ABSTRACT
Objective: To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. Methods: This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann-Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. Results: A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. Conclusion: This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.
Subject(s)
Pregnancy, High-Risk , Humans , Female , Cross-Sectional Studies , Retrospective Studies , Adult , Pregnancy , Postpartum Period , Referral and Consultation/statistics & numerical data , No-Show Patients/statistics & numerical data , Postnatal Care/statistics & numerical data , Young Adult , Risk FactorsABSTRACT
BACKGROUND: Postpartum Care is a strategy to improve survival of women and newborns, especially in low- and middle-income countries. Early post-partum care can promote healthy behaviors and the identification of risk factors associated with poorer pregnancy-related outcomes. The objective of this study was to assess the association of perceived social support with attendance to post-partum care in women from three Latin-American and Caribbean countries: Costa Rica, Dominican Republic and Honduras. METHODS: Women aged 18+ who completed a pregnancy in the past 5 years were interviewed in local healthcare and community settings in each country. Perceived social support (PSS) was the primary explanatory variable and the primary outcome was self-reported attendance to post-partum care. Odds Ratios (OR) with 95% confidence intervals derived from logistic regression documented the association between variables. Adjusted Odds Ratios (AOR) were calculated, controlling for social and pregnancy-related confounders. Hosmer- Lemeshow's Goodness-of-Fit statistic was computed to assess model fit. RESULTS: Our cohort of 1199 women across the three Latin-American and Caribbean countries showed relatively high attendance to post-partum care (82.6%, n = 990). However, 51.7% (n = 581) of women reported lower levels of total PSS. Women were more likely to attend postpartum care if they had mean and higher levels of PSS Family subscale (OR: 1.9, 95%CI: 1.4, 2.7), Friends subscale (OR 1.3, 95%CI: 0.9,1.8), Significant Other subscale (OR 1.8, 95%CI: 1.3, 2.4) and the Total PSS (OR 1.8, 95%CI: 1.3, 2.5). All associations were statistically significant at p < 0.05, with exception of the Friends subscale. Women with higher levels of total PSS were more likely to attend to post-partum care (AOR:1.40, 0.97, 1.92) even after controlling for confounders (education, country, and food insecurity). CONCLUSIONS: Women with higher perceived social support levels were more likely to attend to post-partum care. From all countries, women from Dominican Republic had lower perceived social support levels and this may influence attendance at post-partum care for this subgroup. Societal and geographic factors can act as determinants when evaluating perceived social support during pregnancy.
Subject(s)
Maternal Health Services/statistics & numerical data , Postnatal Care/statistics & numerical data , Social Support , Adult , Cohort Studies , Costa Rica , Cross-Sectional Studies , Dominican Republic , Female , Honduras , Humans , Middle Aged , Postnatal Care/psychology , Young AdultABSTRACT
OBJECTIVES: We assess the relationship between distance to a woman's assigned health clinic and obstetric care utilisation. DESIGN: We employ a cross-sectional study design using baseline data from the evaluation of a conditional cash transfer programme to promote greater utilisation of maternal and infant health services. Data were collected between December 2016 and January 2017. SETTING: The study is conducted in Ngäbe Buglé, the largest of Panama's three indigenous territories, where maternal mortality is three times the national average. PARTICIPANTS: We analyse a representative sample of 1336 indigenous women with a birth in the 12 months prior to the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes include obstetric care utilisation measures for prenatal, childbirth and postpartum events. Secondary outcomes include reasons for not receiving prenatal care, alarming symptoms, child weight at birth and stillbirths or miscarriages. RESULTS: Compared with women in closest geographic proximity to a health centre (top quintile, Q1), women who lived farthest from a health centre (bottom quintile, Q5) had significantly lower obstetric care utilisation outcomes for critical prenatal, childbirth and postpartum events. Mothers in Q5 were 36 percentage points less likely to have had at least one prenatal care appointment in a hospital, health centre or clinic compared with mothers in Q1 (p<0.01), and 52 percentage points less likely to attend an institutional first appointment (p<0.01). The gap in institutional delivery and postnatal care between mothers in Q1 and Q5 was about 35 percentage points (p<0.01). All utilisation outcomes were negatively correlated with distance, and differences in obstetric care utilisation persisted even when controlling for household wealth, maternal age and maternal education. CONCLUSION: Distance is an important barrier to obstetric care utilisation, with women in more distant locations suffering significantly lower use of prenatal, childbirth and postpartum care compared with women in closer vicinity to a health establishment. Expanding the supply of healthcare and implementing demand side incentives to promote the use of health services in remote communities are relevant policies to reduce disparities in obstetric care utilisation. TRIAL REGISTRATION NUMBER: AEA Registry (RCT ID AEARCTR-0001751).
Subject(s)
Health Services Accessibility/statistics & numerical data , Postnatal Care/statistics & numerical data , Prenatal Care/statistics & numerical data , Abortion, Spontaneous/epidemiology , Adult , Cross-Sectional Studies , Female , Humans , Indigenous Peoples/statistics & numerical data , Panama/epidemiology , Poverty Areas , Pregnancy , Stillbirth/epidemiologyABSTRACT
The objective of this study was to analyze the psychometric properties of the hospital birth satisfaction scale with data from the first follow-up interview of the Birth in Brazil survey. The 11 questions of the scale were asked by telephone up to six months after discharge in a stratified random sample of 16,109 women residing in all five regions of the country. The sample was randomly divided into two halves. Exploratory factor analysis (EFA) was applied to the first half in order to identify the scale's factorial structure. The scree plot suggested the scale to be one-dimensional. The EFA demonstrated a good fit of the one-dimensional model. Factor loadings were greater than 0.5 for all items, except for the mean time transpired between leaving the home and arriving at the maternity hospital, which was excluded from the next analysis. The confirmatory factor analysis applied to the sample's second half with the remaining ten items had a good fit and the factor loadings were > 0.50 with p-values < 0.001. The associations between birth satisfaction and the external variables, the mother's education level (standardized coefficient = 0.073; p = 0.035), private insurance (SC = 0.183; p < 0.001) and having a companion at some point during the hospitalization for labor (SC = 0.193; p = 0.001) were all as expected. There was evidence of configural and metric invariance according to type of hospital (private or public) and type of delivery (cesarean or vaginal). These results showed that the hospital birth satisfaction scale in Brazil is a one-dimensional instrument composed of ten items.
