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1.
Rev Lat Am Enfermagem ; 28: e3359, 2020.
Artigo em Espanhol, Português, Inglês | MEDLINE | ID: mdl-32785566

RESUMO

Objective to map the current knowledge on recommendations for labor, childbirth, and newborn (NB) care in the context of the novel coronavirus. Method scoping review of papers identified in databases, repositories, and reference lists of papers included in the study. Two researchers independently read the papers' full texts, extracted and analyzed data, and synthesized content. Results 19 papers were included, the content of which was synthesized and organized into two conceptual categories: 1) Recommendations concerning childbirth with three subcategories - Indications to anticipate delivery, Route of delivery, and Preparation of the staff and birth room, and 2) Recommendations concerning postpartum care with four categories - Breastfeeding, NB care, Hospital discharge, and Care provided to NB at home. Conclusion prevent the transmission of the virus in the pregnancy-postpartum cycle, assess whether there is a need to interrupt pregnancies, decrease the circulation of people, avoid skin-to-skin contact and water births, prefer epidural over general anesthesia, keep mothers who tested positive or are symptomatic isolated from NB, and encourage breastfeeding. Future studies are needed to address directed pushing, instrumental delivery, delayed umbilical cord clamping, and bathing NB immediately after birth.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviços de Saúde Materna , Pneumonia Viral/epidemiologia , Período Pós-Parto , Gravidez , Betacoronavirus , Feminino , Humanos , Recém-Nascido , Pandemias , Parto
2.
Adv Exp Med Biol ; 1252: 3-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816256

RESUMO

The mature breast is located within the anterior thoracic wall, lying atop the pectoralis major muscle. Pubertal changes lead to incomplete development of the breast , a process which is only completed during pregnancy . The incomplete breast consists mostly of adipose tissue but also lactiferous units called lobes. These eventually drain into the lactiferous ducts and then into the lactiferous sinus and then to the nipple-areolar complex. During pregnancy , the breast undergoes both anatomic and physiologic changes to prepare for lactation. During the first trimester, the ductal system expands and branches out into the adipose tissue in response to the increase of estrogen. Elevated levels of estrogen also cause a decrease in adipose tissue and ductal proliferation and elongation. Estrogen also stimulates the pituitary gland which leads to elevated levels of prolactin. By the twentieth week of gestation, mammary glands are sufficiently developed to produce components of milk due to prolactin stimulation. Milk production is inhibited by high estrogen and progesterone levels and colostrum is produced during this time. In the third trimester and then rapidly after birth, these levels decrease, allowing for milk production and eventual let-down to allow for breastfeeding. Most pregnancies cause the areola to darken, the breast to increase in size, and the Montgomery glands to become more prominent. Post-lactational involution occurs at the cessation of milk production caused by a decline in prolactin.


Assuntos
Mama/anatomia & histologia , Mama/fisiologia , Lactação/fisiologia , Gravidez/fisiologia , Estrogênios , Feminino , Humanos , Leite Humano , Parto , Prolactina
3.
PLoS One ; 15(7): e0234575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645002

RESUMO

INTRODUCTION: Improving maternal health is a global public health challenge especially in sub-Saharan Africa. The optimum utilisation of antenatal care (ANC) by pregnant women is known to improve maternal health outcomes. Maternal morbidity and mortality rates in Ghana remain unacceptably high, particularly in rural settings where skilled delivery care often times is disproportionally low. This study assessed factors associated with optimum utilisation of antenatal care in rural Ghana. METHODS: A cross-sectional design was applied to collect data among eligible participants between October 2018 and January 2019. A total of 322 women who gave birth and attended the postnatal clinic were recruited for the study. Consecutive sampling was employed in recruiting participants. The associations between the dependent variables (ANC service utilisation and knowledge of ANC) and independent variables (socio-demographic characteristics) were examined using ordinary least squares logistic regression at 95% confidence interval in STATA version 14.0. RESULTS: Of the 322 participants, 69.0% reported utilising at least four or more times ANC services. Determinants of women attending ANC for four or more times was significantly associated with age [OR = 4.36 (95%CI: 2.16-8.80), p<0.001], educational level [OR = 10.18 (95%CI: 3.86-26.87), p<0.001], and insured with National Health Insurance Scheme [OR = 3.42 (95%CI: 1.72-6.82), p<0.001]. Not married [OR = 0.65 (0.39-1.09), p = 0.011] or divorced [OR = 0.33 (95%CI: 0.13-0.83), p = 0.019] was negatively associated with utilisation of four or more ANC services. The majority (79.0%) of the participants had a good level of knowledge regarding antenatal care. CONCLUSION: Although the majority of women in this study had good knowledge of ANC services, a significant number of them did not complete the recommended number of ANC visits for at least four times during a normal pregnancy. Awareness and further education to reproductive-age women on the significant role adequate ANC attendance plays in advancing health and well-being require further investments, particularly among rural women in Ghana.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/tendências , Adulto , Estudos Transversais , Parto Obstétrico , Feminino , Gana/epidemiologia , Humanos , Serviços de Saúde Materna , Pessoa de Meia-Idade , Parto , Gestantes , Cuidado Pré-Natal/estatística & dados numéricos , População Rural , Fatores Socioeconômicos
5.
PLoS One ; 15(7): e0235385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645067

