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1.
Orv Hetil ; 161(10): 374-381, 2020 Mar.
Artículo en Húngaro | MEDLINE | ID: mdl-32115991

RESUMEN

Introduction: Pregnancy is usually desired, yet it has its own difficulties that can be overwhelming, thus depression might occur. The prevalence of this is 6.58-26.7% in the international literature and 6.5-17.9% in Hungarian studies. Aim: The aim was to analyze the data of the perinatal depression screening program of Békéscsaba which started in 2014. We wanted to study the pathological rate and the connection between demographic data and depression symptoms. Method: Until august 2019, 1708 women took part in the program. The screening is done by perinatal nurses: they explain the aims and hand over the Edinburgh Postnatal Depression Scale three times during pregnancy and once postpartum. They also suggest women in need to attend the psychological intervention as part of the screening. Results: The prevalence of the pathological questionnaires were 15.31%, 14.29%, 11.87%, and 12.68% at the four measuring occasions. In the whole sample, 18.27% of women had pathological score at least once. The depression scores of the four measurements correlated significantly with each other. Women who did not plan their pregnancies had higher level of depression in all four measurements. In the first trimester, women who were under 21 years old and/or were single had higher depression scores. In the second trimester, multipara women tended to have higher scores. Conclusion: The high prevalence and the constant level of depression emphasize the importance of the screening and psychological intervention, as previous studies found connection between depression and some perinatal complications. Some demographic factors can indicate more vulnerable women. Orv Hetil. 2020; 161(10): 374-381.


Asunto(s)
Depresión Posparto/psicología , Depresión/diagnóstico , Tamizaje Masivo/métodos , Complicaciones del Embarazo/psicología , Atención Prenatal/métodos , Adulto , Depresión/epidemiología , Depresión/psicología , Depresión Posparto/diagnóstico , Depresión Posparto/epidemiología , Femenino , Humanos , Hungría/epidemiología , Edad Materna , Atención Perinatal , Embarazo , Atención Prenatal/estadística & datos numéricos , Prevalencia , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Adulto Joven
2.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(2): 129-132, 2020 Feb 06.
Artículo en Chino | MEDLINE | ID: mdl-32074697

RESUMEN

Objective: To explore the association between the frequency of prenatal care in childbearing aged women and risk of small for gestational age (SGA) among neonatal twins in Shaanxi Province. Methods: From July to December 2013, a total of 30 027 childbearing aged women, who were pregnant from January 2010 to November 2013 and had definite outcomes, were selected from 30 districts (counties) of Shaanxi Province by using the multi-stage random sampling method. The questionnaires with a face-to-face survey method were used to retrospectively collect demographic information, pregnancy history, lifestyle during pregnancy, disease history, nutritional supplements, and health care during pregnancy. Information on the gestational age and birth weight of the newborn were obtained by consulting the medical certificate of birth and were registered as twin A and twin B by birth order. Finally, 356 childbearing aged women and their twin babies with complete data were included in the analysis. A generalized estimation equation model was used to analyze the association between the frequency of prenatal care and the risk of SGA among neonatal twins. Results: The age of childbearing aged women was (27.44±4.68) years old, of which 79.49% (283 women) were rural residents and 44.38% (158 women) had seven or more times prenatal care. The gestational age and birth weight were (37.64±2.51) weeks and (2 510±497) g, respectively. The prevalence of SGA was 51.40% (183/356) for twin A and 53.37% (190/356) for twin B, respectively. The prevalence of SGA was 44.30% (70/158) for twin A with seven or more times prenatal care and 42.41% (67/158) for twin B with seven or more times prenatal care, which was lower than that for twins with less than seven times prenatal care, respectively [57.07% (113/198) and 62.12% (123/198)] (P values were 0.017 and <0.001). The results of generalized estimation equation model suggested that compared to those with less than seven times prenatal care, after adjusting for parity, birth order, place of residence, maternal age, occupation, education, family wealth index, passive smoking, pregnancy-induced hypertension syndrome, folic acid, and iron supplement during perinatal period, and gender of the newborn, the OR (95%CI) of risk of SGA among childbearing aged women with seven or more times prenatal care was 0.60 (0.40-0.91). Conclusion: Seven or more times prenatal care could reduce the risk of SGA among neonatal twins in Shanxi Province.


Asunto(s)
Recién Nacido Pequeño para la Edad Gestacional , Atención Prenatal/estadística & datos numéricos , Gemelos/estadística & datos numéricos , Adulto , China/epidemiología , Femenino , Humanos , Recién Nacido , Embarazo , Estudios Retrospectivos , Medición de Riesgo , Adulto Joven
3.
Medicine (Baltimore) ; 99(1): e18447, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895773

