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2.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 41-47, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965355

RESUMO

Since the outbreak of a cluster of patients with pneumonia of unknown cause in Wuhan, Hubei Province, China, in December 2019, the disease was later officially named coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), quickly spreading globally. Pregnant women and children are particularly vulnerable during disasters and emergencies. Comprehensive and applicable emergency preparedness and response are definitely important methods to prevent and contain the COVID-19 pandemic. The rational allocation of pharmaceutical resources plays an important role in the medical emergency plan. This paper aimed to share experiences for the allocation of pharmaceutical resources in hospitals focusing primarily on women and children during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Coronavirus , Centros de Saúde Materno-Infantil/organização & administração , Preparações Farmacêuticas/provisão & distribução , Pneumonia Viral , Alocação de Recursos/estatística & dados numéricos , Betacoronavirus , Criança , China , Feminino , Humanos , Pandemias , Gravidez
3.
Matern Child Health J ; 24(4): 405-411, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32052275

RESUMO

PURPOSE: To examine the extent to which communities participating in the Collective Impact Learning Collaborative (CILC) increased capacity to create conditions for collective impact (CI) to address racial disparities in maternal and child health (MCH) and align local efforts with state MCH priorities over a 12-month period. DESCRIPTION: Eight communities participated in a learning collaborative that involved the provision of technical assistance via webinars, monthly team calls, and site visits to facilitate the development of a collective impact initiative. A Ready-Set-Go approach to technical assistance was used to guide the communities through each phase of development while also providing individual assistance to teams based on their capacity at the start of participation. ASSESSMENT: A pre/post design measured change in capacity to engage in CI efforts over time. A survey designed to assess the completion of core tasks related to early indicators of CI was completed at baseline and 12 months later. Wilcoxon Signed Ranks Test and Mann-Whitney test determined statistically significant progress towards outcomes over 12 months and differences in progress between high- and low- capacity teams. CONCLUSION: In 12 months, teams with little established groundwork made significant progress, in some ways exceeding progress of more established teams. Statistically significant progress was achieved in eleven of fourteen outcomes measured. Five teams aligned local efforts with state priorities after 12 months. Findings suggest technical assistance to establish conditions for collective impact can support progress even when pre-conditions for collective impact are not previously established.


Assuntos
Saúde da Criança/normas , Saúde Materna/normas , Saúde da Criança/estatística & dados numéricos , Participação da Comunidade/métodos , Participação da Comunidade/tendências , Humanos , Saúde Materna/estatística & dados numéricos , Centros de Saúde Materno-Infantil/organização & administração , Centros de Saúde Materno-Infantil/tendências , Inquéritos e Questionários
4.
Health Policy Plan ; 35(1): 102-106, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31625554

RESUMO

The application of mixed methods in Health Policy and Systems Research (HPSR) has expanded remarkably. Nevertheless, a recent review has highlighted how many mixed methods studies do not conceptualize the quantitative and the qualitative component as part of a single research effort, failing to make use of integrated approaches to data collection and analysis. More specifically, current mixed methods studies rarely rely on emergent designs as a specific feature of this methodological approach. In our work, we postulate that explicitly acknowledging the emergent nature of mixed methods research by building on a continuous exchange between quantitative and qualitative strains of data collection and analysis leads to a richer and more informative application in the field of HPSR. We illustrate our point by reflecting on our own experience conducting the mixed methods impact evaluation of a complex health system intervention in Malawi, the Results Based Financing for Maternal and Newborn Health Initiative. We describe how in the light of a contradiction between the initial set of quantitative and qualitative findings, we modified our design multiple times to include additional sources of quantitative and qualitative data and analytical approaches. To find an answer to the initial riddle, we made use of household survey data, routine health facility data, and multiple rounds of interviews with both healthcare workers and service users. We highlight what contextual factors made it possible for us to maintain the high level of methodological flexibility that ultimately allowed us to solve the riddle. This process of constant reiteration between quantitative and qualitative data allowed us to provide policymakers with a more credible and comprehensive picture of what dynamics the intervention had triggered and with what effects, in a way that we would have never been able to do had we kept faithful to our original mixed methods design.


Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Centros de Saúde Materno-Infantil/economia , Projetos de Pesquisa , Coleta de Dados/métodos , Feminino , Pessoal de Saúde , Humanos , Recém-Nascido , Entrevistas como Assunto , Malaui , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários
5.
Rev Assoc Med Bras (1992) ; 66(Suppl 2): 41-47, 2020. graf
Artigo em Inglês | LILACS, Sec. Est. Saúde SP | ID: biblio-1136384

RESUMO

SUMMARY Since the outbreak of a cluster of patients with pneumonia of unknown cause in Wuhan, Hubei Province, China, in December 2019, the disease was later officially named coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), quickly spreading globally. Pregnant women and children are particularly vulnerable during disasters and emergencies. Comprehensive and applicable emergency preparedness and response are definitely important methods to prevent and contain the COVID-19 pandemic. The rational allocation of pharmaceutical resources plays an important role in the medical emergency plan. This paper aimed to share experiences for the allocation of pharmaceutical resources in hospitals focusing primarily on women and children during the COVID-19 pandemic.


RESUMO Desde o aparecimento de um aglomerado de doentes com pneumonia de causa desconhecida em Wuhan, província de Hubei, China, em dezembro de 2019, a doença foi mais tarde oficialmente nomeada doença do coronavírus 2019 (Covid-19), causada pelo novo vírus da síndrome respiratória aguda grave coronavírus (Sars-CoV-2), que rapidamente se espalhou em nível mundial. As mulheres grávidas e as crianças são particularmente vulneráveis durante catástrofes e emergâncias. A preparação e a resposta de emergência abrangentes e aplicáveis são métodos definitivamente importantes para prevenir e conter a pandemia de Covid-19. A alocação racional dos recursos farmacêuticos desempenha um papel importante no plano de emergência médica. Este documento objetivou compartilhar experiências para a alocação de recursos farmacêuticos em hospitais focando principalmente mulheres e crianças durante a pandemia de Covid-19.


Assuntos
Humanos , Feminino , Gravidez , Criança , Pneumonia Viral , Preparações Farmacêuticas/provisão & distribução , Coronavirus , Alocação de Recursos/estatística & dados numéricos , Centros de Saúde Materno-Infantil/organização & administração , China , Infecções por Coronavirus , Pandemias , Betacoronavirus
7.
Epidemiol Prev ; 44(5-6 Suppl 2): 81-87, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-33412797

RESUMO

This paper aims to describe the Italian obstetric surveillance system (ItOSS) preparedness as an element for a timely response to the new Coronavirus pandemic. ItOSS is a surveillance network that has been collecting data on maternal mortality and conducting population studies on obstetric near misses since 2013. At the beginning of the pandemic, ItOSS launched a new population-based project to monitor SARS-CoV-2 infection during pregnancy and post-partum and promptly give back information useful to clinicians and decision-makers. All the regions and autonomous provinces, for a total of 289 birth units (PN), joined the study. Data relating to pregnant or post-partum women with a confirmed SARS-CoV-2 infection diagnosis addressing the maternities for outpatient visits or hospitalization were collected. The project methodology entails that each participating maternity reports the cases to ItOSS uploading data through an open-source platform. The on-line form includes sociodemographic and clinical data and maternal-neonatal outcomes. Biological samples to detect possible vertical transmission are also collected voluntarily. A total of 534 incident cases were reported from February 25th to July 10th 2020; 7 regions also collected biological samples for 227 cases; data collection is still ongoing.A preliminary analysis of the first 146 SARS-CoV-2 positive women who gave birth between February 25th to April 22nd shows an incidence rate of the infection equal to 2.1/1,000 in Italy and 6.9/1,000 in the Lombardy Region (Northern Italy). The brief time needed to setting up and operating the project, the national coverage, the adoption of shared tools for data collection, the quality and completeness of the information collected show how the availability of active networks like ItOSS represents a crucial element to hold a high level of preparedness in case of a health emergency.


