Association of congenital heart defects (CHD) with factors related to maternal health and pregnancy in newborns in Puerto Rico.

Background: Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States, there is a compelling need to investigate the intricate interplay among BMI, pregestational, and gestational maternal diabetes, and their potential impact on the occurrence of congenital heart defects (CHD) during neonatal development. Methods: Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico, we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020. Our assessment encompassed a range of variables, including maternal age, gestational age, BMI, pregestational diabetes, gestational diabetes, hypertension, history of abortion, and presence of preeclampsia. Results: A cohort of 673 patients was included in our study. The average maternal age was 26 years, within a range of 22 to 32 years. The mean gestational age measured 39 weeks, with a median span of 38 to 39 weeks. Of the 673 patients, 274 (41%) mothers gave birth to neonates diagnosed with CHD. Within this group, 22 cases were linked to pre-gestational diabetes, while 202 were not; 20 instances were associated with gestational diabetes, compared to 200 without; and 148 cases exhibited an overweight or obese BMI, whereas 126 displayed a normal BMI. Conclusion: We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD. However, our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD. These results may aid in developing effective strategies to prevent and manage CHD in neonates.

Changes in reproductive, maternal, and child health in Haiti during the pre- and peri-COVID-19 pandemic / Cambios en materia de salud reproductiva, materna e infantil en los periodos pre y peripandémico de la COVID-19 en Haití / Mudanças na saúde reprodutiva, materna e infantil no Haiti antes e durante a pandemia de COVID-19

[ABSTRACT]. Objective. To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. Methods. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. Results. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneu- mococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. Conclusions. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

[RESUMEN]. Objetivo. Evaluar los cambios en materia de salud reproductiva, materna, neonatal, infantil y adolescente que se produjeron en Haití desde agosto del 2018 hasta septiembre del 2021, antes de la pandemia de COVID-19 y durante ella. Metodología. Estudio retrospectivo basado en datos de vigilancia del sistema único de información de salud de Haití para estudiar los periodos pre y peripandémico. La comparación de los indicadores de salud a nivel nacional de estos dos periodos se realizó mediante pruebas de t de dos muestras para comparar proporciones, y se calculó el promedio de la variación mensual absoluta mediante una regresión ponderada por la varianza. Resultados. Al comparar el periodo prepandémico con el peripandémico, se observó un descenso estadísticamente significativo de la mayoría de los indicadores porcentuales evaluados. Sin embargo, los indicadores porcentuales más afectados fueron los de mujeres embarazadas con cuatro visitas de atención prenatal, con cinco visitas de atención prenatal o más, o que recibieron una segunda dosis de la vacuna contra el tétanos; estos indicadores disminuyeron en más de cuatro puntos porcentuales en el segundo periodo en comparación con el primero. Asimismo, las proporciones de niños y niñas que recibieron las vacunas contra la difteria, el tétanos y la tosferina (DTPa), contra la poliomielitis, antirrotavírica, BCG, y pentavalente también disminuyeron en más de ocho puntos porcentuales. En cambio, la proporción de niños y niñas que recibieron la vacuna antineumocócica conjugada aumentó en más de cuatro puntos porcentuales. También se observó un descenso estadísticamente significativo en el promedio de la variación mensual absoluta de varios indicadores de salud reproductiva e infantil. Conclusiones. La pandemia de COVID-19 puede haber contribuido al descenso observado en varios indica- dores relacionados con la salud reproductiva, materna, neonatal, infantil y adolescente en Haití. Sin embargo, no se puede descartar el papel que ha desempeñado en dicho descenso la crisis sociopolítica y el control ejercido por los grupos armados sobre la población en los últimos tres años.

