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Midwives Tetanus Immunization and Infant Mortality 传统的助产士破伤风免疫和婴儿死亡率课件
Traditional Midwives, Tetanus Immunization, and Infant Mortality in Rural Haiti Krista Pfaendler GHIG Journal Club December 6, 2004 Parturition Around the World in 1978 2/3 of the world’s babies are born at home, attended by a traditional birth attendant (TBA) Home birth environment is often characterized by prevalence of infections and poor sanitation In rural Haiti, TBAs known as matrones perform 80% of deliveries Maternal mortality rates are high (367 deaths/100,000 live births) Background on Haiti Occupies western 1/3 of Hispaniola 5 million people 11,000 square miles Haitians take pride in the fact that they defeated French forces in 1804, becoming the first Negro republic in the world Haiti and the Artibonite Valley The Artibonite Valley is the region served by H?pital Albert Schweitzer, located in Deschapelles Home Birth in the Artibonite Valley Thatch-covered homes with packed earth floors, mud walls, little furniture Mat on the floor serves as a bed Most deliveries occur on the mat, with the mother in a squatting or semi-seated position and husband or relative supporting TBA or a trusted grandmother will be called in when labor becomes intense Midwives/TBAs Believe in letting nature take its course May administer teas and potions to ease pain Rarely perform vaginal or rectal exams Often very perceptive about early signs of obstructed labor Willing to help transport patient to modern facility if delivery will be difficult Under-utilization of maternity beds Of estimated 3600 deliveries per year in Artibonite Valley, less than 10% took place in maternity unit that has the capacity to conduct at least 20% of deliveries Delivery Marshal F.N. Advances in Pediatrics (1968): At delivery, “the baby usually falls on dirt, whether in a house or outside, and later lies on a straw mat beside the mother. It is likely that the soil and climate conditions, and modes of human and animal living in Haiti foster the accumulation and widespread distribution of tetanus ba
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