The People s Kepunuc of China (P C) has made dramatic improvements in its maternal and newborn mortality rates (MNMRs) over the past few decades. However, certain geographic and cultural areas continue to have higher MNMRs. The Tibet Autonomous Region (TAR) continues to have significantly higher MNMRs than the overall PRC due to the rural and impoverished nature of the region, logistic and financial constraints on the availability of biomedicine and cultural mores that have historically isolated pregnant and laboring women. Investigators on this project have previously documented, beginning in 1993, that prenatal care is virtually non-existent in rural TAR and that very few births are attended by skilled birth attendants. In addition, the TAR has no organized medical transport system. A multidisciplinary approach to these problems is outlined that will include representatives from medical anthropology, United States biomedicine, TAR biomedicine and TAR traditional Tibetan medicine. The unique capabilities and accomplishments of the individuals represented by this collaboration will allow testing of the hypotheses: 1) ethnographic research in Tibetan women can identify the current status of, and barriers to, maternal and newborn care and transport, 2) that rates of antepartum care and peripartum attendance by skilled birth attendants can be increased by development of a culturally sensitive Traditional- Biomedical Perinatal Training and Care Program, and, 3) a functional maternal transport system can be developed and utilized. The proposed project will be implemented in two counties of the Lhasa prefecture of the TAR, with two matched counties serving as concurrent controls. 4) A concurrent maternal and newborn mortality review mechanism (Continuous Quality Improvement) will allow further improvement in outcomes for pregnant women and their newborn babies, both during the life of this proposal and beyond.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01HD040613-02
Application #
6536366
Study Section
Special Emphasis Panel (ZHD1-DSR-R (07))
Program Officer
Wright, Linda
Project Start
2001-09-18
Project End
2003-04-30
Budget Start
2002-05-01
Budget End
2003-04-30
Support Year
2
Fiscal Year
2002
Total Cost
$95,004
Indirect Cost
Name
University of Utah
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
City
Salt Lake City
State
UT
Country
United States
Zip Code
84112
Miller, Suellen; Tudor, Carrie; Thorsten, Vanessa et al. (2009) Randomized double masked trial of Zhi Byed 11, a Tibetan traditional medicine, versus misoprostol to prevent postpartum hemorrhage in Lhasa, Tibet. J Midwifery Womens Health 54:133-141.e1
Miller, Suellen; Tudor, Carrie; Thorsten, Vanessa et al. (2008) Comparison of maternal and newborn outcomes of Tibetan and Han Chinese delivering in Lhasa, Tibet. J Obstet Gynaecol Res 34:986-93
Miller, S; Tudor, C; Nyima et al. (2007) Maternal and neonatal outcomes of hospital vaginal deliveries in Tibet. Int J Gynaecol Obstet 98:217-21
Miller, Suellen; Le, Phuoc V; Craig, Sienna et al. (2007) How to make consent informed: possible lessons from Tibet. IRB 29:7-14
Adams, Vincanne; Miller, Suellen; Chertow, Jennifer et al. (2005) Having a ""safe delivery"": conflicting views from Tibet. Health Care Women Int 26:821-51
Adams, Vincanne; Miller, Suellen; Craig, Sienna et al. (2005) The challenge of cross-cultural clinical trials research: case report from the Tibetan Autonomous Region, People's Republic of China. Med Anthropol Q 19:267-89