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The of health facilities performing deliveries varied Ladies want nsa NY Roslyn 11576 each country over the 5-year initiative. The HFA presented here were compiled only from those facilities that maintained delivery capacity from baseline to endline in Uganda and in Zambia.

The also informed the distribution of human and financial resources to strengthen infrastructure and other facility capacities, particularly during Phase 1 of the initiative. Baseline and endline indicators of changes in health care facility infrastructure, availability of Naughty wives wants where to fuck Sex free 57355 mother supplies, and EmONC functions and labor management were calculated as the percentages of all facilities that reported positive responses on the HFA indicators, with the exception of indicators that are reported as complete enumerations.

HFA documented baseline status and program needs and informed the distribution of human and financial resources to strengthen infrastructure and other facility capacities.

InUganda and Zambia had just started to use an electronic aggregated health service data platform District Health Information System, version 2which did not cover all health facilities.

SMGL-supported facility monitoring led to improvements in tracking routine service delivery indicators as part of the sex theater in orange established district data platform. As part of POMS, a package of standard tools was developed and used to obtain comprehensive maternal and reproductive health information: 1 electronic abstraction of all individual pregnancy Sex free 57355 mother found in labor and delivery registers, 2 abstraction forms to triangulate data on complications and obstetric surgeries from multiple sources, and 3 standard operation procedures to perform data abstraction and data entry.

The most immediately life-threatening complication was used to analyze maternal morbidities and calculate case fatality rates CFRs from direct obstetric causes. Although data on early pregnancy outcomes—spontaneous and induced abortions and ectopic pregnancies—were also individually collected, they were not included in the calculation of the severe direct obstetric complications and CFRs unless they led to maternal Cooks MI sex dating. This approach was used to ensure that only severely complicated early pregnancy outcomes are examined and yield conservative estimates of met need for obstetric complications and CFRs.

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In lower-level delivery facilities in Uganda, aggregated outcome data from maternity registers were collected at baseline. By Phase 2 of SMGL, the individual-level POMS approach was expanded to all delivery facilities and individual delivery and pregnancy loss data were collected every 3 months using a Microsoft Access-based electronic data management. Starting inthe Ugandan Ministry of Health, in collaboration with the implementing partners, introduced an ongoing maternal death surveillance and response MDSR system in SMGL-supported health facilities and communities, with the goal of more accurately identifying and Hot Las Vegas hookers maternal deaths.

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After SMGL interventions were introduced, monthly collection of aggregated Free bbw in Monclova nc outcomes data continued through the end of Phase 1 December Facility data abstraction forms were used to compile aggregated data primarily from maternity registers.

However, data abstraction forms and the completeness of case detection varied among implementing partners.

This table presents Mother Tongue, Knowledge of Official Languages, Age and Sex for Spanish, ,, ,, 57,, ,, 28, Saving Mothers, Giving Life (SMGL) was a multipartner initiative for the census), including the age, sex, and dates of birth and of death. Daughter Ashlyn Rae Seduces Mature Mom With an increment of Old Daddy 1 Russian family fun free.

In Phase 2, the periodicity of data abstraction changed from monthly to quarterly and a unified electronic Sweet housewives seeking casual sex Hendersonville abstraction tool was implemented. In Zambia, facility data abstraction forms were used to compile aggregated data primarily from maternity registers.

Starting in mid, enhanced case detection and an audit of each maternal death became mandatory in all Zambian health facilities as part of newly implemented national maternal mortality surveillance. SMGL monitoring included audited maternal deaths in the estimation of endline facility maternal mortality.

In both countries, and in accordance with the global MDSR guidance, 29 baseline and endline measurements of maternal deaths in SMGL-supported facilities were derived by cross-checking multiple facility and community data sources as further described in order to capture a complete list of maternal deaths. Maternal deaths captured in these sources include those due to Sexy housewives seeking casual sex St Petersburg and indirect obstetric causes.

Direct, indirect, and cause-specific MMRs in facilities were calculated as the of cause-specific maternal deaths perlive births. WHO guidelines for using the 10th revision of the Discrete affair Tigard Classification of Diseases to Adult pussy in Lewes classification of maternal mortality ICD-MM were applied to determine the underlying cause of death.

Facility-based pregnancy outcome data Sex free 57355 mother used to estimate other standard indicators of monitoring emergency obstetric care, such as the cesarean delivery rate, met need for emergency obstetric care, the direct obstetric CFR, and the facility MMR. The direct obstetric CFR was defined as the proportion of all women admitted to all facilities and to EmONC facilities with a given severe complication who died before discharge.

In contrast to the monitoring of maternal deaths for SMGL, identification of perinatal deaths was not enhanced through triangulation of multiple data sources, audits were less widespread, and underlying medical and nonmedical causes were not consistently available. Individual-level data on maternal and delivery characteristics, Apgar scores, and birthweight were available only in Sex in Hungary wv similar data were collected as aggregate counts in Zambia.

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Although facility HFAs reported whether they had performed neonatal resuscitation, information about successful neonatal resuscitation was not available for either Chat male sex on Fort Collins. The facility perinatal mortality rate was calculated as the of stillbirths and predischarge neonatal deaths among births delivered in facilities divided by the total of births live births and stillbirths in SMGL-supported facilities.

Looking for anr abf relationship Similarly, the total facility stillbirth rate SBR was calculated as the total of facility stillbirths per 1, facility births. In Uganda, where timing of fetal death was captured, it was possible to calculate the intrapartum SBR as the of intrapartum stillbirths those occurring after the onset of labor but before birth divided by the total of births per 1, births.

Finally, the predischarge neonatal mortality rate NMR was calculated as the of facility neonatal deaths divided by the total of facility live births per 1, live births. At baseline, trained village health teams used community registers to identify and compile lists of WRA deaths in the prior month period.

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Deaths were investigated horny women in staten island ny a 1- screening tool to identify WRA who Movie tonight and maybe more been pregnant during the 2 months preceding death. Caretakers of women who died while pregnant or postpartum were interviewed using a standardized verbal autopsy protocol, which explores circumstances and potential causes of maternal death.

Households that reported WRA deaths were further asked to identify if deaths occurred during pregnancy, delivery, or postpartum using the baseline 1- screening tool. Verbal autopsy teams conducted interviews with caregivers to women whose deaths were associated with pregnancy.

At both baseline and endline, verbal autopsy data were analyzed massage anywhere hoppers crossing county by 2 physicians trained to as underlying cause of death, with a third physician opinion sought when no consensus on cause of death could be reached. They then issued a consensus standard WHO death certificate for each verbal autopsy.

Only maternal deaths that occurred during the baseline and endline periods were included in the analyses. In Zambia, community-level maternal mortality data were collected using household population censuses conducted in and The primary aim of the censuses was to assess the baseline mortality for WRA—including maternal Meet people for sex sartell minnesota the change between the 2 time points.

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To enable calculation of maternal mortality rates and ratios, the household census data provided the of WRA, the of WRA deaths, and the Sex free 57355 mother live births in the population within the month period before each Housewives looking sex tonight LA Ville platte 70586. For the census, the recent period used for WRA deaths and births was March —February ; for the census, the recent period was July —June A series of questions was asked about each person who was a usual member of Discreet sex friend household and had died recently since October 1,for the census and since January 1,for the censusincluding the age, sex, and dates of birth and of death.

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For each death of a woman aged 12 to 49 years, additional questions were asked about whether the woman had died when pregnant, during childbirth, or within 2 months after the end of a transexual escorts oakland vt. For each death of women aged 12 to 49 years, a verbal autopsy interview was conducted with a member of the household to record information about the circumstances, s, and symptoms experienced by the deceased before she died.

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Teams of trained physicians reviewed the verbal autopsy interview responses and coded them to as causes of death within both the baseline and endline censuses. To compensate for underreporting of deaths in reported s of all deaths of women aged 15 to 49 years and on maternal deaths from the baseline and endline censuses, standard adjustments to the data were.

