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1.
J Glob Health ; 9(2): 020428, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673341

RESUMO

Background: Health Alliance International (HAI) with the Ministry of Health (MoH) of Timor-Leste and Catalpa International implemented a mobile phone-based mHealth program in 2013 known as Liga Inan ("Connecting Mothers"). Liga Inan was designed as a sustainable and scalable effort that would support MoH efforts to improve maternal and newborn health care-seeking and home practices. Key aims were to use mobile phone technology to improve communication between pregnant women and their MoH health providers and to increase optimal maternal health behaviors. MoH health staff registered pregnant women into Liga Inan at their first antenatal care (ANC) visit and followed them through pregnancy, delivery and six months postpartum. A web-based platform sent text messages twice weekly to promote safe pregnancy/delivery and facilitated phone communication between pregnant women and their MoH care providers. Methods: For the program's final evaluation, baseline (2012) and final (2015) surveys interviewed women in one intervention district and one adjacent control district who had given birth in the preceding two years. Primary outcomes were receiving four or more ANC visits, using skilled birth attendants, delivery in health facilities, and timely postnatal care. Results: Multivariate analysis compared endline maternal health behaviors for women in the intervention district compared to baseline and to women in the control district. Controlling for other factors, women in the intervention district had nearly twice the odds of having a skilled birth attendant and a facility delivery, nearly five times the odds of receiving a postpartum care visit within two days of delivery, and over five times the odds of having their newborn's health checked within two days of birth. There was no significant association between Liga Inan exposure and receipt of four or more ANC visits. Conclusions: Liga Inan was associated with substantial increases in MoH health provider-assisted and facility-based births and timely postnatal care in Timor-Leste. These positive results led the MoH to incorporate Liga Inan into the national maternal and child health program. To date the program has expanded to cover all 13 districts in the country, with gradual assumption of management and financial responsibility by the MoH under way.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Telemedicina/organização & administração , Adolescente , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Avaliação de Programas e Projetos de Saúde , Timor-Leste , Adulto Jovem
2.
Afr J Reprod Health ; 23(3): 30-41, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31782629

RESUMO

Maternal mortality is attracting attention worldwide, but maternal health problems after delivery have received less attention. Most studies focus on prenatal maternal health problems. We aimed to identify factors associated with postpartum health problems among married women of reproductive age in Democratic Republic of the Congo. We employed a cross-sectional study design and randomly enrolled 700 married women of reproductive age in Kenge city. Data collection instrument was developed using the UNICEF Multiple Indicator Cluster Survey. T-test, chi-square test, and binary logistic regression analysis were performed using the SPSS version 24.0. Significant risk factors associated with postpartum health problems were initial postnatal care period; within 24 hours (Odds Ratio [OR]=2.197, 95% confidence interval [CI]: [1.156-4.174], p=.016); within 7 days (OR=1.972, 95% CI: [1.102-3.528, p=.022]; within 14 days (OR=2.124, 95% CI: [1.082-4.172], p=.029) among reproductive health and health service utilization characteristics. Health education by RECO (Relais Cmunataure) was associated with postpartum health problems including PCIME (Prise en Charge Integree des Maladies de l'Enfant; OR=1.845, 95% CI: [1.038- 3.282], p=.037); hand washing (OR=1.897, 95% CI: [1.060-3.396], p=.031); malaria (OR=2.003, 95% CI: [1.192-3.366], p=.009) among Maternal and Child Health intervention characteristics. In conclusion, it is necessary to develop and promote health policies and educational programs focusing on PNC service within 24 hours, PNC services within 7 days, PCIME, hand washing, prevention of malaria.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , República Democrática do Congo/epidemiologia , Feminino , Febre/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Malária/epidemiologia , Casamento , Pessoa de Meia-Idade , Hemorragia Pós-Parto/epidemiologia , Período Pós-Parto , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
3.
PLoS Med ; 16(10): e1002943, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31644531

