ABSTRACT

Background: Hepatitis B virus(HBV) and neonatal tetanus infections remain endemic in Nigeria despite the availability of safe, effective vaccines. We aimed to determine health facilities' capacity for hepatitis B vaccine birth dose (HepB­BD) and maternal tetanus­diphtheria (Td) vaccination and to assess knowledge, attitudes, and practices of HepB­BD and maternal Td vaccine administration among health facility staff in Nigeria. Materials and Methods: This was a cross­sectional study assessing public primary and secondary health facilities in Adamawa and Enugu States. Amultistage sampling approach was used to select 40 facilities and 79 health­care workers(HCWs) from each state. Astructured facility assessment tool and standardized questionnaire evaluated facility characteristics and HCW knowledge, attitudes, and practices related to HepB­BD and maternal Td vaccination. Frequencies and proportions were reported as descriptive statistics. Results: The survey of 80 facilities revealed that 73.8% implemented HepB­BD and maternal Td vaccination policies. HepB­BD was administered within 24 h of birth at 61.3% of facilities and at all times at 57.5%. However, administration seldom occurred in labor and delivery (35%) or maternity wards (16.3%). Nearly half of the facilities (46.3%) had HCWs believing there were contraindications to HepB­BD vaccination. Among 158 HCWs, 26.5% believed tetanus could be transmitted through unprotected sex, prevented by vaccination at birth (46.1%), or by avoiding sharing food and utensils. 65% of HCWs knew HBV infection had the worst outcome for newborns. Conclusions: The limited implementation of national policies on HepB­BD and maternal Td vaccination, coupled with knowledge gaps among HCWs, pose significant challenges to timely vaccination, necessitating interventions to address these gaps.

Contexte: Le virus de l'hépatite B (VHB) et les infections néonatales au tétanos restent endémiques au Nigéria malgré la disponibilité de vaccins sûrs et efficaces. Notre objectif était d'évaluer la capacité des établissements de santé à administrer la dose de naissance du vaccin contre l'hépatite B (HepB-BD) et le vaccin antitétanique et diphtérique (Td) maternel, ainsi que d'évaluer les connaissances, les attitudes et les pratiques du personnel des établissements de santé concernant l'administration du vaccin HepB-BD et du vaccin Td maternel au Nigéria. Matériel et méthodes: Il s'agissait d'une étude transversale portant sur les établissements de santé primaires et secondaires publics des États d'Adamawa et d'Enugu. Une approche d'échantillonnage à plusieurs degrés a été utilisée pour sélectionner 40 établissements et 79 agents de santé (AS) dans chaque État. Un outil d'évaluation structuré des établissements et un questionnaire standardisé ont permis d'évaluer les caractéristiques des établissements et les connaissances, attitudes et pratiques des AS en matière de vaccination par le HepB-BD et le Td maternel. Les fréquences et les proportions ont été rapportées sous forme de statistiques descriptives. Résultats: Les résultats de l'enquête menée auprès de 80 établissements ont révélé que 73,8 % d'entre eux appliquaient des politiques de vaccination par le HepB-BD et le Td maternel. Le HepB-BD était administré dans les 24 heures suivant la naissance dans 61,3 % des établissements et à tout moment dans 57,5 % d'entre eux. Cependant, l'administration se faisait rarement en salle de travail et d'accouchement (35 %) ou en maternité (16,3 %). Près de la moitié des établissements (46,3 %) comptaient des AS qui pensaient qu'il existait des contre-indications à la vaccination par le HepB-BD. Parmi les 158 AS, 26,5 % pensaient que le tétanos pouvait être transmis par des relations sexuelles non protégées, qu'il pouvait être prévenu par la vaccination à la naissance (46,1 %) ou en évitant de partager la nourriture et les ustensiles. Soixante-cinq pour cent des AS savaient que l'infection par le VHB avait les pires conséquences pour les nouveau-nés. Conclusion: La mise en œuvre limitée des politiques nationales sur la vaccination par le HepB-BD et le Td maternel, associée aux lacunes de connaissances parmi les AS, constituent des défis importants pour la vaccination à temps, ce qui nécessite des interventions pour combler ces lacunes.

ABSTRACT

Introduction: maternal mortality is a worldwide community health concern. Home deliveries are common in Ethiopia, and most births occur at home without the assistance of health experts. Maternal mortality reduced in recent decades but still has a very high maternal mortality rate in Ethiopia. Therefore, this study aimed to identify the risk factors surrounding giving birth at home among women in Ethiopia. Methods: this study's data source was the 2019 Ethiopian Demographic and Health Survey (EDHS). A total of 23,007 women who met the study's objective and criteria were included. A binary logistic regression model and a multistage stratified sampling technique were used. Results: women living in a rural area (AOR = 2.135, 95% CI: 1.805, 2.525), women in the middle (AOR = 0.670, 95% CI: 0.590, 0.760), and wealth index (AOR = 0.375, 95% CI: 0.326, 0.430), mothers who attended primary education (AOR = 0.819, 95% CI: 0.733, 0.915), secondary and above (AOR = 0.388, 95% CI: 0.303, 0.496), 4-6 living children (AOR= 0.780, 95% CI: 0.160, 0.873), mother age from 21-30 (AOR= 0.291, 95% CI: 0.243, 0.349) and mother age from 31 and above (AOR = 0.074, 95% CI: 0.060, 0.091) were significantly associated predictors for giving birth at home in Ethiopia. Conclusion: we discovered that geographical region, place of residence, education level, marital status, age of mother at first birth, mother age group, number of living children, religion, and wealth index were significantly associated predictors of giving birth at home among Ethiopian women.

ABSTRACT

BACKGROUND: Postpartum depression (PPD) is a significant clinical and public health problem in Sub-Saharan Africa (SSA). Despite the magnitude of PPD, early detection, treatment, and prevention of PPD remain a challenge in Ethiopia. This study aims to assess the magnitude and associated factors of PPD among women visiting the postnatal clinic at Tirunesh Beijing Hospital, Addis Ababa, Ethiopia. METHOD: A hospital-based, cross-sectional study was conducted among 396 women attending the postnatal clinic at the hospital. Depressive symptoms were assessed using a locally pre-validated Edinburgh Postnatal Depression Scale (EPDS). Data were analyzed using SPSS version 26. Descriptive analysis was employed for socio-demographic characteristics and to determine the magnitude of PPD. Bivariable and multivariable logistic regression analyses were used to identify factors associated with PPD. Odds ratios (OR) with 95% confidence intervals (CI) were computed, and a p-value cut-off <0.05 was used to consider the significance of associations. RESULT: In this study, 24% of women experienced postpartum depression. Mothers aged 25­30 years were less likely to develop PPD (AOR=0.07, 95% CI: 0.02, 0.24). Women who were illiterate (AOR=4.8, 95% CI: 1.92, 14.52), those who experienced intimate partner violence (AOR=7.1, 95% CI: 2.76, 16.12), had unwanted or unplanned pregnancies (AOR=6.1, 95% CI: 2.01, 13.25), had low-birth-weight babies (AOR=3.2, 95% CI: 1.29, 12.84), and those with poor family support (AOR=3.4, 95% CI: 1.40, 10.92) were significantly associated with postpartum depression. CONCLUSION: The magnitude of postpartum depression was higher among mothers visiting the postnatal clinic. This highlights the need for targeted interventions addressing the needs of postpartum women who experience various risk factors. Further well-designed and representative studies are recommended to inform policy and devise targeted strategies to address PPD.