Subject(s)
Delivery, Obstetric/standards , Hospitals, Maternity/standards , Labor, Obstetric , Maternal-Child Health Services/standards , Patient Satisfaction/statistics & numerical data , Postnatal Care/standards , Surveys and Questionnaires , Brazil , Delivery, Obstetric/statistics & numerical data , Female , Hospitals, Maternity/statistics & numerical data , Humans , Infant, Newborn , Maternal-Child Health Services/statistics & numerical data , Postnatal Care/statistics & numerical data , Pregnancy , Psychometrics , Reproducibility of ResultsABSTRACT
BACKGROUND: Provision of postpartum care can support new families in adapting to a new situation. We aimed to determine whether various determinants of socioeconomic status (SES) were associated with utilization of postpartum care. In addition, to stress the relevance of increasing postpartum care uptake among low SES-groups, an assessment of the potential (cost-)effectiveness of postpartum care is required. METHODS: National retrospective cohort study using linked routinely collected healthcare data from all registered singleton deliveries (2010-13) in the Netherlands. Small-for-gestational age and preterm babies were excluded. The associations between SES and postpartum care uptake, and between uptake and health care expenditure were studied using multivariable regression analyses. RESULTS: Of all 569 921 deliveries included, 1.2% did not receive postpartum care. Among women who did receive care, care duration was below the recommended minimum of 24 h in 15.3%. All indicators of low SES were independently associated with a lack in care uptake. Extremes of maternal age, single parenthood and being of non-Dutch origin were associated with reduced uptake independent of SES determinants. No uptake of postpartum care was associated with maternal healthcare expenses in the highest quartile: aOR 1.34 (95% CI 1.10-1.67). Uptake below the recommended amount was associated with higher maternal and infant healthcare expenses: aOR 1.09 (95% CI 1.03-1.18) and aOR 1.20 (95% CI 1.13-1.27), respectively. CONCLUSION: Although uptake was generally high, low SES women less often received postpartum care, this being associated with higher subsequent healthcare expenses. Strategies to effectively reduce these substantial inequities in early life are urgently needed.
Subject(s)
Health Expenditures/statistics & numerical data , Home Care Services/statistics & numerical data , Postnatal Care/statistics & numerical data , Adult , Cost-Benefit Analysis , Home Care Services/economics , Humans , Morocco , Netherlands , Netherlands Antilles , Postnatal Care/economics , Socioeconomic Factors , Suriname , Turkey , Young AdultABSTRACT
BACKGROUND: Fetal aortic stenosis (AoS) may progress to hypoplastic left heart syndrome (HLHS) in utero. There are currently no data, prenatal or postnatal, describing survival of fetuses or neonates with AoS or HLHS in a country with suboptimal postnatal management. STUDY DESIGN: Prospective cohort study performed in Mexico, including cases diagnosed with AoS and HLHS within a 6-year period. AoS patients fulfilling previously published criteria for evolving HLHS (eHLHS) were offered fetal aortic valvuloplasty. Outcome variables were perinatal mortality, postnatal management, type of postnatal circulation, and overall survival. RESULTS: Fifty-four patients were included: 16 AoS and 38 HLHS. Eighteen patients had associated anomalies and/or an abnormal karyotype. Seventy-four percent of HLHS received comfort measures, with only three cases reporting an attempt at surgical palliation, and one survivor of the first stage. Fetal aortic valvuloplasty was performed successfully in nine cases of eHLHS. Overall postnatal survival was 44% in AoS with fetal aortic valvuloplasty, and one case (ongoing) in the HLHS group. CONCLUSIONS: HLHS in Mexico carries more than a 95% risk of postnatal death, with little or no experience at surgical palliation in most centers. Fetal aortic valvuloplasty in AoS may prevent progression to HLHS and in this small cohort was associated with ≈50% survival.
Subject(s)
Balloon Valvuloplasty , Fetal Heart/surgery , Fetoscopy , Hypoplastic Left Heart Syndrome/surgery , Postnatal Care/statistics & numerical data , Pregnancy Outcome/epidemiology , Adult , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/pathology , Aortic Valve Stenosis/surgery , Balloon Valvuloplasty/methods , Balloon Valvuloplasty/statistics & numerical data , Cohort Studies , Coronary Circulation/physiology , Female , Fetal Heart/pathology , Fetoscopy/adverse effects , Fetoscopy/rehabilitation , Fetoscopy/statistics & numerical data , Gestational Age , Humans , Hypoplastic Left Heart Syndrome/diagnosis , Hypoplastic Left Heart Syndrome/epidemiology , Infant, Newborn , Male , Mexico/epidemiology , Perinatal Mortality , Postnatal Care/standards , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Pregnancy , Prenatal Care/methods , Prenatal Care/statistics & numerical data , Retrospective Studies , Survival Analysis , Young AdultABSTRACT
The objective of this study was to analyze the psychometric properties of the hospital birth satisfaction scale with data from the first follow-up interview of the Birth in Brazil survey. The 11 questions of the scale were asked by telephone up to six months after discharge in a stratified random sample of 16,109 women residing in all five regions of the country. The sample was randomly divided into two halves. Exploratory factor analysis (EFA) was applied to the first half in order to identify the scale's factorial structure. The scree plot suggested the scale to be one-dimensional. The EFA demonstrated a good fit of the one-dimensional model. Factor loadings were greater than 0.5 for all items, except for the mean time transpired between leaving the home and arriving at the maternity hospital, which was excluded from the next analysis. The confirmatory factor analysis applied to the sample's second half with the remaining ten items had a good fit and the factor loadings were > 0.50 with p-values < 0.001. The associations between birth satisfaction and the external variables, the mother's education level (standardized coefficient = 0.073; p = 0.035), private insurance (SC = 0.183; p < 0.001) and having a companion at some point during the hospitalization for labor (SC = 0.193; p = 0.001) were all as expected. There was evidence of configural and metric invariance according to type of hospital (private or public) and type of delivery (cesarean or vaginal). These results showed that the hospital birth satisfaction scale in Brazil is a one-dimensional instrument composed of ten items.
