All cases of obstetric fistula can be prevented with timely
All cases of obstetric fistula can be prevented with timely access to emergency obstetric care, especially caesarean section. Obstetric fistula was virtually eliminated in Europe and the USA between 1935 and 1950, because of universal access to safe delivery care. That it is still a public health problem in some countries shows the enormous gap in maternal health care between high-income and low-income nations and is a result of the egregious failure of health systems in these regions to provide safe maternity care. Poor women without timely access to safe intrapartum care are most vulnerable to obstetric fistula and the physical and psychological consequences affect quality of life. Affected women are often abandoned by their husbands and families, and ostracised by their communities. In many societies, obstetric fistula is stigmatised. It is not surprising that these women have been considered as “the most dispossessed, outcast, powerless group of women in the world”.
Since the etizolam vendor of the “Campaign to End Fistula” by UNFPA and other organisations in 2003, awareness among policy makers has significantly increased. However, the lack of reliable data for prevalence and incidence has hampered efforts to formulate an appropriate and coordinated response to obstetric fistula. The collection of accurate and reliable maternal morbidity data in low-income countries is difficult, especially for obstetric fistula.
Estimation of the burden of obstetric fistula in low-income countries is still a challenge. At a recent meeting, an urgent call was made to develop appropriate methods for measuring national burdens of obstetric fistula so that effective maternal health care can be developed. Obstetric fistula disproportionately affects the poorest women, whose voices are scarcely heard. Every life counts and we hope that the need for better data to inform decision-making and planning at the national level will be recognised in international and national safe motherhood agendas and appropriate resources will be mobilised to collect reliable data about obstetric fistula.
The reduction in mortality in children younger than 5 years over recent decades has been impressive, but shortfalls still exist in achievement of the MDG4 targets. Acceleration of progress for child survival would need increased emphasis on quality care at and around birth, and timely and efficacious treatment for neonatal infections, diarrhoea, and pneumonia in regions where these causes contribute substantially to mortality in children younger than 5 years. The challenge in provision of standard care is increased wherever health systems are weak, socioeconomic conditions are suboptimum, and settings are remote and inaccessible. Innovative implementation research is being widely promoted to provide solutions that improve equitable delivery of established interventions without compromising safety or effectiveness. This type of research is challenging and often complex. In , Abdullah Baqui and colleagues report their findings from a large equivalence trial in Bangladesh, in which two antibiotic regimens were compared with the standard regimen (intramuscular injections of procaine benzylpenicillin and gentamicin once per day for 7 days) for treatment of clinically suspected serious infection in young infants (aged 0–59 days) who were treated in an outpatient setting after their parents sought help but refused hospital admission.
Appropriate ways to prioritise investments in health services has always been a challenge for countries, with various devices used based on whether whether the rationale is mainly economic or social. The present health focus calls for both a social and economic perspective, since universal health coverage dimensions are built from both viewpoints. In their Article in , Stéphane Verguet and colleagues present interesting perspectives about the prioritisation of services as countries move towards universal health coverage. Using extended cost-effectiveness analysis, Verguet and colleagues compare nine common interventions in Ethiopia in terms of the numbers of deaths prevented (health gains) and cases of poverty averted (financial risk protection afforded). Their findings show that vaccination and caesarean section avert the most deaths per US$100 000 spent (measles vaccination averts 367 deaths per $100 000 spent, pneumococcal conjugate vaccination averts 170, and caesarean section averts 141), whereas caesarean section, tuberculosis treatment, and hypertension treatment prevent the most cases of poverty per $100 000 spent. Their approach enables the prioritisation of interventions that usually score poorly in traditional cost-effectiveness approaches but have major effects on household economies.