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1.
Nutrients ; 13(7)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34206490

RESUMO

Dietary content during pregnancy is important because it is necessary for the growth of the fetus. With the assumption that the nutritional status of the fetus can be monitored by measuring amino acid concentrations in the amniotic fluid, we investigated whether the habitual dietary intake of pregnant women affected the composition of the amniotic fluid and the significance of performing amniotic fluid analysis. The subjects were 34 mothers who delivered full-term babies by cesarean section. Three biological samples were collected from the mothers: blood, cord blood, and amniotic fluid. At the same time, the mothers' prenatal nutritional intake information was also recorded. When the amino acid contents of the samples were compared with the mothers' nutrient intake, many amino acids in the amniotic fluid were positively correlated with lipid intake, but not with protein intake. There was a negative correlation between lipid intake and carbohydrate intake, and the amino acid contents of the amniotic fluid were also negatively correlated with carbohydrate intake. The results of this study were consistent with those found in animal models, suggesting that the analysis of amniotic fluid may be a useful method to investigate the effects of habitual diet during human pregnancy on the fetus.


Assuntos
Aminoácidos/análise , Líquido Amniótico/química , Carboidratos da Dieta/análise , Gorduras na Dieta/análise , Ingestão de Alimentos/fisiologia , Sangue Fetal/química , Adulto , Dieta/estatística & dados numéricos , Inquéritos sobre Dietas , Feminino , Desenvolvimento Fetal/fisiologia , Humanos , Fenômenos Fisiológicos da Nutrição Materna , Avaliação Nutricional , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Reprodutibilidade dos Testes
2.
Medicine (Baltimore) ; 100(28): e26578, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34260537

RESUMO

ABSTRACT: Decentralized response has been the hallmark of the National AIDS Control Programme in India. District-level HIV burden estimates quantifying the distribution of the epidemics are needed to enhance this decentralized response further to monitor the progress on prevention, testing, and treatment interventions. In this paper, we describe the methodology and results of district-level estimates using the Spectrum model piloted in 5 states of India under National AIDS Control Programme.Using state spectrum model for HIV estimations 2017, we disaggregated state results by the district in pilot states. Each district was considered a subepidemic and HIV epidemic configuration was carried out in its general population as well as in key population. We used HIV surveillance data from antenatal clinics and routine pregnant women testing to model the general population's epidemic curve. We used HIV prevalence data available from HIV sentinel surveillance and integrated biological and behavioral surveys to inform the epidemic curve for key population. Estimation and projection packgage classic platform was used for the curve fitting. District-wide estimates extracted from subpopulation summary in Spectrum results section were used to calculate relative burden for each district and applied to approved State HIV Estimations 2017 estimates.No district in Tamil Nadu had an adult HIV prevalence of higher than 0.5% except for one, and the epidemic seems to be declining. In Maharashtra, the epidemic has shown a decline, with all except 5 districts showing an adult prevalence of less than 0.50%. In Gujarat and Uttar Pradesh, few districts showed rising HIV prevalence. However, none had an adult prevalence of higher than 0.50%. In Mizoram, 6 of 8 districts showed a rising HIV trend with an adult prevalence of 1% or more in 5 districts.Disaggregation of state-level estimates by districts provided insights on epidemic diversity within the analyzed states. It also provided baseline evidence to measure the progress toward the goal of end of AIDS by 2030.


Assuntos
Infecções por HIV/epidemiologia , Vigilância em Saúde Pública/métodos , Adolescente , Adulto , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto Jovem
3.
PLoS One ; 16(6): e0252735, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34138877

