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2.
Surg Oncol ; 30: 33-39, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31500782

RESUMO

BACKGROUND AND OBJECTIVES: Neoadjuvant chemoradiotherapy (nCRT) induces a pathological complete response (pCR) in 25-85% of oesophago-gastric cancer. As surgery entails morbidity and mortality risks and quality of life (QL) impairment, its avoidance in patients without residual disease is desirable. This study aimed to compare quality of life of patients with a cCR who chose surveillance with those who chose surgery. METHODS: Four groups of patients were studied. Group 1(n = 31) were controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy after nCRT; Group 4 (n = 26) had gastrectomy alone. A 33-point novel questionnaire was administered at two 3 month time points. Participants were also interviewed with a validated questionnaire. RESULTS: Mean(±sd) quality of life scores in cCR patients offered surveillance (28.9 ±â€¯4.5) were superior to patients undergoing oesophagectomy (32.3 ±â€¯58. p=0.042) or gastrectomy (33.19 ±â€¯5.9, p=0.004). This result was replicated in the validated questionnaire (p=0.017). There was a trend towards increased reflux-related respiratory symptoms in the oesophagectomy group (7.3 ±â€¯2.2 vs 6.5 ±â€¯1.9; p=0.396) and towards early dumping (8.2 ±â€¯1.4 vs 7.1 ±â€¯1.; p=0.239) and vagotomy-related symptoms (1.82 ±â€¯0.9 vs 1.4 ±â€¯0.6; p=0.438) in the gastrectomy group. CONCLUSIONS: Avoidance of surgery in cCR patients is rewarded with a superior quality of life to those undergoing surgery.

3.
PLoS One ; 14(9): e0221789, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31483813

RESUMO

BACKGROUND: Jamestown, an urban coastal slum in Accra, Ghana, has one of the highest adolescent pregnancy rates in the country. We sought to understand the decision (to keep or terminate) factors and experiences surrounding adolescent pregnancies. METHODS: Thirty semi-structured indepth interviews were carried out among adolescents (aged 13-19 years) who had been pregnant at least once. Half of these were adolescent mothers and the other half had at least one past experience of induced abortion. A pretested and validated questionnaire to assess the awareness and use of contraception in adolescent participants was also administered. To aid social contextualization, semi-structured in depth interviews were carried out among 23 purposively selected stakeholders. RESULTS: The main role players in decision making included family, friends, school teachers and the partner, with pregnant adolescents playing the most prominent role. Adolescents showed a high degree of certainty in deciding to either abort or carry pregnancies to term. Interestingly, religious considerations were rarely taken into account. Although almost all adolescents (96.1%) were aware of contraception, none was using any prior to getting pregnant. Of the 15 adolescents who had had abortion experiences, 13 (87.0%) were carried out under unsafe circumstances. The main barriers to accessing safe abortion services included poor awareness of the fairly liberal nature of the Ghanaian abortion law, stigma, high cost and non-harmonization of safe abortion service fees, negative abortion experiences (death and bleeding), and distrust in the health care providers. Adolescents who chose to continue their pregnancies to term were motivated by personal and sociocultural factors. CONCLUSION: Decision-making in adolescent pregnancies is influenced by multiple external factors, many of which are modifiable. Despite legal access to services, options for the safe termination of pregnancy or its prevention are not predominantly taken, resulting in a high number of negative experiences and outcomes. Including safe abortion care within the sexual and reproductive health package, could diminish barriers to safe abortion services. Given the vulnerability of the Jamestown setting, a comprehensive sexual education package that addresses the main decision factors is recommended. Interventions aiming to reduce adolescent pregnancy rates should also recognize that adolescent pregnancies are culturally acceptable in some settings, and under certain circumstances, are desired by the adolescents themselves.

