OBJECTIVE: To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework. METHODS: This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month period in 2010-2011. The ratios of Potentially Life-Threatening Conditions, Severe Maternal Outcomes, Maternal Near Miss, and Maternal Death were estimated and stratified by stages of obstetric transition. The characteristics of each stage are defined. RESULTS: Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. Medicalization increased with obstetric transition stage. In Stage IV, women had 2.4 times the cesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) as women in Stage II. The mean age of primiparous women also increased with stage. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. CONCLUSIONS: This analysis supports the concept of obstetric transition using multicountry data. The Obstetric Transition Model could provide justification for customizing strategies for reducing maternal mortality according to a country's stage in the obstetric transition.

RESUMEN OBJETIVO: Evaluar si las características propuestas del Modelo de Transición Obstétrica, un marco teórico que puede explicar los cambios graduales que experimentan los países a medida que eliminan la mortalidad materna evitable, se pueden observar en una amplia base de datos de salud materna y perinatal de varios países; y tratar sobre el proceso dinámico de reducción de la mortalidad materna utilizando este modelo como marco teórico. MÉTODOS: Este estudio consistió en un análisis secundario de un estudio transversal realizado por la Organización Mundial de la Salud que recopiló información sobre más de 300 000 mujeres que dieron a luz en 359 establecimientos de salud de 29 países de África, Asia, América Latina y Oriente Medio, durante un período de 2 a 4 meses en el 2010 y el 2011. Se calcularon los índices de afecciones potencialmente mortales, resultados maternos graves, morbilidad materna extremadamente grave, y muerte materna, y se estratificaron según las etapas de transición obstétrica. Se definen las características de cada etapa. RESULTADOS: Los datos de 314 623 mujeres indicaron que la fecundidad femenina, calculada indirectamente por el número de partos, fue mayor en los países que se hallaban en las primeras etapas de la transición obstétrica, desde un promedio de 3 hijos en el estadio II a 1,8 en el estadio IV. El nivel de medicalización de los establecimientos de salud de los países participantes, definido por el número de partos por cesárea y el número de partos inducidos, tuvo tendencia a aumentar según avanzaba la etapa de transición obstétrica. En el estadio IV, las mujeres tuvieron 2,4 veces más partos por cesárea (15,3% en el estadio II y 36,7% en el estadio IV) y 2,6 veces más inducciones de parto (7,1% en el estadio II y 18,8% en el estadio IV) que las mujeres en el estadio II. A medida que avanzaban las etapas de transición obstétrica, también se incrementaba la media de edad de las mujeres primíparas. La ocurrencia de rotura uterina mostraba una tendencia descendente, y se reducía 5,2 veces, de 178 a 34 casos por 100 000 nacidos vivos, a medida que un país efectuaba la transición del estadio II al IV. CONCLUSIONES: Este análisis apoya el concepto de transición obstétrica utilizando datos de varios países. El Modelo de Transición Obstétrica podría justificar la adaptación de las estrategias para reducir la mortalidad materna según la etapa de transición obstétrica en que se halla un país.

Objective To develop a global research agenda that will guide investment in effective interventions to satisfy the large unmet need for modern methods of family planning. Methods In a global survey, experts on contraception were invited to identify and rank the types of research that would be needed – and the knowledge gaps that would have to be filled – to reduce the unmet need for family planning in the next decade. The experts were then asked to score the research on a given topic in terms of the likelihood of its leading to an intervention that would: (i) be deliverable, affordable and sustainable; (ii) substantially reduce the unmet need for contraceptives; (iii) be effective and efficient in improving health systems; (iv) be ethically implemented; and (v) improve equity in the target population. The overall scores were then ranked. Findings Most of the topics that received the 15 highest scores fell into three categories: implementation of policies in family planning; the integration of services to address barriers to contraceptive use; and interventions targeted at underserved groups, such as adolescents. Conclusion Experts on contraception gave top priority ranking to research on improving the implementation and integration of health services and on strengthening the health systems supporting family planning services. The results of the exercise may help decision-makers, researchers and funding agencies to develop a clear and focused approach to satisfying the global need for family planning and reach the target set by the Family Planning 2020 initiative.

Resumen Objetivo Desarrollar una agenda global de investigación que guíe la inversión en intervenciones efectivas para cubrir la gran necesidad insatisfecha de métodos modernos de planificación familiar. Métodos En una encuesta mundial, se invitó a expertos en anticoncepción a identificar y clasificar los tipos de investigación que serían necesarios, así como las lagunas de conocimientos que deben colmarse para reducir la necesidad insatisfecha de planificación familiar en la próxima década. A continuación, se pidió a los expertos que puntuaran la investigación de una materia concreta en términos de la probabilidad de que condujera a una intervención que: (i) fuera viable, asequible y sostenible; (ii) redujera sustancialmente la necesidad insatisfecha de anticonceptivos; (iii) fuera eficaz y eficiente en la mejora de los sistemas sanitarios; (iv) pudiera aplicarse con ética; y (v) mejorara la equidad en la población meta. A continuación, se clasificaron las puntuaciones generales. Resultados La mayoría de los temas que recibieron las 15 calificaciones más altas se dividieron en tres categorías: la aplicación de las políticas de planificación familiar, la integración de servicios para abordar las barreras al uso de anticonceptivos y las intervenciones dirigidas a grupos desatendidos, como los adolescentes. Conclusión Los expertos en anticoncepción dieron máxima prioridad a la investigación destinada a mejorar la aplicación e integración de los servicios sanitarios y al fortalecimiento de los sistemas sanitarios que apoyan los servicios de planificación familiar. Los resultados del ejercicio pueden ayudar a los gobernantes, investigadores y organismos de financiación a desarrollar un enfoque claro y a satisfacer la necesidad internacional de planificación familiar, así como a alcanzar el objetivo fijado por la iniciativa Planificación Familiar 2020.