[RESUMO]. Objetivo. Avaliar mudanças na saúde reprodutiva, materna, neonatal, da criança e do adolescente no Haiti entre agosto de 2018 e setembro de 2021, antes e durante a pandemia de COVID-19. Métodos. Estudo retrospectivo usando dados de vigilância do Sistema Único de Informações de Saúde do Haiti, examinando dois períodos, antes e durante a pandemia de COVID-19. Os indicadores de saúde do país nos dois períodos foram comparados por meio de testes t de duas amostras para proporções, e as variações mensais absolutas médias foram calculadas por meio de regressão linear ponderada. Resultados. Entre o período anterior e o período durante a pandemia de COVID-19, houve uma queda estatisticamente significante na proporção da maioria dos indicadores avaliados. Os indicadores mais afetados, porém, foram as proporções de gestantes com quatro consultas de pré-natal, gestantes com cinco ou mais consultas de pré-natal e gestantes que receberam uma segunda dose de vacina antitetânica, que sofreram uma diminuição de mais de 4 pontos percentuais na comparação entre os dois períodos. Similarmente, as proporções de crianças que receberam vacinas contra difteria, tétano e pertússis (DTPa), BCG, poliomielite, pentavalente e rotavírus também diminuíram em mais de 8 pontos percentuais. Por outro lado, no caso da vacina pneumocócica conjugada houve um aumento de mais de 4 pontos percentuais. Além disso, foi observada uma redução estatisticamente significante nas variações mensais absolutas médias de vários indicadores de saúde reprodutiva e infantil avaliados. Conclusões. A pandemia de COVID-19 pode ter contribuído para a piora observada em vários indicadores de saúde reprodutiva, materna, neonatal, da criança e do adolescente no Haiti. No entanto, não se pode descartar o papel desempenhado pela crise sociopolítica e pelo controle exercido por grupos armados sobre a população nos últimos três anos.

Integração da vigilância e atenção à saúde no tratamento da sífilis gestacional: análise dos indicadores do PQAVS e do Previne Brasil na Paraíba / Integration of surveillance and health care in the management of gestational syphilis: analysis of PQAVS and Previne Brasil indicators in Paraíba / Integración de la vigilancia y la atención a la salud en el tratamiento de la sífilis gestacional: análisis de los indicadores PQAVS y Previne Brasil en Paraíba

Este artigo se baseia em um estudo feito com o objetivo de analisar indicadores sobre a testagem da sífilis na gestação no Programa de Qualificação das Ações de Vigilância em Saúde (PQAVS) e no Programa Previne Brasil no estado da Paraíba, e também de levantar aspectos do tratamento terapêutico para sífilis gestacional. Trata-se de uma pesquisa descritiva-exploratória, na qual foram sistematizados dados do indicador 11, testes por gestantes, do PQAVS e do indicador de desempenho da Atenção Primária à Saúde (APS), com base na proporção de gestantes que realizaram exames de sífilis e HIV durante o pré-natal em 2020; também foi feita a sistematização do webquestionário direcionado a profissionais da APS (médicos/enfermeiros) e autoaplicado sobre a atuação e tratamento terapêutico para sífilis gestacional. Dos 223 municípios da Paraíba, apenas 12% atingiram a meta do PQAVS e 39% a do Previne Brasil em 2020. Em relação ao webquestionário, houve a participação de 142 profissionais, dos quais 85% realizam o tratamento terapêutico preconizado pelo Ministério da Saúde para a APS. Desse modo, deve ser ressaltada a importância da ampliação da oferta de testes para sífilis, dos insumos para o tratamento adequado e da qualificação dos profissionais e da informação em saúde.

This article is based on a study to analyze indicators on syphilis testing during pregnancy in the PQAVS - Programa de Qualificação das Ações de Vigilância em Saúde (Health Surveillance Actions Qualification Programme) and in the Programa Previne Brasil (Previne Brasil Programme) in the state of Paraíba, Brazil, and also to survey aspects of the therapeutic management for gestational syphilis. It is a descriptive-exploratory research, in which data from indicator 11, tests for pregnant women, from the PQAVS and from the Primary Health Care (PHC) performance indicator, based on the proportion of pregnant women with syphilis and HIV tests during prenatal care in 2020 were systematised; in addition to this systematization, a self-administered webquestionnaire on the performance and therapeutic management for gestational syphilis by professionals (doctors/nurses) from the PHC was also systematised. Taking into account the 223 municipalities in Paraíba, only 12% reached the PQAVS goal and 39% reached the Previne Brasil goal in 2020. Regarding the webquestionnaire, 85% of the 142 professionals who answered it, carry out the therapeutic management recommended by the Ministry of Health for the PHC. Thus, it is fundamental to emphasise the importance of expanding the supply of tests for syphilis, supplies for adequate treatment, and the qualification of health professionals and information.