4.
BMJ Open ; 9(9): e029785, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519675

RESUMO

OBJECTIVE: To assess the completeness of obstetric referral letters/notes at the district level of healthcare. DESIGN: An implementation research within three districts in Greater Accra region using mixed methods. During baseline and intervention phases, referral processes for all obstetric referrals from lower level facilities seen at the district hospitals were documented including indications for referrals, availability and completeness of referral notes/forms. An assessment of before and after intervention availability and completeness of referral forms was carried out. Focus group discussions, non-participant observations and in-depth interviews with health workers and pregnant women were conducted for qualitative data. SETTING: Three (3) districts in the Greater Accra region of Ghana. PARTICIPANTS: Pregnant women referred from lower levels of care to and seen at the district hospital, health workers within the three districts and pregnant women attending antenatal clinic in the district and their family members or spouses. INTERVENTION: An enhanced interfacility referral communication system consisting of training, provision of communication tools for facilities, formation of hospital referral teams and strengthening feedback mechanisms. OUTCOME: Completeness of obstetric referral letters/notes. RESULTS: Proportion of obstetric referrals with referral notes improved from 27.2% to 44.3% from the baseline to intervention period. Mean completeness (95% CI) of all forms was 71.3% (64.1% to 78.5%) for the study period, improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1% to 82.7%) from baseline to intervention periods. Health workers reported they do not always provide referral notes and that most referral notes are not completely filled due to various reasons. CONCLUSIONS: Most obstetric referrals did not have referral notes. The few notes provided were not completely filled. Interventions such as training of health workers, regular review of referral processes and use of electronic records can help improve both the provision of and completeness of the referral notes.

5.
Science ; 365(6449): 101, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31296743
6.
JMIR Mhealth Uhealth ; 7(5): e12879, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-31127719

RESUMO

BACKGROUND: Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. OBJECTIVE: This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). METHODS: For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. RESULTS: In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each 6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and r=0.79; P<.001 and P=.03, respectively). CONCLUSIONS: There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus support for HW training and ultimately improved maternal and neonatal health.

7.
Neurology ; 90(1): 47, 2018 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-29284655
8.
PLoS One ; 12(12): e0188671, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29211781

RESUMO

BACKGROUND: Maternal obesity in pregnancy has been linked with increased risk of pregnancy induced hypertension (PIH). In some tertiary referral hospitals in Ghana, PIH is the leading cause of institutional maternal mortality. OBJECTIVE: To evaluate blood pressure changes during pregnancy amongst different body mass index (BMI) groups and how this relates to the risk of developing PIH. METHODS: Women who had a dating ultrasound before 20 weeks gestation and registering for antenatal care at the Korle-Bu Teaching Hospital in Accra, between February and December 2013 and met the inclusion criteria were recruited into a cohort study. BMI was assessed at baseline. Blood pressure measurements were taken at (±2) 24, 28 and 36 weeks. Primary outcome measure of interest during follow-up was a diagnosis of PIH at these points. BP changes during follow up at the three points were measured. Descriptive analysis of baseline factors was carried out and compared for the BMI groups. Relative risk (RR) of PIH was estimated at 95% confidence interval. RESULTS: Mean (SD) age for the 361 women was 30.9 (4.8) years. Incidence of PIH amongst the cohort was 10.5% (95% CI: 7.45% - 14.45%) and 40.4% and 33.0% of them were overweight and obese respectively at baseline. Pregnant women who were obese at baseline had a three-fold increased risk of PIH compared to those with normal BMI [RR = 3.01 (1.06-8.52), p = 0.04]. CONCLUSION: Obese women have a significantly increased risk of PIH. Women should be screened at booking for obesity status. Antenatal protocols should have interventions for prevention or early detection of obesity and management of obesity to improve outcomes.


Assuntos
Pressão Sanguínea , Índice de Massa Corporal , Hospitais de Ensino/organização & administração , Hipertensão/complicações , Obesidade/complicações , Complicações na Gravidez/fisiopatologia , Cuidado Pré-Natal/organização & administração , Adulto , Estudos de Coortes , Feminino , Gana , Humanos , Hipertensão/fisiopatologia , Obesidade/fisiopatologia , Gravidez
9.
BMJ Glob Health ; 2(4): e000209, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29104766

RESUMO

Background: A substantial reduction in neonatal mortality is the main priority to reduce under-five mortality. A clear understanding of the variation in neonatal mortality and the underlying causes is important for targeted intervention. We aimed to explore variation in neonatal mortality and identify underlying causes of variation in neonatal mortality in sub-Saharan Africa (SSA). Methods: This ecological study used 2012 publicly available data from WHO, the US Agency for International Development and the World Bank. Variation in neonatal mortality across 49 SSA countries was examined using control chart and explanatory spatial data analysis. Associations between country-level characteristics and neonatal mortality were examined using linear regression analysis. Results: The control chart showed that 28 (57%) SSA countries exhibited special-cause variation, 14 countries were below and 14 above the 99.8% control-limits. The remaining 21 (43%) SSA countries showed common-cause variation. No spatial clustering was observed for neonatal mortality (Global Moran's I statistic -0.10; p=0.74). Linear regression analysis showed HIV/AIDS prevalence among the population of reproductive age to be positively associated with neonatal mortality (ß=0.463; 95% CI 0.135 to 0.790; p<0.01). Declining socioeconomic deprivation (ß=-0.234; 95% CI -0.424 to -0.044; p<0.05) and high quality of healthcare governance (ß=-1.327, 95% CI -2.073 to -0.580; p<0.01) were inversely associated with neonatal mortality. Conclusion: This study shows a wide variation in neonatal mortality in SSA. A substantial part of this variation can be explained by differences in the quality of healthcare governance, prevalence of HIV and socioeconomic deprivation. Future studies should validate our findings using more rigorous epidemiological study designs.

10.
Pediatr Crit Care Med ; 18(10): 915-923, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28737595

RESUMO

OBJECTIVES: To evaluate for any association between time of admission to the PICU and mortality. DESIGN: Retrospective cohort study of admissions to PICUs in the Virtual Pediatric Systems (VPS, LLC, Los Angeles, CA) database from 2009 to 2014. SETTING: One hundred and twenty-nine PICUs in the United States. PATIENTS: Patients less than 18 years old admitted to participating PICUs; excluding those post cardiac bypass. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 391,779 admissions were included with an observed PICU mortality of 2.31%. Overall mortality was highest for patients admitted from 07:00 to 07:59 (3.32%) and lowest for patients admitted from 14:00 to 14:59 (1.99%). The highest mortality on weekdays occurred for admissions from 08:00 to 08:59 (3.30%) and on weekends for admissions from 09:00 to 09:59 (4.66%). In multivariable regression, admission during the morning 06:00-09:59 and midday 10:00-13:59 were independently associated with PICU death when compared with the afternoon time period 14:00-17:59 (morning odds ratio, 1.15; 95% CI, 1.04-1.26; p = 0.006 and midday odds ratio, 1.09; 95% CI; 1.01-1.18; p = 0.03). When separated into weekday versus weekend admissions, only morning admissions were associated with increased odds of death on weekdays (odds ratio, 1.13; 95% CI, 1.01-1.27; p = 0.03), whereas weekend admissions during the morning (odds ratio, 1.33; 95% CI, 1.14-1.55; p = 0.004), midday (odds ratio, 1.27; 95% CI, 1.11-1.45; p = 0.0006), and afternoon (odds ratio, 1.17; 95% CI, 1.03-1.32; p = 0.01) were associated with increased risk of death when compared with weekday afternoons. CONCLUSIONS: Admission to the PICU during the morning period from 06:00 to 09:59 on weekdays and admission throughout the day on weekends (06:00-17:59) were independently associated with PICU death as compared to admission during weekday afternoons. Potential contributing factors deserving further study include handoffs of care, rounds, delays related to resource availability, or unrecognized patient deterioration prior to transfer.


Assuntos
Mortalidade Hospitalar , Unidades de Terapia Intensiva Pediátrica , Admissão do Paciente , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Análise Multivariada , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
11.
Trials ; 18(1): 157, 2017 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-28372580

RESUMO

BACKGROUND: Mobile health (mHealth) presents one of the potential solutions to maximize health worker impact and efficiency in an effort to reach the Sustainable Development Goals 3.1 and 3.2, particularly in sub-Saharan African countries. Poor-quality clinical decision-making is known to be associated with poor pregnancy and birth outcomes. This study aims to assess the effect of a clinical decision-making support system (CDMSS) directed at frontline health care providers on neonatal and maternal health outcomes. METHODS/DESIGN: A cluster randomized controlled trial will be conducted in 16 eligible districts (clusters) in the Eastern Region of Ghana to assess the effect of an mHealth CDMSS for maternal and neonatal health care services on maternal and neonatal outcomes. The CDMSS intervention consists of an Unstructured Supplementary Service Data (USSD)-based text messaging of standard emergency obstetric and neonatal protocols to providers on their request. The primary outcome of the intervention is the incidence of institutional neonatal mortality. Outcomes will be assessed through an analysis of data on maternal and neonatal morbidity and mortality extracted from the District Health Information Management System-2 (DHIMS-2) and health facility-based records. The quality of maternal and neonatal health care will be assessed in two purposively selected clusters from each study arm. DISCUSSION: In this trial the effect of a mobile CDMSS on institutional maternal and neonatal health outcomes will be evaluated to generate evidence-based recommendations for the use of mobile CDMSS in Ghana and other West African countries. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02468310 . Registered on 7 September 2015; Pan African Clinical Trials Registry, identifier: PACTR20151200109073 . Registered on 9 December 2015 retrospectively from trial start date.