O estudo teve como objetivo analisar as propriedades psicométricas da escala de satisfação com a assistência hospitalar no parto, a partir dos dados da primeira entrevista de seguimento do estudo Nascer no Brasil. As 11 perguntas da escala foram endereçadas via telefone dentro de seis meses depois da alta hospitalar em uma amostra aleatória estratificada de 16.109 mulheres residentes nas cinco macrorregiões brasileiras. A amostra foi dividida aleatoriamente em duas metades. Na primeira metade, foi realizada análise fatorial exploratória (AFE) para identificar a estrutura fatorial da escala. O gráfico de declividade sugeriu que a escala era unidimensional. A AFE demonstrou bom ajuste do modelo unidimensional. As cargas fatoriais foram maiores de 0,50 para todos os itens, exceto para o tempo médio de viagem da residência da parturiente até a maternidade, que foi excluído da análise subsequente. A análise fatorial confirmatória realizada com os dez itens remanescentes na segunda metade da amostra mostrou bom ajuste, com cargas fatoriais > 0,50 e valores de p < 0,001. As associações entre a satisfação com a assistência hospitalar no parto e as variáveis externas de escolaridade materna (coeficiente padronizado = 0,073; p = 0,035), plano de saúde privado (CP = 0,183; p < 0,001) e ter acompanhante em algum momento durante a internação para o parto (CP = 0,193; p = 0,001) foram na direção esperada. Houve evidências de invariância configural e métrica de acordo com o tipo de hospital (privado vs. público) e tipo de parto (cesáreo vs. vaginal). Os resultados mostram que a escala de satisfação com a assistência hospitalar no parto no Brasil é um instrumento unidimensional constituído de dez itens.
El objetivo de este estudio fue analizar las propiedades psicométricas de la escala de satisfacción sobre cuidados hospitalarios durante el parto, con datos procedentes de la primera entrevista de seguimiento, pertenecientes a la encuesta Nacer en Brasil. Se hicieron 11 preguntas de esta escala por teléfono hasta seis meses después del parto, mediante un muestreo aleatorio estratificado a 16.109 mujeres, residentes en las cinco regiones del país. Se dividió el mismo aleatoriamente en dos mitades. En la primera, se realizó un análisis factorial exploratorio (AFE) para identificar la estructura factorial de la escala. El gráfico de sedimentación indicó que la escala era unidimensional. El AFE demostró un buen ajuste al modelo unidimensional. Las cargas factoriales fueron superiores al 0,5 en todos los ítems, excepto en el tiempo empleado en ir de casa al hospital materno-infantil, que se excluyó del siguiente análisis. En la segunda mitad de la muestra se realizó un análisis factorial confirmatorio con los diez ítems restantes que tuvo un buen ajuste y cuyas cargas factoriales fueron > 0,50 con p-valor < 0,001. Las asociaciones entre la satisfacción con los cuidados hospitalarios recibidos para el parto, las variables externas, escolaridad maternal (coeficiente estandarizado = 0,073; p = 0,035), seguro privado (CE = 0,183; p < 0,001) y contar con pareja en algún momento durante la hospitalización para el parto (CE = 0,193; p = 0,001), estuvieron en línea con lo esperado. Hubo evidencia de invarianza métrica y de configuración, según el tipo de hospital (privado o público), y tipo de parto (cesárea o vaginal). Estos resultados mostraron que la escala de satisfacción sobre cuidados hospitalarios durante el parto en Brasil es un instrumento unidimensional compuesto de diez ítems.
Subject(s)
Humans , Pregnancy , Infant, Newborn , Postnatal Care/standards , Labor, Obstetric , Surveys and Questionnaires , Patient Satisfaction/statistics & numerical data , Delivery, Obstetric/standards , Maternal-Child Health Services/standards , Hospitals, Maternity/standards , Postnatal Care/statistics & numerical data , Psychometrics , Brazil , Reproducibility of Results , Delivery, Obstetric/statistics & numerical data , Maternal-Child Health Services/statistics & numerical data , Hospitals, Maternity/statistics & numerical dataABSTRACT
OBJECTIVE: To evaluate the active health Ombudsman service as an instrument to evaluate the quality of delivery and birth care in the Cegonha Network of the Federal District of Brazil. METHODS: This is a cross-sectional study of the telephone survey type carried out with 1,007 mothers with deliveries between October 15, 2013 and November 19, 2013 in the twelve public maternity hospitals that make up the Cegonha Network of the Federal District of Brazil. The instrument has 25 multiple choice or Likert scale questions, including sociodemographic data and acceptability evaluation in five domains: accessibility, relationship between the patient and health professionals, conditions of the structure of the service, information to the patient, and equity and opinion of the patient. We have studied qualitative or categorical variables according to the frequency and distribution of proportions. We have used the score transformed into a scale from zero to 100 for the analysis of the Likert-type scale questions. Results have been expressed as mean and standard deviation. RESULTS: Access to prenatal appointments was evaluated as good or excellent by 86.1% of the participants and laboratory tests was evaluated as good or excellent by 85.2% of them. The access to imaging tests was evaluations as good or excellent by 45.7% of the women; 79.5% of the interviewees had their delivery in the maternity hospital where they sought initial care and 18.3% received a home visit by a community health agent after discharge. Most women reported that newborns were placed skin-to-skin immediately after birth, 48.9% had a companion at the time of the delivery, 76.3% were advised about the first appointment of the newborn, and 94.8% were advised on breastfeeding in the maternity hospital. Regarding the evaluation of health professionals, 85.9% of the women considered reception and cordiality as good or excellent at the prenatal care and 94.8% considered it as good or excellent at the maternity hospital. CONCLUSIONS: The active health Ombudsman service has contributed to evaluate the quality of public management by allowing the incorporation of the perspective of users of the health service in the evaluation of the acceptability of the Cegonha Network in the Federal District of Brazil.