El presente artículo se basa en un estudio efectuado con el objetivo de analizar indicadores sobre la prueba de sífilis durante el embarazo en el PQAVS - Programa de Qualificação das Ações de Vigilância em Saúde (Programa de Calificación para Acciones de Vigilancia en Salud) y en el Programa Previne Brasil en el estado de Paraíba, Brasil, y de resaltar aspectos del tratamiento terapéutico de la sífilis gestacional. Se trata de una investigación descriptiva-exploratoria, en la que se sistematizaron datos del indicador 11, pruebas realizadas por embarazadas, del PQAVS y del indicador de desempeño de la Atención Primaria de Salud (APS), a partir de la proporción de gestantes que se sometieron a pruebas de sífilis y de HIV durante la atención prenatal en 2020; también se sistematizóel cuestionario web dirigido a profesionales de la APS (médicos/enfermeros) y autoadministrado sobre el desempeño y el tratamiento terapéutico de la sífilis gestacional. De los 223 municipios de Paraíba, apenas 12% alcanzaron la meta del PQAVS y 39% lograron la meta del Previne Brasil en 2020. En relación al cuestionario web, participaron 142 profesionales, de los cuales 85% realizan el tratamiento terapéutico recomendado por el Ministerio de Salud para la APS. Así, es fundamental la importancia de ampliar la oferta de pruebas para la sífilis, de los medicamentos para el tratamiento adecuado, la calificación de los profesionales e la información relacionada a la salud.

El acceso a los servicios de salud sexual y reproductiva en la región de las Américas

Esta publicación presenta los lineamientos y acuerdos del documento informativo “Estado del acceso a servicios de salud sexual y reproductiva”, elaborado por la Organización Panamericana de la Salud a solicitud de sus Estados Miembros en la 30.ª Conferencia Sanitaria Panamericana. El documento fue presentado y aprobado por unanimidad por los países de la Región de las Américas en la 60.º Reunión delConsejo Directivo, 75.ª Sesión del Comité Regional de la Organización Mundial de la Salud para las Américas, realizada en Washington, D.C., Estados Unidos de América, del 25 al 29 de septiembre del 2023. Su objetivo es describir el estado de situación del acceso a los servicios de salud sexual y reproductiva (SSR) en la Región de las Américas, identificar respuestas sanitarias y barreras de acceso, y sugerir recomendaciones para los países. El documento desarrollado a partir de una revisión y sistematización de datos, planes e iniciativas, artículos científicos, informes de Naciones Unidas y marcos jurídicos y regulatorios sobre SSR.

Access to sexual and reproductive health services in the Region of the Americas

This brief presents the guidelines and agreements in the information document Status of access to sexual and reproductive health services, prepared by the Pan American Health Organization (PAHO) at the request of its Member States at the 30th Pan American Sanitary Conference. It was presented and unanimously approved by the countries of the Region of the Americas at the 60th Meeting of the Directing Council, 75th session of the WHO Regional Committee for the Americas, held in Washington, D.C., USA, September 25-29, 2023. Its objective is to describe the status of access to sexual and reproductive health services in the Americas region, identify health responses and barriers to access, and suggest recommendations for countries. It was developed based on a review and systematization of data, plans and initiatives, scientific papers, United Nations reports, and legal and regulatory frameworks on sexual and reproductive health.

Tande nou gwonde! (Hear us roar!)- Youth perspectives of maternal near-misses: Protocol for a photovoice study of young childbearing people's perspectives of maternal near-misses in northwest Haiti.