Assuntos
/epidemiologia , Defesa Civil , Notificação de Doenças/métodos , Pandemias , Vigilância da População , Adulto , Coleta de Dados , Feminino , Humanos , Incidência , Transmissão Vertical de Doença Infecciosa , Itália/epidemiologia , Mortalidade Materna , Centros de Saúde Materno-Infantil/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Manejo de Espécimes
8.
Rev. latinoam. enferm. (Online) ; 28: e3364, 2020. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1126952

RESUMO

Objective: to analyze the relationship between maternal self-efficacy to breastfeed and sociodemographic, obstetric, and neonatal variables; between the duration of exclusive breastfeeding and sociodemographic variables; and between the breastfeeding self-efficacy and the duration of exclusive breastfeeding at the intervals of 30, 60, and 180 days postpartum. Method: a longitudinal and prospective study conducted with 224 women. A sociodemographic questionnaire, the Breastfeeding Self-Efficacy Scale - Short Form, and a questionnaire on breastfeeding and child feeding were used for collecting the data. Fisher's exact test and Pearson's correlation coefficient test were used for analysis. Results: there was no association between breastfeeding self-efficacy and the duration of exclusive breastfeeding identified at 30, 60, and 180 days. Self-efficacy was associated with the type of delivery and complications in the postpartum period. There was also an association between religion and exclusive breastfeeding 30 and 60 days postpartum, and assistance with baby care and exclusive breastfeeding at 60 days. Conclusion: It was identified that the type of delivery, complications in the postpartum period, religion, and assistance with baby care corroborate to increase maternal confidence in the ability to breastfeed.


Objetivo: analisar a relação entre a autoeficácia materna para amamentar e as variáveis sociodemográficas, obstétricas e neonatais; a duração do aleitamento materno exclusivo e as variáveis sociodemográficas, e a autoeficácia para amamentar e a duração do aleitamento materno exclusivo nos intervalos de 30, 60 e 180 dias pós-parto. Método: estudo longitudinal e prospectivo realizado com 224 mulheres. Para coleta de dados, utilizou-se um questionário sociodemográfico, a Breastfeeding Self-Efficacy Scale - Short Form e um questionário sobre amamentação e alimentação da criança. Para análise utilizou-se o Teste Exato de Fisher e o Coeficiente de Correlação de Pearson. Resultados: identificou-se que não houve associação entre a autoeficácia para amamentar e a duração do aleitamento materno exclusivo em 30, 60 e 180 dias. A autoeficácia apresentou associação com o tipo de parto e intercorrência no pós-parto. Também se encontrou associação entre a religião e o aleitamento materno exclusivo com 30 e 60 dias pós-parto, e auxílio aos cuidados com o bebê e o aleitamento materno exclusivo em 60 dias. Conclusão: identificou-se que o tipo de parto, intercorrência no pós-parto, religião e auxílio aos cuidados com o bebê corroboram para incrementar a confiança materna na capacidade para amamentação.


Objetivo: analizar la relación entre la autoeficacia materna para amamantar y las variables sociodemográficas, obstétricas y neonatales; la duración del amamantamiento materno exclusivo y las variables sociodemográficas, y la autoeficacia para amamantar y la duración de la lactancia materna exclusiva a intervalos de 30, 60 y 180 días posparto. Método: estudio longitudinal y prospectivo realizado con 224 mujeres. Para la recolección de datos, se utilizó un cuestionario sociodemográfico, la Breastfeeding Self-Efficacy Scale - Short Form y un cuestionario sobre amamantamiento y alimentación infantil. La Prueba Exacta de Fisher y el coeficiente de correlación de Pearson se utilizaron para el análisis. Resultados: se identificó que no hubo asociación entre la autoeficacia para amamantar y la duración de la lactancia materna exclusiva en 30, 60 y 180 días. La autoeficacia se asoció con el tipo de parto y las intercurrencias en el período posparto. También hubo una asociación entre la religión y la lactancia materna exclusiva con 30 y 60 días posparto, y entre la asistencia en los cuidados del bebé y la lactancia materna exclusiva en 60 días Conclusión: se identificó que el tipo de parto, las intercurrencias en el período posparto, la religión y la asistencia en los cuidados del bebé corroboran para aumentar la confianza materna en la capacidad de amamantar.