RESUMO

BACKGROUND: Postpartum care has the potential to avert a substantial proportion of maternal and perinatal mortality and morbidity. There is a crucial gap in understanding the quality of postpartum care for women giving birth in health facilities in low- and middle-income settings. This is particularly the case in sub-Saharan Africa (SSA), where the levels of maternal and neonatal mortality are highest globally despite rapid increases in facility-based childbirth. This study estimated the percentage of women receiving a postpartum health check following childbirth in a health facility in SSA and examined the determinants of receiving such check. METHODS AND FINDINGS: We used the most recent Demographic and Health Survey (DHS) conducted in 33 SSA countries between 2000-2016. We estimated the percentage of women receiving a postpartum check by a health professional while in the childbirth facility and the associated 95% confidence interval (CI) for each country. We analyzed determinants of receiving such checks using logistic regression of the pooled data. The analysis sample included 137,218 women whose most recent live birth in the 5- year period before the survey took place in a health facility. Of this pooled sample, 65.7% of women were under 30 years of age, 85.9% were currently married, and 57% resided in rural areas. Across countries, the median percentage of women who reported receiving a check was 71.7%, ranging from 26.6% in Eswatini (Swaziland) to 94.4% in Burkina Faso. The most fully adjusted model showed that factors from all four conceptual categories (obstetric/neonatal risk factors, care environment, and women's sociodemographic and child-related characteristics) were significant determinants of receiving a check. Women with a cesarean section had a significantly higher adjusted odds ratio (aOR) of 1.88 (95% CI 1.72-2.05, p < 0.001) of receiving a check. Women giving birth in lower-level public facilities had lower odds of receiving a check (aOR 0.94, 95% CI 0.90-0.98, p = 0.002) compared to those in public hospitals, as did women attended by a nurse/midwife (compared to doctor/nonphysician clinician) (aOR 0.74, 95% CI 0.69-0.78, p < 0.001). This study was limited by the accuracy of the respondent's recall of the provider, timing, and receipt of postpartum checks. The outcome of interest was measured using three slightly different question sets across the 33 included countries. CONCLUSIONS: The suboptimal levels of postpartum checks in health facilities in many of the included SSA countries partially reflect the lack of importance given to postpartum care in the global discourse on essential interventions and quality improvement in maternal health. Addressing disparities in access to both facility-based childbirth and good-quality postpartum care in SSA is critical to addressing stalling declines in maternal mortality and morbidity.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Instalações de Saúde , Cuidado Pós-Natal/organização & administração , Cuidado Pós-Natal/estatística & dados numéricos , Adolescente , Adulto , África ao Sul do Saara , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Mortalidade Infantil , Pessoa de Meia-Idade , Obstetrícia , Razão de Chances , Parto , Período Pós-Parto , Gravidez , Análise de Regressão , Fatores de Risco , População Rural , Adulto Jovem
4.
Prof Inferm ; 72(2): 111-119, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31550427

RESUMO

INTRODUCTION: Continuity of care in the postpartum period is strongly recommended by international guidelines. Several studies demonstrate how an individualized follow-up program may decrease newborn's mortality and morbidity and prevent or early identify chronic diseases or diseases with long-term effects for mother, newborn and family. In Italy the lastest recommendations on postnatal care of mothers and newborns have been relea- sed in 2000. AIM: To describe the organization of healthy term newborns post-discharge follow-up in the 10 birth centers of Ligurian public hospitals. METHODS: Descriptive study, conducted in 2015 through telephonic interview with head nurses (or their delegates) of the centers. RESULTS: All 10 birth centers participated in the study recommend a follow-up visit, but only half have a formalized procedure for follow-up. Most of them recommend the first follow-up visit within 2-3 days from discharge. Half of centers provide the first follow-up visit at the birth center's clinic, three don't recommend follow-up visits after the first one. None of them links the follow-up visit of the newborn with the mother's one; usually the needs of mother and newborn are identified and met by pediatric nurses, nurses and neonatologist. All the centers provide a telephone number for post-discharge needs. Two centers make calls to mothers considered to be at risk of postpartum depression. DISCUSSION: The study describes different newborn care pathways related to follow-up after discharge in the Ligurian birth centers. At the moment there is no homogeneous implementation of the interventions recommended at national level.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Continuidade da Assistência ao Paciente/organização & administração , Cuidado Pós-Natal/métodos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Feminino , Hospitais Públicos , Humanos , Recém-Nascido , Itália , Alta do Paciente , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Inquéritos e Questionários , Fatores de Tempo
5.
BMC Pregnancy Childbirth ; 19(1): 339, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533640

RESUMO

BACKGROUND: There is broad agreement that antenatal care (ANC) interventions, skilled attendance at birth and management of complications arising after delivery are key strategies that can tackle the high burden of maternal mortality in sub-Saharan Africa. In Kenya, utilisation rate of these services has remained low despite a government policy on free maternal care. The present study sought to understand what factors are leading to the low healthcare seeking during pregnancy, child birth and postnatal period in Siaya County in Kenya. METHODS: Six Focus Group Discussions were conducted with 50 women attending ANC in 6 public primary healthcare facilities. Participants were drawn from a sample of 200 women who were eligible participants in a Conditional Cash Transfer project aimed at increasing utilization of healthcare services during pregnancy and postnatal period. Interviews were conducted at the health facilities, recorded, transcribed and analysed using thematic analysis. RESULTS: Multiple factors beyond the commonly reported distance to health facility and lack of transportation and finances explained the low utilization of services. Emergent themes included a lack of understanding of the role of ANC beyond the treatment of regular ailments. Women with no complicated pregnancies therefore missed or went in late for the visits. A missed health visit contributed to future missed visits, not just for ANC but also for facility delivery and postnatal care. The underlying cause of this relationship was a fear of reprimand from the health staff and denial of care. The negative attitude of the health workers explained the pervasive fear expressed by the participants, as well as being on its own a reason for not making the visits. The effect was not just on the woman with the negative experience, but spiraled and affected the decision of other women and their social networks. CONCLUSIONS: The complexity of the barriers to healthcare visits implies that narrow focused solutions are unlikely to succeed. Instead, there should broad-based solutions that focus on the entire continuum of maternal care with a special focus on ANC. There is an urgent need to shift the negative attitude of healthcare workers towards their clients.


