WHO Indicators Research Articles

Assessment of infant and young child feeding practice among tribal women in Bhatar block of Burdwan district in West Bengal, India

Background: The first two years of life involve rapid physical, cognitive and social development that requires optimal nutrition. Tribal populations are the most backward section of the society. In West Bengal, the Santal tribe contributes to 51.8% Scheduled Tribe population of the state. Aims & Objective: The present study was conducted to assess infant and young child feeding practice among Santal women in Bhatar block of Burdwan District, West Bengal in India. Materials and Methods: It was a descriptive study of cross-sectional design. Bhatar block was purposively selected and 10 villages inhabited by Santals were chosen purposively. Data were collected by interview method using a pre-designed pre-tested schedule from 120 mothers having children of 0-23 months of age. WHO indicators for assessing infant and child feeding practices were used. Results: Breast feeding was initiated within one hour of birth in 48.33% cases, 46.15% babies were exclusively breastfed and in 47.37 % cases breastfeeding was continued at 1 year of the baby. Solid, semisolid or soft foods were correctly introduced at 6-8 months in 46.67% infants. Only 30.85% mothers maintained minimum dietary diversity while 41.49% mothers maintained minimum meal frequency. Conclusion: The poor status of indicators of Infant and child feeding practice found in present study may be attributed to high rate of illiteracy and poor socio-economic condition among Santal women. Therefore intense total literacy campaign, income generating activities and health education by health personnel is the need of the day.

P6.055 Monitoring HIV Resistance: First Brazilian Experience with Clinical Indicators in a Public Care Unit at Amazon State

Background World Health Organization has provided countries with “Early Warning Indicators” to monitor ART sites and minimise the emergence of drug resistance, using routine information from medical and pharmacy records. In Brazil the percentage of multiexperienced people is about 8%, at brazilian universal free access, which concerns about complications in quality of life related to therapeutic failure. We evaluated two cohorts at a public health care site at Amazonas state,to propose the indicators validation on this population. Methods Through electronic local system and following the WHO methodology, patients who started ART treatment twelve months ago, and received care at the unit, were selected for WHO sample size indicated. The research resulted in 315 adults. Results As results were compared to the original WHO indicators for EWI 1 (percentage of ART prescribing practises with appropriate first-line regimen) at the studied site were 91% and 95%, for 2009 and 2010 respectively, WHO recommends 100% for this indicator. EWI 2 (patients lost of follow-up 12 months after ART initiation): 30% (2009) and 36% (2010) (WHO = less than 20%). EWI 3 (patients on appropriate first-line regimen 12 months after ART initiation): 40% (2009) and 49% (2010); (WHO = up to 70%). About 75% picked up ART drugs on time (EWI 4), instead WHO recommends up to 90%.EWI 8 (patients with viral load supression after 12 months of ART): 31% for 2009, and 30% (2010),WHO recommends up to 70%. Conclusions EWI were implemented in other Latin America countries to determine a valid tool compared to viral load. Brazil does not have yet a national monitoring system to monitor sites. This one, located at an HIV late diagnosis area showed deficit in maintenance in care. The managers need to improve monitoring adherence and prevent HIV resistance by therapeutic failure, since there was not any local indicator which achieved WHO recommendations.

Infant Feeding Practices and Challenges: A Pilot‐Study in Lebanon

The improvement of infant feeding practices has been reported as an effective preventive strategy for reducing the burden of Non Communicable Diseases (NCDs). While high rates of NCDs are reported from Lebanon, little is known on child feeding practices in the country. This paper is based on a pilot‐study investigating feeding practices and nutritional status among 0–2 years old children, in one of the main rural areas of Lebanon (Beqaa). Subjects (n=150) were recruited from selected villages by cluster random sampling. Data on feeding practices, anthropometric measurements and 24‐hour dietary recalls were collected. Stunting, underweight and wasting were identified in 16.8, 9.1 and 4.1% of children, respectively; overweight and obesity were documented in 11.5 and 2.7%, respectively. Less than 10% of infants were exclusively breastfed for the first 6 months, with 52.6% being introduced to complementary foods at less than 4 months of age. Approximately, 45% of subjects did not meet the WHO indicators for Minimum Dietary Diversity and Minimal Acceptable Diet. Inadequate nutrient intakes were noted, particularly for iron, calcium, vitamin D and folate. Findings highlight the need for nationwide investigations of feeding practices and child nutritional status in Lebanon. Evidence‐based interventions can then be spearheaded to enhance early childhood nutrition, thus potentially reducing the burden of NCDs.

