Auxiliary technologies related to transport and communication for obstetric emergencies

OBJECTIVES

To review the evidence on appropriate transport and communications technologies for obstetrical referrals in developing countries.

METHODS

Review of articles published in peer-reviewed journals and gray literature, supplemented by email and telephone consultations with key informants and field programmers.

RESULTS

A wide range of transportation options have been attempted. Initial approaches--such as those relying on ambulances owned and operated by health systems--have evolved into recommendations that emphasize community-based solutions. There are fewer options within the realm of communications technologies, and the recommendations are more consistent. Public health researchers are only beginning to evaluate the cost and effectiveness of different options.

CONCLUSIONS

One of the greatest barriers to effective use of transport and communications for obstetric emergencies is the short time interval necessary for action, which limits options for obstetric referrals more than for other medical referrals. Although evidence is still scarce, experience suggests that motorized transport is likely to be the most acceptable and effective transportation option. More sophisticated communications technologies such as cell phones are both practical and effective, and are increasingly becoming the technologies of choice for low-resource settings.

Toward consistency in breastfeeding definitions

On 28 April 1988, the Interagency Group for Action on Breastfeeding met to develop and agree upon a set of definitions that could be used as standardized terminology for the collection and description of cross-sectional information on breastfeeding behavior. The schema and potential framework suggested at the meeting were reviewed extensively by breastfeeding researchers and program personnel, revised at subsequent meetings by a variety of organizations, and compared against published research on patterns of breastfeeding and their effects on infant nutrition, health, and fertility. This schema and framework: (1) acknowledge that the term "breastfeeding" alone is insufficient to describe the numerous types of breastfeeding behavior, (2) distinguish full from partial breastfeeding, (3) subdivide full breastfeeding into categories of exclusive and almost exclusive breastfeeding, (4) differentiate among levels of partial breastfeeding, and (5) recognize that there can be token breastfeeding with little to no nutritional impact. The schema and framework should assist researchers and agencies in their efforts to accurately describe and interpret breastfeeding practices.