Assuntos
Humanos , Feminino , Aleitamento Materno , Saúde da Criança , Inquéritos e Questionários , Autoeficácia , Parto , Período Pós-Parto , Nutrição da Criança , Centros de Saúde Materno-Infantil , Enfermagem Obstétrica
9.
Matronas prof ; 20/21(4/1): 28-34, 2019-2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192425

RESUMO

OBJETIVO: Analizar la información que proporcionan los incidentes de seguridad reportados mediante el sistema de notificación de incidentes en el Servicio de Medicina Maternofetal del Hospital Clínic de Barcelona en el primer año tras su implantación. METODOLOGÍA: Se ha realizado un estudio transversal observacional descriptivo incluyendo todos los incidentes de seguridad reportados al Servicio de Medicina Maternofetal del Hospital Clínic de Barcelona en 2016. Las variables estudiadas fueron las siguientes: tipo de incidente, riesgo, turno y notificador. Para su análisis se utilizó el programa Microsoft Excel de Windows. RESULTADOS: Los incidentes de seguridad más frecuentes corresponden a los relacionados con la gestión clínica y los procedimientos, seguidos de los de medicación. La mayoría de los incidentes que se reportan son de riesgo bajo y se observaron en el turno de día; sin embargo, los de riesgo alto se produjeron durante el turno de noche. Destaca también que el colectivo que más notifica es el de enfermeras y matronas. CONCLUSIONES: El personal de enfermería, y concretamente las matronas, son una pieza fundamental en la seguridad obstétrica. Es básico seguir las estrategias y prácticas seguras recomendadas y continuar trabajando para crear una cultura de seguridad


OBJECTIVE: Analyze the information provided by the security incidents reported through the incident reporting system in the Materno-Fetal Medicine Service of the Hospital Clínic of Barcelona in the first year after its implementation. METHODOLOGY: A descriptive observational cross-sectional study was conducted, including all safety incidents reported to the Maternal-Fetal Medicine Service of the Hospital Clínic de Barcelona in 2016. The variables studied were: type of incident, risk, shift and notifier. For its analysis, the Microsoft Excel Windows program was used. RESULTS: The most frequent safety incidents correspond to those related to clinical management and procedures, followed by those of medication. The majority of incidents that are reported are of low risk and were observed in the day shift, however, those of high risk occurred during the night shift. It also highlights that the group that most notifies is that of nurses and midwives. CONCLUSIONS: Nursing and specifically midwives are a fundamental part of obstetric safety. It is essential to follow the recommended safe strategies and practices and continue working to create a safety culture


Assuntos
Humanos , Feminino , Segurança do Paciente , Centros de Saúde Materno-Infantil/estatística & dados numéricos , Enfermeiras Obstétricas/normas , Gestão de Riscos/normas , Estudos Transversais , Enfermeiras Obstétricas/estatística & dados numéricos , Obstetrícia/normas , Gestão de Riscos/estatística & dados numéricos
10.
Isr J Health Policy Res ; 8(1): 84, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31806009

RESUMO

BACKGROUND: The prevalence rate of postpartum depression (PPD) is 9 to 17% among mothers, with higher rates among low income and immigrant populations. Due to the negative effects of PPD symptoms on both the mother and baby, treating mothers with depression symptoms is of great importance. This study examined treatment preferences for PPD among Israeli mothers with and without PPD symptoms, specifically focusing on treatment centers, type of professional and mode of treatment, to help develop relevant policies to promote the health of mothers by reaching a deeper understanding of their preferences. METHODS: 1000 mothers who attended Maternal Child Health Clinics (MCHCs) in Israel for their infant's first medical exam participated in a cross-sectional survey. RESULTS: In this sample, 8.4% of the participants suffered from PPD. Mothers with PPD compared to those without symptoms had lower economic status, were more likely to be single, to be first-time mothers, have an unemployed partner and to have immigrated to Israel. Mothers with PPD preferred private mental health practice and community treatment centers by mental healthcare professionals. They also preferred group interventions and personal psychotherapy rather than technology-based interventions. CONCLUSIONS: The study findings support the formulation of mother-sensitive health policies based on understanding mothers' preferences, and thus, help prepare treatment alternatives that will suit different groups of mothers with PPD, for the benefit of mothers, newborns, and families. Disseminating the results of this study among professionals as part of professional training, can promote appropriate treatment facilities and modes of care for mothers with PPD.