Drug Prescribing Trends in a General Hospital in Sharjah, United Arab Emirates

Prescription analysis illustrates the prescribing behavior of physicians and pinpoint areas of improvement, if any, to help in rationalizing drug use. The present study was undertaken to investigate the trends of drug prescribing by consultants in a general hospital in Sharjah, United Arab Emirates. 1239 prescriptions were collected from a governmental general hospital covering the month of April, 2011. The prescriptions were issued to outpatients. Prescribing patterns were analyzed using WHO indicators and focusing mainly on information related to patient, prescriber and the prescribed drugs. The average number of drugs per prescription was 2.2. All prescriptions were head lettered in name of hospital and were handwritten. Generic drugs were prescribed in 19.4% of all prescriptions. Name of patient, age, and sex were present in 100% and so the name, signature and official stamp of the prescriber. None of the prescription contained address of patient, diagnosis of complaint or a history of allergy. The dose of the prescribed drug with its frequency of administration and route of administration were present in 73.2% and 5.6% of prescriptions respectively whereas duration of treatment was mentioned in all prescriptions. Patients were prescribed one, two, three, four or more than four drugs per prescription in 21.3%, 22.18%, 18.56%, 11.94% and 25.66% respectively. The most commonly prescribed therapeutic classes of drugs were antihypertensive drugs (35.68%), antiepileptics (30.9%), antidiabetics (19.49%), nonsteroidal anti-inflammatory drugs (NSAIDs 8.19%) and anticoagulants (5.57%). Diuretics (28.39%), beta blockers (25.93%) and angiotensin receptor blockers (24.28%) were the most commonly prescribed drugs of the first class (28.39%). The most frequently prescribed antiepileptic was sodium valproate (60.38%) and antidiabetic was metformin (58.71%). The present study pinpointed areas for further improvements to prescription writing and suggests that feedback through personal interviews and workshops may be an effective intervention to enforce rational drug use.

A review of the assessment tools used to evaluate whether medicines are prescribed rationally or not

ObjectiveThe rational use of medicines is recognised as important by the WHO.1 It is important that medicines are used in children safely, effectively and in the most economic way. The...

General practitioners' prescribing patterns for the elderly in a province of Iran

To determine prescribing patterns by general physicians working in primary care (GPs) in Iran for the elderly and the prevalence of inappropriate prescribing. We collected information about prescribed medicines for 10% of patients in primary care aged 65 years or above in six cities in one province during two separate months 1 year apart. Inappropriate prescribing was determined using Beers criteria, excluding diagnosis-related medications. The WHO indicators for appropriateness of prescribing in general practice and drug-drug interactions (DDIs) were also assessed. A total of 2041 patients were studied (mean age 73 years, 56% were women). Drugs for the alimentary system (20%), nervous system (15%), cardiovascular system (14%), and anti-infectives (12%) were most frequently prescribed. Almost all drugs (96%) were prescribed by generic names. Thirty percent of patients received at least one inappropriate drug (27% for men; 33% for women), whereof 94% were categorized as high risk for adverse effects. Indomethacin, diphenhydramine, and methocarbamol were the most common inappropriate medications. The average number of drugs per patient was 4.4 (4.2 for men; 4.5 for women). Forty-four percent of patients received five or more drugs. Antibiotics and injections were prescribed in 39 and 55% of all patients, respectively. Clinically relevant DDIs were observed for 14% of the patients. Our findings call for further interventions aiming at educating GPs to reduce potential errors. National drug policies and prescribing guidelines should be implemented to address the problem of inappropriate drug usage among the elderly.

Evaluation of Tanzania National Measles Surveillance System with laboratory component, for 2006 and 2007

Background: Measles is among the seven vaccine preventable diseases of priority under the Expanded Program on Immunization in Tanzania. The objectives of the measles surveillance system which was established in 1975 are to establish disease early detection, prevention, control of its outbreak, monitor disease pattern and integrate enhanced surveillance for polio and measles cases. The objective of this evaluation was to determine whether the surveillance system is achieving its objectives, purposes and to asses its attributes. Methods: Used the Centres for Disease Control and Prevention (CDC) guideline document, discussions and interviews with different stakeholders, reviewing National measles data for 2006 and 2007 with reference to WHO indicators of quality measles surveillance system. Results: There was a total of 7656 suspected measles cases with 2871 (37.5%) of cases confirmed by IgM laboratory testing which is above WHO target of 10%. The system is highly sensitive with low Predictive Value Positive, flexible and acceptable. Not simple as it requires laboratory confirmation. Quality of data in terms of completeness and timeliness is good with description of age and vaccination status. There is poor data feedback communication with low levels and between Expanded Programme in Immunization headquarters and Epidemiology Section. Conclusion: The System mainly achieves its objectives and purposes, but should strengthen the timely distribution of feedback to lower levels, and strengthens data communication with Epidemiology section, for better preparedness in case of any outbreak. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

Professional practices and perception towards rational use of medicines according to WHO methodology in United Arab Emirates.