RESUMO

The present study aims to: a) systematically map the of birth cohort studies from the South Asian region b) examine the major research foci and landmark contributions from these cohorts using reproducible scientometric techniques and c) offer recommendations on establishing new birth cohorts in Pakistan, building upon the strengths, weaknesses and gaps of previous cohorts. Bibliographic records for a total of 260 articles, published during through December 2018, were retrieved from the Web of Science (core database). All data were analysed using Microsoft Excel (2013), Web of Science platform and CiteSpace. A series of network analysis were then run for each time-period using the link reduction method and pathfinder network scaling. The co-cited articles were clustered into their homogeneous research clusters. The clusters were named using the Latent Semantic Indexing (LSI) method that utilized author keywords as source of names for these clusters. The scientometric analyses of original research output from these birth cohorts also paint a pessimistic landscape in Pakistan- where Pakistani sites for birth cohorts contributed only 31 publications; a majority of these utilized the MAL-ED birth cohort data. A majority of original studies were published from birth cohorts in India (156), Bangladesh (63), and Nepal (15). Out of these contributions, 31 studies reported data from multiple countries. The three major birth cohorts include prospective and multi-country MAL-ED birth cohort and The Pakistan Early Childhood Development Scale Up Trial, and a retrospective Maternal and infant nutrition intervention cohort. In addition to these, a few small-scale birth cohorts reported findings pertaining to neonatal sepsis, intrauterine growth retardation and its effects on linear growth of children and environmental enteropathy.


Assuntos
Parto , Ciência , Bibliometria , Estudos de Coortes , Comportamento Cooperativo , Geografia , Humanos , Estudos Longitudinais , Paquistão , Publicações , Pesquisa
8.
Pol Merkur Lekarski ; 48(285): 157-161, 2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32564038

RESUMO

Social trends, a new style of modern young woman, which includes the polygamy of sexual relationships, increases the incidence and probability of infection caused by sexually transmitted pathogens, including the human papillomavirus. In women entered into motherhood with chronic papillomavirus carrier, pregnancy is accompanied with an increase in obstetrics and perinatal complications. The inability to use antiviral therapy due to its embryo- and fetotoxic effects requires searching for safe agents for timely and effective preconceptional and prenatal preparation for the fetal infection prevention. AIM: The aim of the study was to evaluate a reduce level of obstetrics and perinatal complications in pregnant women infected with the human papillomavirus by using adequate preconceptional and prenatal preparation. MATERIALS AND METHODS: The immune status assessment was provided in 89 women who were chronic carriers of papillomavirus infection by determining the T and B lymphocyte levels, the concentration of proinflammatory (IL-2, IL-6, TNF-α) and anti-inflammatory (IL-4, IL-10) factors and the follow-up analysis of the pregnancy course and childbirth. RESULTS: Pregnancy course in women who are chronic carriers of human papillomavirus infection is accompanied by the high incidence of perinatal complications such as placental dysfunction, polyhydramnios, gestosis, premature membrane rupture, preterm labour, oligohydramnios, and fetal growth retardation syndrome. Chronic carriage of human papillomavirus infection leads to decrease in the CD3+, CD4+, and CD19+ levels associated with an increased CD8+ level and activation of proinflammatory cytokines (IL-2, IL-6, TNF-α) against the background of a decrease in their anti-inflammatory concentration analogues (IL-4, IL- 10) during pregnancy, which, in turn, creates favourable conditions for viral reactivation and subsequently causes reproductive complications and losses. CONCLUSIONS: The use of Proteflazid which contain a complex of plant flavonoids with a direct antiviral effect on human papillomavirus, for the purpose of preconceptional and prenatal preparation in women who are chronic carriers of human papillomavirus infection, contributes to the pregnant woman's immune balance restoration and significant perinatal complication reduction.