INTRODUCTION: Globally, a shift is occurring to recognize the importance of young peoples' health and well-being, their unique health challenges, and the potential they hold as key drivers of change in their communities. In Haiti, one of the four leading causes of death for those 20-24 years old is pregnancy, childbirth, and the weeks after birth or at the end of a pregnancy. Important gaps remain in existing knowledge about youth perspectives of maternal health and well-being within their communities. Youth with lived experiences of maternal near-misses are well-positioned to contribute to the understanding of maternal health in their communities and their potential role in bringing about change. OBJECTIVES: To explore and understand youth perspectives of maternal near-miss experiences that occurred in a local healthcare facility or at home in rural Haiti. METHODS: We will conduct a qualitative, community-based participatory research study regarding maternal near-miss experiences to understand current challenges and identify solutions to improve community maternal health, specifically focused on youth maternal health. We will use Photovoice to seek an understanding of the lived experiences of youth maternal near-miss survivors. Participants will be from La Pointe, a Haitian community served by their local healthcare facility. We will undertake purposeful sampling to recruit approximately 20 female youth, aged 15-24 years. Data will be generated through photos, individual interviews and small group discussions (grouped by setting of near-miss experience). Data generation and analysis are expected to occur over a three-month period. ETHICS AND DISSEMINATION: Ethics approval will be sought from Centre Médical Béraca in La Pointe, Haiti, and from the Hamilton Integrated Research Ethics Board in Hamilton ON, Canada. We will involve community stakeholders, especially youth, in developing dissemination and knowledge mobilisation strategies. Our findings will be disseminated as an open access publication, be presented publicly, at conferences, and defended as part of a doctoral thesis.

Maternal health surveillance panel: a tool for expanding epidemiological surveillance of women's health and its determinants.

OBJECTIVE: To present the methodology used in the development of two products for maternal health surveillance and its determinants and discuss their possible uses. METHODS: Based on a theoretical model of the determinants of maternal death and databases of Brazilian health information systems, two free products were developed: an interactive panel "surveillance of maternal health" and an educational material "Aparecida: a story about the vulnerability of Brazilian women to maternal death", both available on the website of the Brazilian Obstetric Observatory. RESULTS: More than 30 indicators were calculated for the period 2012-2020, containing information on socioeconomic conditions and access to health services, reproductive planning, prenatal care, delivery care, conditions of birth and maternal mortality and morbidity. The indicators related to severe maternal morbidity in public hospitalizations stand out, calculated for the first time for the country. The panel allows analysis by municipality or aggregated by health region, state, macro-region and country; historical series analysis; and comparisons across locations and with benchmarks. Information quality data are presented and discussed in an integrated manner with the indicators. In the educational material, visualizations with national and international data are presented, aiming to help in the understanding of the determinants of maternal death and facilitate the interpretation of the indicators. CONCLUSION: It is expected that the two products have the potential to expand epidemiological surveillance of maternal health and its determinants, contributing to the formulation of health policies and actions that promote women's health and reduce maternal mortality.

A composite index; socioeconomic deprivation and coverage of reproductive and maternal health interventions.

Objective: To examine inequalities in the coverage of reproductive and maternal health interventions in low- and middle-income countries and territories using a composite index of socioeconomic deprivation status. Methods: We obtained data on education and living standards from national household surveys conducted between 2015 and 2019 to calculate socioeconomic deprivation status. We assessed the coverage of reproductive and maternal health interventions, using three indicators: (i) demand for family planning satisfied with modern methods; (ii) women who received antenatal care in at least four visits; and (iii) the presence of a skilled attendant at delivery. Absolute and relative inequalities were evaluated both directly and using the slope index of inequality and the concentration index. Findings: In the 73 countries and territories with available data, the median proportions of deprivation were 41% in the low-income category, 11% in the lower-middle-income category and less than 1% in the upper-middle-income category. The coverage analysis, conducted for 48 countries with sufficient data, showed consistently lower median coverage among deprived households across all health indicators. The coverage of skilled attendant at delivery showed the largest inequalities, where coverage among the socioeconomically deprived was substantially lower in almost all countries. Antenatal care visits and demand for family planning satisfied with modern methods also showed significant disparities, favouring the less deprived population. Conclusion: The findings highlight persistent disparities in the coverage of reproductive and maternal health interventions, requiring efforts to reduce those disparities and improve coverage, particularly for skilled attendant at delivery.