Assuntos
Parto Obstétrico , Parto Domiciliar/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pós-Natal , Cuidado Pré-Natal , Adulto , Atitude do Pessoal de Saúde , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Quênia/epidemiologia , Mortalidade Materna , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/organização & administração , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Pesquisa Qualitativa , Melhoria de Qualidade
6.
Int J Equity Health ; 18(1): 146, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533741

RESUMO

BACKGROUND: In 2012, the WHO described the quality of health care as the route to equity and dignity for women and children. AIM OF THE WORK: To provide community based support and empowerment to women in childbearing period to seek optimal prenatal, natal and postnatal healthcare. Achieving this is anticipated to decrease maternal morbidity and mortality in Egypt. SUBJECTS AND METHODS: An interventional study was conducted among women in childbearing period in the poorest two governorates of Upper Egypt. The study passed through three stages over three and a half years; pre-interventional assessment of awareness (n = 1000), educational interventions targeting the health providers and all women in childbearing period in their communities (n = 20,494), and post-intervention evaluation of change in awareness of their rights for prenatal, natal and postnatal care (no = 1150). RESULTS: The studied indicators relating to receiving care in pregnancy, labor, and puerperium have changed dramatically as a result of the study interventions. Results of the study showed that before interventions, the surveyed women had inaccurate knowledge regarding most of the items related to their rights. The percentages of women aware of their right to have pregnancy card increased and those who possessed a pregnancy card were doubled with a significant percent change of more than 25%. Some indicators showed more than 75% improvement, including; percent of surveyed women who knew that it's their right to follow up their pregnancy and to deliver with a specialized doctor, a trained nurse or at an equipped health facility, and those who knew their right to have at least two home preparations necessary for safe delivery at home. CONCLUSION AND RECOMMENDATIONS: More work is needed in order to achieve the targeted reduction of maternal mortality. This could be achieved by ensuring accessible and high quality care provided by the governmental health facilities together with increasing the awareness of women regarding their rights in receiving such care.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Direitos Sexuais e Reprodutivos , Direitos da Mulher , Egito/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mortalidade Materna , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos
7.
BMC Res Notes ; 12(1): 483, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382978

RESUMO

OBJECTIVE: Most neonatal deaths occur in low income and middle-income countries and about half of the deaths occur at home. It is estimated that about 75% of neonatal deaths could be avoided with simple, low-cost tools that already exist such as antibiotics for pneumonia and sepsis, sterile blades to cut the umbilical cords using knit caps and kangaroo care to keep babies warm. The aim of this study is to assess the knowledge, attitudes, and practices of newborn care among postnatal mothers at Bahir Dar, Ethiopia 2016. An institutional based cross-sectional study design was used. The sample size was calculated by using a single population proportion formula. The total sample size was 422. The collected data was coded and entered to Epi-Data version 3.1 and exported and analyzed using SPSS version 23.0. Both descriptive and multivariate logistic regression was performed. RESULT: A total of 414 postnatal mothers were interviewed with a response rate of 98.1%, among them 55.3% had good knowledge and 60.6% had a good practice of newborn care. Age of the mother, occupation, the month of pregnancy at first ANC visits, overall knowledge and attitude level was found to have a significant association with newborn care practice.