ABSTRACT

Background: The World Health Organization Safe Childbirth Checklist (WHO SCC) was developed to increase the uptake of essential birth practices; however, only a few studies have adopted this process in French West African countries. Aim: This study aimed to describe the WHO SCC adaptation process across Burkina Faso, Côte d'Ivoire, and Guinea, and the lessons learned. Setting: Adaptation processes were conducted in the above-mentioned countries. Methods: From May 2022 to November 2022, a cross-country adaptation of the WHO SCC was carried out using a co-creation approach following a modified Delphi process. This process included the contextual adaptation of the tool by local technical advisory groups in each country based on national guidelines, the harmonisation and production of a single modified SCC by the Cross-Country Technical Advisory Group, a pre-test of the modified SCC, and adoption. Results: Minor modifications were made on 27 items. No items were deleted. Two items related to hand hygiene and the use of protective equipment were added at the 'just before pushing' pause point. The modified SCC implemented in each country consisted of 31 items, with variations observed in the timing of the monitoring signs when plotting the partograph. The tool was introduced following the A3 and kakemono formats. Conclusion: The study emphasised the importance of engaging all stakeholders and end users in the adaptation process for a sustainable use of the tool. Contribution: This collaborative effort between countries to develop a unified SCC highlights the importance of adaptation based on national guidelines and local contexts.

ABSTRACT

Introducción: Diversas investigaciones han establecido la relación entre temperatura y duración del embarazo, la exposición a temperaturas altas durante el embarazo plantea interrogantes en especial el papel que esta juega frente a los partos prematuros y partos de bajo peso, es indispensable determinar si las temperaturas altas o bajas tienen un comportamiento protector o de riesgo sobre el feto durante la gestación en regiones tropicales. Objetivo: describir la relación entre la exposición a temperaturas altas y bajas durante el embarazo y su efecto en la edad gestacional y peso al momento del parto en los recién nacidos del departamento del Guaviare-Colombia. Metodología: Estudio tipo observacional, analítico, retrospectivo de corte transversal que busco determinar la relación entre exposición a temperaturas altas y bajas durante el embarazo y su efecto en la edad gestacional y peso al momento del parto en los recién nacidos, el universo estuvo conformado por 10.137 nacidos vivos, de los cuales 9.932 cumplieron los criterios de inclusión. Se determinó Odds Ratio para estimar la asociación entre las variables. Resultados: Dentro de la semana de retraso 3 el estar expuesto a temperaturas máximas percentil 90 es un factor protector para la ganancia ponderal de peso OR < 1, la exposición a temperaturas mínimas percentil 10 se asoció como factor protector para el parto prematuro en la semana de retraso 1 y 2 OR < 1.Conclusión: A pesar del beneficio de las altas y bajas temperaturas durante el embarazo en la ganancia ponderal de peso y disminución del parto prematuro, es recomendable prevenir la exposición a temperaturas extremas durante el periodo de gestación[AU]

Introduction: Various investigations have established the relationship between temperature and duration of pregnancy. Exposure to high temperatures during pregnancy raises questions, especially the role it plays in premature births and low-weight births. It is essential to determine whether high temperatures or low have a protective or risky behavior on the fetus during pregnancy in tropical regions.Objective: to describe the relationship between exposure to high and low temperatures during pregnancy and its effect on gestational age and weight at the time of delivery in newborns in the department of Guaviare-Colombia.Methodology:Observational, analytical, retrospective cross-sectional study that sought to determine the relationship between exposure to high and low temperatures during pregnancy and its effect on gestational age and weight at the time of delivery in newborns. The universe was made up of 10,137 births. alive, of which 9,932 met the inclusion criteria. Odds Ratio was determined to estimate the association between the variables.Results:Within the 3rd week of delay, being exposed to maximum temperatures at the 90th percentile is a protective factor for weight gain OR < 1, exposure to minimum temperatures at the 10th percentile was associated as a protective factor for premature birth in the week. of delay 1 and 2 OR < 1. Conclusion: Despite the benefit of high and low temperatures during pregnancy in weight gain and reduction in premature birth, it is advisable to prevent exposure to extreme temperatures during the gestation period[AU]

Introdução: Várias investigações estabeleceram a relação entre temperatura e duração da gravidez. A exposição a altas temperaturas durante a gravidez levanta questões, especialmente o papel que desempenha nos partos prematuros e nos nascimentos de baixo peso. É essencial determinar se as temperaturas altas ou baixas têm um comportamento protetor ou de risco para o feto durante a gravidez em regiões tropicais. Objetivo:descrever a relação entre a exposição a altas e baixas temperaturas durante a gravidez e seu efeito na idade gestacional e no peso no momento do parto em recém-nascidos no departamento de Guaviare-Colômbia. Metodologia: Estudo observacional, analítico, retrospectivo e transversal que buscou determinar a relação entre a exposição a altas e baixas temperaturas durante a gravidez e seu efeito na idade gestacional e no peso no momento do parto em recém-nascidos. O universo foi composto por 10.137 nascimentos. vivos, dos quais 9.932 preencheram os critérios de inclusão. O Odds Ratio foi determinado para estimar a associação entre as variáveis. Resultados:Na 3ª semana de atraso, a exposição a temperaturas máximas no percentil 90 é fator de proteção para ganho de peso OR < 1, a exposição a temperaturas mínimas no percentil 10 foi associada como fator de proteção para parto prematuro na semana. de atraso 1 e 2 OR < 1.Conclusão:Apesar do benefício das altas e baixas temperaturas durante a gravidez no ganho de peso e redução do parto prematuro, é aconselhável evitar a exposição a temperaturas extremas durante o período de gestação[AU]

