–2016 National Family Health Survey (NFHS). The participants (n = 41,412) were children aged under-five years from north Indian state of Uttar Pradesh. The main outcome measure was child deaths defined by under-five mortality. The univariate, bivariate and multivariate analyses were used in data analysis. Kaplan–Meier analyses, Log-rank tests and Cox’s regression analyses were performed to fulfill the objective of the study.

There were a total of 2,835 deaths out of 41,412 births in the past five years preceding the survey period. Children of very small size at birth were significantly two and half times more likely to die than children of average size at birth. The estimated adjusted hazard ratio indicated that the children of severely anemic mothers were significantly 1.5 times more likely to die compared to children of not anemic mothers. Size of child at birth, mother’s anemia level, mother’s age at time of her first birth, wealth index and mother’s education were significantly associated with the under-five mortality in northern India.

The limitation of this study is recall errors arising from the dates of birth and death given by women interviewed in the survey were minimized by restricting the analyses to births within the five-year period preceding the survey.

This study advocates the promotion of comprehensive prevention strategies through appropriate institutional mechanism would be the best intervention or adaptive mechanism to reduce the adverse impact of size of child at birth, mother’s anemia level on under-five mortality in Uttar Pradesh, India.

This research is original. This study enjoys a unique importance by exploring effect of size of child at birth and mother’s anemia on child survival in developing countries like India.

Parental illness can affect child and adolescent psychosocial well‐being. Mental health effects of parental bereavement generally and HIV‐related bereavement specifically have been poorly explored in children. HIV‐related illness has a number of specific features that may directly affect mental health considerations. Infection is clustered in families. Bereavement is often multiple. Death is often preceded by severe illness and multiple opportunistic infections. AIDS is stigmatised, which may impede disclosure, social support and adjustment. In low‐income countries where HIV infection is concentrated, access to palliative care as well as medical care may be limited. This review systematically identifies studies on HIV and bereavement in children. Searches of electronic databases for relevant articles revealed 14 studies examining bereavement with sufficient measurement and controlled methodology providing standardised behavioural and emotional outcome measures. Scrutiny of the results revealed the majority (12: 86%) recorded an adverse behavioural or emotional impact on the child. A detailed analysis of the studies provides insights to risks as well as protective factors that may inform future interventions. Only one systematic intervention was identified whereby a coping skills intervention had positive and long‐lasting effects. This paper examines urgent future needs and the requirement for evidence‐based policy and provision.

There is extensive research documenting the physical outcomes of childbirth, but significantly less on socio-psychological outcomes. Investigating women’s perception of dignified treatment during birth contributes to a salient, under-examined aspect of women’s childbirth experiences.

We use a two-part conceptualization of dignity, respect and autonomy, to understand how birth experiences and interactions either facilitate or undermine women’s perceived dignity. Data came from the Listening-to-Mothers I survey, the first nationally representative study of postpartum women in the United States (n = 1,406). Through linear regression analysis, we separately modeled women’s perception of respectful treatment and women’s perception of medical autonomy during birth.

Overall women reported high scores for both autonomy and respect. Differences between the models emerged related primarily to the role of interventions and provider support. While women’s perceived dignity is related to elements that she brings in to the delivery room (e.g., birth knowledge, health status), much variation was explained by the medical encounter itself (e.g., type of medical interventions, pain management, nurse support, and number of staff present).

This study is cross-sectional, and required either a telephone or internet access, thus limiting the full generalizability of findings. Two findings have direct practical relevance for promoting women’s dignity in childbirth. First, the number of staff persons present during labor and birth was negatively associated with both respect and autonomy. Second, that women with high levels of knowledge about their legal rights during childbirth were more likely to report high scores on the dignity scale. Limiting staff in the delivery room and including knowledge of legal rights in childbirth education or during prenatal visits may be two mechanisms to promote dignity in birth.

These findings address an important, under-examined aspect of women’s childbirth experiences. This study investigates how different birth experiences and interactions either promote or violate childbearing women’s perception of dignity, and has significant implications for the provision of maternal healthcare. The results reinforce the importance of focusing on the socio-psychological dimensions of childbirth.

South Africa is in the last stage of the first demographic transition (FDT) – yet already depicts aspects of the second transition. The last stage of the FDT is characterized by lower levels of fertility closer to or at the replacement level of the average of 2.1 children per woman, and improvements in mortality displayed by declining infant and childhood mortality leading to increasing life expectancy at birth. The second demographic transition (SDT) is driven by lifestyle changes that are determinants of demographic patterns. Such lifestyle changes are declining marriage rates, increasing attention on human development, and thus changing family formation patterns. South Africa’s youth are at the centre of this transition. The population census of 2011 shows an age structure of South Africa that is characterized by a larger proportion of 20-35-year-olds. This resulted from a long period of declining fertility and to some extent improvements in mortality at all ages. This age structure, with adequate investments - is expected to yield a period of economic growth resulting from a reduced dependency ratio. However, improved health care, investments in human development, and higher employment opportunities are required to harness the benefit. This chapter aims to explore the national and provincial preparedness of South African youth to contribute to economic growth of the country. In particular, the chapter will focus on demographic factors such as sex ratio; youth mortality and morbidity; and youth fertility levels as these factors are highly correlated with human development.

This paper aims to highlight the role of the United Nations in the formulation and implementation of the current understanding of “population assistance” and examine some of the arguments for “population assistance” in the form of reproductive health care.

It presents the data for global population assistance and briefly compares these figures with data for other developmental sectors, recommending certain policy changes if real development is to be achieved.

During the last decade increasingly large amounts of money have been spent on limiting population growth of underdeveloped countries. Population control is seen as the corner‐stone of development and population activities. Thus, population control has become “population assistance,” and birth control has become “reproductive health services.” Population control is pursued at the expense of women's rights and to the detriment of real economic growth and social improvement.

For more than two decades, John Conway O'Brien has written on the importance of ethics for economic growth. In a recent article, he concluded that “although the illuminated may have been activated by the most altruistic of motives, their search for the good society was doomed from the start.” This paper attests the validity of his remarks.