Assuntos
Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Mães/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
8.
BMC Pregnancy Childbirth ; 19(1): 310, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455264

RESUMO

BACKGROUND: Globally in 2017 neonatal death accounted for 46% of under-five deaths. Nepal is among the developing countries which has a high number of neonatal deaths. The rates are high among poor socio-economic groups, marginalized, as well as people living in remote areas of Nepal. This paper, thus tries to examine the utilization pattern and maternal, household, and health service factors affecting underprivileged ethnic groups in Midwest Nepal. METHODS: A cross-sectional mixed method study was conducted from September 2017 to April 2018 in Bardiya district. Quantitative data were collected from a household survey of women who gave live births within the last 12 months prior to data collection (n = 362). Interviews were also undertaken with 10 purposively selected key informants. Logistic regression model was used to determine the factors associated with essential neonatal care utilization. Thematic analysis was undertaken on the qualitative data. RESULTS: Overall, neonatal care utilization was 58.6% (53.3-63.7%), with big variations seen in the coverage of selected neonatal care components. Factors such as birth order (2.059, 1.13-3.75), ethnicity (2.28, 1.33-3.91), religion (2.37, 1.03-5.46), perceived quality of maternal and neonatal services (2.66, 1.61-4.39) and awareness on immediate essential newborn cares (2.22, 1.28-3.87) were identified as the determining factors of neonatal care utilization. CONCLUSIONS: The coverage of birth preparedness and complication readiness, adequate breastfeeding, and postnatal care attendance were very low as compared to the national target for each component. The determinants of essential neonatal care existed at maternal, household as well as health facility level and included ethnicity, religion, perceived quality of maternal and neonatal services, birth order and awareness on immediate essential newborn care. Appropriate birth spacing, improving the quality of maternal and neonatal services at health facilities and raising mother's level of awareness about neonatal care practices are recommended.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto , Intervalo entre Nascimentos , Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Estudos Transversais , Grupos Étnicos/psicologia , Características da Família , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Nepal , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cuidado Pós-Natal/psicologia , Gravidez , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Populações Vulneráveis/psicologia , Adulto Jovem
9.
Midwifery ; 77: 71-77, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31255911

RESUMO

OBJECTIVE: We aimed to explore midwives' perspectives on post-abortion care (PAC) in Uganda. Specifically, we sought to improve understanding of the quality of care. DESIGN: This was a qualitative study using individual in-depth interviews and an inductive thematic analysis. SETTING AND PARTICIPANTS: Interviews were conducted with 22 midwives (the 'informants') providing PAC in a public hospital in Kampala, Uganda. The narratives were based on experiences in current and previous workplaces, in rural and urban settings. FINDINGS: The findings comprise one main theme - morality versus duty to provide quality post-abortion care - and three sub-themes. Our findings confirm that the midwives were committed to saving women's lives but had conflicting personal morality in relation to abortion and sense of professional duty, which seemed to influence their quality of care. Midwives were proud to provide PAC, which was described as a natural part of midwifery. However, structural challenges, such as lack of supplies and equipment and high patient loads, hampered provision of good quality care and left informants feeling frustrated. Although abortion was often implied to be immoral, the experience of PAC provision appeared to shape views on legality, leading to an ambiguous, yet more liberal, stance. Abortion stigma was reported to exist within communities and the health workforce, extending to both providers and care-seeking women. Informants had witnessed mistreatment of women seeking care due to abortion complications, through deliberate care delays and denial of pain medication. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: Midwives in PAC were dedicated to saving women's lives; however, conflicting morality and duty and poor working conditions seemed to impede good-quality care. Enabling midwives to provide good quality care includes increasing the patient-midwife ratio and ensuring essential resources are available. Additionally, efforts that de-stigmatise abortion and promote accountability are needed. Implementation of policies on respectful post-abortion care could aid in ensuring all women are treated with respect.


Assuntos
Aborto Induzido/enfermagem , Obrigações Morais , Princípios Morais , Enfermeiras Obstétricas/psicologia , Cuidado Pós-Natal/métodos , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Cuidado Pós-Natal/psicologia , Cuidado Pós-Natal/estatística & dados numéricos , Pesquisa Qualitativa , Uganda
10.
BMC Pregnancy Childbirth ; 19(1): 178, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31113407

