Maternal health during pregnancy and perinatal mortality in Bangladesh: evidence form a large-scale community-based clinical trial

Perinatal mortality is very high in Bangladesh. In this setting, few community-level studies have assessed the influence of underlying maternal health factors on perinatal outcomes. We used the data from a community-based clinical controlled trial conducted between 1994 and 1997 in the catchment areas of a large MCH/FP hospital located in Mirpur, a suburban area of Dhaka in Bangladesh, to investigate the levels of perinatal mortality and its associated maternal health factors during pregnancy. A total of 2007 women were followed after recruitment up to delivery, maternal death, or until they dropped out of the study. Of these, 1584 who gave birth formed our study subjects. The stillbirth rate was 39.1 per 1000 births [95% confidence interval (CI) 39.0, 39.3] and the perinatal mortality rate (up to 3 days) was 54.3 per 1000 births [95% CI 54.0, 54.6] among the study population. In the fully adjusted logistic regression model, the risk of perinatal mortality was as high as 2.7 times [95% CI 1.5, 4.9] more likely for women with hypertensive disorders, 5.0 times [95% CI 2.3, 10.8] as high for women who had antepartum haemorrhage and 2.6 times [95% CI 1.2, 5.8] as high for women who had higher haemoglobin levels in pregnancy when compared with their counterparts. The inclusion of potential confounding variables such as poor obstetric history, sociodemographic characteristics and preterm delivery influenced only marginally the net effect of important maternal health factors associated with perinatal mortality. Perinatal mortality in the study setting was significantly associated with poor maternal health conditions during pregnancy. The results of this study point towards the urgent need for monitoring complications in high-risk pregnancies, calling for the specific components of the safe motherhood programme interventions that are designed to manage these complications of pregnancy.

The (new ?) basics of a teacher professional learning community

This paper argues for the need to further theorise the concept of teacher professional learning communities and provides empirical evidence to support this case. The paper presents findings from an ongoing research project, which investigates the nature of teacher professional learning communities. The study reveals that actual communities do not conform to a normailized articulation of features, as outlined in much of the literature on this topic. Consequently, it represents an attempt to engage in the difficult but necessary task of simultaneously fashioning theory from practice, whilst interpreting theory, in practice. The study proposes that current functionalist understandings of teacher professional learning communities are based upon a literature base which is insufficiently nuanced to capture the complexity inherent within these bodies. A broader base of a more critical sociological literature is also drawn upon to better understand actual, "lived" teacher communities, which are somewhat difficult to describe. In part, such communities exhibit features of functionalist conceptions but they are also organic entities which may be quite unpredictable in their outcomes and cannot be reduced to specific features; they each have their own specific "logic of practice" (Bourdieu, 1990) which influences their activities, in their particular field. The argument proposed here is that in one particular community, this complexity may be represented by the many purposes which the community served, arguably often unbeknown to its members, which fashioned the actual community. This paper tries to add to the existing theoretical base of literature, at the same time as providing evidence to support this theorisation.