Subject(s)
Delivery, Obstetric/statistics & numerical data , Maternal-Child Health Services/statistics & numerical data , Quality of Health Care/statistics & numerical data , Adolescent , Adult , Brazil , Child , Cross-Sectional Studies , Educational Status , Female , Hospitals, Maternity/statistics & numerical data , Humans , Interviews as Topic , Middle Aged , Patient Reported Outcome Measures , Patient Satisfaction/statistics & numerical data , Postnatal Care/statistics & numerical data , Pregnancy , Prenatal Care/statistics & numerical data , Retrospective Studies , Young AdultABSTRACT
This paper proposes alternative models for the analysis of count data featuring a given spatial structure, which corresponds to geographical areas. We assume that the overdispersion data structure partially results from the existing and well justified spatial correlation between geographical adjacent regions, so an extension of existing overdispersion models that include spatial neighborhood structures within a Bayesian framework is proposed. These models allow practitioners to quantify the association explained by the considered neighborhood structures and the one modelled by additional factors. Finally, using the information provided by the Colombian National Demographic and Health Survey, the usefulness of the proposed models is illustrated by fitting them to infant mortality rates and to data including the proportion of mothers who, after giving birth to their last child, underwent a postnatal screening period in Colombia.
Subject(s)
Models, Statistical , Spatial Analysis , Bayes Theorem , Colombia , Humans , Infant , Infant Mortality/trends , Poisson Distribution , Postnatal Care/statistics & numerical dataABSTRACT
ABSTRACT OBJECTIVE To evaluate the active health Ombudsman service as an instrument to evaluate the quality of delivery and birth care in the Cegonha Network of the Federal District of Brazil. METHODS This is a cross-sectional study of the telephone survey type carried out with 1,007 mothers with deliveries between October 15, 2013 and November 19, 2013 in the twelve public maternity hospitals that make up the Cegonha Network of the Federal District of Brazil. The instrument has 25 multiple choice or Likert scale questions, including sociodemographic data and acceptability evaluation in five domains: accessibility, relationship between the patient and health professionals, conditions of the structure of the service, information to the patient, and equity and opinion of the patient. We have studied qualitative or categorical variables according to the frequency and distribution of proportions. We have used the score transformed into a scale from zero to 100 for the analysis of the Likert-type scale questions. Results have been expressed as mean and standard deviation. RESULTS Access to prenatal appointments was evaluated as good or excellent by 86.1% of the participants and laboratory tests was evaluated as good or excellent by 85.2% of them. The access to imaging tests was evaluations as good or excellent by 45.7% of the women; 79.5% of the interviewees had their delivery in the maternity hospital where they sought initial care and 18.3% received a home visit by a community health agent after discharge. Most women reported that newborns were placed skin-to-skin immediately after birth, 48.9% had a companion at the time of the delivery, 76.3% were advised about the first appointment of the newborn, and 94.8% were advised on breastfeeding in the maternity hospital. Regarding the evaluation of health professionals, 85.9% of the women considered reception and cordiality as good or excellent at the prenatal care and 94.8% considered it as good or excellent at the maternity hospital. CONCLUSIONS The active health Ombudsman service has contributed to evaluate the quality of public management by allowing the incorporation of the perspective of users of the health service in the evaluation of the acceptability of the Cegonha Network in the Federal District of Brazil.
RESUMO OBJETIVO Avaliar a ouvidoria ativa em saúde como ferramenta de avaliação da qualidade da atenção ao parto e nascimento da Rede Cegonha do Distrito Federal. MÉTODOS Estudo transversal, do tipo inquérito por via telefônica, em 1.007 puérperas com partos realizados entre 15/10/2013 e 19/11/2013, nas 12 maternidades públicas que compõem a Rede Cegonha no Distrito Federal. O instrumento continha 25 questões de múltipla escolha ou do tipo escala Likert, que incluiu dados sociodemográficos e avaliação da aceitabilidade em cinco domínios: acessibilidade, relacionamento entre o paciente e os profissionais de saúde, condições da estrutura do serviço, informação ao paciente, e equidade e opinião do paciente. Variáveis qualitativas ou categóricas foram estudadas de acordo com a frequência e distribuição de proporções. Utilizou-se o escore transformado para uma escala de zero a 100 para análise das questões do tipo escala Likert. Resultados foram expressos em média e desvio-padrão. RESULTADOS O acesso às consultas de pré-natal foi avaliado como bom ou ótimo por 86,1% das participantes e os exames laboratoriais como bom ou ótimo por 85,2%. O acesso aos exames de imagem teve 45,7% avaliações boas ou ótimas; 79,5% das entrevistadas realizaram o parto na maternidade onde buscaram atendimento inicial e 18,3% receberam visita domiciliar por agente comunitário de saúde após a alta. A maioria relatou que os recém-nascidos foram colocados em seus colos ou peitos imediatamente após o nascimento, 48,9% tiveram presença de acompanhante no momento do parto, 76,3% foram orientadas em relação à primeira consulta dos recém-nascidos e 94,8% sobre aleitamento materno na maternidade. Quanto à avaliação dos profissionais de saúde, 85,9% das mulheres consideraram o acolhimento e a cordialidade recebidos como bons ou ótimos no pré-natal e 94,8%, como bons ou ótimos na maternidade. CONCLUSÕES A ouvidoria ativa em saúde contribuiu para a avaliação da qualidade da gestão pública, possibilitando a incorporação da perspectiva das usuárias do serviço de saúde na avaliação da aceitabilidade da Rede Cegonha no Distrito Federal.