Inappropriate prescribing reduces the quality of medical care and leads to a waste of resources. No study has been reported concerning rational drug use in United Arab Emirates, UAE, recently. assessing patterns of use and defining problems regarding the rational drug use.Setting baseline situational analysis study for practices in the health care system relevant to drug use. A descriptive pilot study, consisting of pharmacists, physicians and patients (100 of each of category) from four private hospitals, (12) medical clinics, (80) community pharmacies in addition to 150 prescriptions. A questionnaire of three sections was designed to include WHO indicators regarding patients, facility and prescribing patterns that are relevant to rational drug use was carried out in four emirates of the UAE in the period December 2008-Febreuary 2009. Consultation and dispensing times were 10 (SD=2.75) min and 68 (SD=9.7) seconds, respectively. Average no. of drugs per prescription was (2.9 + 0.97), % of prescriptions using generic name (7.35%), % of antibiotic containing prescriptions (31.1%), % of injection containing prescriptions (2.9%), adherence to Standard Treatment Protocols (46%), adherence to the essential drug list (64%), patient's knowledge of correct dosage (55%), adequately labeled drugs (45%), patient's information (65%). Several areas of deficiency in rational drug use had been defined in the private sector through UAE that can be remedied through adopting several strategies such as adherence to national standard treatment guidelines and essential drug list based on treatments of choice, interaction between health care system and providing drugs information to consumers.

Protecting children from violence and maltreatment: A qualitative comparative analysis assessing the implementation of U.N. CRC Article 19

Objectives (1) To identify which United Nations Convention on the Rights of the Child (CRC) recommended child protection (CP) measures, such as policy, reporting systems, and services for child abuse and neglect (CAN) victims, individually or in combination, were most important in establishing a basic level of child protection in 42 countries; and (2) to assess whether these measures were necessary or sufficient to achieve basic child protection in developing and industrialized countries. Method Child protection and/or rights expert respondents from 42 countries completed a questionnaire on CRC Article 19 (CRC19) required CP measures implementation and rated their country's effectiveness in implementation, the current level of effectiveness of child protection, and the relevance of improvements in child protection since the CRC was adopted in 1989. Information from the Committee on the Rights of the Child Concluding Observations, as well as UNICEF and WHO indicators on child health and protection issues were used to check and supplement responses. Qualitative comparative analysis (QCA) was used to identify child protection measure implementation effectiveness. Results Results indicate that child protection judged as comparatively more successful among study countries is a result of having the following measures in place from two types of social programs: a CP infrastructure (legislation plus services) and at least one information-based intervention support program. Conclusions Fourteen (33%) countries were determined to have established at least a basic CP system toward protection of children from violence and maltreatment. These countries reported having the three required elements described above. The study reinforces the need for governments to take a systems approach to child protection, including policy/legislation, information-based programs and social services, as well as professional training and public awareness raising. The top-ranked countries included: Australia, Bahrain, Belgium, Brazil, Canada, Estonia, Germany, Italy, Jordan, Lebanon, Malaysia, Republic of Korea, the Russian Federation, and the United Kingdom. Practice implications Governments need to establish CP systems with multiple, well-integrated, effective CP measures as elaborated above, working with trained professionals and also raising public awareness to ensure successful protection for all children in every country. Partial measures are not effective. Further, in addition to establishing, implementing, and evaluating the effectiveness of professional interventions, the actual outcomes for children, not studied or reported on here, need to be the priority focus for child protection going forward.

