Background: An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP). Methods: A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths. Results: It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours. Conclusion:The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major contributing factor for maternal deaths in Unnao district, UP. The UP Government, besides strengthening Emergency Obstetric and Newborn Care (EmONC) and Basic Emergency Obstetric and Newborn Care (BEmONC) services in the district and state as a whole, also needs to focus on developing a functional and effective referral system on a priority basis to reduce the maternal deaths in Unnao district.

BackgroundViolence against sex workers can heighten their vulnerability to HIV and other sexually transmitted infections (STIs). Evidence suggests the risk of acquiring STI/HIV infections among female sex workers (FSWs) who have experienced violence to be almost three-times higher than FSWs, who have not experienced violence. Moreover, an experience of physical and sexual violence makes it difficult for them to negotiate safer sex with their partners and often act as a barrier to utilization of prevention services.MethodsThis study utilizes data from 2785 FSWs aged 18 years and above who participated in a cross-sectional behavioural study conducted during 2013–14 in Thane district, Maharashtra. A probability-based two-stage cluster sampling method was used for data collection. This study assesses the effect of physical violence on self-reported STI symptoms (any STI and multiple STIs) and treatment seeking for the last STI symptom using propensity score matching method.ResultsAbout 18% of sampled FSWs reported physical violence at the time of the survey. The likelihood of experiencing such violence was significantly higher among FSWs who solicited clients at public places, engaged in other economic activities apart from sex work, had savings, and reported high client volume per week. FSWs experiencing violence were also inconsistent condom users while engaging in sex with regular partners and clients. The average adjusted effect of violence clearly depicted an increase in the risk of any STI (11%, p<0.05) and multiple STIs (8%, p<0.10) and reduction in treatment seeking (10%, p<0.05).ConclusionsThis study demonstrates a significant effect of physical violence on reporting of any STI symptom and treatment seeking. Findings call for the immediate inclusion of strategies aimed to address violence related challenges in HIV prevention program currently being provided at Thane district. Such strategies would further help in enhancing the access to tailored STI prevention and care services among FSWs in the district.

Even in the face of vigorous commitment to improving maternal health services in India, inadequate staffing, supplies, and equipment at health facilities, as well as transportation costs and delays in referral, appear to contribute to a substantial proportion of maternal deaths in a representative district in Uttar Pradesh.

Background: Till 2008, Jharkhand had only 12 designated first referral units (FRUs) at the district level and none of them were fully functional. Aims & Objective: This paper focuses on the processes, experiences and health system challenges in operationalizing FRUs in Jharkhand. Materials and Methods: In an operations research, a pre and post assessment of designated FRUs in the study area was undertaken using standardized tool during March 2009 and February 2011. Results: There was 33 % (04) increase in availability of obstetricians, surgeons and pathologists across the facilities. The availability of pediatrician was improved in 26% (02) facilities, while there were only 14 % (01) of anaesthetists across all the seven facilities. There was significant improvement (P= 0.017) in availability of skilled human resource post intervention. This can be attributed to increased manpower recruitment and reallocation of specialists to designated FRUs post intervention. Only 29 % (02) of the facilities operated with a blood bank or blood storage unit. Magnesium-sulphate availability had improved by 29 % across the facilities. There was rise in availability of Misoprostol in four (57%) facilities and dip in availability of Nifedepine in six (86 %) and lignocainehydrochloride in one (14 %). About four (58 %) of the facilities did not have maternal-newborn care equipments. At the end of the project, only three out of seven designated FRUs achieved operational status. Conclusion: This piece of work on small scale generated evidence from Jharkhand made to think strategically to scale-up operationalization of FRUs. Lack of leadership, management, skilled human resources, infrastructure and medical supplies impeded operationalization of FRUs in Jharkhand. Access to comprehensive emergency obstetric and newborn care services (CEmONC) is remaining as a major issue.

Background: Postpartum hemorrhage is responsible for 39% of maternal deaths in India. Provision of blood transfusion is one of the key components of functional First Referral Units (FRU) meant for providing Comprehensive Emergency Obstetric Care (CEmONC). However, in the absence of functional FRUs, there is hardly any facility available which can provide safe blood transfusion to a haemorrhagic woman in Uttar Pradesh (UP). Aims & Objectives: The objective of this study was to argue for improving access and availability of safe blood transfusion for women, who are haemorrhagic and/ or severely anaemic, on priority basis, to prevent maternal deaths. Materials and Methods: Community based maternal death review and facility review was conducted in district Unnao, UP, and information gathered on maternal deaths. Out of the 57 maternal deaths analyzed, 37 were due to hemorrhage and severe anaemia. Pearson correlation test was performed between maternal mortality ratio (MMR) and number of estimated pregnancies per blood bank, for five key states including UP. Results: Out of 57 maternal deaths, 37 maternal deaths were due to hemorrhage (39%) and severe anaemia (26%). Out of 15 facilities assessed; only the district hospital (6.7%) had a blood bank and transfusion facility and the rest 14 (93.3%) of the facilities had no provision for blood transfusion, blood storage unit (BSU) or dedicated staffs to handle any emergency. A significant correlation was observed between the MMR and number of pregnancies per blood bank (r = 0.970, p=0.006). Conclusion: Given the role of blood transfusion in multiple obstetric emergencies, provision of blood bank /BSU at the FRUs, district hospitals, sub-divisional hospital (SDH) or community health center (CHC) needs to be given high level of priority to avert preventable maternal deaths in UP.