Subject(s)
Humans , Female , Child , Adolescent , Adult , Aged , Young Adult , Quality of Health Care/statistics & numerical data , Delivery, Obstetric/statistics & numerical data , Maternal-Child Health Services/statistics & numerical data , Postnatal Care/statistics & numerical data , Prenatal Care/statistics & numerical data , Brazil , Cross-Sectional Studies , Interviews as Topic , Retrospective Studies , Patient Satisfaction/statistics & numerical data , Educational Status , Patient Reported Outcome Measures , Hospitals, Maternity/statistics & numerical data , Middle AgedABSTRACT
This study compares maternal health care utilization of women living with HIV with that of their HIV-negative peers in Haiti. Data from the 2012-2013 Haiti Demographic and Health Survey were analyzed. Three percent of mothers were HIV-positive. These mothers had over two times greater odds than HIV-negative mothers of accessing prenatal care in the first trimester and to deliver in a medical institution, and 1.9 greater odds of having a medical personnel at delivery. Haiti has made progress in increasing maternal health care utilization, specifically in an effort to reduce mother-to-child-transmission of HIV. Haiti's ability to bring institutions together, implement practical policies, and actively engage the most vulnerable pregnant women, those with HIV and those residing in remote areas, may offer valuable insight to similar resource-poor nations seeking to reduce rates of mother-to-child transmission.
Subject(s)
HIV Infections/epidemiology , Infectious Disease Transmission, Vertical/prevention & control , Maternal Health Services/statistics & numerical data , Pregnancy Complications, Infectious/epidemiology , Adolescent , Adult , Delivery, Obstetric/statistics & numerical data , Female , Haiti/epidemiology , Health Care Surveys , Humans , Infant, Newborn , Postnatal Care/statistics & numerical data , Pregnancy , Prenatal Care/statistics & numerical data , Socioeconomic Factors , Young AdultABSTRACT
OBJECTIVES: Women make up approximately half of the world's one billion migrants. Immigrant women tend to be one of the most vulnerable population groups with respect to healthcare. Cancer screening (CS) and maternal and reproductive health have been included among the 10 main issues pertinent to women's health. The aim of this study is to explore breast and cervical CS participation and to acquire information regarding access to healthcare services during pregnancy, childbirth and the postpartum period among age eligible immigrant women in Southern Italy. METHODS: A structured questionnaire was used to collect data from each participant. Women aged 25-64 years who had not had a hysterectomy and women aged 50-69 years without history of breast cancer were considered eligible for the evaluation of cervical and breast CS participation, respectively. Moreover, women who had delivered at least once in Italy were enrolled to describe antenatal and postpartum care services use. All women were recruited through the third sector and non-profit organisations (NPOs). RESULTS: Rate of cervical CS among the 419 eligible women was low (39.1%), and about one-third had had a Pap test for screening purposes within a 3-year period from interview (32.8%). Regarding breast CS practices, of the 125 eligible women 45.6% had had a mammography for control purposes and less than a quarter (26, 20.8%) had their mammography within the recommended time interval of 2 years. About 80% of the respondents did not report difficulties of access and use of antenatal and postpartum services. CONCLUSION: This study provides currently unavailable information about adherence to CS and maternal and child health that could encourage future research to develop and test culturally appropriate, women-centred strategies for promoting timely and regular CS among immigrant women in Italy.
Subject(s)
Breast Neoplasms/diagnosis , Early Detection of Cancer/statistics & numerical data , Patient Acceptance of Health Care/ethnology , Patient Acceptance of Health Care/statistics & numerical data , Prenatal Care/statistics & numerical data , Uterine Cervical Neoplasms/diagnosis , Adolescent , Adult , Africa/ethnology , Aged , Asia/ethnology , Cross-Sectional Studies , Emigrants and Immigrants/statistics & numerical data , Female , Health Services Accessibility/statistics & numerical data , Humans , Italy , Mammography/statistics & numerical data , Middle Aged , Papanicolaou Test/statistics & numerical data , Postnatal Care/statistics & numerical data , Pregnancy , South America/ethnology , Surveys and Questionnaires , Vaginal Smears/statistics & numerical data , Young AdultABSTRACT
This study provides evidence for those working in the maternal health metrics and health system performance fields, as well as those interested in achieving universal and effective health care coverage. Based on the perspective of continuity of health care and applying quasi-experimental methods to analyse the cross-sectional 2009 National Demographic Dynamics Survey (n = 14 414 women), we estimated the middle-term effects of Mexico's new public health insurance scheme, Seguro Popular de Salud (SPS) (vs women without health insurance) on seven indicators related to maternal health care (according to official guidelines): (a) access to skilled antenatal care (ANC); (b) timely ANC; (c) frequent ANC; (d) adequate content of ANC; (e) institutional delivery; (f) postnatal consultation and (g) access to standardized comprehensive antenatal and postnatal care (or the intersection of the seven process indicators). Our results show that 94% of all pregnancies were attended by trained health personnel. However, comprehensive access to ANC declines steeply in both groups as we move along the maternal healthcare continuum. The percentage of institutional deliveries providing timely, frequent and adequate content of ANC reached 70% among SPS women (vs 64.7% in the uninsured), and only 57.4% of SPS-affiliated women received standardized comprehensive care (vs 53.7% in the uninsured group). In Mexico, access to comprehensive antenatal and postnatal care as defined by Mexican guidelines (in accordance to WHO recommendations) is far from optimal. Even though a positive influence of SPS on maternal care was documented, important challenges still remain. Our results identified key bottlenecks of the maternal healthcare continuum that should be addressed by policy makers through a combination of supply side interventions and interventions directed to social determinants of access to health care.