ABSTRACT

Introdução: A assistência ao parto é composta de práticas que interferem diretamente no sentimento de segurança, bem-estar e satisfação das mulheres. Procedimentos aplicados sem indicação ou sem consentimento podem provocar danos e interferir na experiência de parto, configurando-se como violência obstétrica. Objetivo: Identificar a prevalência de práticas recomendadas e não recomendadas na assistência ao parto, segundo a Organização Mundial da Saúde, bem como a percepção das mulheres em terem vivenciado desrespeito, maus-tratos ou humilhação no parto. Métodos: Estudo transversal, com 287 mulheres selecionadas aleatoriamente em duas maternidades de Porto Alegre, pública e privada, em 2016. As puérperas responderam a um questionário estruturado, face a face, quatro semanas após o parto, sobre aspectos socioeconômicos, histórico de saúde, experiência de parto (práticas e intervenções) e percepção de ter sofrido desrespeito, maus-tratos ou humilhação pelos profissionais. Resultados: Das intervenções não recomendadas de rotina, o uso de ocitocina foi a mais prevalente (56%), seguido da amniotomia (48,5%) e da episiotomia (37,1%). A manobra de pressão fúndica uterina (Kristeller) foi realizada em 11,3% dos partos; quando estratificado por maternidade, a prevalência foi de 25,7% na privada e 8,2% na pública. A amniotomia ocorreu em 48,5% dos partos, 55,4% daqueles realizados na maternidade pública e 14,7%, na maternidade privada. A taxa geral de cesariana foi de 48,1%, 31,4% na maternidade pública e 82,8% na maternidade privada. A percepção de ter sido desrespeitada, maltratada ou humilhada ocorreu para 12,5% das mulheres entrevistadas, 14,9% na maternidade pública e 7,5% na maternidade privada. Quanto às boas práticas de assistência, o incentivo a ter acompanhante, a oferta de líquidos e alimentos, o incentivo à movimentação durante o trabalho de parto, a percepção de ter sido acolhida na maternidade e o contato pele a pele foram mais frequentes na maternidade pública. Já o sentimento de estar à vontade para fazer perguntas e participar das decisões foi mais frequente na maternidade privada. Conclusões: É frequente a aplicação de práticas não recomendadas de rotina na assistência ao parto em ambas as maternidades. A maternidade pública apresentou maior prevalência de boas práticas em comparação com a privada. A prevalência de práticas não recomendadas é superior à prevalência de ter sofrido desrespeito, humilhação ou maus-tratos no parto, pela percepção das puérperas, o que sugere o não reconhecimento pelas mulheres de situações de violência. Nesse cenário, a atenção pré-natal é um espaço de troca de informações sobre boas práticas e reconhecimento de práticas consideradas como violência obstétrica.

Introduction: Childbirth care includes practices that interfere directly in the women's sense of safeness, well-being and satisfaction. Procedures that are performed without indication or the women's consent can harm the health of women and their babies and impact their childbirth experience, configuring obstetric violence. Objective: To identify the prevalence of recommended and non-recommended practices in childbirth care, according to the World Health Organization, and the women's perception of disrespect, mistreatment and abuse. Methods: Cross-sectional study including 287 postpartum women randomly selected in two facilities (private and public) in the city of Porto Alegre in 2016. The participants responded to face-to-face interviews 4 weeks after delivery. A structured questionnaire was used, including variables regarding socioeconomical status, obstetric history, birth experience (care provided and interventions) and the perception of having experienced disrespect, mistreatment, or humiliation by healthcare professionals. Results: Among the interventions, the use of synthetic oxytocin was the most prevalent (56%), followed by amniotomy (48.5%) and episiotomy (37.1%). Uterine fundal pressure maneuver was used in 11.3% of the deliveries; within the private facility, the prevalence was 25.7% compared to 8.2% in the public. Amniotomy was performed in 48.5% of the deliveries; 55.4% in the public facility as opposed to 14.7% in the private. The cesarean section rate in the total sample was 48.1%; however, the rate in the private facility was 82.8%. The proportion of women who felt they were a victim of disrespect, mistreatment or abuse was 12.5%: 14.9% within the public hospital and 7.5% within the private hospital. As for good practices, the incentive to have a companion, the offer of liquids and food, the incentive to move around during labor, the perception of having been welcomed in the maternity ward and skin-to-skin contact were more frequent in the public facility. The feeling of being comfortable asking questions and participating in decisions was more frequent in the private maternity hospital. Conclusions: The application of non-recommended routine practices in childbirth care is frequent in both maternity hospitals. The public maternity hospital showed a higher prevalence of good practices compared to the private one. The prevalence of non-recommended practices is higher than the prevalence of experiencing disrespect, humiliation, or mistreatment during childbirth, as perceived by the postpartum women, suggesting a lack of recognition by women of situations of violence. In this scenario, prenatal care provides a space for exchanging information about good practices and raising awareness about practices considered obstetric violence.

Introducción: La asistencia al parto está compuesta por prácticas que afectan directamente el sentimiento de seguridad, bienestar y satisfacción de las mujeres. Los procedimientos aplicados sin indicación o sin consentimiento pueden provocar daños e interferir en la experiencia de parto, configurándose como violencia obstétrica. Objetivo: Identificar la prevalencia de prácticas recomendadas y no recomendadas en la asistencia al parto, según la Organización Mundial de la Salud, así como la percepción de las mujeres respecto a haber experimentado falta de respeto, maltrato o humillación en el parto. Métodos: Estudio transversal con 287 mujeres seleccionadas aleatoriamente en dos maternidades de Porto Alegre, una pública y otra privada, en 2016. Las puérperas respondieron a un cuestionario estructurado, cara a cara, cuatro semanas después del parto, sobre aspectos socioeconómicos, antecedentes de salud, experiencia de parto (prácticas e intervenciones) y percepción de haber sufrido falta de respeto, maltrato o humillación por parte de los profesionales. Resultados: De las intervenciones no recomendadas de rutina, el uso de oxitocina fue el más prevalente (56%), seguido de la amniotomía (48,5%) y la episiotomía (37,1%). La maniobra de presión fundal uterina (Kristeller) se realizó en el 11,3% de los partos; al estratificar por maternidad, la prevalencia fue del 25,7% en la privada y del 8,2% en la pública. La amniotomía ocurrió en el 48,5% de los partos, siendo el 55,4% en la maternidad pública y el 14,7% en la privada. La tasa general de cesáreas fue del 48,1%, con un 31,4% en la maternidad pública y un 82,8% en la privada. La percepción de haber faltado el respeto, maltratada o humillada se dio en el 12,5% de las mujeres entrevistadas: un 14,9% en la maternidad pública y un 7,5% en la privada. En cuanto a las buenas prácticas de asistencia, el fomento de tener un acompañante, la oferta de líquidos y alimentos, el estímulo a la movilidad durante el trabajo de parto, la percepción de haber sido acogida en la maternidad y el contacto piel a piel fueron más frecuentes en la maternidad pública. Por otro lado, el sentimiento de estar cómoda para hacer preguntas y participar en las decisiones fue más frecuente en la maternidad privada. Conclusiones: Es frecuente la aplicación de prácticas no recomendadas de rutina en la asistencia al parto en ambas maternidades. La maternidad pública presentó una mayor prevalencia de buenas prácticas en comparación con la privada. La prevalencia de prácticas no recomendadas es superior a la prevalencia de haber sufrido falta de respeto, humillación o maltrato en el parto, según la percepción de las puérperas, lo que sugiere un escaso reconocimiento por parte de las mujeres de situaciones de violencia. En este escenario, la atención prenatal es un espacio para el intercambio de información sobre buenas prácticas y el reconocimiento de prácticas consideradas violencia obstétrica.