Assuntos
Tomada de Decisão Clínica , Sistemas de Apoio a Decisões Clínicas , Mortalidade Infantil , Serviços de Saúde Materna , Mortalidade Materna , Complicações na Gravidez/terapia , Telemedicina/métodos , Mensagem de Texto , Sistemas de Apoio a Decisões Clínicas/normas , Países em Desenvolvimento , Feminino , Gana , Humanos , Lactente , Saúde do Lactente , Recém-Nascido , Saúde Materna , Serviços de Saúde Materna/normas , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/mortalidade , Projetos de Pesquisa , Fatores de Risco , Telemedicina/normas , Fatores de Tempo
13.
BMC Pregnancy Childbirth ; 16(1): 369, 2016 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-27881104

RESUMO

BACKGROUND: Guideline utilization aims at improvement in quality of care and better health outcomes. The objective of the current study was to determine the effect of provider complete adherence to the first antenatal care guidelines on the risk of maternal and neonatal complications in a low resource setting. METHODS: Women delivering in 11 health facilities in the Greater Accra region of Ghana were recruited into a cohort study. Their first antenatal visit records were reviewed to assess providers' adherence to the guidelines, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected. Participants were followed up for 6 weeks post-partum to complete data collection on outcomes. The incidence of maternal and neonatal complications was estimated. The effects of complete adherence on risk of maternal and neonatal complications were estimated and expressed as relative risks (RRs) with their 95% confidence intervals (CI) adjusted for a potential clustering effect of health facilities. RESULTS: Overall, 926 women were followed up to 6 weeks post-partum. Mean age (SD) of participants was 28.2 (5.4) years. Complete adherence to guidelines pertained to the care of 48.5% of women. Incidence of preterm deliveries, low birth weight, stillbirths and neonatal mortality were 5.3, 6.1, 0.4 and 1.4% respectively. Complete adherence to the guidelines decreased risk of any neonatal complication [0.72 (0.65-0.93); p = 0.01] and delivery complication [0.66 (0.44-0.99), p = 0.04]. CONCLUSION: Complete provider adherence to antenatal care guidelines at first antenatal visit influences delivery and neonatal outcomes. While there is the need to explore and understand explanatory mechanisms for these observations, programs that promote complete adherence to guidelines will improve the pregnancy outcomes.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/normas , Setor Público , Adulto , Anemia/epidemiologia , Feminino , Gana/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Recém-Nascido , Hemorragia Pós-Parto/epidemiologia , Guias de Prática Clínica como Assunto , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Natimorto/epidemiologia , Adulto Jovem
14.
BMC Pregnancy Childbirth ; 16: 274, 2016 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-27649795

RESUMO

BACKGROUND: Stillbirth is a major contributor to perinatal mortality and it is particularly common in low- and middle-income countries, where annually about three million stillbirths occur in the third trimester. This study aims to develop a prediction model for early detection of pregnancies at high risk of stillbirth. METHODS: This retrospective cohort study examined 6,573 pregnant women who delivered at Federal Medical Centre Bida, a tertiary level of healthcare in Nigeria from January 2010 to December 2013. Descriptive statistics were performed and missing data imputed. Multivariable logistic regression was applied to examine the associations between selected candidate predictors and stillbirth. Discrimination and calibration were used to assess the model's performance. The prediction model was validated internally and over-optimism was corrected. RESULTS: We developed a prediction model for stillbirth that comprised maternal comorbidity, place of residence, maternal occupation, parity, bleeding in pregnancy, and fetal presentation. As a secondary analysis, we extended the model by including fetal growth rate as a predictor, to examine how beneficial ultrasound parameters would be for the predictive performance of the model. After internal validation, both calibration and discriminative performance of both the basic and extended model were excellent (i.e. C-statistic basic model = 0.80 (95 % CI 0.78-0.83) and extended model = 0.82 (95 % CI 0.80-0.83)). CONCLUSION: We developed a simple but informative prediction model for early detection of pregnancies with a high risk of stillbirth for early intervention in a low resource setting. Future research should focus on external validation of the performance of this promising model.