RESUMEN

Prenatal examination is a pivotal measure to prevent high-risk pregnancy and to ensure the safety of both mother and infant. However, pregnant women in Linzhi Prefecture in the Tibet Autonomous Region (TAR) often cannot obtain regular prenatal examinations due to limited accessibility of healthcare facilities, shortage of medical staff, and lack of medical equipment. Health education is an important approach to solve this ever-growing issue of pregnant women in rural Tibet.To evaluate the efficacy of flexible methods of health education programs on improving compliance among pregnant women from Tibet, China.In May to November of 2018, a total of 168 pregnant women receiving prenatal examination in a tertiary referral hospital in Linzhi Prefecture were recruited and randomly assigned to a control (n = 85) and intervention group (n = 83). All pregnant women were followed up until delivery. The pregnant women in the control group received regular prenatal examination and health education programs. Other than receiving routine prenatal care, participants of the interventional group also voluntarily joined the WeChat Social Messaging platform. Online resources posted by the maternity schools provided convenience and flexibility for the pregnant woman. The number of prenatal examinations was statistically significant between the 2 groups. The effect of flexible patterns of health education programs on improving the compliance of pregnant women in Tibet was assessed.The number of prenatal examinations in the intervention group was 2.646 times, which was higher than that in the control group (P < .01). Multivariate analysis demonstrated that interventional measures and ethnicity were the influencing factors of the number of prenatal examinations for pregnant women in Linzhi after the adjustment of age, history of adverse pregnancy, education level, ethnicity, multiparity, gestational complications, and medical history. The number of prenatal examinations for the pregnant Tibetan women was 0.535 times lower compared with that of the pregnant Han women (95% CI: -0.089, 1.157, P = .091).Flexible forms of health education during the antenatal period can effectively increase the compliance of pregnant women in Tibet.


Asunto(s)
Educación en Salud/métodos , Cooperación del Paciente , Atención Prenatal/estadística & datos numéricos , Adulto , Femenino , Humanos , Embarazo , Red Social , Tibet
4.
Pan Afr Med J ; 34: 68, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31819784

RESUMEN

Introduction: More than 20 million infants were born with low birth weight in worldwide. Low birth weight contributes more than 80 percent of all the neonatal mortality. In Ethiopia, studies have shown that there is a high prevalence of low birth weight among newborns. Thus, this study was aimed to determine the magnitude and associated factors with low birth weight among newborns delivered at term in Kambata-Tembaro zone, Southern Ethiopia, 2018. Methods: Institution based cross-sectional study design was used. The sample size was proportionally allocated to each hospital. The total of 341 study participants was enrolled using systematic random sampling techniques. Data were collected by interview-administered questionnaire and entered using Epi-Info version-7 and exported to SPSS version 20 for analysis. Multivariate logistic regression analysis was carried out to identify associated factors with the low birth weight. Results: The prevalence of low birth weight was 18% and significantly associated with the mothers' non-employment [aOR=5.4;95%CI:1.7-17.4], residing in the rural [AOR=5.4; 95%CI:2.1-14.7], unintended pregnancy [aOR=2.0;95%CI:1.2-3.8], not attending antenatal care [aOR=2.3;95%CI: 1.3-2.7], mothers with greater than three births [aOR=1.5;95% CI:1.8-2.6], birth interval less than or equal to two years [aOR=1.9;95%CI:1.6-3.6] and intimate partner violence during pregnancy [aOR=2.1:95% CI: 1.1-3.9]. Conclusion: The study finding shown that the prevalence of low birth weight among newborn was high (18%) in the study. Preventing of low birth weight is an important intervention to reduce neonatal death. Therefore, maximizing women economic status, providing quality family planning services, enabling pregnant women to use antenatal care and preventing intimate partner violence during pregnancy via launching women empowering strategies in the community level is highly recommend.


Asunto(s)
Servicios de Planificación Familiar/estadística & datos numéricos , Recién Nacido de Bajo Peso , Violencia de Pareja/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Hospitales/estadística & datos numéricos , Humanos , Recién Nacido , Embarazo , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
5.
PLoS Med ; 16(12): e1002990, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31851685

RESUMEN

BACKGROUND: In low-resource settings where disease burdens remain high and many health facilities lack essentials such as drugs or commodities, functional equipment, and trained personnel, poor quality of care often results and the impact can be profound. In this paper, we systematically quantify the potential gain of addressing quality of care globally using country-level data about antenatal, childbirth, and postnatal care interventions. METHODS AND FINDINGS: In this study, we created deterministic models to project health outcomes if quality of care was addressed in a representative sample of 81 low- and middle-income countries (LMICs). First, available data from health facility surveys (e.g., Service Provision Assessment [SPA] and Service Availability and Readiness Assessment [SARA]) conducted 2007-2016 were linked to household surveys (e.g., Demographic and Health Surveys [DHS] and Multiple Indicator Cluster Surveys [MICS]) to estimate baseline coverage for a core subset of 19 maternal and newborn health interventions. Next, models were constructed with the Lives Saved Tool (LiST) using country-specific baseline levels in countries with a linked dataset (n = 17) and sample medians applied as a proxy in countries without linked data. Lastly, these 2016 starting baseline levels were raised to reach targets in 2020 as endline based upon country-specific utilization (e.g., proportion of women who attended 4+ antenatal visits, percentage of births delivered in a health facility) from the latest DHS or MICS population-based reports. Our findings indicate that if high-quality health systems could effectively deliver this subset of evidence-based interventions to mothers and their newborns who are already seeking care, there would be an estimated 28% decrease in maternal deaths, 28% decrease in neonatal deaths, and 22% fewer stillbirths compared to a scenario without any change or improvement in quality of care. Totals of 86,000 (range, 77,800-92,400) maternal and 0.67 million (range, 0.59 million-0.75 million) neonatal lives could be saved, and 0.52 million (range, 0.48 million-0.55 million) stillbirths could be prevented across the 81 countries in the calendar year 2020 when adequate quality care is provided at current levels of utilization. Limitations include the paucity of data to individually assess quality of care for each intervention in all LMICs and the necessary assumption that quality of care being provided among the subset of countries with linked datasets is comparable or representative of LMICs overall. CONCLUSIONS: Our findings suggest that efforts to close the quality gap would still produce substantial benefits at current levels of access or utilization. With estimated mortality rate declines of 21%-32% on average, gains from this first step would be significant if quality was improved for selected antenatal, intrapartum, and postnatal interventions to benefit pregnant women and newborns seeking care. Interventions provided at or around the time of childbirth are most critical and accounted for 64% of the impact overall estimated in this quality improvement analysis.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Instituciones de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Embarazo , Atención Prenatal/estadística & datos numéricos , Mortinato/epidemiología
6.
BMC Public Health ; 19(1): 1443, 2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31684923