ABSTRACT

Objetivo: Compreender percepções e significados de doulas na Atenção Obstétrica e Neonatal no processo de parturição. Método: Pesquisa qualitativa, descritiva, realizada entre outubro de 2021 a maio de 2022, com dez doulas. Utilizou-se a técnica de Snowball Sampling para composição amostral. Para coleta de dados foram utilizadas entrevistas semiestruturadas, analisadas por meio da técnica de análise textual discursiva. Resultados: Emergiram quatro categorias: porque escolher atuar como doula; a doula como fonte de conhecimento e empoderamento feminino; o trabalho da doula para a garantia de uma assistência digna à mulher; e as barreiras impostas à atuação da doula pela equipe multiprofissional. Conclusão: A doula causa uma ruptura no universo obstétrico hegemônico, pois ao mesmo tempo que sua prática remete ao apoio entre mulheres no processo de parturição, a sua ascensão representa uma frente contra o modelo atual de saúde centrado na doença, no profissional de saúde, em intervenções e no hospital.(AU)

Objective: Understand perceptions and meanings of doulas in Obstetric and Neonatal Care in the parturition process. Method: Qualitative, descriptive research, carried out between October 2021 and May 2022, with ten doulas. The Snowball Sampling technique was used for sample composition. Semi-structured interviews were used to collect data, analyzed using the discursive textual analysis technique. Results: Four categories emerged: why choose to work as a doula; the doula as a source of knowledge and female empowerment; the work of the doula to guarantee dignified assistance to women; and the barriers imposed on the doula's performance by the multidisciplinary team. Conclusion: The doula causes a rupture in the hegemonic obstetric universe, because at the same time that its practice refers to support among women in the parturition process, its rise represents a front against the current health model centered on the disease, on the health professional, in interventions and in the hospital.(AU)

Objetivo: Comprender percepciones y significados de las doulas en Atención Obstétrica y Neonatal en el proceso del parto. Método: Investigación cualitativa, descriptiva, realizada entre octubre de 2021 y mayo de 2022, con diez doulas. Se utilizó la técnica de la bola de nieve. Muestreo para composición de muestras. Se utilizaron entrevistas para recopilar datos. semiestructurado, analizado mediante la técnica de análisis textual discursivo. Resultados: Surgieron cuatro categorías: por qué elegir trabajar como doula; la doula como fuente de conocimiento y empoderamiento femenino; el trabajo de la doula para garantía de asistencia digna a las mujeres; y las barreras impuestas al trabajo de la doula por el equipo multidisciplinario. Conclusión: La doula provoca una ruptura en el universo obstétrica hegemónica, porque al mismo tiempo que su práctica refiere al apoyo entre mujeres en proceso de parto, su ascenso representa un frente contra la modelo de salud actual centrado en la enfermedad, el profesional de la salud, las intervenciones y en el hospital.(AU)

ABSTRACT

Objetivo: Determinar los factores asociados al rechazo de la contracepción posparto en un Hospital Público, 2021. Métodos: Estudio observacional, analítico, transversal; incluyó 251 puérperas inmediatas atendidas en un Hospital Público entre mayo y junio del 2021. La variable principal fue rechazo de la contracepción posparto y factores asociados: sociodemográficos, obstétricos, personal-cultural, institucional. Se usó un cuestionario válido y confiable. Además, la prueba Chi cuadrado de Pearson y Regresión de Poisson para el análisis estadístico y se tuvo aprobación de Comité de Ética. Resultados: El 16,7 % rechazó los contraceptivos modernos. El nivel educativo bajo (p < 0,011; RPa: 4,51; IC: 1,42-14,35), la percepción de una mala situación económica (p = 0,001; RPa: 3,65; IC: 1,72-7,76), las complicaciones durante el trabajo de parto y dos horas posparto (p = 0,041; RPa: 8,16; IC: 1,09-61,19), el embarazo planificado (p = 0,002; RPa: 2,51; IC: 1,38-4,55), la experiencia negativa de contracepción (p = 0,000; RPa: 11,26; IC: 5,85-21,66), la actitud negativa de la pareja (p = 0,006; RPa: 4,90; IC: 1,57-15,31) y la percepción de conocimiento insuficiente sobre contracepción (p = 0,049; RPa: 0,53; IC: 0,28-0,996); se asociaron al rechazo de contracepción en el posparto. Conclusión: El nivel educativo bajo, la percepción de una mala situación económica, las complicaciones durante el trabajo de parto y dos horas posparto, el embarazo planificado, la experiencia negativa de contracepción, la actitud negativa de la pareja, se asocian al rechazo de contracepción posparto; la percepción de conocimiento insuficiente sobre contracepción se asoció a la disminución de rechazo(AU)

Objective: To determine the factors associated with the refusal of postpartum contraception in a Public Hospital, 2021. Methods: Observational, analytical, cross-sectional study; included 251 immediate postpartum women treated in a Public Hospital between May and June 2021. The main variable was rejection of postpartum contraception and associated factors: sociodemographic, obstetric, personal-cultural, and institutional. A valid and reliable questionnaire was used. In addition, Pearson's Chi-square test and Poisson's regression were used for statistical analysis and the Ethics Committee was approved. Results: 16.7% rejected modern contraceptives. Low educational level (p < 0.011; PRa: 4.51; CI: 1.42-14.35), the perception of a bad economic situation (p = 0.001; RPa: 3.65; CI: 1.72-7.76), complications during labor and two hours postpartum (p = 0.041; PRa: 8.16; CI: 1.09-61.19), planned pregnancy (p = 0.002; PRa: 2.51; CI: 1.38-4.55), negative experience of contraception (p = 0.000; PRa: 11.26; CI: 5.85-21.66), the negative attitude of the partner (p = 0.006; RPa: 4.90; CI: 1.57-15.31) and the perception of insufficient knowledge about contraception (p = 0.049; RPa: 0.53; CI: 0.28-0.996); were associated with contraceptive rejection in the postpartum period. Conclusion: Low educational level, perception of a poor economic situation, complications during labor and two hours postpartum, planned pregnancy, negative contraceptive experience, negative partner attitude, are associated with postpartum contraceptive rejection; The perception of insufficient knowledge about contraception was associated with a decrease in rejection(AU)

ABSTRACT

Los problemas de salud mental materna durante el embarazo, parto y puerperio son un desafío para la salud pública. Su falta de reconocimiento atenta contra el diagnóstico y tratamientos oportunos, e impacta en la madre y el establecimiento del vínculo fundamental del binomio. Debemos reconocer los factores de riesgo (edad, situación socioeconómica, antecedentes psicopatológicos, disfunción familiar, entorno desfavorable), las manifestaciones clínicas y las herramientas de detección. Existen evidencias de que el efecto del estrés, la ansiedad y la depresión durante el embarazo afectan negativamente el neurodesarrollo fetal y condicionan los resultados del desarrollo infantil. Describimos el impacto negativo de la depresión puerperal durante los primeros meses de vida, que afecta el vínculo madre-hija/o, el desarrollo posnatal (emocional, conductual, cognitivo, lenguaje) y el mantenimiento de la lactancia materna. También reconocemos factores protectores que atemperan sus efectos. Es fundamental establecer estrategias preventivas y abordajes diagnósticos y terapéuticos interdisciplinarios para minimizar los riesgos sobre la madre y sus hijas/os.

Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.

ABSTRACT

INTRODUCTION: Antenatal education is a low-cost intervention designed to increase the knowledge of pregnant women on pregnancy and childbirth and reduce fear related to labor pain. However, the impact of antenatal education programs on maternal outcomes is unclear. OBJECTIVE: To investigate whether structured antenatal education programs affect maternal health outcomes. METHODS: Electronic databases were searched from inception to November 2019, and randomized controlled trials investigating antenatal educational programs for low-risk pregnant women were included. RESULTS: A total of 348 studies were identified; nine were included in this review. One study assessed the number of antenatal visits, while three showed that antenatal education programs significantly improved childbirth self-efficacy (outcome expectancy16.00 [95% CI 9.86-22.15] and efficacy expectancy 20.44 [95% CI=13.62-27.25]). Self-diagnosis on labor was investigated in two studies, and five demonstrated that antenatal education increased the frequency of vaginal delivery (odds ratio 1.28 [95% CI 1.01-1.63]) but not episiotomy (as observed in three studies). CONCLUSION: Structured antenatal education programs may increase childbirth self-efficacy and the frequency of vaginal delivery.

INTRODUÇÃO: A educação pré-natal é intervenção de baixo custo que visa aumentar o conhecimento da gestante sobre a gravidez e o parto e, geralmente, promove a diminuição do medo relacionado à dor no parto. Porém, a forma de ação dos programas de educação pré-natal nos desfechos maternos é pouco conhecida. OBJETIVO: Investigar se programas estruturados de educação pré-natal influenciam os resultados de saúde materna. MÉTODOS: Bases de dados eletrônicas foram pesquisadas sem limite de início até novembro de 2019. Ensaios clínicos controlados e randomizados que investigaram mulheres grávidas adultas de baixo risco que cumpriram programas educacionais pré-natais foram incluídos. RESULTADOS: 348 estudos foram identificados, mas nove foram incluídos nesta revisão. O número de visitas pré-natais foi avaliado em um estudo, três estudos mostraram que a educação pré-natal melhorou significativamente a autoeficácia no parto (Outcome Expectancy 16,00 [IC 95% 9,86-22,15] e Efficacy Expectancy 20,44 [IC 95% 13,42-27,25]; o autodiagnóstico do parto foi investigado em dois estudos; cinco estudos demonstraram que a educação pré-natal favorece a frequência de parto vaginal 1,28 [IC 95% 1,01-1,63], mas não altera a de episiotomia, como visto em três estudos. CONCLUSÃO: O programa estruturado de educação pré-natal aumenta a probabilidade de autoeficácia no parto e a frequência de partos vaginais

ABSTRACT

Pregnancy, despite being a physiological process, can lead to morbidity and mortality, which is increased at risk ages, defined as younger or equal to15 years and older or equal to 35 years. For an adequate approach it is necessary to know the local reality of the population, therefore, the objective of this study is to describe and analyze the discharges of births and cesarean sections at risk age in the Maule Region from 2017 to 2021 using the database collected from the Biostatistics Unit of the Maule Health Service, which includes the hospitals of the region. Within the observed period, a total of 30,599 deliveries and cesarean sections were studied, being these a total of 5,581 at risk age, of which 0.65% corresponds to women younger or equal to 15 years and 17.57% to women older or equal to 35 years. There is a downward tendency in births in general, mostly evidenced in less or equal to 15 years, and on the contrary, a rise in births and cesarean sections of more or equal to 35 years, differing with the statistics at the country level. The tendency of increasing maternal age of pregnancies in the Maule region and its consequences are a fundamental factor when planning new public policies, so we consider it of vital importance to promote research and update the evidence, with a focus on the local population.

El embarazo a pesar de ser un proceso fisiológico puede conllevar morbimortalidad, la cual se acrecienta en edades de riesgo, definida como menor o igual a 15 años y mayor o igual a 35 años. Para el adecuado enfrentamiento se necesita conocer la realidad local, por ello, el objetivo de este estudio es describir y analizar los egresos de partos y cesáreas en edad de riesgo en la Región del Maule desde el año 2017 a 2021 utilizando la base de datos recogida desde la Unidad de Bioestadística del Servicio de Salud Maule, la cual incluye los hospitales de la región. Dentro del periodo observado se estudió un total de 30.599 partos y cesáreas, siendo estos un total de 5.581 en edad de riesgo, de los cuales 0.65% corresponde a mujeres menores o igual a 15 años y 17.57% a mujeres mayores o igual a 35 años. Existe una tendencia a la baja de los nacimientos en general, mayormente evidenciado en menores o igual a 15 años, y por el contrario, un alza en los partos y cesáreas de mayores o igual a 35 años, difiriendo con las estadísticas a nivel país. El aumento de la edad materna de los embarazos en la región del Maule y sus consecuencias son un factor fundamental a la hora de planificar nuevas políticas públicas, por lo que consideramos de vital importancia promover la realización de investigaciones y actualización de la evidencia sobre el tema, con un enfoque en la población local.

ABSTRACT

Objetivo: Analisar as preferências e vivências das mulheres perante as vias de parto. Métodos: Trata-se de uma pesquisa qualitativa do tipo exploratória, através de relatos de experiências de um total de 19 mulheres, as quais tiveram seus filhos por via de parto normal ou cesariana, nos anos de 2020 ou 2021. Resultados: A cesariana e o parto normal possuem divergências perante as experiências vivenciadas pelas mulheres. O procedimento da cesárea vem se tornando uma conduta rotineira, dificultando a autonomia da parturiente nas tomadas de decisões. Diferente do parto normal, o qual segundo relatos observados nas entrevistas, é um processo que envolve e depende mais da mulher. O parto normal ainda é temido pelas mulheres pelo medo da dor, enfatizando a necessidade de um acompanhamento de qualidade durante todo o processo de pré-natal, trabalho de parto e parto. Conclusão: Percebeu-se através do estudo que a preferência pelo parto normal vem crescendo ao longo dos últimos anos, mesmo a cesariana ainda sendo a via de parto com maiores índices. Os sentimentos e experiências das mulheres durante o parto são relativos conforme suas vivências e preferências, sendo considerado também a influência das condutas dos profissionais. (AU)