Qualidade das prescrições em município de Minas Gerais: uma abordagem farmacoepidemiológica

To evaluate the quality of medical prescriptions dispensed in pharmacies. This cross-sectional study was conducted to assess if prescriptions met all the necessary requirements. A total of 800 prescriptions was collected in four different pharmacies in the city of Muriaé, MG. Prescriptions were assessed according to the requirements of the WHO indicators, including presence and legibility of essential information. Each prescription contains an average of 2.2 medications, and 22.1% of drugs were antibiotics. Drugs were prescribed by generic name in 33% of all prescriptions and 46.5% were part of RENAME. As for readability, 32% of prescriptions had poor legibility, 36% were illegible, and 32% readable. Essential information was lacking in several respects: the pharmaceutical form (64%), concentration (47%), dose (22%), interval between doses (63%), duration of treatment (30%) and route of administration (84%) were absent in prescriptions. The prescriptions assessed in this study did not provide all the information necessary for correct and safe use of medication and drugs. They were largely legible, showed a high percentage of trade names with limited presence in the RENAME and many were for antibiotics.

Médicaments essentiels génériques et accès aux soins de santé primaires aux populations dans la préfecture sanitaire de Mambéré-Kadéï

To assess whether people in Mambéré-Kadéï have access to essential medicines for primary health care. The study was conducted in 14 public health care centres of the medical district of Mambéré-Kadéi (Central African Republic). This cross-sectional study assessed the drugs prescribed for 40 randomly selected outpatients consulting in each of 14 randomly selected public health centres from June 1, 2000, through March 30, 2001. The methodology used was adapted from the World Health Organization study protocol (WHO indicators) and the International Network for Rational Use of Drugs (INRUD). Accessibility and affordability of key medicines. Complete data were available for 512 study consultations. A mean of 79.3%( 95% Confidence Interval (CI): 77.5-81.7%) of the 14 essential generic drugs monitored were available in the health centre pharmacies. A median prescription cost 2800 Francs FCA ($4.5), a cost within the ability to pay of 73.2% (CI: 72.8-76.2). These results suggest that the population in Mambéré-Kadéï had access to affordable essential medicines. Although availability and accessibility of the generic essential drugs are good in this medical district, the study also showed the need for action to improve access to primary health care for the patients too poor to pay: 26.8% (95% CI: 23.8-28.2).

Rational drug prescribing and dispensing in tertiary care teaching hospital of Western Nepal

Background: Previous studies have acknowledged that irrational use of medicines is a problem in Nepal. Studies from the Manipal Teaching Hospital have identified lacunae in prescribing and recommended interventions to improve the drug use pattern in the hospital. Educational and managerial interventions have been carried out to improve the use of medicines. Objectives: The study was conducted with the objectives of analyzing the prescriptions for rational prescribing and dispensing, and to evaluate the patient’s knowledge regarding use of drugs as per the International Network for Rational Use of Drugs (INRUD)/WHO indicators. Methods: The prescription and labeling of the dispensed drugs were checked for their accuracy and necessary details were entered in the encounter form developed as per the INRUD/WHO indicators. Patients were interviewed for their knowledge regarding dose, duration, and frequency of the drug prescribed. The filled encounter forms were analyzed for the results. Results: The average drugs per prescription were 2.53. Only 16.38% of drugs were prescribed by generic name and 18.08% of the total drugs were fixed-dose combinations. It was found that only 37.09% and 31.06% of the drugs prescribed were from the Essential drug list of Nepal and WHO Essential drug list respectively. A very high percentage (97.92%) of the drugs was prescribed from the hospital drug list and 47.75% of the drugs were from the Nepalese National Formulary. The average cost per prescription was found to be NRs. 224.83 (USD 3.10). It was found that all of the medication envelopes were labeled with name of the drug and time of administration. All the patients knew the duration of the therapy and time of administration time of drugs. Conclusion: The study reported an improvement in the drug use at Manipal Teaching Hospital. There was also a reduction in the prescription cost and improvement in patient knowledge regarding the medications. However, larger studies covering more patients are needed.

Making Drugs Affordable for the Poor in a Tertiary Care Hospital

The public sector health care facilities are expected to provide health care services including medicines at low costs. The costs are escalating and the poor population is unable to afford them. The most important factor for high costs is prescribing of expensive newer drugs irrationally due to the pressure of pharmaceutical companies. An attempt to promote rational prescribing through interventions, such as essential drugs lists, clinical protocols and training has not been very effective. The margin of profit manufacturer to retailers is high. Two attempts to supply medicines at low cost, one through a not-for-profit association, Rajasthan Medicare Relief Society (RMRS) and the other through a public sector undertaking, Rajasthan State Consumer Cooperative Federation (COOPS) are described. Quantitative data was collected using WHO indicators and qualitative information through interviews. The RMRS store stocks only the expensive drugs that are prescribed by the doctors. Although the cost is 30 per cent to 50 per cent below maximum retail price (MRP), only 20 per cent of the drugs are from the Rajasthan state essential drugs list (RSEDL) indicating an irrational use of expensive newer drugs. The benefit of reduction of the costs does not reach the public in the true sense. The COOPS provide medicines at 2 per cent below the MRP, where 30 per cent of the drugs are from the RSEDL. Mostly the government servants buy medicines from these stores to get the reimbursement from their employers. The study suggests that though these two types of outlets provide the medicines at low cost to the public, the actual benefits do not reach them due to irrational prescribing of expensive non-essential medicines.