RESUMEN

BACKGROUND: In Ethiopia, malaria infections and other complications during pregnancy contribute to the high burden of maternal morbidity and mortality. Preventive measures are available, however little is known about the factors influencing the uptake of maternal health services and interventions by pregnant women in Ethiopia. METHODS: We analyzed data from a community-based cross-sectional survey conducted in 2016 in three rural districts of Jimma Zone, Ethiopia, with 3784 women who had a pregnancy outcome in the year preceding the survey. We used multivariable logistic regression models accounting for clustering to identify the determinants of antenatal care (ANC) attendance and insecticide-treated net (ITN) ownership and use, and the prevalence and predictors of malaria infection among pregnant women. RESULTS: Eighty-four percent of interviewed women reported receiving at least one ANC visit during their last pregnancy, while 47% reported attending four or more ANC visits. Common reasons for not attending ANC included women's lack of awareness of its importance (48%), distance to health facility (23%) and unavailability of transportation (14%). Important determinants of ANC attendance included higher education level and wealth status, woman's ability to make healthcare decisions, and pregnancy intendedness. An estimated 48% of women reported owning an ITN during their last pregnancy. Of these, 55% reported to have always slept under it during their last pregnancy. Analysis revealed that the odds of owning and using ITNs were respectively 2.07 (95% CI: 1.62-2.63) and 1.73 (95% CI: 1.32-2.27) times higher among women who attended at least one ANC visit. The self-reported prevalence of malaria infection during pregnancy was low (1.4%) across the three districts. We found that young, uneducated, and unemployed women presented higher odds of malaria infection during their last pregnancy. CONCLUSION: ANC and ITN uptake during pregnancy in Jimma Zone fall below the respective targets of 95 and 90% set in the Ethiopian Health Sector Transformation Plan for 2020, suggesting that more intensive programmatic efforts still need to be directed towards improving access to these health services. Reaching ANC non-users and ITN ownership and use as part of ANC services could be emphasized to address these gaps.


Asunto(s)
Mosquiteros Tratados con Insecticida/estadística & datos numéricos , Malaria/prevención & control , Propiedad/estadística & datos numéricos , Complicaciones Parasitarias del Embarazo/prevención & control , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Etiopía , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
7.
BMC Public Health ; 19(1): 1501, 2019 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-31711460

RESUMEN

BACKGROUND: Maternal morbidity and mortality continued to be major issues in many countries. Globally a total of 10.7 million women have died between 1990 and 2015 due to maternal causes where sub-Saharan Africa alone accounts for 66% of maternal death. Since most maternal deaths are avoidable; skilled attendance during pregnancy, childbirth, and the postpartum is among the most critical interventions for improving maternal and neonatal survival. The study aimed to assess the magnitude and associated factors of utilization of skilled birth attendant at birth among women who gave birth in the last 24 months preceding the study in Gura Dhamole Woreda, Bale Zone Southeast Ethiopia, 2017. METHODS: Community based cross-sectional study was implemented from March 25 to April 24, 2017 in Gura Dhamole Woreda on total of 402 study subjects who were selected by Multi-stage sampling technique. The data were collected using pre-tested structured questionnaire and data was coded, entered, cleaned and analyzed using Statistical Package for Social Service (SPSS) Version 20. Odds ratio with 95% Confidence Interval (CI) was used to assess associations the dependent and independent variables. Logistic regression model was employed to identify independent predictors and variables were declared statistically significant at P value < 0.05. RESULT: In this study only 29.2% of women were assisted by Skilled Birth Attendance (SBA) during their child birth. Place of residence, mother education, travel time, joint decision on the place of delivery, ANC visit frequency, birth preparedness and complication readiness status, knowledge on obstetric danger signs after delivery and knowledge of presence of maternity waiting homes were significantly associated with SBA utilization. CONCLUSION: Skilled birth attendant utilization in the study area was low. Strategies that improve attendance of antenatal care utilization and attention to birth preparedness and complication readiness and counseling on danger signs are recommended.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Partería/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Etiopía , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Parto Domiciliario/estadística & datos numéricos , Humanos , Mortalidad Materna , Madres/psicología , Embarazo
8.
Pan Afr Med J ; 33: 325, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692871