Objective: To analyze the preferences and experiences of women regarding birth routes. Methods: This is an exploratory qualitative research, through the experience reports of a total of 19 women, who had their children by normal birth or cesarean section, in the years 2020 or 2021. Results: Cesarean and normal birth have divergences in the experiences of women. The cesarean procedure has become a routine conduct, hindering the autonomy of the mother in decision-making. Unlike normal birth, which according to reports observed in the interviews, is a process that involves and depends more on the woman. Normal birth is still feared by women for fear of pain, emphasizing the need for quality monitoring throughout the prenatal process, labor and delivery. Conclusion: The study showed that the preference for normal birth has been growing over the past few years, even though the cesarean section is still the most commonly used method of delivery. The feelings and experiences of women during childbirth are relative according to their experiences and preferences, being also considered the influence of the professionals' behaviors. (AU)

Objetivo: Analizar las preferencias y vivencias de las mujeres ante las vías de parto. Métodos: Se trata de una investigación cualitativa de tipo exploratorio, a través de los relatos de experiencias de un total de 19 mujeres, que tienen sus hijos por vía de parto normal o cesárea, en los años 2020 o 2021. Resultados: La cesárea y el parto normal tienen divergencias ante las experiencias vividas por las mujeres. El procedimiento de cesárea se ha convertido en una conducta rutinaria, dificultando la autonomía de la parturienta en la toma de decisiones. A diferencia del parto normal, que según los informes observados en las entrevistas, es un proceso que implica y depende más de la mujer. El parto normal aún es temido por las mujeres por el dolor, enfatizando la necesidad de un acompañamiento de calidad durante todo el proceso prenatal, el trabajo de parto y el parto. Conclusión: Se percibe a través del estudio que la preferencia por el parto normal está creciendo a lo largo de los últimos años, aunque la cesárea sigue siendo la vía de parto con mayores índices. Los sentimientos y las experiencias de las mujeres durante el parto son relativos a sus vidas y preferencias, considerando también la influencia de las conductas de los profesionales. (AU)

ABSTRACT

Introdução: o parto é reconhecido como um processo fisiológico que alude à procriação e ao desenvolvimento entre as sociedades; entretanto, pouco se tem falado sobre a assistência humanizada ao parto. Portanto, é necessário identificar a experiência das mulheres durante o parto normal a fim de gerar práticas que garantam uma melhor qualidade de atendimento. Objetivo: caracterizar as evidências científicas relacionadas às experiências das mulheres durante a assistência ao parto normal. Materiais e método: foi realizada uma revisão integrativa, segundo Cooper, e revisadas seis bases de dados: Cochrane, PubMed, Science Direct, Springer, Scopus e Cinahl, com os descritores em espanhol, inglês e português, "parto normal", "parto humanizado", "humanização da assistência", "violência obstétrica", "pesquisa qualitativa", limitados ao período de 2010 a 2023, com os seguintes critérios de inclusão/exclusão: artigos qualitativos em texto completo sobre partos normais, com pontuação maior ou igual a 8 segundo o Critical Appraisal Skills Programme em espanhol (CASPe). Resultados: emergiram seis unidades temáticas: microagressões e macroimpactos: parto ­ entre a dor e o medo; agindo com respeito ­ o parto como um processo natural; silenciar, calar e suportar; meu parto, minha escolha; tornando visível o invisível ­ normalizando a violência durante o parto; e o rito do parto ­ a dignidade da mulher. Conclusões: as experiências de parto das mulheres são moldadas pelo contexto cultural em que elas vivem; os modelos biomédico e tradicional colidem e impactam a vida das mulheres. É necessário que as mulheres estejam cientes de seus direitos reprodutivos para contribuir com a humanização do parto.

Introducción: el parto es reconocido como un proceso fisiológico que alude a la procreación y al desarrollo entre las sociedades; no obstante, poco se ha habla sobre la atención humanizada del mismo. Por lo anterior, es necesario identificar la experiencia de las mujeres durante la atención del parto vaginal para generar prácticas que garanticen una mejor calidad en la atención. Objetivo: caracterizar la evidencia científica relacionada con las experiencias de las mujeres durante la atención del parto vaginal. Materiales y Método: se realizó una revisión integrativa, según Cooper; se revisaron seis bases de datos Cochrane, PubMed, Science Direct, Springer, Scopus y Cinahl, con los descriptores: Parto Normal; Parto Humanizado; Humanización de la Atención; Violencia Obstétrica e Investigación Cualitativa, en idioma español, inglés y portugués, limitada al periodo 2010-2023, con los siguientes criterios de inclusión/exclusión: artículos cualitativos en texto completo sobre partos vaginales, con puntuación mayor o igual a 8 según CASPe. Resultados: se obtuvieron seis unidades temáticas: microagresiones y macro-impactos: el parto: entre el dolor y el miedo; actuar con respeto: el parto como proceso natural; silenciar, callar y soportar; mi parto, mi elección; haciendo visible lo invisible: normalizando la violencia durante el parto; y el rito de parir: dignidad de la mujer. Conclusiones: las experiencias de las mujeres durante el parto están moldeadas por el contexto cultural en el que viven; el modelo biomédico y el tradicional chocan e impactan la vida de la mujer. Es necesario que las mujeres conozcan sus derechos reproductivos para contribuir con la humanización del parto.

Introduction: Childbirth is recognized as a physiological process essential to procreation and societal development. Nevertheless, it often lacks adequate discussion on humanized care practices. Therefore, it is necessary to identify women's experiences during vaginal birth care to create practices that ensure better quality care. Objective: To characterize scientific evidence related to women's experiences during vaginal birth care. Materials and Methods: An integrative review was conducted following Cooper's methodology; six databases were reviewed: Cochrane, PubMed, Science Direct, Springer, Scopus, and Cinahl, using the descriptors: Normal Birth; Humanized Birth; Humanization of Care; Obstetric Violence; Qualitative Research, in Spanish, English, and Portuguese, limited to the 2010-2023 period, with the following inclusion/exclusion criteria: Qualitative full-text articles on vaginal births with a score of 8 or higher according to CASPe. Results: Six thematic units emerged: microaggressions and macro-impacts: childbirth: between pain and fear; acting with respect: childbirth as a natural process; silencing, enduring, and bearing; my birth, my choice; making the invisible visible: normalizing violence during childbirth; and the ritual of childbirth: women's dignity. Conclusions: Women's childbirth experiences are influenced by the cultural contexts in which they live; the biomedical model and traditional practices clash and impact women's lives. Women must know their reproductive rights to contribute to a humanized childbirth.