Assuntos
Depressão Pós-Parto/terapia , Mães/psicologia , Preferência do Paciente/estatística & dados numéricos , Estudos de Casos e Controles , Estudos Transversais , Depressão Pós-Parto/epidemiologia , Status Econômico/estatística & dados numéricos , Feminino , Humanos , Israel/epidemiologia , Centros de Saúde Materno-Infantil/estatística & dados numéricos , Preferência do Paciente/psicologia , Inquéritos e Questionários
11.
Pan Afr Med J ; 34: 47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762913

RESUMO

Introduction: Despite the fact that mothers know the exact age to wean their infants, majority of the mothers do not practice exclusive breastfeeding due to cultural beliefs and practices. The purpose of the study was to explore cultural beliefs and practices associated with weaning children at the Maternal Child Health Clinic Kalisizo Hospital. Methods: This was a simple qualitative study. Seven in-depth-interviews were conducted among 7 mothers of children within the ages 0-12 months attending post-natal care services using self-generated semi-structured key informant's guide. This took place at the Maternal Child Health Clinic Kalisizo Hospital. Purposive sampling method was used to select mothers for the study. Three themes were generated namely: identification of the different cultural beliefs and practices associated with weaning, how the different cultural beliefs are practiced and the impacts of these cultural beliefs and practices. Data were analysed using thematic analysis. Results: Although a majority of the mothers knew the recommended age to wean their infants, they did not ignore the ill-informed cultural beliefs, taboos and practices from their elders such as peer pressure, advice and counselling from mother-in laws and teachings from older women who are seen as role models. Conclusion: Adherence to cultural beliefs, taboos and practices, have a powerful influence on weaning, hence hindering exclusive breast feeding.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Mães/estatística & dados numéricos , Desmame/etnologia , Adolescente , Adulto , Aleitamento Materno/etnologia , Feminino , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Centros de Saúde Materno-Infantil , Pesquisa Qualitativa , Uganda , Adulto Jovem
12.
Afr Health Sci ; 19(2): 1841-1848, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656466

RESUMO

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


Assuntos
Saúde Materna , Centros de Saúde Materno-Infantil/organização & administração , Serviços de Saúde Materno-Infantil/normas , Cooperação do Paciente , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Adulto , Criança , Centros Comunitários de Saúde/organização & administração , Comportamento Contraceptivo , Estudos Transversais , Feminino , Humanos , Quênia , Mortalidade Materna , Gravidez , Atenção Primária à Saúde/organização & administração , Fatores Socioeconômicos
13.
BMJ Open ; 9(9): e030133, 2019 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-31543503

RESUMO

OBJECTIVE: To examine the characteristics of women and babies admitted to the residential parenting services (RPS) of Tresillian and Karitane in the first year following birth. DESIGN: A linked population data cohort study was undertaken for the years 2000-2012. SETTING: New South Wales (NSW), Australia. PARTICIPANTS: All women giving birth and babies born in NSW were compared with those admitted to RPS. RESULTS: During the time period there were a total of 1 097 762 births (2000-2012) in NSW and 32 991 admissions to RPS. Women in cohort 1: (those admitted to RPS) were older at the time of birth, more likely to be admitted as a private patient at the time of birth, be born in Australia and be having their first baby compared with women in cohort 2 (those not admitted to an RPS). Women admitted to RPS experienced more birth intervention (induction, instrumental birth, caesarean section), had more multiple births and were more likely to have a male infant. Their babies were also more likely to be resuscitated and have experienced birth trauma to the scalp. Between 2000 and 2012 the average age of women in the RPS increased by nearly 2 years; their infants were older on admission and women were less likely to smoke. Over the time period there was a drop in the numbers of women admitted to RPS having a normal vaginal birth and an increase in women having an instrumental birth. CONCLUSION: Women who access RPS in the first year after birth are more socially advantaged and have higher birth intervention than those who do not, due in part to higher numbers birthing in the private sector where intervention rates are high. The rise in women admitted to RPS (2000-2012) who have had instrumental births is intriguing as overall rates did not increase.


Assuntos
Hospitalização , Comportamento do Lactente , Comportamento Materno/psicologia , Centros de Saúde Materno-Infantil/organização & administração , Poder Familiar/psicologia , Instituições Residenciais/estatística & dados numéricos , Adulto , Austrália/epidemiologia , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Parto Obstétrico/reabilitação , Feminino , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Lactente , Comportamento do Lactente/fisiologia , Comportamento do Lactente/psicologia , Masculino , Saúde Mental , Gravidez , Resultado da Gravidez/epidemiologia , Resultado da Gravidez/psicologia , Fatores Socioeconômicos , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle
14.
BMJ Open ; 9(8): e030506, 2019 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-31427341