Assuntos
Recursos em Saúde/provisão & distribução , Gravidez de Alto Risco , Diagnóstico Pré-Natal/estatística & dados numéricos , Natimorto , Adulto , Feminino , Desenvolvimento Fetal , Humanos , Modelos Logísticos , Análise Multivariada , Nigéria , Valor Preditivo dos Testes , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos
15.
Ann N Y Acad Sci ; 1377(1): 32-43, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27680943

RESUMO

Hands-on science is the ideal platform for observing young children's ability to solve problems, think deeply, and use their creative ingenuity to explore the world around them. Science is naturally interesting and offers authentic reasons to read for information and use math skills to collect, compile, and analyze data. This chapter will share one approach to nurturing and recognizing young children with high-potential: U-STARS∼PLUS (Using Science, Talents, and Abilities to Recognize Students∼Promoting Learning for Underrepresented Students). Each of the five components (high-end learning environments; teacher's observations of potential; engaging science activities; partnerships with parents; and capacity building for system change) will be explained. Concrete examples will be given for each area showing how it works and why it is important. Special attention will be paid to the needs of educationally vulnerable gifted children who remain underserved: racially, ethnically, and linguistically different; economically disadvantaged, and children who are twice exceptional (2e).


Assuntos
Aptidão , Criança Superdotada/educação , Criança Superdotada/psicologia , Pais/psicologia , Professores Escolares/psicologia , Estudantes/psicologia , Aptidão/fisiologia , Criança , Humanos , Aprendizagem/fisiologia , Professores Escolares/normas , Pensamento/fisiologia
16.
BMC Health Serv Res ; 16(1): 505, 2016 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-27654404

RESUMO

BACKGROUND: Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines. METHODS: A cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment. RESULTS: Eleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8-54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities. CONCLUSION: Although antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.


Assuntos
Fidelidade a Diretrizes/normas , Área Carente de Assistência Médica , Guias de Prática Clínica como Assunto/normas , Cuidado Pré-Natal/normas , Adulto , Antimaláricos/uso terapêutico , Estudos Transversais , Combinação de Medicamentos , Feminino , Gana , Instalações de Saúde/normas , Recursos em Saúde/normas , Recursos em Saúde/provisão & distribução , Hospitais/normas , Humanos , Sulfato de Magnésio/uso terapêutico , Gravidez , Estudos Prospectivos , Pirimetamina/uso terapêutico , Sulfadoxina/uso terapêutico , Tocolíticos/uso terapêutico , Carga de Trabalho/estatística & dados numéricos
17.
J Med Internet Res ; 18(8): e226, 2016 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-27543152

RESUMO

BACKGROUND: Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs. OBJECTIVE: We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC. METHODS: The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper. RESULTS: A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones. CONCLUSIONS: mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to address this gap.


Assuntos
Pessoal de Saúde/educação , Resultado da Gravidez , Telemedicina/métodos , Feminino , Humanos , Pobreza , Gravidez , Classe Social
18.
Glob Health Action ; 9: 31907, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27558221

RESUMO

BACKGROUND: Following the adoption of the Millennium Development Goal 4 (MDG 4) in Ghana to reduce under-five mortality by two-thirds between 1990 and 2015, efforts were made towards its attainment. However, impacts and challenges of implemented intervention programs have not been examined to inform implementation of Sustainable Development Goal 3.2 (SDG 3.2) that seeks to end preventable deaths of newborns and children aged under-five. Thus, this study aimed to compare trends in neonatal, infant, and under-five mortality over two decades and to highlight the impacts and challenges of health policies and intervention programs implemented. DESIGN: Ghana Demographic and Health Survey data (1988-2008) were analyzed using trend analysis. Poisson regression analysis was applied to quantify the incidence rate ratio of the trends. Implemented health policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify their impact and challenges. RESULTS: Since 1988, the annual average rate of decline in neonatal, infant, and under-five mortality in Ghana was 0.6, 1.0, and 1.2%, respectively. From 1988 to 1989, neonatal, infant, and under-five mortality declined from 48 to 33 per 1,000, 72 to 58 per 1,000, and 108 to 83 per 1,000, respectively, whereas from 1989 to 2008, neonatal mortality increased by 2 per 1,000 while infant and under-five mortality further declined by 6 per 1,000 and 17 per 1,000, respectively. However, the observed declines were not statistically significant except for under-five mortality; thus, the proportion of infant and under-five mortality attributed to neonatal death has increased. Most intervention programs implemented to address childhood mortality seem not to have been implemented comprehensively. CONCLUSION: Progress towards attaining MDG 4 in Ghana was below the targeted rate, particularly for neonatal mortality as most health policies and programs targeted infant and under-five mortality. Implementing neonatal-specific interventions and improving existing programs will be essential to attain SDG 3.2 in Ghana and beyond.