ABSTRACT

Comparar as distintas posições verticalizadas adotadas por parturientes durante o trabalho de parto, associando à ocorrência de possíveis lacerações perineais e seus respectivos graus. Metodologia: Trata-se de um estudo epidemiológico, observacional, descritivo, transversal, retrospectivo, de abordagem quantitativa. O estudo foi realizado na Casa de Parto de São Sebastião, localizada no Distrito Federal, a qual contou com uma amostra aleatória de 499 mulheres, que tiveram seus partos no período de janeiro de 2018 a dezembro de 2021. Resultados: O estudo apontou que 354 mulheres adotaram posições verticalizadas durante o período expulsivo e 249 obtiveram algum grau de laceração; já 145 adotaram posições não verticalizadas e 74 tiveram algum grau de laceração. Entre as posições verticalizadas, a mais adotada foi com o uso da banqueta de parto (37%). Conclusão: As posições verticalizadas estão associadas ao maior número de lacerações, porém o grau da laceração varia entre as posições.(AU)

To compare the different upright positions adopted by parturients during labor, associating them with the occurrence of possible perineal lacerations and their respective degrees. Methodology: This is an epidemiological, observational, descriptive, cross-sectional, retrospective study with a quantitative approach. The study was carried out at the Casa de Parto de São Sebastião, located in the Federal District, which had a random sample of 499 women who gave birth between January 2018 and December 2021. Results: The study found that 354 women adopted upright positions during the expulsive period and 249 had some degree of laceration; 145 adopted non-upright positions and 74 had some degree of laceration. Among the upright positions, the most commonly adopted was the use of the birthing stool (37%). Conclusion: Upright positions are associated with a higher number of lacerations, but the degree of laceration varies between positions.(AU)

Comparar las diferentes posiciones erguidas adoptadas por las parturientas durante el trabajo de parto, asociándolas con la ocurrencia de posibles laceraciones perineales y sus respectivos grados. Metodología: Se trata de un estudio epidemiológico, observacional, descriptivo, transversal, retrospectivo y con abordaje cuantitativo. El estudio se realizó en la Casa de Parto de São Sebastião, ubicada en el Distrito Federal, que contó con una muestra aleatoria de 499 mujeres que dieron a luz entre enero de 2018 y diciembre de 2021. Resultados: El estudio encontró que 354 mujeres adoptaron posiciones erguidas durante el período expulsivo y 249 tuvieron algún grado de laceración; 145 adoptaron posiciones no erguidas y 74 tuvieron algún grado de laceración. Entre las posturas erguidas, la más adoptada fue el uso del taburete de parto (37%). Conclusión: Las posiciones verticales se asocian con el mayor número de laceraciones, pero el grado de laceración varía entre las posiciones.(AU)

ABSTRACT

Los dispositivos intrauterinos de cobre son utilizados como métodos anticoncepcionales y es uno de los métodos más utilizados por su seguridad, reversibilidad y eficacia en la prevención de embarazos, que es superior al 97 %. Se presenta un caso de falla en la anticoncepción con dispositivos intrauterinos de cobre después de 5 años de uso en gestante de 26 años, que acudió al área de emergencias cursando con embarazo de 38 semanas y 4 días en periodo expulsivo; se obtuvo recién nacido a término sano. El periodo de alumbramiento patológico (prolongado) por presencia de dispositivo intrauterino de cobre en membranas ovulares(AU)

Copper intrauterine devices are used as contraceptive methods and are one of the most used methods due to their safety, reversibility and effectiveness in preventing pregnancy, which is greater than 97%. A case of failure in contraception with a copper intrauterine devices is presented after 5 years of use in a 26-year-old pregnant woman, who went to the emergency room with a pregnancy of 38 weeks and 4 days in the expulsive period; a healthy term newborn was obtained.The pathological (prolonged) delivery period due to the presence of copper intrauterine devices in ovular membranes(AU)

ABSTRACT

Introducción. La adolescencia es un periodo de desarrollo biopsicosocial que va desde los 10 a 19 años, el embarazo entre estas edades supone una preocupación para la salud pública por todo lo que conlleva. Objetivo. Conocer la frecuencia y características clínico-epidemiológicas de gestantes adolescentes atendidas en el servicio de maternidad del Hospital Regional de Pedro Juan Caballero entre diciembre del 2021 a noviembre del 2022 Materiales y Método. Estudio descriptivo, retrospectivo de corte transversal, muestreo por conveniencia de adolescentes atendidas en el servicio de ginecología del Hospital Regional de Pedro Juan Caballero en el periodo diciembre 2021 a noviembre del 2022.Resultados. De 1615 puérperas, el 20% (n=317) fueron adolescentes, 26% de ellas tenían 19 años, 78,5% en unión libre, 38,2% tenía por lo menos 5 controles prenatales. En los antecedentes gineco obstétricos el 81% eran nulíparas. El peso de los 317 niños fue 2501 a 4000 gramos en un 83%y en puntaje APGAR 98,7% presentó un puntaje de 7-10; 82% nació entre 37-42 semanas y 50,3% fueron varones. La vía de parto más común fue la vaginal con 73% y de presentación cefálica en un 97%. Conclusión. La frecuencia de gestantes adolescentes representa una quinta parte del total de gestantes atendidas, más de dos tercios nacieron con peso adecuado, en su mayoría un APGAR de 7-10 a los 5 minutos y la vía por la cual nacieron en su mayoría fue la vaginal, en presentación cefálica. Palabras clave: gestante; adolescentes; parto

Introduction. Adolescence is a period of biopsychosocial development that goes from 10 to 19 years old. Pregnancy between these ages is a concern for public health due to everything it entails. Objetive.to know the frequency of teenage pregnant women treated in the maternity service of the Pedro Juan Caballero Regional Hospital in the period from December 2021 to November 2022.Material and Method. Descriptive, retrospective cross-sectional, convenience sampling of adolescents treated in the Gynecology service of the Pedro Juan Caballero Regional Hospital in the period December 2021 to November 2022. Results.20% of the total pregnant women attended were adolescents, 26% of the adolescents were 19 years old, marital status, common-law union 74.5%. 38.2% had at least 5 prenatal checkups. In the Obstetric Gynecological History, 81% were nulliparous. The weight of the 317 children was 2501 to 4000 grams in 83% and in the APGAR score 98.7% had a score of 7-10;82% were born between 37-42 weeks and 50.3% were boys. The most common route of delivery was vaginal with 73% and cephalic presentation in 97%. Conclusion.The frequency of pregnant adolescents represents a fifth of the total pregnant women attended, morethan two thirds were born with adequate weight, mostly an APGAR of 7-10 at 5 minutes and the route by which they were mostly born was vaginal, in cephalic presentation. Key words: pregnant woman; adolescents; childbirth

ABSTRACT

OBJETIVO: revelar como foi a vivência do parto para os homens que participaram do nascimento de seus filhos. MÉTODO: estudo descritivo, de natureza qualitativa e de campo, tendo como técnica de coleta de dados o grupo focal, no formato virtual, denominado de roda de relato de parto. Os dados foram analisados através do software IRAMUTEQ. RESULTADOS: cinco (05) depoentes participaram da coleta de dados, gerando dez (10) relatos. A partir das análises foram geradas seis classes de palavras, representadas por meio de um filograma das quais se destacaram alguns termos relevantes para o estudo como "participar", "vontade", "possibilidade", "medo", "hospital", "decisão", entre outras. CONCLUSÃO: a participação da figura paterna, no momento do nascimento, assim como em todo o processo gravídico ressignifica a masculinidade e insere o pai em uma posição de protagonismo na vivência da paternidade.