RESUMEN

Introduction: Anaemia in pregnancy remains a critical public health concern in many African settings; but its determinants are not clear. The purpose of this study was to assess anaemia at antenatal care initiation and associated factors among pregnant women in a local district of Ghana. Methods: A facility-based cross-sectional survey was conducted. A total of 378 pregnant women attending antenatal care at two health facilities were surveyed. Data on haemoglobin level, helminths and malaria infection status at first antenatal care registration were extracted from antenatal records booklets of each pregnant women. Questionnaires were then used to collect data on socio-demographic and dietary variables. Binary and multivariate logistic regression analyses were done to assess factors associated with anaemia. Results: The prevalence of anaemia was 56%, with mild anaemia being the highest form (31.0%). Anaemia prevalence was highest (73.2%) among respondents aged 15-19 years. Factors that significantly independently reduced the odds of anaemia in pregnancy after controlling for potential confounders were early (within first trimester) antenatal care initiation (AOR=5.01; 95% CI =1.41-17.76; p=0.013) and consumption of egg three or more times in a week (AOR=0.30; 95% CI=0.15-0.81; P=0.014). Conclusion: Health facility and community-based preconception and conception care interventions must not only aim to educate women and community members about the importance of early ANC initiation, balanced diet, protein and iron-rich foods sources that may reduce anaemia, but must also engage community leaders and men to address food taboos and cultural prohibitions that negatively affect pregnant woman.


Asunto(s)
Anemia/epidemiología , Educación en Salud/métodos , Complicaciones Hematológicas del Embarazo/epidemiología , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Ghana , Humanos , Embarazo , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
9.
BMC Public Health ; 19(1): 1467, 2019 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-31694607

RESUMEN

BACKGROUND: Malaria and tetanus infections among pregnant women represent two major public health problems in sub-Saharan Africa. Optimum use of Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (IPTp-SP) and immunization against tetanus among pregnant women during antenatal care (ANC) visits are recommended strategies to prevent these issues. Despite these recommendations, many women in Africa remain deprived of these cost-effective and life-saving interventions. In this study, we aimed to examine the prevalence of women using these two services, and the association between women's uptake of IPTp-SP and tetanus toxoid (TT) with antenatal care use in Ivory Coast. METHODS: This study was based on the fifth round of Multiple Indicator Cluster Survey (MICS 5) conducted in Ivory Coast in 2016. Participants were 9583 women aged between 15 and 49 years. Outcomes were TT and Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP). Data analysis was conducted using bivariate and multiple logistic regression. RESULTS: In this study, the prevalence of taking TT immunization and IPTp-SP drugs was 81.97 and 17.83% respectively. Of the participants who took these drugs at all, the prevalence of taking adequate doses of TT immunization was 78.75% and that of IPTp-SP was 35.46%. In the multivariable analysis model, higher age groups, 25-29 years (OR = 2.028, 95%CI = 1.120-3.669) were found to be positively associated with uptake of adequate doses of IPTp-SP drugs. Women who attended at least four ANC visits had higher odds of taking IPTp-SP drugs (OR = 1.656, 95%CI = 1.194-2.299) and TT immunization (OR = 2.347, 95%CI = 1.384-3.981), and also had higher odds of receiving adequate doses of IPTp-SP drugs (OR = 3.291, 95%CI = 2.157-5.020) and that of TT immunization (OR = 1.968, 95%CI = 1.398-2.771). The odds of taking IPTp-SP drugs were significantly higher among women with primary (OR = 2.504, 95%CI = 1.020-6.146) and secondary/higher education (OR = 3.298, 95%CI = 1.343-8.097) compared to those with no education. Also, women with higher parity had lower odds of taking TT immunization (OR = 0.218, 95%CI = 0.055-0.858) compared to those with lower parity. Findings from this study also revealed that the odds of taking adequate doses of IPTp-SP drugs were significantly lower among participants from Mandé du Nord ethnicity (OR = 0.378,95%CI = 0.145-0.983) compared to those from other ethnicities. CONCLUSION: In this study, uptake of IPTp-SP drugs was much lower than TT immunization. High number of ANC visits were found to be significantly associated with taking IPTp-SP drugs and TT immunization and also with that of taking them in adequate doses. Vaccination promotion is necessary to protect pregnant women and reduce adverse health outcomes among the newborn in Ivory Coast.


Asunto(s)
Antimaláricos/uso terapéutico , Malaria/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal/estadística & datos numéricos , Toxoide Tetánico/uso terapéutico , Tétanos/prevención & control , Adolescente , Adulto , Costa de Marfil , Combinación de Medicamentos , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Análisis Multivariante , Embarazo , Pirimetamina/uso terapéutico , Sulfadoxina/uso terapéutico , Encuestas y Cuestionarios , Adulto Joven
10.
BMC Public Health ; 19(1): 1493, 2019 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-31703734

