Correspondence

up human resources, adaptation to strategy for reducing maternal Vinod K Paul

country context, financing through mortality in India, the country with vinodkpaul@hotmail.com
locally developed schemes, donor the highest burden of maternal All India Institute of Medical Sciences, New Delhi
mobilisation, and tracking progress in deaths.2 110029, India
maternal survival—are consistent with In fact, India’s long-standing stra- 1 Fauveau V. Strategies for reducing maternal
those described in the World Health tegy has been promotion of facility- mortality. Lancet 2006; 368: 2121–22.
2 WHO, UNICEF, UNFPA. Maternal mortality in
Report 20051 and supported by our based intrapartum care (the main 2000: estimates by WHO, UNICEF, UNFPA.
organisations. We are working hard recommendation of The Lancet’s Geneva: World Health Organization, 2004.
together to improve collaboration and maternal survival series).3 One of 3 Campbell OMR, Graham W, on behalf of The
Lancet Maternal Survival series steering
coordination with governments to the avowed goals of the National group. Strategies for reducing maternal
support more effectively short-term, Population Policy (2000) is to attain mortality: getting on with what works.
Lancet 2006; 368: 1284–99.
middle-term, and long-term strategies. an institutional delivery rate of 80% 4 International Institute of Population
Investments and funding for efficient by 2010. Nationwide, the proportion Sciences. District level household and facility
interventions within health systems of deliveries in facilities has increased survey on reproductive and child health
(round II, 2002-04). Mumbai: International
should be urgently increased as the from 34% in 1998–99 to 41% in Institute of Population Sciences, 2006.
new partnerships aim to improve aid 2002–04.4 5 Registrar General of India. Maternal mortality
in India: 1997–2003. Trends, causes and risk
effectiveness. Further acceleration in this direction factors. New Delhi: Registrar General of India,
We will arrange to disseminate seems inevitable under the National 2006.
the maternal survival series to our Rural Health Mission (NRHM)
colleagues in countries and regions. launched in 2005. This scheme
We will use the opportunity provided provides a conditional cash transfer Department of Error
through this series and the related of US$31 to mothers for institutional Brinar VV, Habek M. Dementia and white-matter
comments to review and discuss with deliveries, and a cash incentive of $13 demyelination in young patient with
country counterparts the reinvigoration to health workers who facilitate this neurosyphilis. Lancet 2006; 368: 2258—The
last sentence of the second paragraph of this
of national efforts to improve maternal process. More than 12 000 primary Case Report (Dec 23/30) should have read:
and newborn health. health centres should be open for “The patient was started on a 4-week course
Finally we also welcome The Lancet’s 24-h delivery services and nearly of 15 g/day intravenous benzylpenicillin
potassium per day...”.
series on sexual and reproductive 3000 public facilities will be upgraded
health, as a necessary link between the to provide comprehensive emergency Heininger U, Seward JF. Varicella. Lancet 2006;
three previous series. obstetric care by 2012. In Gujarat, 368: 1365–76—In this Seminar (Oct 14), the
second sentence of the Epidemiology section
We declare that we have no conflict of interest. more than 35 000 women from poor (p 1367) should read: “In most temperate
households were delivered by private climates more than 90% of people are
*Arletty Pinel, Q M Islam, obstetricians in less than a year using infected before adolescence, whereas in many
Pascal Villeneuve, tropical climates the disease is acquired later
a voucher system.
Rama Lakshminarayanan in life and adults are more susceptible than
In 1997–98, India’s maternal those in temperate climates.” On the same
pinel@unfpa.org
mortality ratio (MMR, number page, in the last paragraph before the Clinical
Chief, Reproductive Health Branch, Technical Features section, the second sentence should
Support Division, UNFPA, 220 East 42nd Street,
of maternal deaths per
read: “The high age of infection and the
New York, NY 10017, USA (AP); Director, Making 100 000 livebirths) stood at 398; severity of disease in adults in tropical
Pregnancy Safer, Family and Child Health, WHO, this declined to 301 in 2001–03,5 countries might cause such countries to have
Geneva Switzerland (QMI); Chief, Health Section, increased morbidity and mortality from
UNICEF, New York, NY, USA (PV); and Coordinator,
a remarkable decrease of 24% in a
varicella and its complications, such as
Reproductive and Child Health Programs, World short span of time. The prediction congenital varicella syndrome.” On page 1369,
Bank, Washington, DC, USA (RL) for 2015 is an MMR of 160. Although the last two sentences should read
1 WHO. Make every mother and child count. The this misses India’s fifth Millennium “Seroconversion rates are greater than 98%
World Health Report 2005. Geneva: World for measles, mumps, and rubella after two
Health Organization, 2005.
Development Goal (MDG 5), which doses of MMRV. For varicella, a gp ELISA level
is pegged at 109, a faster decline in of more than 5 units can be measured in more
MMR is a distinct possibility because than 90% of children after one dose of MMRV,
and in 99% of children after two doses”. On
of the extraordinary attention given page 1371, in the last paragraph of the section
Meeting MDG 5: good to maternal health under the NRHM. on Varicella vaccination programmes, the
Increased resources are also flowing to second sentence should read
news from India education, women’s empowerment, “Immunocompromised children who are
vaccinated against varicella have a
Vincent Fauveau (Dec 16, p 2121)1 has and rural employment. Indeed, MDG 5 substantially reduced risk of developing
unwittingly created the impression may well be within striking range for herpes zoster. Healthy vaccinated children
that deployment of midwifery- India. may also have a reduced risk. However data
from longer follow up studies are needed.”
trained health workers is the main I declare that I have no conflict of interest.

558 www.thelancet.com Vol 369 February 17, 2007