Subject(s)
Insurance, Health/statistics & numerical data , Maternal Health Services/statistics & numerical data , Universal Health Insurance/statistics & numerical data , Adolescent , Adult , Cohort Studies , Cross-Sectional Studies , Delivery, Obstetric/statistics & numerical data , Female , Humans , Maternal Health Services/organization & administration , Medically Uninsured/statistics & numerical data , Mexico , Middle Aged , Postnatal Care/statistics & numerical data , Pregnancy , Prenatal Care/statistics & numerical data , Retrospective StudiesABSTRACT
BACKGROUND: The risk-benefit of early discharge in newborns is controversial. We haven't found studies that analyze newborn variables and their impact in morbility with early postnatal discharge. We analyze the main variables and their statistical association with the need of additional therapy in early discharged newborns. METHODS: Observational prolective study in full-term newborns from their birth until their discharge from August to December, 2013. It was made a telephone follow-up to know their health status. The dependent variables were the hours of hospital stay, additional therapies and treatment in the first month. RESULTS: 701 full-term newborns were included in the study, 41 used additional treatment, 23 had to be at the ICU (22 < 24 hours). There was a relative risk (RR) of 12.9 if the Apgar was < 8.8. Also, the risk of needing additional therapy was 9 times greater if the baby was born after a pregnancy of less than 38 weeks. Low weight for gestational age triplicated the risk for admission to ICU. The main variables that had an influence in requiring additional therapy were an Apgar < 8 at 5 minutes, having more than 38 weeks of gestation, and low weight. CONCLUSION: The elements to manage patients with early discharge are concrete signs that would cause suspicion, follow-up with pediatrician at 3 days of life, more attention to those with an Apgar < 8 at 5 minutes of life, having less than 38 weeks of gestation, or low birth weight for gestational age.
Introducción: el riesgo-beneficio del alta temprana en neonatos es controversial. No encontramos estudios concluyentes que analicen las variables del neonato y el impacto en su morbilidad al alta temprana. Asociamos estadísticamente variables con alguna terapia adicional que pudiera poner en riesgo al neonato de alta temprana. Métodos: estudio prolectivo observacional en recién nacidos de término desde el nacimiento hasta el alta (de agosto a diciembre de 2013). Se hizo seguimiento telefónico al mes de vida para conocer su estado de salud. Las variables dependientes fueron las horas intrahospitalarias, las terapias adicionales y la atención intrahospitalaria en el primer mes. Resultados: 701 neonatos a término, 41 con terapia adicional, 23 ingresos a UCIN (22 en < 24 horas). Hubo un RR de 12.9 si el Apgar era < 8.8. Hubo 9 veces más riesgo de terapia adicional si había < 38 semanas de gestación. El peso bajo triplicó el riesgo para ingreso a UCIN. Hubo 143 altas tempranas, 58 % seguimiento telefónico, 0 % de reingresos. Las principales variables que influyen en requerir terapia adicional son el Apgar < 8 a los 5 minutos, tener < 38 semanas de gestación y peso bajo.Conclusión: los elementos para el manejo de pacientes con alta temprana son datos de alarma, seguimiento con pediatra a los tres días de vida, vigilancia estrecha si el APGAR es < 8 a los 5 minutos o < 38 semanas de gestación o si hay peso bajo para la edad gestacional.
Subject(s)
Health Status Indicators , Patient Discharge , Postnatal Care/methods , Female , Follow-Up Studies , Humans , Infant, Newborn , Male , Mexico , Postnatal Care/statistics & numerical data , Risk AssessmentABSTRACT
OBJECTIVE: To evaluate women's care during home visits for the "First Comprehensive Care Week". METHOD: A cross-sectional study was carried out in a specialized service in Recife, Pernambuco, Brazil. A total of 190 women who had recently given birth enrolled at the Family Health Strategy answered the questionnaire between September and December 2013 to verify the association between home visits and the investigated variables. This association was verified using the chi-square test with a confidence level of 95%. RESULTS: Most of the women were 29 years old or under (68.5%), with high gestational risk (59.5%), and primiparous (46.9%). On the first week after hospital discharge, 42.1% received a home visit. An association was detected between local pre-natal care and a home visit on the first week (p = 0.049). The participation of the nurses during the visits was associated with better performance for breast and abdomen examinations (p = 0.000) and investigations on emotional conditions (p = 0.029). CONCLUSIONS: These findings stress the need to establish a routine home visit plan to solve the issues of women with high-risk pregnancies after labour.