RESUMEN

BACKGROUND: Antenatal care (ANC) services are critical for maternal health but Nigeria performs poorly in ANC utilisation compared to other countries in sub-Saharan Africa. This study aimed to assess socioeconomic inequalities in ANC utilisation and the determinants of these inequalities in Nigeria. METHODS: The 2013 Nigeria Demographic and Health Survey data with 18,559 women was used for analysis. The paper used concentration curves and indices for different measures of ANC utilisation (no ANC visit, 1-3 ANC visits, at least four ANC visits, and the number of ANC visits). A positive (or negative) concentration index means that the measure of ANC utilisation was concentrated on the richer (poorer) population compared to their poorer (richer) counterparts. The concentration indices were also decomposed using standard methodologies to examine the significant determinants of the socioeconomic inequalities in no ANC visit, at least four ANC visits, and the number of ANC visits. RESULTS: No ANC visit was disproportionately concentrated among the poor (concentration index (CI) = - 0.573), whereas at least four ANC visits (CI = 0.582) and a higher number of ANC visits (CI = 0.357) were disproportionately concentrated among the rich. While these results were consistent across all the geopolitical zones and rural and urban areas, the inequalities were more prevalent in the northern zones (which also have the highest incidence of poverty in the country) and the rural areas. The significant contributors to inequalities in ANC utilisation were the zone of residence, wealth, women's education (especially secondary) and employment, urban-rural residence, ethnicity, spousal education, and problems with obtaining permission to seek health care and distance to the clinic. CONCLUSIONS: Addressing wealth inequalities, enhancing literacy, employment and mitigating spatial impediments to health care use will reduce socioeconomic inequalities in ANC utilisation in Nigeria. These factors are the social determinants of health inequalities. Thus, a social determinants of health approach is needed to address socioeconomic inequalities in ANC coverage in Nigeria.


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Servicios de Salud Materna/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Factores Socioeconómicos , Adolescente , Adulto , Grupos Étnicos , Femenino , Encuestas Epidemiológicas , Humanos , Alfabetización , Nigeria , Embarazo , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto Joven
11.
J Glob Health ; 9(2): 020428, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31673341

RESUMEN

Background: Health Alliance International (HAI) with the Ministry of Health (MoH) of Timor-Leste and Catalpa International implemented a mobile phone-based mHealth program in 2013 known as Liga Inan ("Connecting Mothers"). Liga Inan was designed as a sustainable and scalable effort that would support MoH efforts to improve maternal and newborn health care-seeking and home practices. Key aims were to use mobile phone technology to improve communication between pregnant women and their MoH health providers and to increase optimal maternal health behaviors. MoH health staff registered pregnant women into Liga Inan at their first antenatal care (ANC) visit and followed them through pregnancy, delivery and six months postpartum. A web-based platform sent text messages twice weekly to promote safe pregnancy/delivery and facilitated phone communication between pregnant women and their MoH care providers. Methods: For the program's final evaluation, baseline (2012) and final (2015) surveys interviewed women in one intervention district and one adjacent control district who had given birth in the preceding two years. Primary outcomes were receiving four or more ANC visits, using skilled birth attendants, delivery in health facilities, and timely postnatal care. Results: Multivariate analysis compared endline maternal health behaviors for women in the intervention district compared to baseline and to women in the control district. Controlling for other factors, women in the intervention district had nearly twice the odds of having a skilled birth attendant and a facility delivery, nearly five times the odds of receiving a postpartum care visit within two days of delivery, and over five times the odds of having their newborn's health checked within two days of birth. There was no significant association between Liga Inan exposure and receipt of four or more ANC visits. Conclusions: Liga Inan was associated with substantial increases in MoH health provider-assisted and facility-based births and timely postnatal care in Timor-Leste. These positive results led the MoH to incorporate Liga Inan into the national maternal and child health program. To date the program has expanded to cover all 13 districts in the country, with gradual assumption of management and financial responsibility by the MoH under way.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Atención Posnatal/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Telemedicina/organización & administración , Adolescente , Adulto , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Recién Nacido , Persona de Mediana Edad , Embarazo , Evaluación de Programas y Proyectos de Salud , Timor Oriental , Adulto Joven
12.
Pan Afr Med J ; 33: 315, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31723374

RESUMEN

Introduction: The study investigated the prevalence of stillbirth at the Buea regional hospital, by taking cases of pregnant women who attended antenatal clinic(s) and those who did not attend but had their deliveries at the Buea regional hospital. The study specifically estimated the prevalence of stillbirths; identified possible risk factors associated with stillbirths, and determined whether the number of antenatal clinic visits is related to the occurrence of stillbirths-because during antenatal clinic visits, pregnant women are educated on risk factors of stillbirths such as: preterm deliveries; sex of the stillbirth; history of stillbirth; history of abortion(s); what age group of mothers are more likely to have a stillbirth. Methods: The study was a hospital based retrospective study at the maternity in which there were 3577 deliveries registered at the Buea regional hospital dated May 1st, 2014 to April 30th, 2017. With the aid of a checklist data was collected, analysed and presented with the use of tables, pie-charts and bar charts. Results: The prevalence of stillbirths was 26‰; possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; sex of stillbirths were more of females than males; and insufficient antenatal clinic attendance (≤1 antenatal clinic attendance) had more stillbirths. Conclusion: The study established that stillbirths can occur in any woman of child-bearing age. possible risk factors associated with stillbirths included: preterm deliveries; women aged 20-29 years; history of abortion(s); a history of stillbirth; gender of stillbirths were more of females than males; and insufficient antenatal clinic attendance (≤1 antenatal clinic attendance) had more stillbirths.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Nacimiento Prematuro/epidemiología , Atención Prenatal/estadística & datos numéricos , Mortinato/epidemiología , Adulto , Camerún/epidemiología , Femenino , Humanos , Masculino , Edad Materna , Embarazo , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Adulto Joven
13.
Afr J AIDS Res ; 18(4): 332-340, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31779576