A Survey of Prescribing Practices of Health Care Workers in Kibaha District in Tanzania

Background: Previous studies in the public sector in Tanzania, have demonstrated major prescribing problems due to poly-pharmacy and irrational use of antibiotics and injections. Little is understood about prescribing in the private sector. Broad objective: This paper measures and compares prescribing practices in public and private dispensaries in Kibaha District Tanzania. Design and Sampling: This was a retrospective survey of patient records for the period January – December, 2002.One thousand patient records were randomly selected from public dispensaries and 1,000 from private dispensaries. WHO drug use indicators were used to assess prescribing in both sectors. Outcome measures: The following WHO indicators were measured; the average number of drugs per patient, percentage antibiotic prescriptions, percentage injection prescriptions, percentage of drugs prescribed in generic names and percentage of prescriptions according to national essential drug list of Tanzania (NEDLIT). Results: Prescribing of antibiotic and injections was significantly higher in private than in public dispensaries (P

Assessment of prescription profile of pregnant women visiting antenatal clinics.

Managing medical complications in pregnancy is a challenge to clinicians. This study profiled some disease and prescription patterns for pregnant women attending antenatal clinics (ANCs) in Nigeria. A risk classification of the medicines was also determined. Medical case files of 1,200 pregnant women attending antenatal clinics of 3 health facilities in Benin City, Nigeria were investigated. Disease pattern was determined from their diagnoses. The prescription pattern was assessed using WHO indicators, and the United States Food and Drug Administration classification of medicines according to risk to the foetus. A total of 1,897 prescriptions of the 1,200 pregnant women attendees during the period under review were evaluated. Results indicated that malaria 554 (38%) was the most prevalent disease, followed by upper respiratory tract infections (URTIs, 13%) and gastrointestinal disturbances (GIT, 12%). The average number of drugs prescribed per encounter was found to be 3.0, and 2,434 (43%) of medicines were prescribed by generic name. Minerals/ Vitamins 2,396 (42%) were the most frequently prescribed medicines, and antibiotics occurred in 502 (8.8%) of the total medicines. Of all medicines prescribed, 984 (17%) were included in the foetal risk category C and 286 (5%) in category D. The study concluded that malaria fever occurred most frequently followed by URTIs and GIT disturbances among the pregnant women. Minerals, vitamins and to a less extent antimalarials topped the list of the prescribed medicines. The average number of medicines per encounter was much higher than WHO standards. The occurrence of contraindicated medicines was low.

Avaliação da qualidade das prescrições de antimicrobianos dispensadas em unidades públicas de saúde de Belo Horizonte, Minas Gerais, Brasil, 2002

Overuse of antibiotics is a public health problem and has raised discussions concerning their rational use. This cross-sectional study focuses on the use of systemic antibiotics under the Belo Horizonte Municipal Health Department, Minas Gerais, Brazil, evaluating prescriptions dispensed in March 2002, based on WHO indicators for antibiotic use. On average, 20% of prescriptions dispensed involved at least one systemic antibiotic, among which approximately 46% originated from health care facilities not belonging to the municipal system itself. Amoxicillin was the most frequently prescribed antibiotic, followed by benzathine penicillin. Recording of technical data (dose, intervals between doses, administration, and treatment period) varied from 23.6 to 99.6%. Some 10% of prescriptions failed to specify the treatment period. The study showed the need for rules to allow quality improvement of antibiotic prescriptions, assuring the rational use of such medication by municipal health services.