Subject(s)
Comprehensive Health Care , House Calls , Postnatal Care , Adolescent , Adult , Brazil , Child , Comprehensive Health Care/statistics & numerical data , Cross-Sectional Studies , Female , House Calls/statistics & numerical data , Humans , Middle Aged , Postnatal Care/statistics & numerical data , Young AdultABSTRACT
BACKGROUND: The Management of Myelomeningocele Study was a multicenter, randomized controlled trial that compared prenatal repair with standard postnatal repair for fetal myelomeningocele. OBJECTIVE: We sought to describe the long-term impact on the families of the women who participated and to evaluate how the timing of repair influenced the impact on families and parental stress. STUDY DESIGN: Randomized women completed the 24-item Impact on Family Scale and the 36-item Parenting Stress Index Short Form at 12 and 30 months after delivery. A revised 15-item Impact on Family Scale describing overall impact was also computed. Higher scores reflected more negative impacts or greater stress. In addition, we examined Family Support Scale and Family Resource Scale scores along with various neonatal outcomes. Repeated measures analysis was conducted for each scale and subscale. RESULTS: Of 183 women randomized, 171 women completed the Impact on Family Scale and 172 completed the Parenting Stress Index at both 12 and 30 months. The prenatal surgery group had significantly lower revised 15-item Impact on Family Scale scores as well as familial-social impact subscale scores compared to the postnatal surgery group (P = .02 and .004, respectively). There was no difference in total parental stress between the 2 groups (P = .89) or in any of the Parenting Stress Index Short Form subscales. In addition, walking independently at 30 months and family resources at 12 months were associated with both family impact and parental stress. CONCLUSION: The overall negative family impact of caring for a child with spina bifida, up to 30 months of age, was significantly lower in the prenatal surgery group compared to the postnatal surgery group. Ambulation status and family resources were predictive of impact on family and parental stress.
Subject(s)
Fetus/surgery , Meningomyelocele/surgery , Parents/psychology , Stress, Psychological/epidemiology , Adult , Caregivers/psychology , Child, Preschool , Female , Gestational Age , Humans , Infant , Postnatal Care/statistics & numerical data , Risk FactorsABSTRACT
RESUMO Objetivo Avaliar o cuidado prestado à mulher na visita domiciliar da "Primeira Semana de Saúde Integral". Método Estudo transversal realizado em serviço especializado do Recife, Pernambuco. Entre setembro e dezembro de 2013, 190 puérperas cadastradas na Estratégia Saúde da Família responderam a um questionário para verificar a existência de associação entre a visita domiciliar e as variáveis investigadas, utilizando o teste Qui-quadrado, com nível de confiança de 95%. Resultados Predominou idade de até 29 anos (68,5%) e risco gestacional alto (59,5%), sendo 46,9% primíparas. Na primeira semana pós-alta, 42,1% receberam visita. Constatou-se associação entre atenção pré-natal em nível local e visita na primeira semana (p=0,049). A participação do enfermeiro na visita estava associada à maior realização de exame de mama (p=0,000), abdômen (p=0,000) e investigação de condições emocionais (p=0,029). Conclusões Evidencia-se a necessidade de instituir um planejamento rotineiro para efetuar a visita domiciliar programática, priorizando as puérperas de risco.
RESUMEN Objetivo Evaluar la atención prestada a la mujer en la visita domiciliaria de la "Primera Semana de Salud Integral". Método Estudio transversal, realizado en servicio de nivel terciario, en Recife, Pernambuco. Entre septiembre y diciembre de 2013, 190 madres inscritas en la Estrategia Salud de la Familia respondieron a un cuestionario para verificar la existencia de asociación entre las visitas domiciliarias y las variables investigadas. Se utilizó el Chi-cuadrado, con nivel de confianza del 95%. Resultados Predominó edad hasta los 29 años (68,5%) riesgo gestacional alto (59,5%), de los cuales el 46,9% primíparas. La primera semana posalta, el 42,1% recibió VD. Se constató asociación entre atención prenatal en el nivel local y visita en la primera semana (p=0,049). La participación del enfermero en visita estaba asociada a mayor realización de examen de mama (p=0,000), abdomen (p=0,000) e investigación de condiciones emocionales (p=0,029). Conclusiones Necesidad evidenciada de instituir planificación de rutina para efectuar visita domiciliaria programática, priorizando puérperas de riesgo.
ABSTRACT Objective To evaluate women's care during home visits for the "First Comprehensive Care Week". Method A cross-sectional study was carried out in a specialized service in Recife, Pernambuco, Brazil. A total of 190 women who had recently given birth enrolled at the Family Health Strategy answered the questionnaire between September and December 2013 to verify the association between home visits and the investigated variables. This association was verified using the chi-square test with a confidence level of 95%. Results Most of the women were 29 years old or under (68.5%), with high gestational risk (59.5%), and primiparous (46.9%). On the first week after hospital discharge, 42.1% received a home visit. An association was detected between local pre-natal care and a home visit on the first week (p = 0.049). The participation of the nurses during the visits was associated with better performance for breast and abdomen examinations (p = 0.000) and investigations on emotional conditions (p = 0.029). Conclusions These findings stress the need to establish a routine home visit plan to solve the issues of women with high-risk pregnancies after labour.
Subject(s)
Humans , Female , Child , Adolescent , Adult , Young Adult , Postnatal Care , Comprehensive Health Care , House Calls , Postnatal Care/statistics & numerical data , Brazil , Cross-Sectional Studies , Comprehensive Health Care/statistics & numerical data , House Calls/statistics & numerical data , Middle AgedABSTRACT
BACKGROUND: The rates of receipt of postnatal care vary widely between high and low-middle income countries. This study aimed to examine the association between indicators of socioeconomic status during pregnancy and gynecological appointment at any time after childbirth (GA). METHODS: a prospective cohort study with pregnant women recruited from 10 primary care clinics of the public sector in the city of São Paulo, Brazil. Socioeconomic characteristics and obstetric information were obtained through a questionnaire administered during pregnancy and in the postpartum period. Adjusted risk ratios (RR) with 95% confidence intervals (CI) were calculated using Poisson regression. RESULTS: Eight hundred and thirty one pregnant women were included in the study during the antenatal period and 701 were re-assessed during the postnatal period. Among them, 283 (59.6) attended a gynecological consultation. After adjusting for covariates, higher socioeconomic status during pregnancy was associated with greater risk of having a GA (RR:1.23, CI 95%:1.05:1.45 for family per capita monthly income; RR:1.19, CI 95 % 1.01:1.40 for asset score). CONCLUSION: In this sample, the attendance for GA was above average and women with higher socio-economic status were more likely to have receipt of such care. Special efforts should be made to improve the attendance and frequency of gynecological consultations after childbirth among poorer women.
