摘要：Objectives. As part of a community-based reproductive health project in rural Tanzania, a maternal and perinatal health care surveillance system was established to monitor pregnancy outcomes. This report presents preliminary results. Methods. Village health workers were trained to collect data during health education visits to pregnant and postpartum women. Maternal and fetal or infant survival or deaths were tracked on a community monitoring board. Results. Among 904 pregnancies, the fetoneonatal mortality rate was 69.4 deaths per 1000 live births and fetal deaths; 4 maternal deaths occurred. Intrapartum and early neonatal deaths of infants with birthweights of 1500 g or greater represented a large proportion of deaths. Conclusions. These preliminary results will be used to prioritize project interventions, including increasing access to skilled delivery care. Of the more than half million women who die each year from pregnancy-related causes, 99% reside in developing countries. 1 Despite the renewed focus on maternal health brought by the launch of the Safe Motherhood Initiative at an international conference in Nairobi, Kenya, in 1987, maternal mortality ratios in Africa are still alarmingly high, estimated at more than 1000 maternal deaths per 100 000 live births for 1995. 2 At the same time, recognition of the need to consider maternal and newborn care together as a “package” is increasing because many of the same underlying factors lead to both maternal and perinatal deaths. 3 Addressing maternal and newborn health in rural parts of Africa offers particular challenges because of the inadequate public health infrastructure and the distance of communities from facilities providing skilled care. Also, program managers lack access to local data for basic indicators such as maternal and perinatal deaths, cesarean delivery rates, and deliveries by skilled attendants. Available data are often facility based rather than population based, and vital registration systems cover rural areas very poorly. Cooperative for Assistance and Relief Everywhere (CARE)–Tanzania's Community-Based Reproductive Health Project works to address both health care service and management information and surveillance data needs. The project operates in 2 districts of Mwanza Region in Tanzania, with a goal of improving maternal health, maternal and newborn care, family planning, and HIV and other sexually transmitted disease prevention services. 4 In these districts, with a population of approximately 150 000 women of reproductive age, 50% of births occur at home, often alone or attended by a relative or traditional birth attendant, and the travel time to a facility with emergency obstetric care capacity 5 is often 6 hours or more. Vital registration of births and deaths outside of main towns is virtually nonexistent. Through the CARE–Centers for Disease Control and Prevention (CDC) Health Initiative, a maternal and perinatal health care surveillance system was established in the project area. This village-based system includes the monitoring of pregnancy outcomes and enables local and district-level health officials to determine baseline estimates of perinatal, infant, and maternal mortality and other obstetric care indicators. The Maternal and Perinatal Health Care Surveillance System incorporates a community monitoring board, displayed in a prominent location in each village, which tracks maternal, fetal, and infant deaths on a table charting birthweight by age at death (see Table 2 ▶ later in this article), referred to as “BABIES” (Birthweight by Age-at-Death Boxes for Intervention and Evaluation System). 6 The community monitoring boards are color-coded to match birthweight group and age-at-death “cells” (i.e., square boxes on the board) with clusters of underlying causes and their associated prevention intervention packages. The BABIES model proposes that examining the distribution of perinatal deaths by birthweight and age at death can help to direct intervention planning and monitor the effectiveness of interventions. For example, if the intermediate- and normal-birthweight boxes for the intrapartum period indicate high rates of mortality, these deaths, which are primarily caused by asphyxia, could be prevented by strategies that increase access to cesarean deliveries. TABLE 2— Number of Deaths, by Birthweight and Time of Death Time of Death Early Neonatal Late Neonatal Antepartum Intrapartum (0–7 d) (8–28 d) Alive at 28 d Birthweight, g ≥2500 2 7 8 7 708 1500–2499 7 5 4 1 132 <1500 10 3 6 3 1 Maternal deaths 0 1 3 0 900 Open in a separate window In this preliminary analysis, we present data collected from March 2000 through February 2001 for the initial 22 participating villages and provide recommendations for using these surveillance data to plan and evaluate maternal and perinatal health care interventions.