Perfil clínico e epidemiológico de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina / Clinical and epidemiological profile of pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina

Objetivo: Nos últimos anos, a epidemia de HIV tem incidido consideravelmente e de forma silenciosa na população de mulheres gestantes, sobretudo devido à subnotificação, ao diagnóstico tardio e à negligência quanto à realização de teste anti-HIV pelas infectadas. Diante disso, este estudo tem por objetivo descrever o perfil clínico e epidemiológico de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina. Métodos: Trata-se de um estudo ecológico, ana- lítico, retrospectivo, com base em dados secundários retirados das plataformas Sistema de Informações de Agravos de Notificação (Sinan) e Sistema de Monitora- mento Clínico das Pessoas Vivendo com HIV/AIDS (SIMC), acerca de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina, no período entre 2019 e 2022. Resultados: A partir dos dados sociodemográficos, obteve-se um perfil epidemiológico prevalente de mulheres com idade entre 30 e 49 anos, brancas, com baixo nível de escolaridade e entre 1 a 13 semanas de gestação no momento da notificação de infecção por HIV. O perfil clínico apontou para a prevalência de mulheres em uso de terapia antirretroviral, com carga viral acima de 1.000 cópias/ mL e contagem de linfócitos T-CD4+ superior a 350 células/mm3. Conclusão: Apesar do baixo nível de escolaridade e da elevada carga viral, o resultado foi positivo para a população selecionada, uma vez que foi demonstrada boa adesão ao tra- tamento e alta contagem de linfócitos, sendo esses bons preditores de evolução clínica para o HIV.

Objective: In recent years, the HIV epidemic has significantly and silently affected the population of pregnant women, mainly due to underreporting, late diagnosis, and neglect of HIV testing among infected individuals. In light of this, the aim of this study is to describe the clinical and epidemiological profile of pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina. Methods: This is an ecological, analytical, retrospective study based on secondary data retrieved from the Notifiable Diseases Information System (Sinan) and the Clinical Monitoring System for People Living with HIV/ AIDS (SIMC), regarding pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina from 2019 to 2022. Results: Based on sociodemographic data, a prevalent epidemiological profile was identified, with women aged 30 to 49 years, white, with low educational level, and between 1 to 13 weeks of gestation at the time of HIV infection notifica- tion. The clinical profile revealed a prevalence of women on antiretroviral therapy, with a viral load above 1,000 copies/ mL and a T-CD4+ lymphocyte count above 350 cells/mm3. Conclusion: Despite the low educational level and high viral load, the outcome was positive for the selected population, as good treatment adherence and high lymphocyte count were demonstrated, both of which are good predictors of clinical progression for HIV.

Toward zero maternal deaths

Since 2015, maternal mortality has been steadily increasing in the Americas, highlighting the need for urgent action. The maternal mortality ratio (MMR) in 2020 returned to the same level observed in the early 2000s, marking a setback of 20 years. Between 2015 and 2020, the MMR increased by 17% in the Americas, leading to 25 maternal deaths per day in 2020. Compared with other WHO Regions, the Americas has registered the highest increase in the MMR globally. Despite the fact that 98% of births were attended by skilled health personnel in 2020, the MMR in the Americas for that year was 68 deaths per 100 000 live births. It is estimated that since 2020 the MMR has remained at the same high level for the Region. Tackling this negative trend, in March 2023 the Regional Task Force for the Reduction of Maternal Mortality, led by the Pan American Health Organization (PAHO), launched the campaign Zero Maternal Deaths: Prevent the Preventable to accelerate progress toward the regional goal of fewer than 30 maternal deaths per 100 000 live births, as outlined in PAHO’s Sustainable Health Agenda for the Americas.

Recommendations for the management of major obstetric emergencies

This edition of Recommendations for the management of major obstetric emergencies includes the update of the chapters 'Hypertensive states of pregnancy', 'Postpartum hemorrhage', 'Cardiovascular resuscitation in pregnancy', 'Early warning system and rapid response teams in obstetrics'. Following the GRADE system to define the quality of the evidence, recommendations are made for the approach oto pulmonary thromboembolism and pregnancy, amniotic fluid embolism, COVID-19 and pregnancy, influenza and pregnancy, and maternal sepsis. This publication seeks to support efforts to achieve goal 3.1 of the SDGs of reducing the global maternal mortality rate to less than 70 per 100 000 live births until 2030.