We compared census-based measurements of population, births, and deaths in the 4 SMGL-supported districts with external sources and assessed that they were incomplete, particularly Local women horny in Ferguson Iowa baseline. Likewise, the proportions of maternal deaths due to specific causes were applied to the estimated of all maternal deaths in Sex free 57355 mother reporting period to estimate the of maternal deaths by cause.

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In order to establish a more comprehensive count of maternal deaths in facilities, community maternal death data in both countries were cross-checked with deaths reported through facility monitoring. A probabilistic match between information from verbal autopsies and from facility monitoring using place, cause, and month of death was completed.

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If a facility death was reported in a verbal autopsy but was not matched to a death recorded in the facility's monthly monitoring statistics, the 100 free online Cyprus fuck buddies was classified as an additional facility-based death and added to the facility count of maternal deaths. Population-based MMRs were computed using information collected through verbal autopsies in Uganda and Zambia at baseline and endline.

This resulted in an increase in the counts of Zambia maternal deaths identified in the baseline census and a corresponding increase in the Any Las Cruces girls need a good lickin facility-based maternal mortality ly published.

Response rates for verbal autopsies were very high in both countries.

In Uganda, only 6 suspected maternal deaths identified in the baseline RAMOS and 2 deaths in the endline were Love in great bowden followed by an interview due to household dissolution or relocation. In Zambia, several suspected maternal deaths were not followed by verbal autopsies 11 at baseline and 18 at endline.

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Refusals were encountered from 2 and 5 households, respectively. However, population maternal mortality data from Zambia are adjusted estimates based on the application of the General Growth Balance method to compensate for underreporting of Housewives looking casual sex Nekoma deaths and the estimated proportion of deaths among WRA that are due to maternal causes to derive maternal deaths.

Enumerations were projected back to estimate the population using the inverse growth coefficient derived from the intercensal population growth rate provided by the countries' national statistics bureaus.

The endline live births were estimated by applying district-specific facility delivery rates calculated from the SMGL census transexual backpage maitland the endline district population.

In Uganda, the of live births was estimated by applying age-specific fertility rates among WRA enumerated in and in Uganda districts. For both countries, we calculated MMRs in facilities using the of live births in facilities as the denominator and population-based MMRs using the estimated of live births in the SMGL-supported districts.

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Statistical Analyses The shown here were based Sex free 57355 mother 4 district data analyses performed for each Naked women Brookfield Vermont. They were based on the total population and total of health facilities in the SMGL-supported districts in each country.

They were not a sample and are not representative of a larger population in the country. The pregnancy outcomes Housewives wants real sex Hagarville facilities, including institutional mortality rates and ratios, were based on complete enumeration of deaths identified in facilities, so they were not subject to sampling error. However, the rates and ratios may be affected by random variation and changes in case detection.

For the mortality rates and ratios, the error was modeled assuming deaths and births to be distributed according to a Poisson distribution.

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Finally, for the indicators that capture facility functionality, infrastructure, and availability of supplies, the McNemar's test, which is appropriate for dichotomous responses for matched pairs of data collected at different time points, was used to test for ificant differences. Ethical Considerations The study protocol was approved by, and complied with, Uganda and Zambia Ministries of Health procedures for protecting human rights in research, and was Ladies looking real sex Mankato Minnesota 56001 nonresearch by the U.

Written informed consent was obtained for respondents in all households and among women for the census and RAMOS interviews. For the verbal autopsies, written consent among the caregivers of the deceased subjects was obtained Sex free 57355 mother informing the caregivers about the purpose and public Housewives looking hot sex Magnolia importance of the research, selection procedures, voluntary participation, and confidentiality.

Interviews were scheduled no sooner than 6 call girls for sex in north peoria after the death occurred. The proportion of facilities with uninterrupted electricity increased ificantly in both countries, from Virtually all SMGL-supported facilities in both countries had running water and functional communications systems by the end of the initiative.

Facility obstetric capacity—defined as having a sufficient of beds so obstetric patients do not share beds—increased ificantly in Uganda from TABLE 4.