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Ifakara Postpartum Interview StudyRates of illness and death among mothers and infants are still regrettably high in much of Africa. To develop more effective programs and services to improve health and reduce death rates, CDC's Division of Reproductive Health (CDC/DRH)is collecting information on the current care provided and practices followed during the prenatal, delivery, and postpartum periods for both mothers and neonates. Data are collected through postpartum interviews with the mothers; these interviews complement the current practices of a demographic surveillance program run by the Ifakara Health Institute in Tanzania to track a variety of health indicators in Ifakara. CDC/DRH will analyze these data to see how and where care and services can be improved and will provide this information to the district- and national-level government health services. The lessons learned in this study may be more broadly applicable in other areas of Africa. Obstetric Fistula Working GroupProlonged labor without adequate medical care can result not only in the death of the infant but also in permanent injury to the mother (if she survives) when the long pressure from the fetal head creates necrosis and breakage in the wall of the vagina, urethra, bladder, or rectum. This condition, which particularly affects young mothers whose pelvises are not fully grown, is known as obstetric fistula. Fistula formation results in uncontrollable leaking of urine and, less frequently, feces, through the vagina, which often leads to rejection and ostracism of the young women by family and society. An important step in tackling this problem is collecting and disseminating accurate information on the extent of fistula formation and its risk factors, prevention and treatment approaches; and the assistance needed for women living with fistula. This information can be used to convince decision makers of the gravity of the situation and of the need for urgent and effective action. CDC/DRH leads the Data, Indicators, & Research Committee, one of the three components of the International Obstetric Fistula Working Group, a global alliance to end fistula. The group is currently improving the monitoring and evaluation of existing programs that aim to eliminate fistula occurrence and its consequences and help design ways to research the burden that the condition places on individuals and communities. Maternal Mortality Surveillance in Latin AmericaAlthough conditions have improved in recent years, many women in Latin America still die in childbirth or of pregnancy-related causes. Yet in countries that lack strong vital registration systems, these deaths may go unrecorded—and thus officials don’t really know the extent of the maternal mortality problem. To bring about improvements to maternity care and to save lives, policymakers need solid evidence of the dimensions and locations of the problem. CDC/DRH is working with three countries in Latin America—El Salvador, Paraguay, and Honduras—to improve their maternal mortality surveillance systems. CDC/DRH is providing the full spectrum of assistance, depending on the country’s need, from planning a new surveillance system to analyzing data from an already functioning system. Internet Reporting of Maternal MortalityAn effective maternal mortality surveillance system will tell decision makers and officials how many women are dying of pregnancy-related causes, what specifically those causes are, and where these deaths are occurring. This information from the surveillance system can not only provide the foundation for planning effective maternal health services but also help track the improvements in mortality that these services bring about over time. In Colombia, CDC/DRH is working with the Ministry of Social Protection and with the Pan American Health Association to both speed up and increase the accuracy of the reporting and analysis of maternal mortality data through the use of the innovative Web-based Maternal Mortality Epidemiological Surveillance System. This Web-based system is being piloted in Colombia, and if effective may be used in other countries.
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