RESUMO

OBJECTIVES: The aim of this study was to conduct New Zealand-specific research to inform the design of a pulse oximetry screening strategy that ensures equity of access for the New Zealand maternity population. Equity is an important consideration as the test has the potential to benefit some populations and socioeconomic groups more than others. SETTING: New Zealand has an ethnically diverse population and a midwifery-led maternity service. One quaternary hospital and urban primary birthing unit (Region A), two regional hospitals (Region B) and three regional primary birthing units (Region C) from three Health Boards in New Zealand's North Island participated in a feasibility study of pulse oximetry screening. Home births in these regions were also included. PARTICIPANTS: There were 27 172 infants that satisfied the inclusion criteria; 16 644 (61%) were screened. The following data were collected for all well newborn infants with a gestation age ≥35 weeks: date of birth, ethnicity, type of maternity care provider, deprivation index and screening status (yes/no). The study was conducted over a 2-year period from May 2016 to April 2018. RESULTS: Screening rates improved over time. Infants born in Region B (adjusted OR=0.75; 95% CI 0.67 to 0.83) and C (adjusted OR=0.29; 95% CI 0.27 to 0.32) were less likely to receive screening compared with those born in Region A. There were significant associations between screening rates and deprivation, ethnicity and maternity care provider. Lack of human and material resources prohibited universal access to screening. CONCLUSION: A pulse oximetry screening programme that is sector-led is likely to perpetuate inequity. Screening programmes need to be designed so that resources are distributed in the way most likely to optimise health outcomes for infants born with cardiac anomalies. ETHICS APPROVAL: This study was approved by the Health and Disability Ethics Committees of New Zealand (15/NTA/168).


Assuntos
Equidade em Saúde , Triagem Neonatal/métodos , Oximetria , Estudos de Viabilidade , Humanos , Recém-Nascido , Centros de Saúde Materno-Infantil , Tocologia , Nova Zelândia
15.
PLoS One ; 14(7): e0220107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31344081

RESUMO

INTRODUCTION: La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families. METHODS: We conducted a focused ethnography. Immigrants, refugees, asylum seekers and undocumented migrants were invited to participate. We collected data from November to December 2017 via semi-structured interviews and participant observation during group activities at La Maison Bleue. Data were thematically analysed. RESULTS: Twenty-four mothers participated (9 interviewed, 17 observed). Challenges to well-being included family separation, isolation, loss of support, the immigration process, an unfamiliar culture and environment, and language barriers. Key protective factors were women's intrinsic drive to overcome difficulties, their positive outlook and ability to find meaning in their adversity, their faith, culture and traditions, and supportive relationships, both locally and transnationally. La Maison Bleue strengthened resilience by providing a safe space, offering holistic care that responded to both medical and psychosocial needs, and empowering women to achieve their full potential towards better health for themselves and their families. CONCLUSION: Migrant mothers have many strengths and centres like La Maison Bleue can offer a safe space and be an empowering community resource to assist mothers in overcoming the multiple challenges that they face while resettling and raising their young children in a new country.


Assuntos
Empoderamento , Acesso aos Serviços de Saúde , Centros de Saúde Materno-Infantil , Mães/psicologia , Resiliência Psicológica , Migrantes/psicologia , Adolescente , Adulto , Antropologia Cultural , Canadá/epidemiologia , Criança , Pré-Escolar , Barreiras de Comunicação , Redes Comunitárias/organização & administração , Redes Comunitárias/normas , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Centros de Saúde Materno-Infantil/organização & administração , Centros de Saúde Materno-Infantil/normas , Mães/estatística & dados numéricos , Gravidez , Quebeque/epidemiologia , Refugiados/psicologia , Refugiados/estatística & dados numéricos , Migrantes/estatística & dados numéricos
16.
J Int Assoc Provid AIDS Care ; 18: 2325958219857724, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31258023

