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1.
Pediatrics ; 146(Suppl 2): S218-S222, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33004643

RESUMO

Data from the past decade have revealed that neonatal mortality represents a growing burden of the under-5 mortality rate. To further reduce these deaths, the focus must expand to include building capacity of the workforce to provide high-quality obstetric and intrapartum care. Obstetric complications, such as hypertensive disorders and obstructed labor, are significant contributors to neonatal morbidity and mortality. A well-prepared workforce with the necessary knowledge, skills, attitudes, and motivation is required to rapidly detect and manage these complications to save both maternal and newborn lives. Traditional off-site, didactic, and lengthy training approaches have not always yielded the desired results. Helping Mothers Survive training was modeled after Helping Babies Breathe and incorporates further evidence-based methodology to deliver training on-site to the entire team of providers, who continue to practice after training with their peers. Research has revealed that significant gains in health outcomes can be reached by using this approach. In the coronavirus disease 2019 era, we must look to translate the best practices of these training programs into a flexible and sustainable model that can be delivered remotely to maintain quality services to women and their newborns.


Assuntos
Pessoal de Saúde/educação , Capacitação em Serviço/organização & administração , Assistência Perinatal/organização & administração , Fortalecimento Institucional , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Serviços de Saúde Materno-Infantil/organização & administração , Assistência Perinatal/normas , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia
2.
Int J Health Plann Manage ; 35(6): 1306-1310, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32869363

RESUMO

Throughout the world as health systems are being prepared to deal with the SARS-CoV-2 outbreak which will affect the management of HIV, diabetes, mental health and mainly maternal healthcare systems. As all efforts are focused on understanding the epidemiology, clinical features, transmission patterns, and management of the COVID-19 outbreak, there has been very little concern expressed over the effects on maternal health services. It is highly likely that the present situation may exacerbate maternal mortality in suburban and rural areas. The present situation requires governments and NGOs to make necessary arrangements to support people with prenatal and postnatal care.


Assuntos
/epidemiologia , Serviços de Saúde Materna/organização & administração , /prevenção & controle , Feminino , Humanos , Mortalidade Materna , Paquistão/epidemiologia , Assistência Perinatal/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração
3.
Int J Gynaecol Obstet ; 151(2): 188-196, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32757389

RESUMO

OBJECTIVE: To provide a descriptive account of the challenges and administrative preparedness for establishing and sustaining safe obstetric services during the COVID-19 pandemic at Topiwala National Medical College & BYL Nair Charitable Hospital (NH), Mumbai, India. METHODS: The management of pregnant women with COVID-19 was implemented as per international (WHO, RCOG, ACOG) and national (Indian Council of Medical Research) recommendations and guidelines at an academic, tertiary care, COVID-19 hospital in India. RESULTS: Using a multidisciplinary approach and active engagement of a multispecialty team, obstetric services were provided to over 400 women with laboratory-confirmed COVID-19. A sustainable model is established for providing services to pregnant women with COVID-19 in Mumbai Metropolitan Region, India. CONCLUSION: With limited resources, it is possible to set up dedicated maternity services, aligned to international guidelines, for safe pregnancy outcomes in COVID-19 settings. This COVID-19 hospital addressed the challenges and implemented several known and novel methods to establish and sustain obstetric services for women with COVID-19. The model established in the present study can be replicated in other low- and middle-income countries.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Parto Obstétrico/métodos , Controle de Infecções , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Atenção Terciária à Saúde , Adulto , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Índia/epidemiologia , Controle de Infecções/métodos , Controle de Infecções/normas , Inovação Organizacional , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez , Atenção Terciária à Saúde/métodos , Atenção Terciária à Saúde/organização & administração
4.
J Cardiovasc Med (Hagerstown) ; 21(9): 654-659, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32740498

RESUMO

OBJECTIVE: By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the 'Hub-and-Spoke' model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization. METHODS: We describe a modified 'Hub-and-Spoke' model - that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period. RESULTS: From 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal diagnosis, the birth was scheduled. The spoke centers referred to our center six congenital cardiac cases. The postop ExtraCorporeal Membrane Oxygenation support was required in two cases; one case died. None of these patients nor their parents or accompanying person was found to be COVID-19-positive; 2 pediatric intensivists were found to be COVID-19-positive, and needed hospitalization without mechanical ventilation; 13 nurses had positive COVID swabs (4 with symptoms), and were managed and isolated at home. CONCLUSION: Our preliminary data suggest that the model adopted met the immediate needs with a good outcome without increased mortality, nor COVID-19 exposure for the patients who underwent procedures.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Serviço Hospitalar de Cardiologia , Infecções por Coronavirus , Cardiopatias Congênitas , Controle de Infecções , Pandemias , Assistência Perinatal , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/tendências , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/cirurgia , Humanos , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Masculino , Modelos Organizacionais , Inovação Organizacional , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Cuidados Pós-Operatórios/métodos , Gravidez
5.
Midwifery ; 88: 102779, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32600862
6.
Indian pediatr ; 57: 536-548, June 15, 2020.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1117177

RESUMO

During the current rapidly evolving pandemic of COVID-19 infection, pregnant women with suspected or confirmed COVID-19 and their newborn infants form a special vulnerable group that needs immediate attention. Unlike other elective medical and surgical problems for which care can be deferred during the pandemic, pregnancies and childbirths continue. Perinatal period poses unique challenges and care of the mother-baby dyads requires special resources for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. Process: The GRADE approach recommended by the World Health Organization was used to develop the guideline. A Guideline Development Group (GDG) comprising of obstetricians, neonatologists and pediatricians was constituted. The GDG drafted a list of questions which are likely to be faced by clinicians involved in obstetric and neonatal care. An e-survey was carried out amongst a wider group of clinicians to invite more questions and prioritize. Literature search was carried out in PubMed and websites of relevant international and national professional organizations. Existing guidelines, systematic reviews, clinical trials, narrative reviews and other descriptive reports were reviewed. For the practicequestions, the evidence was extracted into evidence profiles. The context, resources required, values and preferences were considered for developing the recommendations. Objectives: To provide recommendations for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. Recommendations: A set of twenty recommendations are provided under the following broad headings: 1) pregnant women with travel history, clinical suspicion or confirmed COVID-19 infection; 2) neonatal care; 3) prevention and infection control; 4) diagnosis; 5) general questions.


Assuntos
Humanos , Feminino , Gravidez , Pneumonia Viral/complicações , Pneumonia Viral/embriologia , Complicações Infecciosas na Gravidez/prevenção & controle , Saúde Materno-Infantil , Infecções por Coronavirus/complicações , Infecções por Coronavirus/embriologia , Assistência Perinatal/organização & administração , Betacoronavirus
7.
Am J Perinatol ; 37(8): 850-853, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32380564

RESUMO

Novel coronavirus disease 2019 (COVID-19) is a pandemic with most American cases in New York. As an institution residing in a high-prevalence zip code, with over 8,000 births annually, we have cared for over 80 COVID-19-infected pregnant women, and have encountered many challenges in applying new national standards for care. In this article, we review how to change outpatient and inpatient practices, develop, and disseminate new hospital protocols, and we highlight the psychosocial challenges for pregnant patients and their providers. KEY POINTS: · Novel coronavirus disease 2019 (COVID-19) information rapidly changes.. · Multidisciplinary communication is key.. · This study addresses psychosocial challenges..


Assuntos
Infecções por Coronavirus , Controle de Infecções , Pandemias , Assistência Perinatal , Pneumonia Viral , Complicações Infecciosas na Gravidez , Padrão de Cuidado/tendências , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Prática Clínica Baseada em Evidências/tendências , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Comunicação Interdisciplinar , Obstetrícia/organização & administração , Obstetrícia/tendências , Inovação Organizacional , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Estados Unidos/epidemiologia
9.
J Neonatal Perinatal Med ; 13(3): 307-311, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32444569

RESUMO

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six "COVID-19 maternity centres" were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards.


Assuntos
Infecções por Coronavirus , Controle de Infecções , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias , Assistência Perinatal , Pneumonia Viral , Padrões de Prática Médica/tendências , Complicações Infecciosas na Gravidez , Betacoronavirus/isolamento & purificação , Aleitamento Materno/métodos , Defesa Civil/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Salas de Parto/normas , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Feminino , Humanos , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Inovação Organizacional , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle
11.
J Pediatr ; 225: 44-50.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32454113

