Health sector reform in Mali, 1989-1996 - TropMed Central Antwerp ...

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unmet: for maternal absolute values alone, the expected rate ranges from 1
to 2%. 56 The high mortality among the emergencies handled contributed to
the enormous maternal health problems of the country. 57
Tragic obstetrical mishaps were in principle avoidable through care at
the DHC. As in many countries, the main strategy for handling pregnancy
problems was a combination of prenatal care and rural maternities. The
latter were often created by the community, showing just how badly they
were needed. In the absence of professional care—in other words, surgery—
for complicated deliveries, these strategies only slightly reduced the gravity
of the situation.
Delivery poses a real and common problem; it offers a genuine
opportunity to organize referrals. 58 Funds readily procured for a perinatal
programme provided the opportunity, though the financing for the whole of
the referral level was available only from 1996.
56 Van den Broek N, Van Lerberghe W & Pangu KA (1989) Cesarean sections for maternal
indications in Kasongo (Zaire). International Journal of Gynecology & Obstetrics 28, 337-342.
De Brouwere V, Laabid A & Van Lerberghe W (1996) Estimation des besoins en
interventions obstétricales au Maroc. Une approche fondée sur l’analyse spatiale des déficits.
Révue d’Epidemiologie et de Santé Publique 44, 111-124. De Brouwere V & Van Lerberghe W
(1998). Les besoins obstétricaux au Maroc. Paris: L’Harmattan. De Brouwere V, Tonglet R
& Van Lerberghe W (1998). Strategies for reducing maternal mortality in developing
countries: what can we learn from the history of the industrialized West? Tropical Medecine
and International Health 3, 771-782.
57 Etard JF (1995) Etude de la mortalité maternelle dans le quartier de Banconi à Bamako.
31p. Bamako: Institut National de Recherche en Santé Publique.
58 Garbouj Mounira (1986). Le système de prise en charge des parturientes en Tunisie:
l’expérience de la région de Nabeul. Dissertation. Faculté de médecine de Tunis.
Studies in HSO&P,20,2003