RESUMO

Reorganizing service delivery to integrate nutrition and infant and young child feeding (IYCF) with prevention of mother-to-child transmission (PMTCT) is important for improving outcomes of HIV-positive mothers and HIV-exposed infants (HEIs). Quality improvement (QI) strategies were implemented at 22 health facilities. The percentage of HIV-positive pregnant women and lactating mothers who received IYCF counseling at each visit improved (45%-100%; mean = 93.1%, standard deviation [SD] = 15.5). Adherence to IYCF practices improved (70%-96%; mean = 92.4%, SD = 8.5). Mother-baby pairs receiving the standard care package improved (0%-100%; mean = 98.6%, SD = 22.6). The HEIs alive at 18 months and infected decreased (mean = 6.2%, SD = 4.8). Statistical significance of change was estimated using Fisher exact test and magnitude of change over time by calculating the odds ratio. For all indicators, improvement was rapid and significant (P < .001), especially in the first 6 months of QI implementation. Using QI to integrate nutrition and ensure consistent and comprehensive PMTCT service delivery improved IYCF adherence and decreased transmission.


Assuntos
Assistência à Saúde/métodos , Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Fenômenos Fisiológicos da Nutrição Pré-Natal , Melhoria de Qualidade , Antirretrovirais/uso terapêutico , Assistência à Saúde/estatística & dados numéricos , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Centros de Saúde Materno-Infantil/estatística & dados numéricos , Mães/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/virologia , Gestantes , Uganda
17.
BMC Public Health ; 19(1): 724, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182062

RESUMO

BACKGROUND: Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem with damaging consequences. However, little is known about the effect of violence assessment and intervention during pregnancy. We hypothesise that routine enquiry about IPV during pregnancy, in combination with information about IPV and safety behaviours, has the potential to increase the use of these behaviours and prevent and reduce IPV. METHODS: The Safe Pregnancy study is a randomised controlled trial (RCT) to test the effectiveness of a tablet-based intervention to promote safety behaviours among pregnant women. Midwives include women who attend routine antenatal care. The intervention consists of a screening questionnaire for violence and information about violence and safety behaviours through a short video shown on a tablet. The materials are available in different languages to ensure participation of Norwegian, Urdu, Somali and English-speaking women. Eligible women answer baseline questions on the tablet including the Abuse Assessment Scale (AAS). Women who screen positive on the AAS will be randomized to an intervention video that contains information about violence and safety behaviours and women in the control group to a video with general information about a healthy and a safe pregnancy. All women receive information about referral resources. Follow up will be at three months post-partum, when the woman attends the maternal and child health centre (MCHC) for the baby's check-up. Outcome measures are: Use of safety behaviours and quality of life (primary outcomes), prevalence of violence, mental health measures and birth outcomes (secondary outcomes). Intention to treat analysis will be performed. DISCUSSION: The project will provide evidence on whether enquiry about violence and a short video intervention on a tablet is effective and feasible to prevent or reduce harm from IPV among women who attend antenatal care. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov. Identifier: NCT03397277 (Registered 11th January 2018).


Assuntos
Promoção da Saúde/métodos , Violência por Parceiro Íntimo/prevenção & controle , Cuidado Pré-Natal/métodos , Telemedicina/métodos , Adulto , Computadores de Mão , Grupos Étnicos , Feminino , Humanos , Violência por Parceiro Íntimo/etnologia , Violência por Parceiro Íntimo/psicologia , Centros de Saúde Materno-Infantil , Noruega , Paquistão , Período Pós-Parto/etnologia , Período Pós-Parto/psicologia , Gravidez , Gestantes/etnologia , Gestantes/psicologia , Prevalência , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta , Somália , Inquéritos e Questionários , Traduções
18.
PLoS One ; 14(5): e0216612, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31071142

RESUMO

BACKGROUND: There is recognition that effective interventions are available to prevent neonatal and maternal deaths but providing reliable and valid coverage estimates remains a challenge. Household surveys rely on recall of self-reported events that may span up to 5 years, raising concerns of recall bias. OBJECTIVE: This study assessed the reliability of maternal recall of pregnancy, delivery, and postpartum events over a six-month period and identified relevant individual characteristics associated with inconsistent reporting. METHODOLOGY: A longitudinal household survey was conducted with 321 pregnant women in 44 enumeration areas in Southern Nationals, Nationalities and People's Region in Ethiopia. Women who were six or more months pregnant were enrolled and interviewed at seven days, six weeks, and six months post-partum using an identical set of questions regarding maternal and neonatal health and receipt of select neonatal care interventions. We compared responses given at 7 days to those reported at 6 weeks and 6 months and conducted sensitivity, specificity, area under receiving operative curve, and Kappa analyses of selected indicators. RESULTS: We find that reporting complications is higher at the first interview after birth than at either the six-week or six-month interview. The specificity of the majority of complications is high, however sensitivity is generally much lower. The sensitivity of reporting any complication during pregnancy, delivery, or post-partum ranged from 54.5% to 67.6% at the 6-week interview and from 39.2% to 63.2% at the 6-month interview. Though sensitivity of receipt of neonatal interventions was high, specificity and kappa demonstrate low consistency. CONCLUSION: As with childbirth, it may be that during the first seven days women note symptoms with higher scrutiny, but if these do not later develop into serious health issues, they may be forgotten over time. Maternal complications and care are likely to be under-reported by women if interviewed for distant events.