19.
PLoS One ; 11(6): e0157542, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27322643

RESUMO

BACKGROUND: The first antenatal clinic (ANC) visit helps to distinguish pregnant women who require standard care, from those with specific problems and so require special attention. There are protocols to guide care providers to provide optimal care to women during ANC. Our objectives were to determine the level of provider adherence to first antenatal visit guidelines in the Safe Motherhood Protocol (SMP), and assess patient factors that determine complete provider adherence. METHODS: This cross-sectional study is part of a cohort study that recruited women who delivered in eleven health facilities and who had utilized antenatal care services during their pregnancy in the Greater Accra region of Ghana. A record review of the first antenatal visit of participants was carried out to assess the level of adherence to the SMP, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected using a questionnaire. Percentages of adherence levels and baseline characteristics were estimated and cluster-adjusted odds ratios (OR) calculated to identify determinants. RESULTS: A total of 948 women who had delivered in eleven public facilities were recruited with a mean age (SD) of 28.2 (5.4) years. Overall, complete adherence to guidelines pertained to only 48.1% of pregnant women. Providers were significantly more likely to completely adhere to guidelines when caring for multiparous women [OR = 5.43 (1.69-17.44), p<0.01] but less likely to do so when attending to women with history of previous pregnancy complications [OR = 0.50 (0.33-0.75), p<0.01]. CONCLUSION: Complete provider adherence to first antenatal visit guidelines is low across different facility types in the Greater Accra region of Ghana and is determined by parity and history of previous pregnancy complication. Providers should be trained and supported to adhere to the guidelines during provision of care to all pregnant women.


Assuntos
Fidelidade a Diretrizes , Guias como Assunto , Pacientes , Cuidado Pré-Natal , Adulto , Demografia , Feminino , Humanos , Razão de Chances , Gravidez
20.
PLoS One ; 11(5): e0154664, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27144393

RESUMO

INTRODUCTION: Maternal and neonatal mortality remains high in many low- and middle-income countries (LMIC). Availability and use of mobile phones is increasing rapidly with 90% of persons in developing countries having a mobile-cellular subscription. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This systematic review assessed the effect of mHealth interventions that support pregnant women during the antenatal, birth and postnatal period in LMIC. METHODS: The review was registered with Prospero (CRD42014010292). Six databases were searched from June 2014-April 2015, accompanied by grey literature search using pre-defined search terms linked to pregnant women in LMIC and mHealth. Quality of articles was assessed with an adapted Cochrane Risk of Bias Tool. Because of heterogeneity in outcomes, settings and study designs a narrative synthesis of quantitative results of intervention studies on maternal outcomes, neonatal outcomes, service utilization, and healthy pregnancy education was conducted. Qualitative and quantitative results were synthesized with a strengths, weaknesses, opportunities, and threats analysis. RESULTS: In total, 3777 articles were found, of which 27 studies were included: twelve intervention studies and fifteen descriptive studies. mHealth interventions targeted at pregnant women increased maternal and neonatal service utilization shown through increased antenatal care attendance, facility-service utilization, skilled attendance at birth, and vaccination rates. Few articles assessed the effect on maternal or neonatal health outcomes, with inconsistent results. CONCLUSION: mHealth interventions may be effective solutions to improve maternal and neonatal service utilization. Further studies assessing mHealth's impact on maternal and neonatal outcomes are recommended. The emerging trend of strong experimental research designs with randomized controlled trials, combined with feasibility research, government involvement and integration of mHealth interventions into the healthcare system is encouraging and can pave the way to improved decision making on best practice implementation of mHealth interventions.


Assuntos
Assistência Perinatal , Cuidado Pré-Natal , Telemedicina , Telefone Celular , Países em Desenvolvimento , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Mortalidade Materna , Avaliação de Resultados (Cuidados de Saúde) , Gravidez
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