Résumé Objectif Développer un agenda de recherche mondial qui guidera les investissements dans les interventions efficaces pour répondre aux grands besoins non satisfaits en méthodes modernes de planification familiale. Méthodes Dans une enquête mondiale, les experts dans le domaine de la contraception ont été invités à identifier et classer les types de recherche qui seraient nécessaires – et les lacunes en termes de connaissances qui devront être comblées – pour réduire le besoin non satisfait de planification familiale dans la prochaine décennie. Les experts ont ensuite été invités à noter la recherche dans un domaine particulier et à évaluer ses chances de déboucher sur une intervention qui: (i) serait livrable, abordable et durable; (ii) réduirait substantiellement le besoin non satisfait de moyens contraceptifs; (iii) serait efficace et efficiente dans l'amélioration des systèmes de santé; (iv) serait mise en œuvre de manière éthique; et (v) améliorerait l'équité dans la population cible. Les notes globales ont ensuite été classées. Résultats La plupart des sujets qui ont reçu les 15 meilleures notes appartiennent à trois catégories: la mise en œuvre de politiques en matière de planification familiale; l'intégration de services pour surmonter les obstacles à l'utilisation des moyens contraceptifs; et les interventions ciblées vers des groupes mal desservis, comme les adolescents. Conclusion Les experts dans le domaine de la contraception ont classé comme hautement prioritaire: l'amélioration de la mise en œuvre et de l'intégration des services de santé et le renforcement des systèmes de santé qui soutiennent les services de planification familiale. Les résultats de l'exercice peuvent aider les décideurs, les chercheurs et les organismes de financement à développer une approche claire et ciblée pour satisfaire les besoins mondiaux en matière de planification familiale et pour atteindre l'objectif fixé par l'initiative de la Planification Familiale 2020.

BACKGROUND: Antiretroviral treatment (ART) has substantially reduced morbidity and mortality for HIV patients. In South Africa, with the largest ART programme globally, attention is needed not only on the further expansion of ART coverage, but also on factors which undermine its effectiveness, such as alcohol use. OBJECTIVE: Given the decentralised approach of nurse-initiated and -sustained ART in the South African primary health sector, it is important to document key aspects of alcohol use to be conveyed to HIV-positive individuals and those at risk for HIV. METHOD: This study comprised a narrative review of relevant literature. RESULTS: Alcohol acts through both behavioural and physiological pathways to impact on the acquisition, further transmission and then progression of HIV disease. Besides links to risky sex, alcohol undermines the immune system, raising susceptibility to contracting and then countering HIV and other infections. There are important drug interactions between alcohol and ART, or therapies for opportunistic infections and other co-morbidities. Moreover, alcohol undermines adherence to the medication which is essential for effective ART. CONCLUSION: Primary healthcare clinic attendees need evidence-based information on the detrimental effects of alcohol consumption on HIV infection, which ensue throughout the clinical course of HIV. This spans the role of alcohol consumption as a risk factor for HIV infection, HIV replication in infected individuals, a person's response to HIV infection and HIV treatment. Primary healthcare workers, especially nurses and HIV counsellors, require training in order to screen for and provide appropriate interventions for HIV-positive patients, those on treatment and treatment-naïve patients, who will benefit from reduced alcohol consumption or the cessation thereof.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis in pregnant women. METHODS: A cross-sectional study was conducted among women attending antenatal care clinics (ANCs). Blood samples were tested for syphilis using the rapid plasma reagin (RPR) and treponemal haemagglutination (TPHA) tests; CT and NG were diagnosed using a manual polymerase chain reaction assay on first-void urine samples. A socio-demographic questionnaire was completed. Results were compared with previous published data on sexually transmitted infection (STI) prevalence in Mozambique. RESULTS: Blood and urine samples were collected from 1 119 and 835 women, respectively. The prevalence of CT was 4.1%, and that of NG 2.5%. The RPR test was positive in 5.2% of the women, and 7.1% had a positive TPHA test. Active syphilis was found in 4.7%. In univariate analysis, CT was associated with having had any level of education (p<0.05), reactive RPR and TPHA were associated with illiteracy (p<0.05), and TPHA was associated with age >25. Multivariate analysis did not show any significant association. In comparison with published data from 1993, a decline was observed for CT (p<0.05), NG and syphilis (p<0.001). CONCLUSIONS: Compared with available data, a decline of STI prevalence was observed in our setting. This might be the result of community-based education programmes focusing on changes to sexual behaviour, as well as the widespread use of the syndromic approach to managing STIs and the expansion of syphilis screening in primary health care settings. However, STI rates are still high, and the problem needs more concrete and sustained efforts for its control.