Assuntos
Cesárea/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Centros de Saúde Materno-Infantil/estatística & dados numéricos , Rememoração Mental/fisiologia , Aceitação pelo Paciente de Cuidados de Saúde , Hemorragia Pós-Parto/psicologia , Complicações na Gravidez/psicologia , Adolescente , Adulto , Etiópia/epidemiologia , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Pessoa de Meia-Idade , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/terapia , Adulto Jovem
19.
Lancet Glob Health ; 7(5): e624-e632, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30898495

RESUMO

BACKGROUND: Ensuring quality of care during pregnancy and childbirth is crucial to improving health outcomes and reducing preventable mortality and morbidity among women and their newborns. In this pursuit, WHO developed a framework and standards, defining 31 quality statements and 352 quality measures to assess and improve quality of maternal and newborn care in health-care facilities. We aimed to assess the capacity of globally used, large-scale facility assessment tools to measure quality of maternal and newborn care as per the WHO framework. METHODS: We identified assessment tools through a purposive sample that met the following inclusion criteria: multicountry, facility-level, major focus on maternal and newborn health, data on input and process indicators, used between 2007 and 2017, and currently in use. We matched questions in the tools with 274 quality measures associated with inputs and processes within the WHO standards. We excluded quality measures relating to outcomes because these are not routinely measured by many assessment tools. We used descriptive statistics to calculate how many quality measures could be assessed using each of the tools under review. Each tool was assigned a 1 for fulfilling a quality measure based on the presence of any or all components as indicated in the standards. FINDINGS: Five surveys met our inclusion criteria: the Service Provision Assessment (SPA), developed for the Demographic and Health Surveys programme; the Service Availability and Readiness Assessment, developed by WHO; the Needs Assessment of Emergency Obstetric and Newborn Care developed by the Averting Maternal Death and Disability programme at Columbia University; and the World Bank's Service Delivery Indicator (SDI) and Impact Evaluation Toolkit for Results Based Financing in Health. The proportion of quality measures covered ranged from 62% for the SPA to 12% for the SDI. Although the broadest tool addressed parts of each of the 31 quality statements, 68 (25%) of 274 input and process quality measures were not measured at all. Measures of health information systems and patient experience of care were least likely to be included. INTERPRETATION: Existing facility assessment tools provide a valuable way to assess quality of maternal and newborn care as one element within the national measurement toolkit. Guidance is clearly needed on priority measures and for better harmonisation across tools to reduce measurement burden and increase data use for quality improvement. Targeted development of measurement modules to address important gaps is a key priority for research. FUNDING: None.


Assuntos
Serviços de Saúde Materna/normas , Centros de Saúde Materno-Infantil/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Feminino , Humanos , Recém-Nascido , Garantia da Qualidade dos Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde/normas , Organização Mundial da Saúde
20.
BMJ Open ; 9(3): e025906, 2019 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-30904867

RESUMO

INTRODUCTION: Research into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs. METHODS AND ANALYSIS: Quasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother-infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition. ETHICS AND DISSEMINATION: The study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.


Assuntos
Centros de Saúde Materno-Infantil/economia , Transtornos Mentais/economia , Estudos Observacionais como Assunto/métodos , Cuidado Pós-Natal/economia , Transtornos Puerperais/economia , Análise Custo-Benefício , Intervenção na Crise/economia , Assistência à Saúde/economia , Feminino , Hospitais Psiquiátricos/economia , Humanos , Transtornos Mentais/terapia , Equipe de Assistência ao Paciente/economia , Gravidez , Transtornos Puerperais/terapia , Resultado do Tratamento
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