Recomendaciones para la atención de las principales emergencias obstétricas

Esta edición de Recomendaciones para la atención de las principales emergencias obstétricas incluye la actualización de los capítulos Estados hipertensivos del embarazo, Hemorragia postparto, Reanimación cardiovascular en el embarazo, Sistema de alerta temprano y equipos de respuesta rápida en Obstetricia. Siguiendo el sistema GRADE para definir la calidad de la evidencia y la fortaleza de la recomendación se plantean recomendaciones para el abordaje del tromboembolismo pulmonar y embarazo, embolismo de líquido amniótico, Covid-19 y embarazo, influenza y embarazo y sepsis materna. Con esta publicación se busca apoyar los esfuerzos para lograr la concretización de la meta 3.1 de los ODS de reducir la tasa mundial de mortalidad materna a menos de 70 por cada 100.00 nacidos vivos hasta el 2030.

Cuidados culturales en el embarazo, parto y posparto en mujeres de la región boyacense colombiana / Cultural Care during Pregnancy, Childbirth and Puerperium in Women from the Colombian Region of Boyacá

Introducción: Las mujeres de la región boyacense colombiana cuentan con una importante herencia de campesina e indígena relacionada con creencias y prácticas de cuidados culturales en la maternidad. Objetivo: Interpretar los cuidados culturales en el embarazo, parto y posparto de mujeres de la región boyacense colombiana. Métodos: Estudio cualitativo fenomenológico, que contó con la participación de 20 mujeres que vivieron su embarazo, parto y posparto en la región boyacense colombiana, con muestreo por bola de nieve. La recolección de la información se hizo mediante observación, diario de campo y entrevistas; el análisis de la información se hizo por medio de codificación abierta, interpretativa y axial con el software Atlas TI 8.0. Resultados: Las mujeres tenían una edad promedio de 33,9 años (DE: 5,7), 14 (70 por ciento) son empleadas, 11 (55 por ciento) tienen un solo hijo. Se identificaron 88 códigos, 12 subcategorías y 3 categorías: cuidados culturales en el embarazo (plantas medicinales, masajes y aromaterapia), en el parto (duchas calientes, ejercicios y posiciones) y puerperio (plantas medicinales para la cicatrización, evitar el frío, guardar tiempo de dieta y uso de método del ritmo). Conclusiones: Se necesita replantear la atención en salud materna y el cuidado de Enfermería para responder a las necesidades culturales de las mujeres, para preservar las prácticas tradicionales beneficiosas y mediar ante las que sean riesgosas(AU)

Introduction: Women in the Colombian region of Boyacá have an important peasant and indigenous heritage related to beliefs and practices of cultural care in maternity. Objective: To interpret the cultural care in pregnancy, childbirth and postpartum of women in the Colombian region of Boyacá. Methods: A qualitative phenomenological study was conducted, with the participation of 20 women who lived their pregnancy, childbirth and postpartum in the Colombian region of Boyacá. Snowball sampling was applied. The information was collected through observation, field diary and interviews. The information was analyzed by means of open, interpretative and axial coding using the Atlas TI 8.0 software. Results: The women had a mean age of 33.9 years (SD: 5.7), 14 (70 percent) are employees, and 11 (55 percent) have only one child. Eighty-eight codes and 12 subcategories were identified, together with 3 categories: cultural care in pregnancy (medicinal plants, massage and aromatherapy), in childbirth (hot showers, exercise and positions) and puerperium (medicinal plants for healing, avoiding cold temperature, keeping diet time and usage of the rhythm method). Conclusions: Maternal health care and nursing care need to be rethought in view of responding to the cultural needs of women to preserve beneficial traditional practices and mediate against risky ones(AU)

A influência do engajamento paterno na qualidade de vida de mães de crianças com deficiência / The influence of paternal engagement on the quality of life of mothers of children with disabilities