RESUMEN

HIV testing rates remain stubbornly low among men - a crucial target population for reaching the ambitious global and regional goals of the HIV programme. In an era of declining donor funding, identifying cost-effective strategies to increase testing rates amongst men remains paramount. Antenatal care is an effective entry-point for the delivery of HIV testing services for women, and partner testing presents an important opportunity to reach their male partners. We present the results of a discrete choice experiment in Uganda, examining preferences among 824 pregnant women and 896 male partners regarding service delivery characteristics of HIV testing. Both men and women preferred nurse administered testing to self-testing (OR = 0.835; p < 0.001), oral testing over a finger-prick test (OR = 1.176; p < 0.001) and testing with a partner over testing alone (OR = 1.230; p < 0.001). Men had a preference for testing at home compared to testing at a clinic (OR = 1.099; p = 0.024), but women were indifferent regarding the testing location. The cost of testing had the biggest effect on preferences. Free testing was preferred over a cost of US$2.90 (OR = 0.781; p < 0.001) or US$2.00 (OR = 0.670; p < 0.001). Offering an incentive of US$3.40 increased men's preferences compared to a free test (OR = 1.168; p < 0.001), although this did not affect women's preferences. Partner testing linked to antenatal care is a potential strategy to increase testing coverage among men, particularly given the preference for partner testing - provided costs to clients remain low. Future cost-effectiveness evaluations should investigate the economic impact of reaching men using these strategies.


Asunto(s)
Infecciones por VIH/diagnóstico , Tamizaje Masivo/psicología , Prioridad del Paciente/estadística & datos numéricos , Mujeres Embarazadas/psicología , Atención Prenatal/estadística & datos numéricos , Parejas Sexuales/psicología , Adulto , Instituciones de Atención Ambulatoria , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Masculino , Embarazo , Atención Prenatal/psicología , Uganda/epidemiología
14.
Afr J Reprod Health ; 23(3): 30-41, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31782629

RESUMEN

Maternal mortality is attracting attention worldwide, but maternal health problems after delivery have received less attention. Most studies focus on prenatal maternal health problems. We aimed to identify factors associated with postpartum health problems among married women of reproductive age in Democratic Republic of the Congo. We employed a cross-sectional study design and randomly enrolled 700 married women of reproductive age in Kenge city. Data collection instrument was developed using the UNICEF Multiple Indicator Cluster Survey. T-test, chi-square test, and binary logistic regression analysis were performed using the SPSS version 24.0. Significant risk factors associated with postpartum health problems were initial postnatal care period; within 24 hours (Odds Ratio [OR]=2.197, 95% confidence interval [CI]: [1.156-4.174], p=.016); within 7 days (OR=1.972, 95% CI: [1.102-3.528, p=.022]; within 14 days (OR=2.124, 95% CI: [1.082-4.172], p=.029) among reproductive health and health service utilization characteristics. Health education by RECO (Relais Cmunataure) was associated with postpartum health problems including PCIME (Prise en Charge Integree des Maladies de l'Enfant; OR=1.845, 95% CI: [1.038- 3.282], p=.037); hand washing (OR=1.897, 95% CI: [1.060-3.396], p=.031); malaria (OR=2.003, 95% CI: [1.192-3.366], p=.009) among Maternal and Child Health intervention characteristics. In conclusion, it is necessary to develop and promote health policies and educational programs focusing on PNC service within 24 hours, PNC services within 7 days, PCIME, hand washing, prevention of malaria.


Asunto(s)
Servicios de Salud Materna/estadística & datos numéricos , Atención Posnatal/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , República Democrática del Congo/epidemiología , Femenino , Fiebre/epidemiología , Encuestas de Atención de la Salud , Humanos , Malaria/epidemiología , Matrimonio , Persona de Mediana Edad , Hemorragia Posparto/epidemiología , Periodo Posparto , Embarazo , Atención Prenatal/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
15.
BMC Public Health ; 19(1): 1472, 2019 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-31699062

RESUMEN

BACKGROUND: Globally, the magnitude of maternal mortality is the major public health problem. Nearly all (99%) of maternal deaths occur in low- and middle-income countries. Of which 66% occur in sub-Saharan Africa. Institutional delivery under the hygienic environment with the necessary skills and equipment promotes to identify and treat complications, infections, and the death of the mother and baby. In Ethiopia, the utilization of maternal health services is very low. For instance, 62% of women had antenatal care utilization during pregnancy while only 26% of women utilize institutions for delivery in 2016. Therefore, this study examined the association between antenatal care follow up and intestinal delivery among a nationally representative woman in Ethiopia. METHODS: A cross-sectional study design was used to examine 7575 women from the 2016 Ethiopia Demographic and Health Survey. Both descriptive and inferential statistics were utilized. Variables in the bivariate logistic regression with p-value < 0.2 were entered into the multivariable logistic regression. Odds ratios and corresponding 95% confidence intervals (CI) were reported. In the multivariable analysis, variables with p-value < 0.05 were considered as statistically significant. RESULTS: The prevalence of institutional delivery service utilization for last childbirth was 11.3%. In comparison with women with no antenatal care visits, the multivariable odds ratio (95% confidence interval) of institutional delivery among those who attend one to three and four or more antenatal care visit were 2.49 (1.66, 3.74) and 3.90 (2.60, 5.84), respectively. Other factors significantly associated with institutional delivery include urban residence 2.25 (1.44, 3.51), complete primary education 3.22 (2.09, 4.98), complete secondary or higher education 1.59 (1.16, 2.17), poorer household wealth index 2.57 (1.57, 4.20), middle household wealth index 1.63 (1.05, 2.52), and richer household wealth index 1.56(1.03, 2.58). CONCLUSION: Antenatal care follow-up was significantly associated with institutional delivery service utilization. As the number of antenatal care visits increased the odds of facility delivery increased. Thus, improved access and utilization of antenatal care can be an effective strategy to increase institutional deliveries and optimal maternal and child health outcomes.


Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Instituciones de Salud/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Renta , Modelos Logísticos , Mortalidad Materna , Oportunidad Relativa , Embarazo , Adulto Joven
16.
BMC Health Serv Res ; 19(1): 810, 2019 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-31699085

RESUMEN

BACKGROUND: Even though maternal mortality during the time of delivery can be prevented with proper medical care in the health facilities with skilled healthcare professionals, unexpectedly death is still high and is a persistent challenge for low-income countries. Therefore identifying factors affecting the preference of institutional delivery after antenatal care service attendance is a key intervention to reduce maternal morbidity and mortality. METHOD: A community-based cross-sectional study was conducted using face to face using interviewer-administered questionnaire from a total of 528 women who gave their last birth within 12 months prior to the study period who attended antenatal care (ANC) services. Descriptive statistics, bivariable and multivariable logistic regressions analysis were performed. Statistical significance was considered at p < 0.05 and odds ratio with 95% CI were calculated to examine factors associated with institutional delivery. RESULTS: Of the 528 pregnant women attending ANC services, 250 (47.3%) gave birth in health facilities (95% CI: 43.2, 51.7%). Urban residence [AOR = 7.8, 95% CI: 4.1, 15.6], four or more ANC visits [AOR = 4.5, 95% CI: 1.6, 12.3], those who got health education on ANC [AOR = 2.9, 95% CI: 1.5, 5.6] and decision on place of delivery with her partner agreement [AOR = 3.3, 95% CI: 1.3, 8.7] were found to be contributing factors for the preference of institutional delivery. CONCLUSION: Institutional delivery was not adequate. Residence, number of antenatal care visits, health education, decisions making on a place of delivery and having awareness of the difference of place of delivery were contributing factors for the preference of institutional delivery.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Prioridad del Paciente/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adulto , Estudios Transversales , Toma de Decisiones , Etiopía , Femenino , Educación en Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud , Humanos , Embarazo , Características de la Residencia/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
17.
S Afr Med J ; 109(9): 652-658, 2019 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-31635589

RESUMEN

BACKGROUND: Despite preventive measures and effective treatment, congenital syphilis continues to impact significantly on neonatal morbidity and mortality. There has been no recent South African (SA) published literature reviewing congenital syphilis, particularly in the context of a tertiary neonatal setting. OBJECTIVES: To describe the clinical features of symptomatic neonates with congenital syphilis and to identify modifiable patient, clinical and health facility factors that contributed to syphilis infection. METHODS: All positive serological tests for syphilis performed in neonates at Groote Schuur Hospital (GSH), Cape Town, SA, between 1 January 2011 and 31 December 2013 were obtained. Folders were reviewed, and neonates with clinical signs of congenital syphilis were included. RESULTS: Of 50 symptomatic neonates, 19 (38%) died. Twenty-eight mothers (56%) were unbooked and therefore received no antenatal care. Most mothers (98%) were inadequately treated. Health worker-related failures included poor notification and partner tracing as well as failure to recheck syphilis serology after 32 weeks' gestation in mothers who initially tested negative. Thirty-four neonates required intensive care unit admission. Two significant predictors of mortality were 1-minute and 5-minute Apgar scores <5. Hydrops fetalis was an independent risk factor for mortality, as were moderate to severely abnormal cranial ultrasound scan findings. CONCLUSIONS: Congenital syphilis in neonates admitted to the GSH neonatal unit was associated with substantial morbidity and mortality. The modifiable factors identified represent inadequate antenatal healthcare and health system failures. These factors are longstanding, highlighting the need to establish governance and audit processes and address the continuing socioeconomic and sociocultural barriers that mothers face as a way forward in ultimately eliminating this entirely preventable disease.


Asunto(s)
Complicaciones Infecciosas del Embarazo/diagnóstico , Atención Prenatal/estadística & datos numéricos , Sífilis Congénita/epidemiología , Sífilis/diagnóstico , Adulto , Puntaje de Apgar , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/microbiología , Estudios Retrospectivos , Sudáfrica/epidemiología , Sífilis/epidemiología , Serodiagnóstico de la Sífilis , Sífilis Congénita/mortalidad , Centros de Atención Terciaria , Adulto Joven
18.
Afr Health Sci ; 19(2): 1841-1848, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31656466

RESUMEN

Background: Maternal, fetal and neonatal mortality are 10 to 100 fold higher in many low-income compared to high-income countries. Reasons for these discrepancies include limited antenatal care and delivery outside health facilities. Objectives: The study aimed at conducting a baseline survey to assess the current levels of maternal health indicators in six counties in Western Kenya. Methods: This was a cross sectional study conducted targeting women residing in Uasin-Gishu, ElgeyoMarakwet, TransNzoia, Bungoma, Busia and Kakamega counties who had given birth five years prior to the interview. Socio-demographic and maternal indicators were collected using forms adopted from KDHS 2009. Interviews were conducted in the homesteads between December 2015 and June 2016. Results: A total of 6257 women participated in the study, median age 27 years IQR 23-32. Majority of the women had post-primary level of education, were married and 40% were members of an income-generating activity. 56.8% were using modern family planning method, 49% attended WHO recommended four plus antenatal clinic visits and only 20% attended in the first trimester. Majority, 85% had their most recent delivery in a health facility. Conclusion: Findings suggest that women are not attending recommended four plus antenatal clinic visits and even those that attend are few are during the first trimester.


