Topic: Systems-based Practice M aternal and neonatal mortality rates remain high in many low-income and middle-income countries. To attain the Millennium Development Goals 4 and 5, different approaches to improve birth outcomes have been tried, including community-based interventions. Effects on survival have been heterogeneous and uncertain. This systematic review and meta-analysis of randomized controlled trials (RCTs) was done to assess the effects of women's groups practicing participatory learning and action on birth outcomes in low-resource settings.Seven databases and citations from reference lists were searched for RCTs carried out in Bangladesh, India, Malawi, and Nepal. Inclusion criteria for studies in the systematic review included: RCT, the intervention contained the stages of a participatory learning and action cycle, most participants were aged 15-49 years, and outcomes reported included maternal mortality, neonatal mortality, and stillbirths. The participatory learning and action cycle had 4 phases: (1) identify and prioritize problems during pregnancy, delivery, and postpartum; (2) plan;(3) implement locally feasible strategies to address the priority problems; and (4) assess the activities. Subgroup analyses were carried out to identify population-level predictors of effect. Incremental cost-effectiveness ratios were used for trials in which significant effects on the neonatal mortality rate were reported. Cost-effectiveness was expressed as the incremental cost per neonatal death averted and life-year saved.Seven RCTs performed between 1999 and 2011 that included a total of 119,428 births met the inclusion criteria. Group facilitators in the participatory programs were local women who were not health workers; they coordinated 9-13 group meetings per month after receiving 7-11 days of training in maternal and newborn health and participatory facilitation techniques. Exposure to women's groups was associated with 37% and 23% reductions in maternal and neonatal mortality, respectively. No association was found between participatory learning programs and a reduction in stillbirths. The proportion of pregnant women participating in the groups was linearly associated with reductions in both maternal and neonatal mortality, but no evidence of associations was found between the effects of the intervention and background mortality or institutional delivery rates. In studies in which Z30% of pregnant women participated in women's groups, a 55% reduction in maternal mortality and a 33% reduction in neonatal morality was observed. The women's participatory learning and action groups had strong effects on clean delivery practices for home deliveries and noticeable effects on breastfeeding. Women's groups were a highly cost-effective intervention as determined by World Health Organization standards. The intervention could save an estimated 283,000 newborns and 41,100 mothers per year if implemented in rural areas of 74 countdown countries (those countries targeted for attaining Millennium Goals by 2015).Wome...

Between 1978 and 1988 congenital adrenal hyperplasia (CAH) was diagnosed in 60 children in Kuwait with an estimated prevalence of 1:9,000 livebirths, which is higher than that reported from Europe and Canada. In addition, there was presumptive evidence of CAH resulting in the death of 20 other children, giving a prevalence figure of 1:7000. There were 41 girls (68%) and 19 boys (32%). Thirty-one of the girls (75.6%) and 11 of the boys (57.9%) were saltlosers. Fifty-four patients (90%) were diagnosed as 21-hydroxylase deficient, 3 patients (5%) had a deficiency of the 3 beta-hydroxy-steroid dehydrogenase enzyme, and 3 patients (5%) showed a deficiency of 11 beta-hydroxylase.

No abstract

Fifty-five Arab children with primary nephrotic syndrome (PNS) were seen at two regional hospitals in Kuwait over a 5-year period. There were 35 boys and 20 girls with a mean age of 5.3 years. The annual incidence was 7.2 and 6.0 per 100,000 children below 10 and 12 years of age, respectively. An initial response to steroids was noted in 84% with almost 50% responding within 1 week of therapy. Nine patients did not respond to steroids; histopathological classification of their renal biopsies showed 5 cases of membranoproliferative nephritis, 3 cases of focal segmental glomerulosclerosis and 1 case of membranous nephropathy. Microscopic haematuria was noted at presentation in 7 of 46 steroid responders, in all 5 patients with membranoproliferative disease and in 1 of 3 with focal segmental glomerulosclerosis. We conclude that the incidence of PNS seems to be higher among Arab children than in Western countries. With regard to initial biochemical abnormalities, steroid response and subsequent relapses, the pattern is the same as elsewhere.

No abstract