Resumo A literatura frequentemente descreve a sobrecarga vivida pelas mães como um dos principais desafios enfrentados pelas famílias com crianças com deficiência, o que pode levar a problemas de saúde mental. Pouco se encontra sobre a participação dos pais e sobre como essa participação impacta a qualidade de vida das mães. Objetiva-se aqui, assim, investigar a correlação entre o engajamento paterno e a qualidade de vida das mães de crianças com deficiência. Trata-se de um estudo transversal, descritivo, quantitativo e qualitativo, realizado com pais e mães de crianças com deficiência em tratamento em uma clínica de reabilitação neurofuncional. Encontrou-se, a partir das respostas de 35 pais e 35 mães, que não há correlação linear entre as variáveis pesquisadas, entretanto, a maioria das mães desejam mais ajuda para cuidar dos filhos e gostariam que os pais fossem mais envolvidos no tratamento deles. O engajamento dos pais de filhos com deficiência demonstrou-se semelhante ao dos pais de crianças típicas, estando mais atrelado ao suporte emocional do que à realização de cuidados diretos e indiretos. Conclui-se que são necessários estudos como este em populações com diferentes características para verificar o comportamento das variáveis e abordagens qualitativas com os pais.

Abstract The literature often describes the burden experienced by mothers as one of the main challenges faced by families with children with disabilities, which can lead to mental health problems. Little is found about the participation of fathers and how this participation impacts the quality of life of mothers. The objective is to investigate the correlation between paternal engagement and the quality of life of mothers of children with disabilities. This is a cross-sectional, descriptive, quantitative and qualitative study, carried out with fathers and mothers of children with disabilities undergoing treatment at a neurofunctional rehabilitation clinic. It was found, based on the responses of 35 fathers and 35 mothers, that there is no linear correlation between the variables surveyed, however most mothers want more help to take care of their children and would like fathers to be more involved in their treatment. The engagement of parents of children with disabilities was similar to that of parents of typical children, being more linked to emotional support than direct and indirect care. It is concluded that studies like this are necessary in populations with different characteristics, to verify the behavior of the variables; and qualitative approaches with parents are needed.

Maternal and Neonatal Immunization Field Guide for Latin America and the Caribbean – Annex COVID-19

This document is an annex to the Pan American Health Organization (PAHO) Maternal Neonatal Immunization Field Guide. This annex incorporates relevant information on COVID-19 vaccines to be considered by decision-makers who plan and/or coordinate immunization programs, as well as for health professionals working in maternal-perinatal health services at all health system levels. As in the original guide, the target audience for this annex continues to be managers and staff of maternal and child health services, immunization programs, health care providers, pregnant and lactating women and birthing persons, and the media.

Mecanismos neuroendocrinos a la base de la asociación entre salud mental materna y lactancia / Neuroendocrine mechanisms underlying the association between maternal mental health and breastfeeding

La lactancia materna es fundamental para la salud del infante y se ve influida por diversos factores, entre ellos la salud mental materna. En particular, las madres que tienen síntomas depresivos tienen mayor riesgo de presentar dificultades de lactancia y de interrumpir tempranamente la lactancia exclusiva y la lactancia en general. Por otra parte, la lactancia materna actúa como un factor protector de la salud mental materna en algunas circunstancias, en tanto las dificultades de lactancia tienen un impacto negativo en la salud mental de la mujer. La presente revisión describe algunos de los mecanismos fisiológicos que subyacen al establecimiento y la mantención de la lactancia, asociados a la prolactina, la oxitocina, la dopamina y la serotonina, así como a la experiencia de la lactancia y la presencia de dificultades en esta área, y como estas interactúan con las dificultades emocionales de la madre. Se ofrece un modelo integrativo que considera aspectos hormonales y fisiológicos para comprender la asociación compleja y bidireccional entre el establecimiento de una lactancia exitosa y la salud mental materna.

