Interventions to improve maternal and neonatal health and nutrition

For each problem noted, signs and symptoms need to be recognized, appropriate responses need to be made, and resources need to be assembled. The level of recognition, responses, and resources is determined by the level of provider, whether at the community (mother/family, community health worker, and traditional birth attendant), health post/health center, or at the hospital. There are other problems that affect pregnancy outcomes, notably sexually transmitted diseases and other infections, that may be more geographically specific than those described here. Prevention of pregnancy, e.g., family planning, is not covered here. Countries vary in their protocols and in the level of staff responsible for managing specific problems. These may differ from what is presented here. A community-based approach is most appropriate where women do not use services at all or use them only infrequently. Unfortunately, this describes the majority of pregnant women in developing countries. This manual should be used as a check list in planning programs aimed at improving pregnancy outcomes, but only after an assessment of the problems has been undertaken. In some areas, such as the Caribbean, hypertension during pregnancy is a relatively major problem. In other areas, such as parts of sub- Saharan Africa, obstructed labor may be more of a problem. The relative importance of problems, along with the availability of resources and the feasibility of the intervention, should determine which interventions are selected for implementation. It is not anticipated that all problems can be managed at once. This manual is not intended to be a technical guide or treatment protocol for clinicians, traditional birth attendants, community health workers, or any other provider. It should be used as a reminder of what might be done should a particular problem be relatively important. (Author abstract)