RESUMO

BACKGROUND: Majority of causes of maternal and newborn mortalities are preventable. However, poor access to and low utilization of health services remain major barriers to optimum health of the mothers and newborns. The objectives of this study were to assess maternal and newborn health services utilization and factors affecting mothers' health service utilization. METHODS: A community based cross-sectional survey was carried out on randomly selected mothers who gave birth within a year preceding the survey. The survey was supplemented with key informant interviews of experts/health professionals. Multivariable logistic model was used to identify factors associated with service utilization. Adjusted odds ratios (AORs) were used to assess the strength of the associations at p-value ≤0.05. The qualitative data were summarized thematically. RESULTS: A total of 789 (99.1% response rate) mothers participated in the study. The proportion of the mothers who got at least one antennal care (ANC) visit, institutional delivery and postnatal care (PNC) were 93.3, 77.4 and 92.0%, respectively. Three-forth (74.2%) of the mothers started ANC lately and only 47.5% of them completed ANC4+ visits. Medium (4-6) family size (AOR: 2.3; 95% CI: 1.1, 4.9), decision on ANC visits with husband (AOR: 30.9; 95% CI: 8.3, 115.4) or husband only (AOR: 15.3; 95%CI: 3.8, 62.3) and listening to radio (AOR: 2.5; 95%CI: 1.1, 5.6) were associated with ANC attendance. Mothers whose husbands read/write (AOR: 1.6; 95% CI: 1.1, 2.), attended formal education (AOR: 2.8; 95% CI: 1.1, 6.8), have positive attitudes (AOR: 10.2; 95% CI: 25.9), living in small (AOR: 3.0; 95% CI: 1.2, 7.6) and medium size family (AOR: 2.3; 95% CI: 1.2, 4.1) were more likely to give birth in-health facilities. The proportion of PNC checkups among mothers who delivered in health facilities and at home were 92.0 and 32.5%, respectively. The key informants mentioned that home delivery, delayed arrival of the mothers, unsafe delivery settings, shortage of skilled personnel and supplies were major obstacles to maternal health services utilization. CONCLUSIONS: Health information communication targeting husbands may improve maternal and newborn health services utilization. In service training of personnel and equipping health facilities with essential supplies can improve the provider side barriers.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Mães/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Parto Obstétrico/métodos , Etiópia , Feminino , Instalações de Saúde/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Humanos , Recém-Nascido , Modelos Logísticos , Razão de Chances , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
11.
Glob Health Action ; 12(1): 1609297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31124401

RESUMO

Background: Failure to attend maternal health services is an intractable challenge for the health-care system in low- and middle-income countries. The use of technology for reminding patients about their appointments has been demonstrated to be an effective (future) tool toward increased health care services utilization in developing countries, such as Ethiopia. Objective: We aimed to investigate the effect of enhanced reminders on postnatal care attendance versus usual care (notification of an appointment at discharge). Methods: The study was a cluster randomized controlled trial: out of eligible 86 health centers, 16 health centers in Addis Ababa (AA) were randomized to either the intervention (8) or the control (8) groups; with a total of 350 mothers equally randomized into each arm. Mothers in the intervention group received the SMS (short message service) or a voice call reminder at 48 and 24 hours before the due postnatal appointment, whereas the control group received only the usual notification of appointments provided by health professionals at discharge from the ward following delivery. We recruited participants on wards after delivery at discharge and followed them up to 6 weeks. This study's primary outcome was postnatal visit compliance. Our assessment consisted of a two-level bivariate and a multivariate ordinal logistic regression analysis. Results: The majority (97.7%) of the participants completed the study; 173(98.9%) of women in the intervention group and 169 (96.5%) of women in the control group. There was a statistically significant difference in postnatal care (PNC) compliance among women who were in the intervention versus the control group (p-value = 0.005). Higher odds of postnatal compliance was observed among the intervention group (AOR:2.98, 95% CI 1.51-5.8). Conclusions: Mobile phone reminders were effective in terms of enhancing adherence to PNC appointments. This indicates integration of mobile phone reminders in postnatal care could improve postnatal appointment compliance.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Agendamento de Consultas , Telefone Celular/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Cooperação do Paciente/estatística & dados numéricos , Cuidado Pós-Natal/organização & administração , Sistemas de Alerta/estatística & dados numéricos , Mensagem de Texto/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Etiópia , Feminino , Humanos , Serviços de Saúde Materna/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Adulto Jovem
12.
Malawi Med J ; 31(1): 2-11, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31143390

RESUMO

Introduction: The World Health Organization (WHO) recommends that every woman be checked after the delivery of a child. However, only 42% of Malawian women are checked by a skilled health worker within 48 hours after delivery. This study aimed at identifying factors associated with postnatal care (PNC) utilization among Malawian women by using nationally representative data. Methods: Secondary data from the 2015-2016 Malawi Demographic and Health Survey (MDHS) was used for the study. A logistic regression model was used to find the adjusted odds of utilizing PNC services among the women. All the analyses controlled for the survey clusters and weighting. All the analyses were conducted in STATA version 14 at a significance level of 5%. Results: Out of the 6,693 women who had a live birth 24 months prior to the 2015-2016 MDHS, only 48.4% were checked by a skilled health worker within 42 days after delivery. Uptake of PNC was significantly associated with older age, being employed, living in an urban area, delivery through caesarean section, a timely first antenatal care (ANC) visit, uptake of recommended number of ANC visits, and receiving the adequate number of tetanus injections. Conclusion: Interventions to increase utilization of PNC services should be tailored to appropriate populations. Particularly, special focus has to be made towards younger women, the women who reside in the rural areas, who are not employed, and who are generally not well to do. Behavioural change interventions must also target women with low perceived risk after delivery. Information should also be consistently provided by health workers in communities and health facilities to women on perinatal care in order to change the women's risk perception on all levels of pregnancy care and to encourage utilization of relevant health services.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Cuidado Pré-Natal , Características de Residência , Adolescente , Adulto , Feminino , Pesquisas sobre Serviços de Saúde , Instalações de Saúde , Humanos , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Gravidez , Fatores Socioeconômicos , Adulto Jovem
13.
J Urol ; 202(4): 812-818, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31075056