Breastfeeding is essential for infant health and development. It is influenced by multiple factors, including maternal mental health. In particular, mothers who present depressive symptoms are at greater risk of presenting breastfeeding difficulties and presenting shorter exclusive breastfeeding and breastfeeding in general. On the other hand, breastfeeding acts as a protective factor for maternal mental health in some circumstances. Also, breastfeeding difficulties have a negative impact on womens mental health. This review describes some of the physiological mechanisms underlying the establishment and maintenance of lactation, associated with prolactin, oxytocin, dopamine, and serotonin. As well as how the lactation experience and the presence of difficulties in this area interact with the mothers emotional functioning. An integrative model is proposed, which considers hormonal and physiological aspects involved in the complex and bidirectional association between breastfeeding successful establishment and maternal mental health.

Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities.

OBJECTIVE: To analyze the experiences of maternal health workers in three Brazilian cities, located in the Northeast (São Luís), Southeast (Niterói), and South (Pelotas) regions during the first year of the COVID-19 pandemic. METHODS: Qualitative research carried out between December 2020 and February 2021. Interviews were conducted, in person or remotely, with 30 health workers, doctors and nurses, working in maternity hospitals of different degrees of complexity. RESULTS: Sociodemographic characteristics, employment relationships and professional qualification of the interviewees were described. Two thematic axes were identified: 1) changes in hospital organization and dynamics in the pandemic; 2) Illness and suffering of health workers. The majority of respondents were women. Most physicians had work relationships in the public and private sectors. In Niterói, health workers had better professional qualifications and more precarious work relationships (as temporary hires), compared to São Luís and Pelotas. In the context of the uncertainties resulting from the pandemic, this situation generated even more insecurity for those workers. The statements at the beginning of the pandemic covered topics such as changes in the organizational dynamics of services, healthcare, telemedicine, and interaction between health workers and users. In the health workers' perception, the initial period of the health emergency, which resulted in intense changes in the provision of services, was marked by an increase in preterm births, perinatal mortality, and fetal losses. Work overload, fear of contamination, concern for family members and uncertainties regarding the new disease caused intense suffering in health workers who had little institutional support in the cities studied. The suffering experienced by health workers went beyond the work dimension, reaching their private life. CONCLUSION: Changes caused by the pandemic required immediate adjustments in professional practices, generating insecurities in healthcare regardless of the location studied. The method of hiring health workers remained the same as the previously practiced one in each city. Due to the risk of disease transmission, measures contrary to humanization practices, and more restrictive in São Luís, were reported as harmful to obstetric care. The Covid-19 pandemic was a huge challenge for the Brazilian health system, aggravating the working conditions experienced by health workers. In addition to the work environment, it was possible to briefly glimpse its effects on private life.

Maternal and perinatal health among pregnant patients in the context of a migratory crisis.

OBJECTIVE: To compare maternal and perinatal outcomes of migrant Venezuelan women with local pregnant patients in a Colombian institution in the context of a migratory crisis. STUDY DESIGN: This cross-sectional study included 11 304 deliveries from the Clínica de Maternidad Rafael Calvo in Cartagena de Indias, Colombia, a tertiary referral center on the north coast of Colombia. Data on maternal demographics and perinatal outcomes were obtained by chart review. RESULTS: In total, 595 patients were identified as Venezuelan migrants, and their perinatal outcomes were compared against those of 10 709 local pregnant patients. Despite similar baseline maternal conditions in both groups, poorer prenatal follow-up care (3 [1-5] vs. 5 [4-7] visits; P < 0.001) and severe complications were more common in Venezuelan migrant pregnant patients and their children. In addition, maternal hypertension was significantly more common in migrants (11.4% [68/595] vs. 8.3% [887/10709]; P = 0.009). Furthermore, in the group of pregnant migrant patients, the rates of severe maternal morbidity (13.4% [80/575] vs. 9.45%, [1013/10709]; P = 0.002), neonatal respiratory distress syndrome (22/595 [3.7%] vs. 237/10709 [2.23%]; P = 0.03), and perinatal mortality (11/586 [1.88%] vs. 67/10651 [0.63%]; P = 0.003) were significantly higher than in the local pregnant population. CONCLUSION: Forced migration during pregnancy may be associated with poorer prenatal care, which may predispose women and their newborns to more frequent adverse maternal and perinatal outcomes.