Subject(s)
Healthcare Disparities/statistics & numerical data , Postnatal Care/statistics & numerical data , Socioeconomic Factors , Adolescent , Adult , Brazil/epidemiology , Cohort Studies , Female , Humans , Postnatal Care/methods , Pregnancy , Prospective Studies , Surveys and QuestionnairesABSTRACT
The aim of this study was to evaluate the care of healthy full-term newborns and to identify variations in childbirth care and practices in the first hour of life. We used data from the Birth in Brazil survey. Unadjusted and adjusted odds ratio (OR) of hospital-delivered care for the mother and during childbirth were estimated for the following outcomes: upper airways and gastric aspiration, use of inhaled oxygen, use of incubator, skin-to-skin contact after birth, rooming-in and breastfeeding in the delivery room and within the first hour of life. We observed wide variations in the care of healthy full-term newborn in the delivery room. Practices considered inadequate, such as use of inhaled oxygen, (9.5%) aspiration of airways (71.1%) and gastric suctioning (39.7%), and the use of incubator (8.8%) were excessively used. Breastfeeding in the delivery room was low (16%), even when the Baby-Friendly Hospital Initiative had been implemented (24%). The results suggest poor knowledge and compliance by health practitioners to good clinical practice. Such noncompliance was probably not due to the differences in resources, since most births take place in hospitals where the necessary resources are available.
Subject(s)
Guideline Adherence/statistics & numerical data , Infant Care/standards , Postnatal Care/standards , Adolescent , Adult , Brazil , Breast Feeding/statistics & numerical data , Cesarean Section/statistics & numerical data , Child , Female , Health Care Surveys , Health Knowledge, Attitudes, Practice , Humans , Infant Care/statistics & numerical data , Infant, Newborn , Natural Childbirth/statistics & numerical data , Postnatal Care/statistics & numerical data , Young AdultABSTRACT
O objetivo do estudo foi avaliar o cuidado ao recém-nascido saudável a termo e identificar variações nesse cuidado no atendimento ao parto e na primeira hora de vida. Utilizou-se a base de dados da pesquisa Nascer no Brasil. Foram estimadas as razões de produtos cruzados OR brutas e ajustadas entre as características do hospital, maternas e de assistência ao parto com os desfechos: aspiração de vias aéreas e gástrica, uso do oxigênio inalatório, uso de incubadora, contato pele a pele, alojamento conjunto e oferta do seio materno na sala de parto e na primeira hora de vida. Foi observada grande variação das práticas usadas na assistência ao recém-nascido a termo na sala de parto. Práticas consideradas inadequadas como uso de oxigênio inalatório (9,5%), aspiração de vias aéreas (71,1%) e gástrica (39,7%) e uso de incubadora (8,8%) foram excessivamente usadas. A ida ao seio na sala de parto foi considerada baixa (16,1%), mesmo nos hospitais com título de Hospital Amigo da Criança (24%). Esses resultados sugerem baixos níveis de conhecimento e aderência às boas práticas clínicas.
El objetivo del estudio fue evaluar el cuidado de los recién nacidos sanos y determinar si existen desigualdades en la prestación de servicios y durante la primera hora de vida. Se utilizó la base de datos de la encuesta Nacer en Brasil. Las ratios se estimaron a través del producto odds ratio (OR) y se realizó un ajuste bruto entre las características del hospital, la madre y la atención del nacimiento con los siguientes resultados: aspiración gástrica y de las vías respiratorias, uso de oxígeno inhalado, incubadora, contacto piel con piel, alojamiento conjunto y ofrecer lactancia materna en la sala de partos y en la primera hora de vida. Existe una alta variación de las prácticas utilizadas en el cuidado del recién nacido. Prácticas consideradas inapropiadas, como el uso de oxígeno inhalado (9,5%), aspiración vías respiratorias (71,1%) y gástrica (39,7%) y el uso de incubadora (8,8%) fueron altos. La lactancia materna en la sala de partos fue baja (16,1%), hasta en los hospitales especializados en la atención a niños (24%). Los resultados sugieren bajos niveles de la adhesión a las buenas prácticas.
The aim of this study was to evaluate the care of healthy full-term newborns and to identify variations in childbirth care and practices in the first hour of life. We used data from the Birth in Brazil survey. Unadjusted and adjusted odds ratio (OR) of hospital-delivered care for the mother and during childbirth were estimated for the following outcomes: upper airways and gastric aspiration, use of inhaled oxygen, use of incubator, skin-to-skin contact after birth, rooming-in and breastfeeding in the delivery room and within the first hour of life. We observed wide variations in the care of healthy full-term newborn in the delivery room. Practices considered inadequate, such as use of inhaled oxygen, (9.5%) aspiration of airways (71.1%) and gastric suctioning (39.7%), and the use of incubator (8.8%) were excessively used. Breastfeeding in the delivery room was low (16%), even when the Baby-Friendly Hospital Initiative had been implemented (24%). The results suggest poor knowledge and compliance by health practitioners to good clinical practice. Such noncompliance was probably not due to the differences in resources, since most births take place in hospitals where the necessary resources are available.