RESUMO

OBJECTIVE: To describe trends in mortality, major morbidity, and perinatal care practices of very low birth weight infants born at NEOCOSUR Neonatal Network centers from January 1, 2001, through December 31, 2016. STUDY DESIGN: A retrospective analysis of prospectively collected data from all inborn infants with a birthweight of 500-1500 g and 23-35 weeks of gestation. RESULTS: We examined data for 13 987 very low birth weight infants with a mean birth weight of 1081 ± 281 g and a gestational age of 28.8 ± 2.9 weeks. Overall mortality was 26.8% without significant changes throughout the study period. Decreases in early onset sepsis from 6.3% to 2.8% (P <.001), late onset sepsis from 21.1% to 19.5% (P = .002), retinopathy of prematurity from 21.3% to 13.8% (P <.001), and hydrocephalus from 3.8% to 2.4% (P <.001), were observed. The incidence for bronchopulmonary dysplasia decreased from 17.3% to 16% (P = .043), incidence of severe intraventricular hemorrhage was 10.4%, necrotizing enterocolitis 11.1%, and periventricular leukomalacia 3.8%, and did not change over the study period. Administration of antenatal corticosteroids increased from 70.2% to 82.3% and cesarean delivery from 65.9% to 75.4% (P <.001). The use of conventional mechanical ventilation decreased from 67.7% to 63.9% (P <.001) and continuous positive airway pressure use increased from 41.3% to 64.3% (P <.001). Survival without major morbidity increased from 37.4% to 44.5% over the study period (P <.001). CONCLUSIONS: Progress in perinatal and neonatal care at network centers was associated with an improvement in survival without major morbidity of very low birth weight infants during a 16-year period. However, overall mortality remained unchanged.


Assuntos
Recém-Nascido de muito Baixo Peso , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Corticosteroides/uso terapêutico , Adulto , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/mortalidade , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/mortalidade , Cesárea , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/mortalidade , Feminino , Idade Gestacional , Humanos , Hidrocefalia/epidemiologia , Hidrocefalia/mortalidade , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/mortalidade , Idade Materna , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/mortalidade , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/mortalidade , Resultado do Tratamento
12.
PLoS One ; 15(4): e0230638, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271787

RESUMO

BACKGROUND: Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. Pregnant women with preeclampsia are at an increased risk of adverse maternal, fetal and neonatal complications. The objective of the study is, therefore, to determine the maternal and perinatal outcome of preeclampsia without severity feature among women managed at a tertiary referral hospital in urban Ethiopia. METHODS: A hospital-based prospective observational study was conducted to evaluate the maternal and perinatal outcome of pregnant women who were on expectant management with the diagnosis of preeclampsia without severe feature at a referral hospital in urban Ethiopia from August 2018 to January 2019. RESULTS: There were a total of 5400 deliveries during the study period, among which 164 (3%) women were diagnosed with preeclampsia without severe features. Fifty-one (31.1%) patients with preeclampsia without severe features presented at a gestational age between 28 to 33 weeks plus six days, while 113 (68.9%) presented at a gestational age between 34 weeks to 36 weeks. Fifty-two (31.7%) women had maternal complication of which, 32 (19.5%) progressed to preeclampsia with severe feature Those patients with early onset of preeclampsia without severe feature were 5.22 and 25.9 times more likely to develop maternal and perinatal complication respectively compared to late-onset after 34 weeks with P-value of <0.0001, (95% CI 2.01-13.6) and <0.0001(95% CI 5.75-115.6) respectively. CONCLUSION: In a setting where home-based self-care is poor expectant outpatient management of preeclampsia without severe features with a once per week visit is not adequate. It's associated with an increased risk of maternal and perinatal morbidity and mortality. Our findings call for special consideration and close surveillance of those women with early-onset diseases.


Assuntos
Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/terapia , Resultado da Gravidez/epidemiologia , Adulto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/mortalidade , Parto Obstétrico/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Assistência Perinatal/organização & administração , Assistência Perinatal/normas , Pré-Eclâmpsia/patologia , Gravidez , Índice de Gravidade de Doença , Centros de Atenção Terciária , Resultado do Tratamento , População Urbana/estatística & dados numéricos , Adulto Jovem
13.
Am J Perinatol ; 37(8): 829-836, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32344441

RESUMO

Novel coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus has rapidly spread, transcending geographic barriers. The World Health Organization and the Centers for Disease Control and Prevention have declared COVID-19 as a public health crisis. Data regarding COVID-19 in pregnancy is limited, consisting of case reports and small cohort studies. However, obstetric patients are not immune from the current COVID-19 pandemic, and obstetric care will inevitably be impacted by the current epidemic. As such, clinical protocols and practice on labor and delivery units must adapt to optimize the safety of patients and health care workers and to better conserve health care resources. In this commentary, we provide suggestions to meet these goals without impacting maternal or neonatal outcomes. KEY POINTS: • Novel coronavirus disease 2019 (COVID-19) is a pandemic.• COVID-19 impacts care of obstetric patients.• Health care should be adapted for the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Parto Obstétrico/métodos , Controle de Infecções , Trabalho de Parto , Pandemias , Assistência Perinatal , Pneumonia Viral , Gestão de Riscos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Assistência Perinatal/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração
14.
Orv Hetil ; 161(12): 452-457, 2020 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-32172586

