RESUMO
OBJECTIVE: Identify health-worker barriers that keep pregnant women who receive prenatal care from being screened for syphilis (Los Andes Health Network, Bolivia). METHODS: Semi-structured interviews were done with 46 health care providers and 249 clinical health records of pregnant women were analyzed in eight public health facilities in the Los Andes network. RESULTS: Health-worker barriers to syphilis screening in pregnant women included lack of time by personnel to raise awareness of the benefit of syphilis screening; some mentioned that syphilis tests should only be done in facilities that attend deliveries and have a laboratory; lack of communication between clinicians and laboratory personnel; and problems with provision of supplies and reagents. The clinical record review found that only 55.4% contained syphilis laboratory results and only 37.4% of perinatal clinical histories had records of laboratory results. The interviews found that providers believe that syphilis screening is done in 100% of pregnant women receiving prenatal care. CONCLUSION: Syphilis screening is not being done according to Bolivia's strategy for the elimination of congenital syphilis, and is not done on more than half of pregnant women in prenatal care with perinatal clinical history records. This is not perceived by health professionals and can become a barrier to syphilis screening in pregnant women.
Assuntos
Acessibilidade aos Serviços de Saúde , Complicações Infecciosas na Gravidez/diagnóstico , Sífilis/diagnóstico , Bolívia , Feminino , Humanos , GravidezRESUMO
RESUMEN Objetivo Identificar barreras del personal de salud por las cuales las embarazadas que asisten al control prenatal no se realizan el tamizaje de sífilis (Red de Salud Los Andes, Bolivia). Métodos Se realizaron 46 entrevistas semiestructuradas a proveedores de salud y se analizaron los registros de 249 expedientes clínicos de embarazadas de ocho establecimientos públicos de salud de la Red Los Andes. Resultados Entre las barreras del personal de salud para el tamizaje de sífilis en embarazadas se identificaron el tiempo insuficiente del personal para sensibilizar sobre el beneficio del tamizaje de sífilis, algunos mencionaron que las pruebas de sífilis se deberían hacer solo en centros donde atienden partos y tienen laboratorio, la poca comunicación entre el personal de la consulta médica y laboratorio, así como también problemas de abastecimiento de suministros y reactivos. En la revisión de expedientes clínicos se observó que 55,4% contaba con los resultados de laboratorio de sífilis en sus expedientes y solo 37,4% de historias clínicas perinatales contaba con registro de resultados de laboratorios. A través de las entrevistas, se pudo observar que los proveedores perciben que el tamizaje de sífilis se realiza al 100% de las embarazadas que asisten al control prenatal. Conclusión El tamizaje para sífilis no se está realizando según lo establecido en la estrategia de país para la eliminación de la sífilis congénita, y no llega a más de la mitad de embarazadas en control prenatal con registros en las historias clínicas perinatales. Esto no es percibido por los profesionales de la salud y puede transformarse en una barrera para el tamizaje de sífilis en mujeres embarazadas.
ABSTRACT Objective Identify health-worker barriers that keep pregnant women who receive prenatal care from being screened for syphilis (Los Andes Health Network, Bolivia). Methods Semi-structured interviews were done with 46 health care providers and 249 clinical health records of pregnant women were analyzed in eight public health facilities in the Los Andes network. Results Health-worker barriers to syphilis screening in pregnant women included lack of time by personnel to raise awareness of the benefit of syphilis screening; some mentioned that syphilis tests should only be done in facilities that attend deliveries and have a laboratory; lack of communication between clinicians and laboratory personnel; and problems with provision of supplies and reagents. The clinical record review found that only 55.4% contained syphilis laboratory results and only 37.4% of perinatal clinical histories had records of laboratory results. The interviews found that providers believe that syphilis screening is done in 100% of pregnant women receiving prenatal care. Conclusion Syphilis screening is not being done according to Bolivia’s strategy for the elimination of congenital syphilis, and is not done on more than half of pregnant women in prenatal care with perinatal clinical history records. This is not perceived by health professionals and can become a barrier to syphilis screening in pregnant women.
Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Sífilis/diagnóstico , Acessibilidade aos Serviços de Saúde , BolíviaRESUMO
Se presenta la Guía de práctica clínica para el tratamiento de la agitación psicomotora y la conducta agresiva del Departamento de Emergencia del Instituto Nacional de Salud Mental ôHonorio Delgado û Hideyo Noguchiõ Lima, Perú, aprobada mediante la Resolución Directoral Nº 071-2013-DG/INSMõHD-HNõ.
We present the Clinical practice guidelines for the treatment of psychomotor agitation and aggressive behavior from the Emergency Department, Instituto Nacional de Salud Mental ôHonorio Delgado û Hideyo Noguchiõ Lima, Peru, approved by Resolución Directoral Nº 071-2013-DG/INSMõHD-HNõ.