RESUMO

PURPOSE: We investigated longer term urological outcomes in patients enrolled in the Management of Myelomeningocele Study (MOMS). MATERIALS AND METHODS: Women who participated in the original trial were asked for consent for followup for their child at age 6 years or older in a single comprehensive study visit to a MOMS center. Participating children underwent urological and radiologic procedures to provide objective evidence of current bladder functioning. Primary urological outcome was defined as any among need for clean intermittent catheterization, vesicostomy, urethral dilatation or augmentation cystoplasty. RESULTS: A total of 156 children were evaluated, with a mean age of 7.4 years. Overall 62% vs 87% in the prenatal and postnatal surgery groups, respectively, were placed on clean intermittent catheterization (RR 0.71, 95% CI 0.58-0.86, p <0.001). Voiding status was significantly different between the groups (p <0.001) as 24% in the prenatal group vs 4% in the postnatal group (RR 5.8, 95% CI 1.8-18.7) were reported to be voiding volitionally. Augmentation cystoplasty, vesicostomy and urethral dilation did not differ between the 2 groups. Aside from a larger post-void residual urodynamic catheterization volume, there were no other statistical differences in videourodynamic data or findings on renal/bladder ultrasound. CONCLUSIONS: Prenatal closure of myelomeningocele resulted in less reported clean intermittent catheterization at school age and the mechanism for this is unclear. Although most children are in diapers or on clean intermittent catheterization, parental reports showed children who underwent prenatal closure may be more likely to void volitionally than the postnatal group. Despite these findings, urological outcomes alone should not be the sole impetus to perform in utero closure in children with spina bifida.


Assuntos
Terapias Fetais/métodos , Meningomielocele/cirurgia , Procedimentos Neurocirúrgicos/métodos , Cuidado Pós-Natal/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transtornos Urinários/terapia , Criança , Feminino , Terapias Fetais/estatística & dados numéricos , Seguimentos , Humanos , Cateterismo Uretral Intermitente/estatística & dados numéricos , Masculino , Meningomielocele/complicações , Meningomielocele/diagnóstico , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Transtornos Urinários/diagnóstico por imagem , Transtornos Urinários/etiologia
15.
PLoS One ; 14(4): e0214841, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022201

RESUMO

OBJECTIVES: Previous studies have attempted to assess the role of health insurance on health care utilization in African settings. However, there is limited evidence on the effects of health insurance on use of maternal health care. In the present study our objective was to measure the prevalence of insurance ownership, types of services covered by the insurance and the association of insurance ownership with the utilization of respective maternal health services in Ghana. METHODS: This study was based on nationally representative Demographic and Health Survey in Ghana (GDHS 2014) encompassing 4,293 mothers aged 15-49 years. Outcome variables were use of early antenatal care (ANC), facility delivery, and postnatal care (PNC) for mothers and children, and the explanatory variables were insurance coverage for these services. Associations were analysed using logistic regression models whilst controlling for potentially confounding variables. RESULTS: Prevalence of health insurance ownership was 66.8% (95%CI = 64.5-68.9) with significant socioeconomic disparities. The prevalence was higher particularly among women who were urban residents, had higher educational and wealth status. In general, insurance coverage for services such as ANC, childbirth and postnatal care was higher in rural areas, but that of cash benefit was higher in urban areas. Findings of multivariate analysis indicated that women who had their ANC services covered had significantly higher odds of attending at least one and four ANC visits, as well as receiving PNC for child. Insurance coverage for childbirth services showed significant association with the PNC for child, not with choice of health facility delivery. Women who had cash benefit were twice as likely to use early ANC visit (OR = 2.046, p<0.05), facility delivery (OR = 1.449, p<0.05), and PNC for mother (OR = 1.290, p<0.05). CONCLUSION: Overall prevalence of health insurance coverage has increased since 2008, with significant disparities across demographic and socioeconomic groups. Insurance ownership for different types of maternal health services showed positive association with service uptake, with exceptions for place of delivery, indicating that insurance coverage alone may not be able to promote facility delivery. More studies are required to measure the progress in maternal healthcare utilisation through the insurance programmes.


Assuntos
Seguro Saúde , Serviços de Saúde Materna , Adolescente , Adulto , Demografia , Feminino , Gana , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Cobertura do Seguro , Serviços de Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal , Fatores Socioeconômicos , Adulto Jovem
16.
PLoS One ; 14(4): e0215613, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31002686

RESUMO

Continuum of Care (CoC) is an essential strategy to prevent maternal and child deaths where health services are arranged in a pathway throughout pregnancy, childbirth and after delivery. However, CoC is still a challenge in Nepal. This study aimed to investigate the correlates of CoC from pregnancy to the postnatal period in Nepalese women aged 15 to 49 years. Secondary analysis was performed on the data from Nepal Multiple Indicator Cluster Survey. This led to a sample size of 2086 women who had a live birth within two years preceding the survey. We constructed three outcome models and conducted multivariable logistic regression, to assess socio-economic and demographic correlates of CoC from pregnancy to childbirth to postnatal period. Overall, 41% of the women received Antenatal Care (ANC), delivery from Skilled Birth Attendant (SBA) as well as the Postnatal Care (PNC) during their most recent birth. Women from rural areas (aOR 0.25, 95%CI: 0.18, 0.36) had reduced odds of receiving CoC while women belonging to advantaged ethnic group (aOR 1.61, 95%CI: 1.18 2.19), from middle wealth status (aOR 2.56, 95%CI: 1.68, 3.91) and upper (aOR 4.50, 95%CI: 3.07, 6.59) wealth status, and women having access to media (aOR 1.76, 95%CI: 1.31, 2.37) had higher odds of receiving CoC from pregnancy to postnatal period. Having more than two births reduced the odds of CoC by 30% (aOR 0.70, 95%CI: 0.50, 0.98). These factors were also significantly associated with ANC services and the continuum from ANC to delivery SBA. The findings suggest that the majority of Nepalese women lack a continuity of care during their pregnancy and childbirth, and several socioeconomic factors affect the spectrum of CoC. Efforts to improve maternal health services utilization in a continuum require strategies that remove demand and supply barriers of health care utilization.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Parto Obstétrico/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Nepal , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Cuidado Pré-Natal/métodos , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 19(1): 127, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987608

RESUMO

BACKGROUND: Previous research has shown that developing countries account for the majority of maternal deaths around the world. Relatively high maternal mortality in developing countries has been linked to high HIV prevalence rates in these countries. Several studies have shown that women living with HIV are more vulnerable and are thus more likely to die during maternity than those who are not. Although there has been increased focus on this subject in contemporary research, the relationship between HIV status and maternal-care-utilization is not very well understood. It is not clear whether factors associated with professional maternal care utilization during antenatal, delivery and postnatal periods are similar for HIV positive and HIV negative women. It is also not known whether being HIV positive has an impact on the choice of care (professional care or traditional birth attendants). Thus the aim of this study is to investigate the differences in factors affecting choice of care during antenatal, delivery and postnatal periods between HIV positive and HIV negative women. We also investigate the effect of HIV positive status on choice of care. METHODS: By using the 2013-2014 Zambia Demographic Health Survey Data (ZDHS), we performed two different quantitative analyses. a) Regression analysis: to identify and compare factors associated with the likelihood of utilizing professional care during antenatal, at birth and postnatal periods between HIV positive and HIV negative women. b) Propensity score matching: to investigate the effect of being HIV positive on the choice of care (Professional care or TBAs). RESULTS: Our results show that reasons for choosing professional care during antenatal, at birth, and postnatal periods are the same for both HIV positive and HIV negative women. Further, we also showed that although the probability of utilizing professional care is slightly higher for HIV positive women, the difference is negligible. CONCLUSION: We demonstrated that in Zambia, utilization of professional care among HIV positive women is not particularly high. We also demonstrate that although institutional care is desirable and an ideal solution for HIV positive women, insisting on institutional care when the health facilities lack adequate trained personnel, drugs, and equipment is counterproductive.


Assuntos
Infecções por HIV/psicologia , HIV , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Complicações Infecciosas na Gravidez/psicologia , Adolescente , Adulto , Comportamento de Escolha , Parto Obstétrico/psicologia , Parto Obstétrico/estatística & dados numéricos , Demografia , Feminino , Humanos , Tocologia/estatística & dados numéricos , Cuidado Pós-Natal/psicologia , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Análise de Regressão , Adulto Jovem , Zâmbia
18.
Ethiop J Health Sci ; 29(2): 153-164, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31011263

RESUMO

Background: Prevalence of optimal complementary feeding practices are lower than expected. Undernutrition contributes 35% of children mortality. Our study was aimed to assess magnitude and factors associated with optimal complementary feeding practices among children 6-23 months in Bensa Dstrict, Sidama Zone, South Ethiopia, 2016. Methods: A community based cross sectional study was conducted from January to February 2016 in (8) randomly selected kebles found in Bensa District. Respondents were selected by using simple random sampling technique after sampling frame was prepared from rapid survey. Pre-tested questionnaire was used to collect information. Then, data were entered into SPSS version 20, Then, crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence interval were computed to examine statistical significance. Result: This study revealed that only 8.6% (95%CI: 6.4, 10.7%) of 6-23 months children had optimal complementary feeding practices. Mother's knowledge on optimal complementary feeding (AOR=5.4, 95%CI: 2.7, 11), postnatal care service utilization (AOR=3.4, 95%CI: 1.7, 7), and household food security (AOR=5, 95%CI: 2.5, 10.5) were positively associated with optimal complementary feeding practices. Conclusion: Mother's knowledge, postnatal care utilization and household food security positively affected optimal complementary feeding practices. Thus, Bensa District Health Office, Sidama Zone Health Departiment and other respective stakeholders should cooperatively work to enhance knowledge of mothers/care takers on optimal complementary feeding practices, household food security and on advantages of postnatal care service utilization.


Assuntos
Comportamento Alimentar , Fenômenos Fisiológicos da Nutrição do Lactente/normas , Mães/psicologia , Adulto , Estudos Transversais , Etiópia , Feminino , Abastecimento de Alimentos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Mães/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
19.
JMIR Mhealth Uhealth ; 7(2): e10645, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30816850

RESUMO

BACKGROUND: The public health system in Bangladesh has been struggling to provide coverage and utilization of basic maternal health care services in pursuit of achieving maternal and child mortality-related goals. Interestingly, the rapid popularization of mobile technology in the country is transforming the landscape of health care access and delivery. However, little is known regarding the use of mobile phones from the perspective of maternal health care service utilization. OBJECTIVE: In this study, we aimed to investigate the prevalence and sociodemographic pattern of mobile phone use for health services among women and relationship between the use of mobile phone use and the uptake of essential maternal health services (MHSs). METHODS: Cross-sectional data from the Bangladesh Demographic and Health Survey on 4494 mothers aged between 15 and 39 years were used in the analysis. Using mobile phones to get health services or advice was hypothesized to have a positive association with the uptake of basic MHSs (antenatal care, ANC, facility delivery services, postnatal care) and postnatal care for the newborn. Data were analyzed using bivariate and multivariable techniques. RESULTS: More than a quarter (1276/4494, 28.4%; 95% CI 26.8-30.3) of the women aged 15-39 years reported using mobile phones to get health services with significant sociodemographic variations in the use of mobile phones. Analysis of the specific purposes revealed that, in most cases, mobile phones were used to contact service providers and consult with the same about what to do, whereas a smaller proportion reported using mobile phone for the purposes of arranging money and transportation. Multivariable analysis showed that compared with respondents who reported not using mobile phones for health care services, those who used them had higher odds of making 3+ ANC visits and delivering at a health facility. The odds were slightly higher for rural residents than for those in the urban areas. CONCLUSIONS: The findings of this study conclude that women who use mobile phones are more likely to use ANC and professional delivery services than those who do not. More in-depth studies are necessary to understand the mechanism through which mobile phone-based services enhance the uptake of maternal health care.


Assuntos
Telefone Celular/estatística & dados numéricos , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/psicologia , Cuidado Pré-Natal/psicologia , Adolescente , Adulto , Bangladesh , Estudos Transversais , Feminino , Comunicação em Saúde/métodos , Comunicação em Saúde/tendências , Humanos , Mães/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos
20.
BMC Res Notes ; 12(1): 136, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871623

RESUMO

OBJECTIVE: The study aimed at assessing skin-to-skin contact (SSC) during the postpartum stay and its determinant factors among mothers at public health institutions in Ethiopia. RESULT: A total of 384 mothers-indexed newborns admitted in postnatal wards were interviewed. The prevalence of mothers' SSC practice to their newborns with in the first 1 h during the postpartum stay was 28.1%. Mothers education (AOR = 18.23 [95% CI 5.26, 63.52]), and number of ANC visits (AOR = 8.55 [95% CI 1.05, 69.54]) were independently associated with SSC practice of mothers to their infants.


Assuntos
Aleitamento Materno/métodos , Instalações de Saúde/estatística & dados numéricos , Método Canguru/métodos , Mães/psicologia , Cuidado Pós-Natal/métodos , Saúde Pública/estatística & dados numéricos , Adulto , Aleitamento Materno/estatística & dados numéricos , Escolaridade , Etiópia , Feminino , Humanos , Recém-Nascido , Método Canguru/estatística & dados numéricos , Relações Mãe-Filho , Vigilância da População/métodos , Cuidado Pós-Natal/estatística & dados numéricos , Período Pós-Parto
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