RESUMO

Perinatal hospice care is a special form of paediatric palliative care, with a focus on prenatally diagnosed malformation, providing physical, psychological and mental support with a holistic approach for the families. Our aim was to analyse how perinatal hospice-palliative care can be implemented and what opportunities it may provide on the basis of available professional guidelines. We introduce study and analysis of the professional guidelines and protocols, mainly from Anglo-Saxon countries, and describe some examples of best practices. Perinatal hospice is a specially demanding care regarding professional and personal challenges. Standardised guidelines based on consensus can serve as starting points, describing proper care and its conditions. Moreover, they can facilitate communication and coordinative processes between the collaborating specialists. Challenging conditions and possible solutions to them can be identified during supportive formative courses. Continuous formation means competency development in palliative care as well as in adequate communication. Orv Hetil. 2020; 161(12): 452-457.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais/organização & administração , Unidades de Terapia Intensiva Neonatal/organização & administração , Cuidados Paliativos/organização & administração , Assistência Perinatal/organização & administração , Criança , Comunicação , Feminino , Humanos , Recém-Nascido , Cuidados Paliativos/métodos , Gravidez
15.
J Nepal Health Res Counc ; 17(4): 431-436, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-32001844

RESUMO

BACKGROUND: Newborn service readiness is facility's observed capacity to provide newborn services and a pre-requisite for quality. Newborn services are priority program of government and efforts are focused on infrastructure and supplies at peripheral health facilities. Study describes health facility readiness for newborn services in four domains of general requirements, equipment, medicines and commodities, and staffing and guidelines. METHODS: Convergent parallel mixed method using concurrent triangulation was done in public health facilities providing institutional deliveries of two randomly selected districts- Taplejung and Solukhumbu of Eastern Mountain Region of Nepal. Face to face interview and observation of facilities were done using structured questionnaire and checklist; in-depth interviews were done using interview guideline from November 2016 to January 2017. Ethical clearance was taken. Descriptive analysis and deductive thematic analysis were done. RESULTS: Mean score of newborn service readiness was 68.7±7.1 with range from 53.3 to 81.4 out of 100. Domains of general requirement, equipment, medicine and commodity, supervision, staffing and guideline were assessed. The gaps identified in general requirements were availability of uninterrupted power supply, means of communication and referral vehicle. Clean wrappers and heater for room temperature maintenance were identified during interviews to be part of the readiness. All health facilities had trained staff while retention of skill was of concern. There was felt need of enforcing adequate training coverage to suffice the need of human resources in remote. CONCLUSIONS: Efforts of improving transportation, heater for room temperature maintenance, trainings with skill retention strategy, utilization of guidelines, availability of skilled birth attendance could result increased and improved newborn service readiness.


Assuntos
Assistência Perinatal/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Comunicação , Medicamentos Essenciais/normas , Medicamentos Essenciais/provisão & distribução , Fontes de Energia Elétrica/provisão & distribução , Equipamentos e Provisões/normas , Equipamentos e Provisões/provisão & distribução , Fidelidade a Diretrizes , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/organização & administração , Calefação/normas , Humanos , Recém-Nascido , Assistência Perinatal/normas , Admissão e Escalonamento de Pessoal/normas , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde/normas
18.
N C Med J ; 81(1): 32-35, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908330

RESUMO

Since its inception in the 1970s, the stratification of perinatal health care into complexity-based levels has resulted in improved outcomes. Recent trends toward de-regionalization based on financial incentives, however, threaten to undermine these gains and should be addressed.


Assuntos
Assistência Perinatal/organização & administração , Feminino , Humanos , Recém-Nascido , North Carolina , Gravidez
19.
N C Med J ; 81(1): 41-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908333

RESUMO

Navigating perinatal specialty care requires access for both patients and their clinicians. Convenience and availability of regional resources, especially in predominantly rural areas, impact the ability to provide care in the ideal setting for each patient's individualized medical needs.


Assuntos
Acesso aos Serviços de Saúde , Assistência Perinatal/organização & administração , Feminino , Humanos , Recém-Nascido , North Carolina , Gravidez
20.
BMC Pregnancy Childbirth ; 20(1): 22, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906939

RESUMO

BACKGROUND: By 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016. METHODS: A CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a "counterfactual site" was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up. RESULTS: Women enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (- 37, 95% CrI: - 224, 170%). CONCLUSIONS: In a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.


Assuntos
Agentes Comunitários de Saúde/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Gestantes , Avaliação de Programas e Projetos de Saúde , Adulto , Feminino , Humanos , Recém-Nascido , Malaui , Masculino , Serviços de Saúde Materna/estatística & dados numéricos , Pessoa de Meia-Idade , Assistência Perinatal/organização & administração , Gravidez , População Rural
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