Treatment of malaria in health care facilities in Benin city, Nigeria

Malaria is a leading cause of morbidity and mortality in Africa, especially in the sub-Saharan region and an assumption is that medical practitioners in this part of the world should be skilled in prescribing drugs for the treatment of malaria. This study assessed the patterns of prescriptions for antimalarial drugs by doctors. Prescriptions were collected retrospectively from the outpatient clinics of all public hospitals, and 9 randomly selected private hospitals in Benin City, Nigeria from January 2000 to July 2001. Out of the 1,970 prescriptions assessed, 32.1% (633) had antimalarials prescribed. Antimalarial prescriptions showed that the most frequently prescribed drug was chloroquine (54.8%). Other antimalarials prescribed were sulphadoxine/pyrimethamine (20.9%), quinine (12.5%), halofantrine (6.2%), sulphalene/pyri- methamine (2.7%), sulphadoxine/pyrimethamine/mefloquine (1.7%), amodiaquine (0.8%), and artesunate (0.5%). More than half of the prescriptions for chloroquine (52%) were for injections. Oral chloroquine for adults was prescribed in doses ranging from 600mg to 3g for a course of therapy. More than one antimalarial drug was prescribed in 29% of encounters, with quinine plus sulphadoxine/pyrimethamine being the most frequent combination. Co-prescription of analgesics with antimalarials occurred in 517 (82.1%) encounters with paracetamol as the most frequently prescribed analgesic. Almost all (95.8%) of dipyrone prescriptions were for injections. Antibiotics were coprescribed in 48.2% of encounters, and ampicillin/amoxicillin were the most frequently prescribed antibiotics. The values for the WHO Core Prescribing Indicators were: average number of drugs per encounter – 4.4; percentage of drugs prescribed by generic name – 50.2%; percentage of encounters with injections prescribed – 42.2%, and percentage of drugs prescribed from the Essential Drugs List – 96.7%. Vitamin/mineral supplements were co-prescribed in 323 (51.3%) encounters. The findings suggest that there is inappropriate use of parenteral chloroquine, dipyrone and antibiotics in the treatment of malaria. There is also the questionable use of vitamin and mineral supplements alongside antimalarials in the therapeutic setting Keywords : Malaria, antimalarial drugs, prescriptions, WHO indicators West African Journal of Pharmacology and Drug Research Vol. 20(1&2) 2005: 26-30

Evaluation of availability, accessibility and prescribing pattern of medicines in the Islamic Republic of Iran

Prescribing, dispensing, availability and affordability of drugs were evaluated in 100 primary health care centres in 5 provinces of the Islamic Republic of Iran using WHO indicators. On average, 92% of the 12 essential drugs monitored were available in the health centre pharmacies and 95% of the drugs prescribed by the physician were dispensed by the health centre pharmacy. The stock-out duration was less than 1 month on average. A complete treatment for pneumonia cost only 2% of the lowest weekly government salary. The national average number of drugs per prescription was 3.4. Prescription of antibiotics and injectable drugs was very high (58% and 41% respectively). Although availability and affordability of essential drugs is good in this country, rational use of drugs needs to be emphasized.

Maternal Exclusive Breast- Feeding Practice In Calabar, Nigeria: Some Related Social Characteristics

Objective: To determine the social characteristic of mother who practice exclusive breast –feeding in Calabar Subject and Methods: A prospective questionnaire based cross sectional survey of breast feeding practices among mother of children aged 0-24 months was carried out in Calabar in April 1998. Using WHO indicators for assessing breast feeding practices, the exclusive breast feeding rate was determined in mothers of children aged 0-6 months. This documents the social characteristics of those mothers who practiced exclusive breast feeding (EBF). Result: Of 1145 mother in the study, 4456 were mothers of children aged 0-6 months. Of this 102 (22.9%) practiced EBF. The maternal characteristics associated with a high EBF rate were being married (p 0.2) Conclusion: This study has shown that being married, attaining higher education, being on paid maternity leave, use of government health facility based ante natal and delivery services as well as being of Cross River state extraction were maternal characteristics associated with EBF. There is need to intensity health education on the benefits and management of breast feeding in order to improve the present EBF rate of 22.9%. KEY WORDS: Maternal Exclusive breast feeding, Social characteristics Nigerian Journal of Clinical Practice Vol.6(2) 2003: 92-94

WHO Indicators for Evaluation of Maternal Health Care Services, Applicability in Least Developed Countries: A Case Study from Eritrea

The World Health Organization has recommended a number of process indicators to monitor the effect of health care programmes on maternal mortality. This study was therefore conducted to know if the recommended process indicators are useful also in the least developed countries. In 1994, all 17 health facilities offering maternal health care in a rural province in Eritrea were visited. An assessment was made of the obstetric services provided, obstetric complications, and accessibility of health facilities. The study revealed that necessary data were available for most indicators. The indicators were helpful to follow the coverage of obstetric care and to identify problems within the health care system. However, in countries where the coverage of assisted deliveries is low with few obstetric complications seen within the health care system, the indicators cannot be used as a tool to monitor the effect of maternal health care programmes on maternal mortality.