Asunto(s)
Salud Materna , Centros de Salud Materno-Infantil/organización & administración , Servicios de Salud Materno-Infantil/normas , Cooperación del Paciente , Atención Prenatal/estadística & datos numéricos , Atención Primaria de Salud/métodos , Adulto , Niño , Centros Comunitarios de Salud/organización & administración , Conducta Anticonceptiva , Estudios Transversales , Femenino , Humanos , Kenia , Mortalidad Materna , Embarazo , Atención Primaria de Salud/organización & administración , Factores Socioeconómicos
19.
Pan Afr Med J ; 33: 123, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31565114

RESUMEN

Introduction: The proportion of antenatal attendants in Ghana who had at least four antenatal visits increased from 78% in 2008 to 87% in 2014. However, it is not known whether these visits followed the recommended timing of focused antenatal clinic attendance in Ghana. We sought to assess the adherence to the clinic schedule and its determinants in the Accra Metropolis. Methods: A cross-sectional study was conducted. Face-to-face interviews were conducted with postpartum women. Multiple logistic regression was used in the analysis of determinants of adherence to the recommended timing of clinic attendance. A p-value of <0.05 was considered statistically significant. Results: Among 446 focused antenatal care clinic attendants, 378 (84.8%) had four or more visits. Among these, 101 (26.7%) adhered to the recommended clinic schedule. Women who adhered were more likely to have had education up to Junior High School [AOR=3.31, 95%CI (1.03-10.61)] or Senior High School [AOR=4.47, 95%CI (1.14-17.51)], or have history of abortion [(AOR=3.36, 95%CI (1.69-7.96)]. For every week increase in gestational age at booking at the antenatal clinic, respondents were 34% less likely to complete all four antenatal visits at the recommended times. [(AOR=0.66, 95% (0.60-0.73)]. Conclusion: Majority of women receiving focused antenatal care in the Accra Metropolis have four or more visits but only about a quarter of them adhered to the recommended clinic schedule. Having high school education, history of abortion and early initiation of antenatal care were predictors of adherence to clinic schedule. Women should be educated on early initiation of antenatal care to enhance adherence.


Asunto(s)
Edad Gestacional , Cooperación del Paciente/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Adulto , Estudios Transversales , Escolaridad , Femenino , Ghana , Humanos , Entrevistas como Asunto , Modelos Logísticos , Embarazo , Factores de Tiempo , Adulto Joven
20.
BMC Health Serv Res ; 19(1): 684, 2019 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-31590662

RESUMEN

BACKGROUND: This study aimed to assess the quality of antenatal care (ANC) women received in Migori county, Kenya-including both service provision and experience dimensions-and to examine factors associated with each dimension. METHODS: We used survey data collected in 2016 in Migori county from 1031 women aged 15-49 who attended ANC at least once in their most recent pregnancy. ANC quality service provision was measured by nine questions on receipt of recommended ANC services, and experience of care by 18 questions on information, communication, dignity, and facility environment. We summed the responses to the individual items to generate ANC service provision and experience of care scores. We used both linear and logistic regression to examine predictors. RESULTS: The average service provision score was 10.9 (SD = 2.4) out of a total of 16. Most women received some recommended services once, but not at the frequency recommended by the Kenyan Ministry of Health. About 90% had their blood pressure measured, and 78% had a urine test, but only 58 and 14% reported blood pressure monitoring and urine test, respectively, at every visit. Only 16% received an ultrasound at any time during ANC. The average experience score is 27.3 (SD = 8.2) out of a total score of 42, with key gaps demonstrated in communication. About half of women were not educated on pregnancy complications. Also, about one-third did not often understand the purposes of tests and medicines received and did not feel able to ask questions to the health care provider. In multivariate analysis, women who were literate, employed, and who received all their ANC in a health center had higher experiences scores than women who were illiterate (coefficient = 1.52, CI:0.26,2.79), unemployed (coefficient = 2.73, CI:1.46,4.00), and received some ANC from a hospital (coefficient = 1.99, CI: 0.84, 3.14) respectively. The wealthiest women had two times higher odds of receiving an ultrasound than the poorest women (OR = 2.00, CI:1.20,3.33). CONCLUSION: Quality of ANC is suboptimal in both service provision and experience domains, with disparities by demographic and socioeconomic factors and facility type. More efforts are needed to improve quality of ANC and to eliminate the disparities.


Asunto(s)
Prestación de Atención de Salud/normas , Complicaciones del Embarazo/terapia , Atención Prenatal/normas , Calidad de la Atención de Salud , Adolescente , Adulto , Femenino , Humanos , Kenia , Modelos Logísticos , Persona de Mediana Edad , Embarazo , Atención Prenatal/estadística & datos numéricos , Salud Rural , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
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