Assuntos
Trabalho de Parto Prematuro , Infecções por Papillomavirus , Complicações Infecciosas na Gravidez , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Prematuro/prevenção & controle , Infecções por Papillomavirus/complicações , Parto , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/terapia
9.
PLoS One ; 15(6): e0234320, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530940

RESUMO

INTRODUCTION: The World Health Organization (WHO) Safe Childbirth Checklist (SCC) is a 29-item checklist based on essential childbirth practices to help health-care workers to deliver consistently high quality maternal and perinatal care. The Checklist was intended to reduce maternal and perinatal mortality and address the primary cause of maternal death, intrapartum stillbirth, and early neonatal death. The objective of this review was to locate international literature reporting on the effectiveness of utilizing the WHO safe childbirth checklist on improving essential childbirth practices, early neonatal death, stillbirth, maternal mortality, and morbidity. METHODS: We searched MEDLINE, google scholar, Cochrane Central Register of Controlled Trials (CENTRAL), met-Register of Controlled Trials (m-RCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/stop/search/en) to retrieve all available comparative studieshttp://www.opengrey.eu/ published in English after 2008. Two reviewers did study selection, critical appraisal, and data extraction independently. We did a random or fixed-effect meta-analysis to pool studies together and effect estimates were expressed as an odds ratio. Quality of evidence for major outcomes was assessed using the Grading of Recommendations, Assessment, development, and evaluation(GRADE). RESULTS: We retained three cluster randomized trials and six pre-and-post intervention studies reporting on WHO SCC's. The WHO SCC utilization improved quality of preeclampsia management(moderate quality of evidence) (OR = 7.05 [95% CI 2.34-21.29]), maternal infection management(moderate quality of evidence) (OR = 7.29[95%CI 2.29-23.27]), Partograph utilization(moderate quality of evidence) (OR = 3.81 [95% 1.72-8.43]), postpartum counselling(low quality of evidence) (RR = 132.51[95% 49.27-356.36]) and still birth(moderate quality of evidence) (OR = 0.92[95% CI 0.87-0.96]). However, the utilization of the checklist had no impact on early neonatal death (very low quality of evidence) (OR = 1.07[95%CI [1.01-1.13]) and maternal death (low quality of evidence) (OR = 1.06[95% CI 0.77-1.45]). CONCLUSIONS: Moderate quality of evidence indicates that WHO SCC utilization is effective in reducing stillbirth and Improving preeclampsia management, maternal infection management and partograph utilization Low quality of evidence indicates that WHO SCC is effective in enhancing postpartum danger sign counseling. Low and very low quality of evidence suggests that WHO SCC has no impact on maternal and early neonatal death, respectively.


Assuntos
Parto , Assistência Perinatal/normas , Lista de Checagem , Feminino , Humanos , Recém-Nascido , Mortalidade Materna , Assistência Perinatal/métodos , Mortalidade Perinatal , Pré-Eclâmpsia/terapia , Gravidez , Natimorto , Organização Mundial da Saúde
10.
PLoS One ; 15(6): e0234318, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530944

RESUMO

BACKGROUND: Efforts to expand access to institutional delivery alone without quality of care do not guarantee better survival. However, little evidence documents the quality of childbirth care in Ethiopia, which limits our ability to improve quality. Therefore, this study assessed the quality of and barriers to routine childbirth care signal functions during intra-partum and immediate postpartum period. METHODS: A sequential explanatory mixed method study was conducted among 225 skilled birth attendants who attended 876 recently delivered women in primary level facilities. A multi stage sampling procedure was used for the quantitative phase whilst purposive sampling was used for the qualitative phase. The quantitative survey recruitment occurred in July to August 2018 and in April 2019 for the qualitative key informant interview and Focus Group Discussions (FGD). A validated quantitative tool from a previous validated measurement study was used to collect quantitative data, whereas an interview guide, informed by the literature and quantitative findings, was used to collect the qualitative data. Principal component analysis and a series of univariate and multivariate linear regression analysis were used to analyze the quantitative data. For the qualitative data, verbatim review of the data was iteratively followed by content analysis and triangulation with the quantitative results. RESULTS: This study showed that one out of five (20.7%, n = 181) mothers received high quality of care in primary level facilities. Primary hospitals (ß = 1.27, 95% CI:0.80,1.84, p = 0.001), facilities which had staff rotation policies (ß = 2.19, 95% CI:0.01,4.31, p = 0.019), maternal involvement in care decisions (ß = 0.92, 95% CI:0.38,1.47, p = 0.001), facilities with maternal and newborn health quality improvement initiatives (ß = 1.58, 95% CI:0.26, 3.43, p = 0.001), compassionate respectful maternity care training (ß = 0.08, 95% CI: 0.07,0.88, p = 0.021), client flow for delivery (ß = 0.19, 95% CI:-0.34, -0.04, p = 0.012), mentorship (ß = 0.02, 95% CI:0.01, 0.78, p = 0.049), and providers' satisfaction (ß = 0.16, 95% CI:0.03, 0.29, p = 0.013) were predictors of quality of care. This is complemented by qualitative research findings that poor quality of care during delivery and immediate postpartum related to: work related burnout, gap between providers' skill and knowledge, lack of enabling working environment, poor motivation scheme and issues related to retention, poor providers caring behavior, unable translate training into practice, mismatch between number of provider and facility client flow for delivery, and in availability of essential medicine and supplies. CONCLUSIONS: There is poor quality of childbirth care in primary level facilities of Tigray. Primary hospitals, facilities with staff rotation, maternal and newborn health quality improvement initiatives, maternal involvement in care decisions, training on compassionate respectful maternity care, mentorship, and high provider satisfaction were found to have significantly increased quality of care. However, client flow for delivery service is negatively associated with quality of care. Efforts must be made to improve the quality of care through catchment-based mentorship to increase providers' level of adherence to good practices and standards. More attention and thoughtful strategies are required to minimize providers' work-related burnout.


Assuntos
Acesso aos Serviços de Saúde , Assistência Perinatal/normas , Qualidade da Assistência à Saúde , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Grupos Focais , Instalações de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Tocologia/normas , Tocologia/estatística & dados numéricos , Enfermagem Obstétrica/normas , Enfermagem Obstétrica/estatística & dados numéricos , Obstetrícia/normas , Obstetrícia/estatística & dados numéricos , Parto , Assistência Perinatal/estatística & dados numéricos , Período Pós-Parto , Gravidez , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
11.
Bratisl Lek Listy ; 121(6): 415-421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484705

RESUMO

AIM: This study aimed to assess the psychometric characteristics of the Slovak translation of the version A of Wijma Delivery Expectancy/Experience Questionnaire (SW-DEQ) among healthy Slovak pregnant women. METHOD: Exploratory factor analysis (EFA) of the SW-DEQ was performed. Several coefficients of internal consistency were employed for the whole scale as well as for separate factors. Concurrent/convergent validity was assessed by correlation analysis of the overall SW-DEQ score with State-Trait Anxiety Inventory, Eysenck Personality Inventory - subscales Neuroticism and Extraversion, as well as with adjusted versions of Beck Depression Inventory and Internal-External Locus of Control Scale. EFA yielded seven factors: 'lack of composure', 'negative appraisal', 'lack of self-efficacy', 'lack of positive anticipation', 'fear and hopelessness', 'loneliness', and 'concern for the child'. RESULTS: The Cronbach's α of the whole scale was .93, while for the separate factors, it ranged between .68 and .87. The sum score of SW-DEQ correlated weakest with extraversion (in nulliparous women) and locus of control (in multiparous women), and strongest with trait anxiety (in both groups). CONCLUSIONS: The Slovak version could be considered a valid and reliable measure of fear of childbirth among pregnant Slovak women. However, the dimensional structure of the measure warrants further confirmation (Tab. 7, Ref. 33).


Assuntos
Parto Obstétrico , Parto , Inquéritos e Questionários , Criança , Feminino , Humanos , Gravidez , Psicometria , Reprodutibilidade dos Testes , Eslováquia
13.
Sante Publique ; 31(6): 751-759, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32550657

RESUMO

OBJECTIVE: Present the results of a study of the experience of maternity in the context of a recent immigration to Quebec. METHOD: Semi-structured interviews were carried out amongst mothers from different countries, having immigrated within the last five years. L'Écuyer's (1990) developmental analysis of the content was used to analyze the results. RESULTS: The data collected from 15 participants demonstrates that they perceive their motherly role as a great responsibility. During the postnatal phase, these women develop autonomy as mothers, but they also suffer from isolation and often only have their spouse to rely on. They experience a vast range of emotions such as happiness, anxiety, and sadness. Their level of distress depends on their representation of their maternity and immigration. To ensure their wellbeing, they keep in touch with their origins and use the professional services available. CONCLUSION: The transition into motherhood leads to a great disruption of these women's lives. Due to social isolation, their responsibilities as mothers seem even more intense. The partner, considered an ally, thus plays an important role by their side. They struggle with trusting Quebecers, however, some services are greatly appreciated: the in-home visit of nurses, the guide From Tiny Tot to Toddler and the Info-Santé telephone service. It would be relevant to conduct more studies on the reality of immigrant fathers and to consider increasing the number of in-home nurse or midwife visits for mothers who are less socially integrated and who perceive their immigration negatively.


Assuntos
Emigrantes e Imigrantes/psicologia , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia , Mães/psicologia , Angústia Psicológica , Estresse Psicológico/psicologia , Adulto , Feminino , Humanos , Parto , Gravidez , Pesquisa Qualitativa , Quebeque
14.
Stud Health Technol Inform ; 270: 213-217, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570377

RESUMO

The aim of our validation study was to assess the quality of hospital data for perinatal algorithms on a national level. In each hospital, we selected 150 discharge abstracts of delivery (after 22 weeks of gestation), in 2014, and their corresponding medical records. Overall, 23 hospitals were included and 3,246 discharge abstracts were studied. This first national validation study of several case-funding algorithms using various perinatal variables suggests that the French national hospital discharge abstracts database is an appropriate data source for epidemiological studies.


Assuntos
Confiabilidade dos Dados , Bases de Dados Factuais , Hospitais/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos/normas , Parto , Alta do Paciente/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Algoritmos , Feminino , França , Humanos , Recém-Nascido , Gravidez
15.
Rev Lat Am Enfermagem ; 28: e3286, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32578750

RESUMO

OBJECTIVE: to develop and validate with a panel of experts a scenario of maternal-child clinical simulation, related to humanized childbirth and birth. METHOD: methodological study based on the Jeffries framework and standardized guides of the International Nursing Association for Clinical Simulation in Learning, which used analysis with descriptive statistics for general aspects of adherence to the aforementioned guide and inferential statistics for validating the checklist of actions through the Intraclass Correlation Coefficient (ICC). RESULTS: the scenario contains learning objectives, necessary resources, prebriefing and debriefing of guidelines, description of the simulated situation, participants and roles, and checklist of expected actions. The validation obtained an agreement level above 80% in all aspects evaluated by 31 experts, highlighting realism of the environment and setting, vital sign parameters, alignment with scientific literature and encouragement of critical thinking and problem solving. In addition, the checklist of actions was validated with 0.899 agreement among experts, statistically analyzed by the ICC and Cronbach's alpha 0.908 (95% confidence interval). CONCLUSION: the simulated scenario on humanized childbirth and birth can strengthen the articulation between women's and children's health disciplines, and was validated by experts.


Assuntos
Parto Obstétrico/educação , Educação em Enfermagem , Humanismo , Parto , Treinamento por Simulação , Adulto , Lista de Checagem , Humanos
16.
PLoS One ; 15(6): e0234472, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579580

RESUMO

BACKGROUND: Despite remarkable progress in the reduction of death in under-five children, neonatal mortality has shown little or no concomitant reduction globally. It is also one of the most common causes of neonatal death in Ethiopia. Little is known on predictors of neonatal sepsis. Risk based screening and commencement of treatment appreciably reduces neonatal death and illness. Therefore, the main aim of this study was to identify predictors of neonatal sepsis in public referral hospitals of Northwest Ethiopia. METHODS: Institutional based unmatched case-control study was conducted among a total of 231 neonates in Debre Markos and Felege Hiwot referral hospitals from March 2018- April 2018. Neonates who fulfill the preseted criteria for sepsis were considered as cases and neonates diagnosed with other medical reasons except sepsis were controls. For each case, two consecutive controls were selected by simple random sampling method. Data were collected using structured pretested questionnaire through a face to face interview with index mothers and by reviewing neonatal record using checklist. The collected data were entered into Epi data version 3.1 and exported to STATA/ SE software version 14. Binary and multivariable logistic regression analyses were employed. Statistical significance was declared at P<0.05. RESULT: Multivariable logistic regression analysis showed that, duration of rupture of membrane ≥ 18hours was significantly associated with sepsis (AOR = 10.4, 95%CI = 2.3-46.5). The other independent predictors of neonatal sepsis were number of maternal antenatal care service ≤3 (AOR = 4.4, 95%CI = 1.7-11.5), meconium stained amniotic fluid (AOR = 3.9, 95%CI = 1.5-9.8), urinary tract infection during pregnancy (AOR = 10.8, 95% CI = 3.4-33.9), intranatal fever (AOR = 3.2, 95% CI = 1.1-9.5), first minute APGAR score <7 (AOR = 3.2, 95% CI = 1.3-7.7), resuscitation at birth (AOR = 5.4, 95% CI = 1.9-15.5), nasogastric tube insertion (AOR = 3.7, 95% CI = 1.4-10.2). CONCLUSION: Neonatal invasive procedures, ANC follow up during pregnancy, different conditions during birth like meconium stained amniotic fluid, low APGAR score and resuscitation at birth were the independent predictors of neonatal sepsis.


Assuntos
Mortalidade Infantil , Sepse Neonatal/epidemiologia , Parto , Morte Perinatal/etiologia , Cuidado Pré-Natal , Adulto , Líquido Amniótico , Índice de Apgar , Estudos de Casos e Controles , Etiópia , Feminino , Hospitais Públicos , Humanos , Lactente , Recém-Nascido , Mães , Gravidez , Infecções Urinárias/complicações , Adulto Jovem
17.
PLoS One ; 15(6): e0234785, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574182

RESUMO

OBJECTIVE: Descriptions of maternity waiting homes (MWHs) as an intervention to increase facility delivery for women living in remote geographic areas dates back to the 1950s, yet there is limited information on the scale-up and sustainability of MWHs. The objective of this study was to describe the evolutionary scale-up of MWHs as a component of health system strengthening efforts and document the successes, challenges, and barriers to sustainability in Liberia. METHODS: Data were collected from a national sample of 119 MWHs in Liberia established between 2010-2018. The study used a mixed method design that included focus group discussions, individual interviews, logbook reviews, and geographic information systems. Qualitative data were grouped into themes using Glaser's constant comparative method. Quantitative data were analyzed using negative binomial regression to measure the differences in the counts of monthly stays at facilities with different funding sources and presence of advisory committee. Additionally, each MWH was geo-located for purposes of geo-visualization. RESULTS: In the years since the original construction of five MWHs, an additional 114 MWHs were constructed in 14 of the 15 counties in Liberia. Monthly stays at facilities funded by community were 2·5 times those funded by NGOs (IRR, 2·46, 95% CI 1·33-4·54). Attributes of sustainability included strong local leadership/active community engagement and community ownership and governance. CONCLUSION: Success factors for scale-up and sustainability included strong government support through development of public policy, local and county leadership, early and sustained engagement with communities, and self-governance. A multi-pronged approach with strong community engagement is key to the scale-up and sustainability of MWHs as an intervention to increase facility delivery for women living the farthest from a healthcare facility.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Abastecimento de Alimentos , Humanos , Libéria , Pessoa de Meia-Idade , Parto , Adulto Jovem
18.
PLoS One ; 15(6): e0234783, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559236

RESUMO

INTRODUCTION: Research on research is key to enhancing efficacy in trial methodology. Clinical trials involving women during pregnancy and childbirth are limited, with a paucity of data guiding evidence-based practice. Following a prioritisation exercise that highlighted the top-ten unanswered recruitment questions, this qualitative evidence synthesis was designed specifically to focus on the barriers and enablers for clinicians/healthcare professionals in helping conduct randomised trials within the context of recruitment during pregnancy and childbirth. METHODS: The synthesis was undertaken using Thomas and Harden's three stage thematic synthesis method and reported following the ENTREQ guidelines. Using a pre-determined SPIDER strategy, we conducted a comprehensive search of databases; Pubmed, CINAHL, PsycINFO, EMBASE, and grey searches for records until January 2019. We included all reports of qualitative data on recruiter's experiences, perceptions, views of recruiting women during pregnancy and childbirth to clinical trials. Altogether 13,401 records were screened, resulting in 31 full-text reviews, of which five were eligible for inclusion. Quality was appraised using CASP. Data were extracted onto a specifically defined form. We used thematic synthesis to identify descriptive and analytical themes, and to interpret and generate theory. Confidence was assessed using GRADE-CERQual. The review protocol is publicly available (OSF https://osf.io/g4dt9/). RESULTS: Five papers (representing four individual studies) from two different countries were included. All studies focused on the experiences of trial recruiters in the maternity setting. We identified four analytical themes; Recruitment through a clinician's lens, Recruiters judgement on acceptability, From protocol to recruiters lived experience, Framing recruitment in context. These were linked by an overarching theme combining beliefs and power. CONCLUSION: The overarching theme combining beliefs and power links the experiences and perceptions of recruiters. This synthesis shows a gap between the trial design study protocol and the recruiter's lived experience. Strategies such as collaborative trial design, mitigating gatekeeping behaviours, and training may support recruiters in their endeavour.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Criança , Ensaios Clínicos como Assunto , Bases de Dados Factuais , Feminino , Humanos , Parto , Gravidez
20.
Womens Health Issues ; 30(4): 248-259, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32505430

RESUMO

BACKGROUND: The United States has a relatively high preterm birth rate compared with other developed nations. Before the enactment of the Affordable Care Act in 2010, many women at risk of a preterm birth were not able to access affordable health insurance or a wide array of preventive and maternity care services needed before, during, and after pregnancy. The various health insurance market reforms and coverage expansions contained in the Affordable Care Act sought in part to address these problems. This analysis aims to describe changes in the patterns of payer mix of preterm births in the context of a post-Affordable Care Act insurance market, explore possible factors for the observed changes, and discuss some of the implications for the Medicaid program. METHODS: We applied a repeated cross-sectional study design to explore payment mix patterns of all births and preterm births between 2011 and 2016, using publicly available National Vital Statistics Birth Data. We included an equal number of years with payment source available in the dataset before and after January 1, 2014, when the coverage expansions became effective. RESULTS: We found a small relative change in payment mix during the study period. Private health insurance (PHI) paid for a higher percentage of all births and this rate increased steadily between 2011 and 2016. Preterm births paid by PHI increased by 1.4 percentage points between 2011 and 2016 and self-pay/uninsured preterm births decreased by 0.3 percentage points over the same time period. Medicaid had the highest, and a relatively stable, preterm birth coverage percentage (48.9% in 2011, 49.2% in 2014, and 48.9% in 2016). Medicaid was also more likely to pay for preterm births than PHI, but this likelihood decreased by more than one-half after 2014 (8.2% in 2013 vs. 3.8% in 2014). CONCLUSIONS: After the 2010 reforms, Medicaid remained a constant source of coverage for the most vulnerable women in society when faced with the high cost of a preterm birth. Nationwide, of the 64 million women ages 15 to 44, 4% gained PHI (directly purchased or employer sponsored) and another 4% Medicaid, with a concomitant 8% decrease in uninsured women of reproductive age between 2013 and 2017. More research is needed to conclude with certainty that the reforms worked as intended, but the important role of Medicaid as a financial safety net is undeniable.


Assuntos
Cobertura do Seguro/economia , Seguro Saúde/economia , Serviços de Saúde Materna/organização & administração , Medicaid/estatística & dados numéricos , Patient Protection and Affordable Care Act , Nascimento Prematuro/economia , Adolescente , Adulto , Custos e Análise de Custo , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Cobertura do Seguro/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde , Parto , Gravidez , Nascimento Prematuro/epidemiologia , Estados Unidos , Adulto Jovem
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