OBJECTIVE: to reveal how the experience was of childbirth for men who participated in the birth of their children. METHOD: a descriptive study, of qualitative and field nature, having as a technique of data collection the focal group, in the virtual format, called the childbirth report circle. The data were analyzed using the IRAMUTEQ software. RESULTS: five (05) deponents participated in data collection, generating ten (10) reports. From the analysis, six classes of words were generated, represented by a phylogram of which some relevant terms stood out for the study such as "participate", "will", "possibility", "fear"," hospital ", and "decision", among others. CONCLUSION: the participation of the paternal figure at the time of birth, as well as in the whole gravidic process resignifies masculinity and inserts the father into a position of protagonism in the experience of paternity.

ABSTRACT

BACKGROUND: Approximately half of the birth injuries are avoidable if appropriate and timely evidence based measures are taken. However, there is a paucity of studies in Ethiopia. Therefore, this study aimed to assess the magnitude of birth injuries and associated factors among neonates delivered in Central Ethiopia. METHODS: Multi-center facility-based cross-sectional study was conducted from March to April 2021. Systematic sampling method was used to select 344 mother-neonate pairs admitted to neonatal intensive care units in the included hospitals. Data were collected using face-to-face interview and review of medical records. Epi-info version 4.1 was used to enter data and SPSS version-25 for analysis. Descriptive statistics, binary and multivariable logistic regressions analyses with 95% CI were done. A cut off value of p-value < 0.05 was used to declare the statistical significance of variables. RESULTS: The magnitude of birth injuries was 24.7% (95% CI=24.7% - 24.8%). The majority 71.6 % of the neonates had soft tissue injuries while 16.6 % of them had birth asphyxia. Both birth asphyxia and physical trauma were encountered in 2.9 % of the neonates. Fetal mal-presentation (AOR=29.69, 95% CI =10.61 - 43.09), ANC follow­up less than four (AOR=3.2, 95% CI, 1.21-8.33), assisted childbirth (AOR =3.33, 95 % CI=1.003 -11.044) and short maternal height (AOR=4.85, 95% CI, (1.26-20) were significantly associated with birth injuries. CONCLUSION: The magnitude of birth injuries was higher than other similar studies in Ethiopia. Fetal malpresentation, antenatal care follow-up less than four, and short maternal height were significantly associated with birth injuries. Thus, promotion of full antenatal care follow-up, close monitoring of mothers during intrapartum period and timely clinical decision of labor and childbirth process of mal-presented children are recommended.

ABSTRACT

Neonatal mortality disturbs the whole of humanity. Its frequency remains very high throughout the world, but more so in developing countries. The DRC is ranked among the countries with the highest number of neonatal deaths in the world with the ratio of 47 per 1000 live births, (Kalonji DC et al 2018). Indeed, the province of Kongo Central has not remained indifferent to this health problem. With a view to improving newborn health during the neonatal period, the present study is conducted and envisages identifying the determinants of neonatal mortality in Kongo Central Province. For this study, the general population consisted of all newborns in the Province of Kongo Central from 2021 to 2022. A random sample of 117 cases met the inclusion criteria, of which we matched 1 case to 2 controls. After data analysis, we found the following results: the overall neonatal mortality rate was 333 per thousand live births. The logistic regression model identified the following determinants of neonatal mortality: age (OR= 1.16562 IC95 [1.035635 -1.3163]. p=0.0105), age less than 2 years (OR= 2.01966 IC95 [1.021601-4.058]. p=0.0449) and acute fetal distress (OR=2.62027IC95 [1.179464-5.878]. p=0.0181). In order to improve neonatal health, pregnant women should be made aware of the importance of prenatal consultations for early detection and appropriate management of high-risk pregnancies. They should be present at the onset of labor and give birth in the presence of qualified personnel

La mortalité néonatale dérange l'humanité toute entière. Sa fréquence demeure très élevée dans le monde entier mais plus dans les pays en développement. La RDC est classée parmi les pays ayant le plus grand nombre de décès néonatals dans le monde avec le ratio de 47 pour 1000 naissances vivantes. En effet, la province de Kongo Central n'est pas restée indifférente face à problème de santé. En vue d'améliorer la santé du nouveau-né pendant la période néonatale, la présente étude est menée et envisage d'identifier les déterminants de la mortalité néonatale dans la Province du Kongo Central. Pour cette étude, la population générale était constituée de tous les nouveau-nés de la Province du Kongo Central de 2021 à 2022. Les cas qui répondaient à ces critères d'inclusion étaient au nombre de 117 pris de façon aléatoire dont nous apparié 1 cas pour 2 témoins. Après analyse des données, nous avons trouvé les résultats suivant : le taux de la mortalité néonatale globale est de 333 pour mille naissances vivantes. Le modèle de la régression logistique a identifié les déterminants de la mortalité néonatale suivants ; l'âge (OR= 1,16562 IC95 [1,035635 -1,3163]. p=0,0105), l'intervalle de moins de 2 ans (OR= 2,01966 IC95 [1,021601-4,058]. p=0.0449) ainsi que, la souffrance fœtale aigue (OR=2,62027IC95 [1,179464-5,878]. p=0.0181). En vue d'améliorer la santé néonatale, il convient de sensibiliser les femmes enceintes sur l'importance des consultations prénatales pour un dépistage précoce et une prise en charge adéquate des grossesses à risque, se présenter dès le début du travail d'accouchement et d'accoucher en présence d'un personnel qualifié.

ABSTRACT

This study examines factors associated with maternal mortality from 01 January 2020 to 31 December 2023 at the general referral hospital and in health centres and maternity units in the Kisenso health zone in the Kinshasa provincial health division. We used advanced statistics, with survival analysis performed using the Kaplan Meier estimator. The Cox model helped us to identify the factors associated with maternal mortality, as it is suitable for this type of study. The results of the analysis of our data show that the factors associated with maternal mortality of pregnant women and women who have recently given birth are: factors related to pregnancy, factors related to management and factors related to gynaecological and obstetric characteristics. Taking these factors into account can contribute to the implementation of interventions aimed at significantly reducing maternal mortality at central, intermediate and operational levels.

Cette étude porte sur les facteurs associés à la mortalité maternelle du 01 janvier 2020 au 31 décembre 2023 à l'hôpital général de référence et dans des centres de santé et maternités de la zone de santé de Kisenso dans la division provinciale de la santé de Kinshasa. Nous avons recouru à la statistique avancée, avec l'analyse de survie effectuée à l'aide de l'estimateur Kaplan Meier. Le modèle de Cox nous a aidés à identifier les facteurs associés à la mortalité maternelle car il convient pour ce genre d'étude. Les résultats de l'analyse de nos données démontrent que les facteurs associés à la mortalité maternelle des gestantes et accouchées sont : les facteurs liés à la grossesse, les facteurs liés à la prise en charge et les facteurs liés aux caractéristiques gynéco-obstétricale. La prise en compte de ces facteurs peut contribuer à la mise en place des interventions visant à réduire sensiblement la mortalité maternelle tant au niveau central, intermédiaire, qu'opérationnel