objective Over time, we have seen a major evolution of measurement initiatives, indicators and methods, such that today a wide range of maternal and perinatal indicators are monitored and new indicators are under development. Monitoring global progress in maternal and newborn health outcomes and development has been dominated in recent decades by efforts to set, measure and achieve global goals and targets: the Millennium Development Goals followed by the Sustainable Development Goals. This paper aims to review, reflect and learn on accelerated progress towards global goals and events, including universal health coverage, and better tracking of maternal and newborn health outcomes.methods We searched for literature of key events and global initiatives over recent decades related to maternal and newborn health. The searches were conducted using PubMed/MEDLINE and the World Health Organization Global Index Medicus.results This paper describes global key events and initiatives over recent decades showing how maternal and neonatal mortality and morbidity, and stillbirths, have been viewed, when they have achieved higher priority on the global agenda, and how they have been measured, monitored and reported. Despite substantial improvements, the enormous maternal and newborn health disparities that persist within and between countries indicate the urgent need to renew the focus on reducing inequities.conclusion The review has featured the long story of the progress in monitoring improving maternal and newborn health outcomes, but has also underlined current gaps and significant inequities. The many global initiatives described in this paper have highlighted the magnitude of the problems and have built the political momentum over the years for effectively addressing maternal and newborn health and well-being, with particular focus on improved measurement and monitoring.

Objectives: To assess the prevalence of syphilis infections among men who have sex with men (MSM) accessing the Brisbane Sexual Health Clinic during the period 1997 up to May 2003, data were collated through three clinical programmes conducted by the service-a large inner city mainstream sexual health clinic and two small outreach sessional clinics conducted on the site of male sex on premises venues (SOPV). Data analysis also provided the opportunity to evaluate the effectiveness of the smaller outreach clinics to access populations of MSM less likely to attend or identify at the larger mainstream clinic, and therefore enhance the detection of previously undiagnosed sexually transmissible infections. Methods: Computerised records from 1997-2003 were collated for a statistical analysis of syphilis and other STI pathology results for all MSM accessing the mainstream clinic, and two outreach clinics. Results: A review of client charts showed that 16 new syphilis diagnoses were made over the previous 5 years, but only two of these infections (both through the mainstream clinic) were early syphilis and therefore transmissible. All other cases were latent infections. A higher proportion of bisexual men was identified with positive syphilis serology but this was just below significance (p = 0.06). Significantly, almost a third of syphilis diagnoses (all latent) were made at SOPV outreach clinics, despite the much lower proportion of clients seen overall through the SOPV clinics. For other sexually transmissible infections, the mainstream clinic demonstrated greater efficiency at case detection. Conclusion: Outreach clinics located in male saunas may serve an effective function in syphilis screening by facilitating access for a particular subpopulation of MSM (bisexual, married men). These outreach clinics may provide important outlets for education and opportunistic screening of asymptomatic MSM and foster a greater willingness for men to honestly self identify. However, larger, mainstream clinics serve a more anonymous venue for the testing of symptomatic men.

Although several of the generated algorithms may be useful in the absence of simple, accurate, affordable diagnostic tests, the high rates of STIs in this population could justify a more aggressive strategy incorporating periodic presumptive treatment to rapidly reduce prevalence.

No abstract

In developing and testing an operational model for the integration of reproductive tract infection/sexually transmitted disease (RTI/STD) management into existing family planning (FP) services in Indonesia, this study allowed for assessment of disease prevalence and evaluation of diagnostic methods for detection of endocervicitis caused by chlamydial infection and/or gonorrhoea. Data were collected over 28 weeks in 1997 at 2 FP clinics in the low-income harbour neighbourhood of North Jakarta. Among 486 consenting female FP clients, prevalence of chlamydial infection was 9.3%, gonorrhoea 1.2%, trichomoniasis 4.5% and syphilis 0.8%. Clinically observed abnormal vaginal discharge, cervical inflammation and vaginal lesions/ulcers were all associated with cervical infection (P<0.05), but insufficiently sensitive (<60%). Clinical diagnosis for cervical infection had 48.8% sensitivity, 75.4% specificity, but only 18.3% positive predictive value (PPV). On-site Gram stains for gonorrhoea were 83.3% sensitive and 94.5% specific, but had only 16.1% PPV. Presence of mucopurulent cervicitis was only 39.6% sensitive for cervical STD, with PPV of only 16.3%. Development of an affordable and accurate detection tool for chlamydial infection remains the main obstacle to effective RTI/STD management in this population.

Recent studies in Indonesia have reported significant levels of STDs in low-risk urban groups. To gather data on rural women, a prevalence study was undertaken in Bali utilizing a women's health mobile clinic. Rural (n=312) women were tested for vaginal reproductive tract infections (RTIs) by on-site wet mount, for Neisseria gonorrhoeae and Chlamydia trachomatis by unamplified DNA (Gen-Probe) test, and for syphilis by rapid plasma reagin (RPR). Results were: candidiasis 5.8%; bacterial vaginosis (BV) 37.2%; trichomoniasis 15.1%; gonorrhoea 0.7%; chlamydial infection 5.6%; syphilis 0%. Overall 55.1% had at least one RTI and 19.2% had at least one STD. Reported non-monogamy, pain with urination and genital lesions, observed cervical friability and cervical motion tenderness were associated with cervical STD infection (P<0.05). We conclude that there is a need for improved services for STD prevention and RTI/STD management in rural Bali, and for condom promotion.

Most cases of syphilis were asymptomatic, supporting routine screening for syphilis. Urethral symptoms predicted infection with N. gonorrhoeae/C. trachomatis better than clinical signs.

Since 1998, many people have contributed to the Population Council studies on gender-based violence (GBV) in Viet Nam. The Population Council Viet Nam (PCVN) wishes to thank all of these real pioneers who have helped in the effort to raise public awareness about violence against women, a practice that is unacceptable and must stop. The authors regret not being able to list each person by name in this report, but would like to acknowledge their valuable contributions. PCVN would like to acknowledge support from the Ford Foundation and an anonymous Foundation, as well as the cooperation of the following key individual researchers and representatives from partner institutions: