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1.
Trials ; 22(1): 588, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479602

RESUMO

INTRODUCTION: Considering the important role of education in promoting parents' attachment to the infant, temporal and spatial limitations, and the need to use new educational methods for spouses' participation in childbirth preparation classes, the present study was conducted to compare the effect of in-person and virtual prenatal care education of the spouses of primiparous women on the father and mother's attachment to the infant. METHODS: This is a quasi-experimental clinical trial that was conducted on primiparous pregnant women referring to three prenatal clinics in Tehran, Iran. Sampling was done by continuous method and pregnant women were divided into three groups of face-to-face education (n = 28), virtual education (n = 31), and control (n = 29). The content of the training program in the virtual and face-to-face groups was similar, which was presented in 4 sessions. At 18-20 weeks of gestation, demographic characteristics and pregnancy records were obtained from the samples, and 12 weeks after the delivery, maternal postnatal attachment scale, and postnatal paternal-infant attachment questionnaire were completed. Both intention-to-treat analysis and per-protocol analysis were performed. RESULTS: There was a statistically significant difference between the two groups of in-person education and control, and also virtual education and control for both intention-to-treat and per-protocol analysis (p < 0.05). However, no statistically significant difference was found between the two groups of in-person and virtual education. Results showed a large and medium effect size between the two groups of in-person education and control, and virtual education and control in terms of father-infant attachment score, respectively. There was also no statistically significant difference between the three groups after the educational intervention in terms of the mother-infant attachment score for both intention-to-treat and per-protocol analysis. CONCLUSION: Considering that education by both in-person and virtual methods had the same effect on improving the score of father-infant attachment, it is suggested that to increase the participation of spouses of pregnant women in the process of prenatal care, the spouses of pregnant women should have the option of virtual education in addition to in-person training. TRIAL REGISTRATION: TCTR.ir TCTR20200515011 . Registered on May 12, 2020.


Assuntos
Pai , Cuidado Pré-Natal , Feminino , Humanos , Lactente , Irã (Geográfico) , Masculino , Mães , Gravidez , Cônjuges
2.
BMC Health Serv Res ; 21(Suppl 1): 512, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34511080

RESUMO

BACKGROUND: Routine health facility data are a critical source of local monitoring of progress and performance at the subnational level. Uganda has been using district health statistics from facility data for many years. We aimed to systematically assess data quality and examine different methods to obtain plausible subnational estimates of coverage for maternal, newborn and child health interventions. METHODS: Annual data from the Uganda routine health facility information system 2015-2019 for all 135 districts were used, as well as national surveys for external comparison and the identification of near-universal coverage interventions. The quality of reported data on antenatal and delivery care and child immunization was assessed through completeness of facility reporting, presence of extreme outliers and internal data consistencies. Adjustments were made when necessary. The denominators for the coverage indicators were derived from population projections and health facility data on near-universal coverage interventions. The coverage results with different denominators were compared with the results from household surveys. RESULTS: Uganda's completeness of reporting by facilities was near 100% and extreme outliers were rare. Inconsistencies in reported events, measured by annual fluctuations and between intervention consistency, were common and more among the 135 districts than the 15 subregions. The reported numbers of vaccinations were improbably high compared to the projected population of births or first antenatal visits - and especially so in 2015-2016. There were also inconsistencies between the population projections and the expected target population based on reported numbers of antenatal visits or immunizations. An alternative approach with denominators derived from facility data gave results that were more plausible and more consistent with survey results than based on population projections, although inconsistent results remained for substantive number of subregions and districts. CONCLUSION: Our systematic assessment of the quality of routine reports of key events and denominators shows that computation of district health statistics is possible with transparent adjustments and methods, providing a general idea of levels and trends for most districts and subregions, but that improvements in data quality are essential to obtain more accurate monitoring.


Assuntos
Serviços de Saúde da Criança , Serviços de Saúde Materna , Criança , Saúde da Criança , Feminino , Instalações de Saúde , Humanos , Recém-Nascido , Gravidez , Cuidado Pré-Natal , Uganda/epidemiologia
3.
BMC Health Serv Res ; 21(1): 948, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34503486

RESUMO

BACKGROUND: Maternal mortality is still a challenge in Uganda, at 336 deaths per 100,000 live births, especially in rural hard to reach communities. Distance to a health facility influences maternal deaths. We explored women's mobility for maternal health, distances travelled for antenatal care (ANC) and childbirth among hard-to-reach Lake Victoria islands fishing communities (FCs) of Kalangala district, Uganda. METHODS: A cross sectional survey among 450 consenting women aged 15-49 years, with a prior childbirth was conducted in 6 islands FCs, during January-May 2018. Data was collected on socio-demographics, ANC, birth attendance, and distances travelled from residence to ANC or childbirth during the most recent childbirth. Regression modeling was used to determine factors associated with over 5 km travel distance and mobility for childbirth. RESULTS: The majority of women were residing in communities with a government (public) health facility [84.2 %, (379/450)]. Most ANC was at facilities within 5 km distance [72 %, (157/218)], while most women had travelled outside their communities for childbirth [58.9 %, (265/450)]. The longest distance travelled was 257.5 km for ANC and 426 km for childbirth attendance. Travel of over 5 km for childbirth was associated with adolescent girls and young women (AGYW) [AOR = 1.9, 95 % CI (1.1-3.6)], up to five years residency duration [AOR = 1.8, 95 % CI (1.0-3.3)], and absence of a public health facility in the community [AOR = 6.1, 95 % CI (1.4-27.1)]. Women who had stayed in the communities for up to 5 years [AOR = 3.0, 95 % CI (1.3-6.7)], those whose partners had completed at least eight years of formal education [AOR = 2.2, 95 % CI (1.0-4.7)], and those with up to one lifetime birth [AOR = 6.0, 95 % CI (2.0-18.1)] were likely to have moved to away from their communities for childbirth. CONCLUSIONS: Despite most women who attended ANC doing so within their communities, we observed that majority chose to give birth outside their communities. Longer travel distances were more likely among AGYW, among shorter term community residents and where public health facilities were absent. TRIAL REGISTRATION: PACTR201903906459874 (Retrospectively registered). https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5977 .


Assuntos
Lagos , Saúde Materna , Adolescente , Estudos Transversais , Parto Obstétrico , Feminino , Instalações de Saúde , Humanos , Gravidez , Cuidado Pré-Natal , Uganda/epidemiologia
4.
BMC Health Serv Res ; 21(1): 898, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34465317

RESUMO

BACKGROUND: There have been dozens of strikes by health workers in Kenya in the past decade, but there are few studies of their impact on maternal and child health services and outcomes. We conducted a retrospective survey study to assess the impact of nationwide strikes by health workers in 2017 on utilization of maternal and child health services in western Kenya. METHODS: We utilized a parent study to enroll women who were pregnant in 2017 when there were prolonged strikes by health workers ("strike group") and women who were pregnant in 2018 when there were no major strikes ("control group"). Trained research assistants administered a close-ended survey to retrospectively collect demographic and pregnancy-related health utilization and outcomes data. Data were collected between March and July 2019. The primary outcomes of interest were antenatal care (ANC) visits, delivery location, and early child immunizations. Generalized estimating equations were used to estimate risk ratios between the strike and control groups, adjusting for socioeconomic status, health insurance status, and clustering. Adjusted risk ratios (ARR) were calculated with 95% confidence intervals (95%CI). RESULTS: Of 1341 women recruited in the parent study in 2017 (strike group), we re-consented 843 women (63%) to participate. Of 924 women recruited in the control arm of the parent study in 2018 (control group), we re-consented 728 women (79%). Women in the strike group were 17% less likely to attend at least four ANC visits during their pregnancy (ARR 0.83, 95%CI 0.74, 0.94) and 16% less likely to deliver in a health facility (ARR 0.84, 95%CI 0.76, 0.92) compared to women in the control group. Whether a child received their first oral polio vaccine did not differ significantly between groups, but children of women in the strike group received their vaccine significantly longer after birth (13 days versus 7 days, p = 0.002). CONCLUSION: We found that women who were pregnant during nationwide strikes by health workers in 2017 were less likely to receive WHO-recommended maternal child health services. Strategies to maintain these services during strikes are urgently needed.


Assuntos
Serviços de Saúde Materna , Cuidado Pré-Natal , Criança , Saúde da Criança , Feminino , Humanos , Quênia/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Estudos Retrospectivos
5.
J Pak Med Assoc ; 71(Suppl 4)(8): S11-S15, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34469423

RESUMO

OBJECTIVE: To conduct a community-based cross-sectional survey to determine the prevalence of human immunodeficiency virus (HIV) among pregnant women in taluka Ratodero, Larkana, and two adjacent talukas: Sajawal, district Kambar Shahdadkot and Garhi Yasin, district Shikarpur. Methods: The study was conducted among pregnant women in the three talukas of rural Sindh: Ratodero, Garhi Yasin, and Sajawal, from October 16, 2020 - December 23, 2020. A total of 1,157 pregnant women were interviewed at their homes and tested using the AlereTM HIV Combo rapid finger prick test. The study captured women's sociodemographic, economic, and health characteristics, including age, education, employment, number of children, home or hospital delivery, antenatal care use, antenatal trimester, history of blood transfusion, and HIV test result. Descriptive statistics were calculated: percentages for categorical variables and mean ± standard deviation (SD) for continuous variables. RESULTS: It was found that 0.35% (4/1,157) of women were HIV-positive, of which 3 were in Ratodero, Larkana, and 1 was in Garhi Yasin, Shikarpur. The average age of women was 28.7 ± 4.0 years. Most of the women (n=1067; 92.2%) did not attend a school, and 99.0% (n=1145) had never had a formal job. The average gestational age was 7.6 (±2.2) months. More than three-quarters of the women participating in the study (n=894; 77.3%) were not registered with a formal healthcare facility for antenatal care. CONCLUSIONS: Considering several HIV sub-epidemics in Larkana in the past decade, HIV infection among pregnant women has remained low in Larkana and adjacent districts.


Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Adulto , Criança , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Lactente , Paquistão/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes , Cuidado Pré-Natal , Prevalência , Adulto Jovem
6.
Reprod Health ; 18(1): 180, 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493314

RESUMO

BACKGROUND: Group antenatal care is a rapidly expanding alternative antenatal care delivery model. Research has shown it to be a safe and effective care model for women, but less is known about the perspectives of the providers leading this care. This systematic review examined published literature that considered health care professionals' experiences of facilitating group antenatal care. METHODS: Systematic searches were conducted in seven databases (Cinahl, Medline, Psychinfo, Embase, Ovid Emcare, Global Health and MIDRS) in April 2020. Qualitative or mixed methods studies with a significant qualitative component were eligible for inclusion if they included a focus on the experiences of health care providers who had facilitated group antenatal care. Prisma screening guidelines were followed and study quality was critically appraised by three independent reviewers. The findings were synthesised thematically. RESULTS: Nineteen papers from nine countries were included. Three main themes emerged within provider experiences of group antenatal care. The first theme, 'Giving women the care providers feel they want and need', addresses richer use of time, more personal care, more support, and continuity of care. The second theme, 'Building skills and relationships', highlights autonomy, role development and hierarchy dissolution. The final theme, 'Value proposition of group antenatal care', discusses provider investment and workload. CONCLUSIONS: Health care providers' experience of delivering group antenatal care was positive overall. Opportunities to deliver high-quality care that benefits women and allows providers to develop their professional role were appreciated. Questions about the providers' perspectives on workload, task shifting, and the structural changes needed to support the sustainability of group antenatal care warrant further exploration.


Assuntos
Pessoal de Saúde , Cuidado Pré-Natal , Criança , Atenção à Saúde , Feminino , Humanos , Recém-Nascido , Assistência Perinatal , Gravidez , Papel Profissional , Pesquisa Qualitativa
7.
J Glob Health ; 11: 13003, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34484710

RESUMO

Background: Adequate antenatal care (ANC) utilization is recognized as one of the important drivers of safe childbirth and positive birth outcomes. The usage of ANC services fluctuates with various personal, socio-economic, and cultural characteristics and in resource-poor settings, adolescent mothers are at a particularly high risk of insufficient ANC utilization. Objectives: This paper investigates whether the usage of ANC services and institutional delivery as well as newborn birth weight differ systematically between adolescent and adult mothers in West and Central Africa. Moreover, we explore to what extent differences in birth weight are explained by ANC usage, adolescence, and select socio-economic characteristics of the mother. Methods: We pooled cross-sectional data from all Demographic and Health Surveys (DHS) and Multi Indicator Cluster Surveys (MICS) conducted in countries in West and Central Africa region between 1986 and 2017 to estimate measures of ANC usage and qualified delivery assistance (along with a combined measure of "adequate maternal healthcare" aggregating these two factors) and newborn birth weight by maternal age group. We estimated various regression models to analyze a) the association between adolescence and adequate prenatal and maternal health care controlling for select socio-economic maternal characteristics as well as the local environment and b) between adolescence, adequate maternal health care, and newborn birth weight outcomes, also controlling for maternal characteristics and the local environment. All regressions were linear probability models for binary outcomes and simple linear models for continuous outcomes. Results: Adequate maternal health care provision was lowest among adolescent mothers: 23.0% among adolescents vs an average of 29.2% across all other age groups. Moreover, we found maternal education and wealth to be positively and significantly associated with receiving adequate maternal health care. Adolescent mothers had the highest risk of low infantile birth weight with 14.5% (95% confidence interval (CI) = 13.6%-15.5%), which is roughly 1.5-2 times higher than in older mothers. We found that adolescence is still strongly associated with low birth weight even when adequate maternal health care and various socio-economic factors as well as the local environment are controlled for. Conclusions: Our findings suggest that ANC supply in resource-poor settings should be particularly tailored to adolescent mothers' needs and that further research is necessary to explore what individual maternal characteristics beyond socio-economic and physical (eg, BMI) factors drive the prevalence of low birth weight. Moreover, the currently used measures of maternal care quality are heavily dependent on pure quantitative measures (number of ANC visits). New indicators incorporating measures of factual quality and scope ought to be developed and incorporated into large routine household surveys such as DHS and MICS.


Assuntos
Serviços de Saúde Materna , Cuidado Pré-Natal , Adolescente , Adulto , Idoso , Peso ao Nascer , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Fatores Socioeconômicos
8.
West Afr J Med ; 38(8): 713-718, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34499828

RESUMO

Prevention of mother-to-child transmission (PMTCT) of HIV programme provides antiretroviral treatment to HIV-positive pregnant women to reduce the likelihood of transmission to their infants. Despite concerted efforts to scale-up PMTCT services in Nigeria, coverage and uptake of the services by Antenatal Care (ANC) attendees is below the acceptable. Private health facilities provide ANC services to large number of women, but they are sparingly involved in PMTCT capacity enhancement interventions. This study assessed the knowledge and utilization of PMTCT services among women accessing antenatal care in Private Health facilities in Abakaliki, Ebonyi State. It was a descriptive cross-sectional study in ANC clinics of the health facilities. Data was collected using interviewer administered questionnaire and analysed with Statistical Package for Social Sciences (SPSS) version 22.0 and test of association was by Chi square at P<0.05 level of significance. Results showed mean age of the respondents was 27± 4.6 years. Majority of the respondents (83.4%) had good knowledge of PMTCT but only 68.4% accessed HIV Counselling and Testing (HCT) in the index pregnancy, with fear of stigmatization given as the major reason for not doing HCT. Only 54.5% of sero-positive attendees took anti-retroviral drugs (ARVs) during pregnancy though they all used ARVs during labour/ delivery. Utilization of PMTCT services of HIV wassignificantly associated with educational status and occupation. CONCLUSION: There was good knowledge of PMTCT but utilization of the services was suboptimal. Training and mentoring of health care workers in private facilities on HIV testing programmes is important to improve uptake of PMTCT services and allay fears of stigmatization among the pregnant women.


Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Adulto , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Nigéria , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal , Instalações Privadas , Adulto Jovem
9.
BMC Public Health ; 21(1): 1570, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412619

RESUMO

BACKGROUND: Antenatal care (ANC) is one of the four pillars of the initiative for safe motherhood. ANC helps to improve the health of pregnant women and reduce the risk of adverse pregnancy outcome. First ANC is used to know the health status of the mothers and the fetus, to estimate the gestational age and expected date of delivery. Our research aims to investigate the Spatio-temporal distribution of delayed first ANC visit and its predictors using multilevel binary logistic regression analysis. METHOD: A total of 10,184 women (2061 in 2005, 3366 in 2011, and 4757 in 2016) were included for this study. The data were cleaned and weighted using STATA version 14. A multilevel binary logistic regression model was fitted to identify significant predictors of delayed first ANC visit. ArcGIS software was used to explore the spatial distribution of delayed first ANC visits and a Bernoulli model was fitted using SaTScan software to identify significant clusters of delayed first ANC visits. RESULTS: Overall, 77.69, 73.95, and 67.61% of women had delayed their first ANC visit in 2005, 2011, and 2016 EDHSs respectively. Women education [AOR = 0.71; 95%CI; 0.60, 0.84], unwanted pregnancy [AOR = 1.41;95%CI; 1.04, 1.89], and rural residence [AOR = 1.68;95%CI; 1.19, 2.38] have significantly associated with delayed first ANC visit. The spatial analysis revealed that delayed first ANC visit varies in each EDHS period. The SaTScan analysis result of EDHS 2005 data identified 122 primary clusters located between the border of Oromia and Eastern SNNPR regions (RR = 1.30, LLR = 32.31, P-value< 0.001), whereas in 2011 EDHS, 145 primary clusters were identified in entire Tigray, B/Gumuz, Amhara western part of Afar and northwest Oromia regions (RR = 1.30, LLR = 40.79, P-value< 0.001). Besides in 2016 EDHS,198 primary clusters were located in the entire SNNPR, Gambella, Northen B/Gumuz, and western Oromia regions. (RR = 1.35, LLR = 83.21, P-value< 0.001). CONCLUSION: In Ethiopia delayed first ANC visit was significantly varied across the country over time Women's education, wanted the last child, and residence were significantly associated with delayed first ANC booking. The effect of each predictor was found to be different across regions of Ethiopia. Therefore, a targeted intervention program is required in highly affected areas of Ethiopia.


Assuntos
Cuidado Pré-Natal , Reprodução , Criança , Etiópia , Feminino , Humanos , Análise Multinível , Gravidez , Análise Espacial
10.
Nutrients ; 13(8)2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34444958

RESUMO

We investigated the effect of an antenatal lifestyle intervention of a low-glycaemic index (GI) diet and physical activity on energy-adjusted dietary inflammatory index (E-DIITM) and explored its relationship with maternal and child health in women with overweight and obesity. This was a secondary analysis of 434 mother-child pairs from the Pregnancy Exercise and Nutrition Study (PEARS) trial in Dublin, Ireland. E-DIITM scores were calculated for early (10-16 weeks) and late (28 weeks) pregnancy. Outcomes included lipids, inflammation markers, insulin resistance, mode of delivery, infant size, pre-eclampsia, and gestational diabetes. T-tests were used to assess changes in E-DIITM. Chi-square, correlations, and multiple regression were employed to investigate relationships with outcomes. The mean (SD) age of participants was 32.45 (4.29) years with median (IQR) BMI 28.25 (26.70, 31.34) kg/m2. There was no change in E-DIITM in the controls (-0.14 (1.19) vs. -0.07 (1.09), p = 0.465) but E-DIITM reduced by 10% after the intervention (0.01 (1.07) vs -0.75 (1.05), p < 0.001). No associations were found between early pregnancy E-DIITM and maternal and child outcomes, except for increased odds of adverse cardiometabolic phenotype in women who delivered male (OR = 2.29, p = 0.010) but not female infants (OR = 0.99, p = 0.960). A low-GI antenatal intervention can reduce the inflammatory potential of diets. Sex differences should be explored further in future research.


Assuntos
Dieta Saudável/estatística & dados numéricos , Obesidade/terapia , Sobrepeso/terapia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Adulto , Fatores de Risco Cardiometabólico , Dieta com Restrição de Carboidratos/métodos , Exercício Físico , Feminino , Índice Glicêmico , Humanos , Recém-Nascido , Inflamação , Irlanda , Estilo de Vida , Fenômenos Fisiológicos da Nutrição Materna/fisiologia , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Gravidez , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Resultado do Tratamento
11.
Int J Qual Health Care ; 33(3)2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34383049

RESUMO

BACKGROUND: Universal Health Coverage (UHC) is a core element of ensuring healthy lives, marking the third Sustainable Development Goal. It requires providing quality primary health-care (PHC) services. Assessment of quality of care considering a wide variety of contexts is a challenge. This study lists practical indicators to enhance the quality of PHC. OBJECTIVES: Demonstrating quality indicators for PHC that are feasible, comprehensive and adaptable to wide array of health systems and resource settings. METHODS: We applied the research framework: Exploration, Preparation, Implementation and Sustainment. Exploration included a scoping review to identify quality indicators. Preparation included an eDelphi to refine the primary indicators' list. A panel of 27 experts reviewed the list that was later pilot tested in PHC facilities. The outcomes were presented to two further expert consultations, to refine indicators and plan for broader testing. Implementation included testing the indicators through a five-step process in 40 facilities. A regional consultation in May 2016 discussed the testing outcomes. RESULTS: Initial efforts identified 83 quality indicators at the PHC level that were then refined to a 34-indicator list covering the six domains of quality. A toolkit was also developed to test the feasibility of each indicator measurement, data availability, challenges and gaps. Pilot testing provided insight into modifying and adding some indicators. Wide variability was encountered within and in between facilities, and timely initiation of antenatal care, for example, ranged 31-90% in Oman and 11-98% in Tunisia. Indicators were highly feasible, and 29 out of 34 were measured in 75% of facilities or more. While challenges included gaps in capacity for data collection, the tool showed high adaptability to the local context and was adopted by countries in the Eastern Mediterranean Region (EMR) including Libya, Oman, Iran, Pakistan, Sudan and Palestine. Stakeholders agreed on the high relevance and applicability of the proposed indicators that have been used to inform improvement. CONCLUSION: A cross-regional set of 34 quality indicators of PHC in the EMR was developed and adopted by a diverse group of countries. The toolkit showed high feasibility in pilot testing reflecting the practicality needed to encourage local uptake and sustainability. The core quality indicators are highly adaptable to different local and regional contexts regardless of current PHC strength or available resources. Continuous evaluation and sharing lessons of implementation and use are needed to ascertain the indicators' effectiveness in driving improvements in PHC and to refine and strengthen the evidence supporting the set of indicators for wider adoption.


Assuntos
Atenção Primária à Saúde , Cobertura Universal do Seguro de Saúde , Feminino , Humanos , Irã (Geográfico) , Omã , Gravidez , Cuidado Pré-Natal
12.
BMJ Open ; 11(8): e049167, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389576

RESUMO

OBJECTIVE: To examine the relationship between women's empowerment and maternal healthcare utilisation in Bangladesh. DESIGN: This cross-sectional study uses data from the most recent nationally representative Bangladesh Demographic and Health Survey, 2017-2018. SETTING: Bangladesh. PARTICIPANTS: Married women aged 15-49 years who had a live birth within the 3 years preceding the survey (n=4767). PRIMARY AND SECONDARY OUTCOME MEASURES: Women's empowerment was measured using the recently developed and validated survey-based Women's emPowERment (SWPER) index. The index includes three domains: social independence, decision-making and attitude to violence. Outcomes included utilisation of at least one antenatal care from skilled providers (ANC1), at least four antenatal care visits (≥4 ANC), delivery assisted by a skilled birth attendant (SBA) and a postnatal visit within 2 days of delivery (PNC). Logistic regression analyses were used to assess the identified relationships. RESULTS: Among participants, 83% received ANC1, 46.3% received ≥4 ANC, 51.9% reported SBA and 50.9% sought PNC. Women with high levels of social empowerment relative to those with low levels were more likely to use ANC1 (adjusted OR (AOR) 1.85; 95% CI 1.40 to 2.45), ≥4 ANC (AOR 1.55; 95% CI 1.27 to 1.90), SBA (AOR 2.12; 95% CI 1.71 to 2.62) and PNC (AOR 1.95; 95% CI 1.56 to 2.44). Compared with women with low levels of decision-making empowerment, women with high levels were more likely to use SBA (AOR 1.49; 95% CI 1.21 to 1.83) and PNC (AOR 1.47; 95% CI 1.19 to 1.81). Additionally, significant inequality was observed among women moving from low to high empowerment in all domains of the empowerment index. CONCLUSIONS: Higher empowerment levels were positively associated with maternal healthcare utilisation in Bangladesh. Our findings suggest the need to address women's empowerment in policies aiming to expand health service utilisation.


Assuntos
Serviços de Saúde Materna , Bangladesh , Estudos Transversais , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Cuidado Pré-Natal , Fatores Socioeconômicos
13.
Pan Afr Med J ; 39: 47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422170

RESUMO

Introduction: birth preparedness and complication readiness (BPCR) intervention should greatly have an impact on the reduction of maternal mortality if implemented properly at all levels. Responsibility for BPCR must be shared among all safe motherhood stakeholders-because a coordinated effort is needed to reduce the delays that contribute to maternal and newborn deaths. This study aimed to assess the factors associated with birth preparedness and complication readiness among pregnant women attending government health facilities in the Bamenda Health District. Methods: this was a cross-sectional analytic study. The study period was 30th October - 30th November, 2016. A total of 345 pregnant women of ≥ 32 weeks gestational age seen at the antenatal consultation (ANC) units were recruited. The dependent variable was birth preparedness and complication readiness while the independent variables were the socio-demographic and reproductive health characteristics. Frequency distributions were used to determine the awareness and practice and logistic regression at 95% confidence interval (CI) and p<0.05 to identify the factors that favour birth preparedness and complication readiness. Results: the most likely factors that favour birth preparedness and complication readiness were monthly income (Odds Ratio (OR) = 2.94, (1.39, 6.25), p = 0.005) and the number of antenatal care visits (OR = 2.16, (1.18, 3.90), p = 0.013). Conclusion: majority of the women in this study were not prepared for birth/complications. The factors most associated with birth preparedness and complication readiness were monthly income and number of antenatal care visits.


Assuntos
Parto Obstétrico/métodos , Conhecimentos, Atitudes e Prática em Saúde , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Camarões , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Mortalidade Materna , Complicações do Trabalho de Parto/prevenção & controle , Gravidez , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-34444335

RESUMO

The MAMAACT intervention aimed to address ethnic and social disparity in stillbirth and infant health by improving management of pregnancy complications. This process evaluation of the intervention was guided by the British Medical Research Council's framework. We examined implementation through dose, reach, and fidelity, important mechanisms and the influence of contextual factors. The intervention included a six-hour training session for antenatal care (ANC) midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials (leaflet and app) on warning signs of severe pregnancy complications and how to respond for pregnant women. A mixed-methods approach was applied. Cross-sectional survey data and administrative data were used to assess intervention reach and dose. Qualitative data (records from dialogue meetings with midwives, participant observations and field notes from ANC visits, focus group interviews with midwives, and individual interviews with non-Western immigrant women) evaluated intervention fidelity, mechanisms, and contextual barriers. More than 80% of women received the MAMAACT leaflet and many found the content useful. The app was used more selectively. Midwives described being more aware and reflective in their communication with women from various cultural backgrounds. Organizational factors in ANC (time pressure, lack of flexibility in visits, poor interpreter services), barriers in women's everyday life (lack of social network, previous negative experiences/lack of trust and domestic responsibilities), and habitual interaction patterns among midwives served as contextual barriers. The reach of the intervention was high and it was evaluated positively by both pregnant women and midwives. Organizational factors hindered changes towards more needs-based communication in ANC potentially hindering the intended mechanisms of the intervention. When interpreting the intervention effects, attention should be drawn to both organizational and interpersonal factors in the clinic as well as the pregnant women's life situations.


Assuntos
Saúde do Lactente , Natimorto , Estudos Transversais , Competência Cultural , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Pesquisa Qualitativa
15.
BMC Pregnancy Childbirth ; 21(1): 573, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34416856

RESUMO

BACKGROUND: Currently, we suffer from an increasing diabetes pandemic and on the other hand from the SARS-CoV-2 pandemic. Already at the beginning of the SARS-CoV-2 pandemic, it was quickly assumed that certain groups are at increased risk to suffer from a severe course of COVID-19. There are serious concerns regarding potential adverse effects on maternal, fetal, and neonatal outcomes. Diabetic pregnancies clearly need special care, but clinical implications as well as the complex interplay of diabetes and SARS-CoV-2 are currently unknown. We summarized the evidence on SARS-CoV-2 in diabetic pregnancies, including the identification of novel potential pathophysiological mechanisms and interactions as well as clinical outcomes and features, screening, and management approaches. METHODS: We carried out a systematic scoping review in MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Library, and Web of Science Core Collection in September 2020. RESULTS: We found that the prognosis of pregnant women with diabetes mellitus and COVID-19 may be associated with potential underlying mechanisms such as a simplified viral uptake by ACE2, a higher basal value of pro-inflammatory cytokines, being hypoxemic as well as platelet activation, embolism, and preeclampsia. In the context of "trans-generational programming" and COVID-19, life-long consequences may be "programmed" during gestation by pro-inflammation, hypoxia, over- or under-expression of transporters and enzymes, and epigenetic modifications based on changes in the intra-uterine milieu. COVID-19 may cause new onset diabetes mellitus, and that vertical transmission from mother to baby might be possible. CONCLUSIONS: Given the challenges in clinical management, the complex interplay between COVID-19 and diabetic pregnancies, evidence-based recommendations are urgently needed. Digital medicine is a future-oriented and effective approach in the context of clinical diabetes management. We anticipate our review to be a starting point to understand and analyze mechanisms and epidemiology to most effectively treat women with SARS-COV-2 and diabetes in pregnancy.


Assuntos
COVID-19/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Saúde Materna/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Gravidez em Diabéticas/epidemiologia , Cuidado Pré-Natal/métodos , Feminino , Humanos , Recém-Nascido , Gravidez , Prevenção Primária/métodos
16.
BMC Pregnancy Childbirth ; 21(1): 574, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34416863

RESUMO

SARS-Cov-2 (Severe Acute Respiratory Coronavirus 2) infection confers a non-negligible risk for younger pregnant women with diabetes, which is still less well investigated. This topic was recently addressed by a systematic scoping review in BMC Pregnancy and Childbirth, aiming to summarize the complex interaction between SARS-Cov-2 infection, pregnancy and diabetes. This commentary will summarize and discuss the main findings of this article and its implications for future research.


Assuntos
COVID-19/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Saúde Materna/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Gravidez em Diabéticas/epidemiologia , Cuidado Pré-Natal/métodos , Feminino , Humanos , Recém-Nascido , Gravidez , Prevenção Primária/métodos
18.
Rev Bras Enferm ; 74(suppl 4): e20201243, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34406275

RESUMO

OBJECTIVES: to describe the contribution of pregnant women to the construction and evaluation of educational technology. METHODS: a participatory study developed in three stages, which occurred between March 2018 and June 2019 for identifying the content, construction, and evaluation of the comic. Non-directive interviews were conducted in educational groups with 34 pregnant women. After the comic was built by a team, including a designer, an instrument was applied to 41 pregnant women to evaluate the items Objectives, Organization, Writing style, Appearance, and Motivation. RESULTS: the comic contains 40 pages of contents, illustrations, and quizzes (word search, cross-puzzle, seven mistakes, etc). The pregnant women evaluated it as easy to understand, self-explanatory, aesthetically attractive, and capable of motivating good care practices during pregnancy, obtaining a minimum agreement of 92.1%. FINAL CONSIDERATIONS: the innovation of the educational technology consisted of incorporating the voices of pregnant women in prenatal care, with the potential to stimulate reflections and the learning process of this target audience.


Assuntos
Gestantes , Cuidado Pré-Natal , Escolaridade , Feminino , Humanos , Motivação , Gravidez
19.
Rev Saude Publica ; 55: 49, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34406277

RESUMO

OBJECTIVES: To explore the experiences of irregular (undocumented) Venezuelan migrants in accessing prenatal health services in Colombia and to examine the economic, social, and cultural resources mobilized by them to gain access to care. METHODS: Data was retrieved from the qualitative component of a multi-method research conducted with pregnant immigrants in Barranquilla, Colombia, between 2018 and 2019, and triangulated with a review of regulations established by the Ministry of Health and Social Protection. RESULTS: Having limited economic capital, participants use social capital from personal networks and migrant organizations. They obtain cultural health capital in the form of information on the health system and use their cultural competencies to interact with this system. CONCLUSIONS FOR PRACTICE: Migrants exert their agency through the use of capitals, although with certain constraints. Policies aimed at this social group should consider the strengths of migrants.


Assuntos
Migrantes , Brasil , Colômbia , Atenção à Saúde , Feminino , Acesso aos Serviços de Saúde , Humanos , Gravidez , Cuidado Pré-Natal , Pesquisa Qualitativa
20.
Rev Saude Publica ; 55: 50, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34406319

RESUMO

OBJECTIVES: To describe the evolution of care during pregnancy and childbirth among postpartum women living in the municipality of Rio Grande, Southern Brazil, using data from surveys carried out every three years between 2007 and 2019. METHODS: Within 48 hours after delivery, a single, standardized questionnaire was applied to all mothers who had children in local hospitals and met the inclusion criteria. Demographic and reproductive characteristics, lifestyle habits, socioeconomic level of the family, and care received during pregnancy and childbirth were investigated. In the analysis, the chi-square test for linear trend was used to assess the distribution of indicators per survey. RESULTS: A total of 12,645 parturients were interviewed (98% of the women eligible to participate in the surveys). In the period evaluated, the proportion of births fell 35% among adolescents and increased 25% among women aged 35 years and over. Mothers gained, on average, two years of schooling, and their families experienced an important economic improvement, followed by loss of income in the last survey. Maternal smoking, before and during pregnancy, fell by half. The rate of mothers who started prenatal care in the first trimester and the number of consultations and laboratory tests increased. Almost 60% of prenatal consultations and 80% of births took place in the Brazilian Unified Health System. In 2019, vaginal delivery was once again the most common. The rates of low birth weight (9%) and prematurity (17%) virtually remained unchanged. CONCLUSIONS: We found an important change in the reproductive profile and increased coverage of various prenatal care and delivery services. Children continue to be born well, but low birth weight and prematurity remain endemic.


Assuntos
Parto , Cuidado Pré-Natal , Adolescente , Brasil , Criança , Escolaridade , Feminino , Humanos , Gravidez , Fatores Socioeconômicos
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