RESUMO

BACKGROUND AND OBJECTIVE: During the COVID-19 pandemic the organization of maternity care changed drastically; this study into the experiences of maternity care professionals with these changes provides suggestions for the organization of care during and after pandemics. DESIGN: An online survey among Dutch midwives, obstetricians and obstetric residents. Multinomial logistic regression analyses were used to investigate associations between the respondents' characteristics and answers. RESULTS: Reported advantages of the changes were fewer prenatal and postpartum consultations (50.1%). The necessity and safety of medical interventions and ultrasounds were considered more critically (75.9%); 14.8% of community midwives stated they referred fewer women to the hospital for decreased fetal movements, whereas 64.2% of the respondents working in hospital-based care experienced fewer consultations for this indication. Respondents felt that women had more confidence in giving birth at home (57.5%). Homebirths seemed to have increased according to 38.5% of the community midwives and 65.3% of the respondents working in hospital-based care. Respondents appreciated the shift to more digital consultations rather than face-to-face consultations. Mentioned disadvantages were that women had appointments alone, (71.1%) and that the community midwife was not allowed to join a woman to obstetric-led care during labour and subsequently stay with her (56.8%). Fewer postpartum visits by family and friends led to more tranquility (59.8%). Overall, however, 48.0% of the respondents felt that the safety of maternity care was compromised due to policy changes. CONCLUSIONS: Maternity care professionals were positive about the decrease in routine care and the increased confidence of women in home birth, but also felt that safety in maternity care was sometimes compromised. According to the respondents in a future crisis situation it should be possible for community midwives to continue to deliver a personal handover after the referral of women to the hospital, and to stay with them.


Assuntos
COVID-19/prevenção & controle , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Adulto , COVID-19/epidemiologia , COVID-19/virologia , Feminino , Parto Domiciliar/métodos , Parto Domiciliar/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Trabalho de Parto , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Países Baixos , Gravidez , Cuidado Pré-Natal/métodos , SARS-CoV-2/fisiologia , Inquéritos e Questionários/estatística & dados numéricos
4.
PLoS One ; 16(6): e0253446, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34138946

RESUMO

BACKGROUND: COVID-19 is a novel respiratory disease associated with severe morbidity and high mortality in the elderly population and people with comorbidities. Studies have suggested that pregnant women are more susceptible to COVID-19 compared to non-pregnant women. However, it's unclear whether pregnant women in Ghana are knowledgeable about COVID-19 and practice preventive measures against it. This study sought to assess the knowledge and preventive practices towards COVID-19 among pregnant women seeking antenatal services in Northern Ghana. METHODS: A cross-sectional study was conducted using a structured questionnaire in the Nabdam district in Ghana. A total of 527 pregnant women were randomly sampled from health facilities offering antenatal care services in the district. Multivariable logistic regression analysis was used to assess the association between the predictors and outcome variables. RESULTS: The prevalence of adequate knowledge and good COVID-19 preventive practices were 85.6%, (95% CI: 82.57, 88.59) and 46.6%, (95% CI: 42.41, 50.95) respectively. Having at least a primary education, residing in an urban area, and receiving COVID-19 education at a health facility were positively associated with adequate knowledge on COVID-19. Factors positively associated with good COVID-19 preventive practices were older age, having at least a primary education, pregnant women with a chronic disease, and living in an urban area. Multiparity was negatively associated with good COVID-19 preventive practices. CONCLUSION: Although majority of women had adequate knowledge of COVID-19, less than half of them were engaged in good COVID-19 preventive practices. Education of pregnant women on COVID-19 preventive practices should be intensified at health facilities while improving upon the water, sanitation and hygiene need particularly in rural communities.


Assuntos
COVID-19/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Gestantes , Cuidado Pré-Natal/estatística & dados numéricos , Medicina Preventiva/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Adulto , COVID-19/epidemiologia , COVID-19/virologia , Estudos Transversais , Escolaridade , Feminino , Gana/epidemiologia , Humanos , Modelos Logísticos , Análise Multivariada , Pandemias/prevenção & controle , Gravidez , Cuidado Pré-Natal/métodos , Medicina Preventiva/métodos , População Rural/estatística & dados numéricos , SARS-CoV-2/fisiologia , Inquéritos e Questionários , Adulto Jovem
5.
Pan Afr Med J ; 38: 289, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122716

RESUMO

Introduction: facility-based births remain low in Nigeria despite the enormous benefits on maternal and neonatal health. We compared the determinants, reasons for choice and willingness to recommend public and private birthing facilities among mothers in Ebonyi, Nigeria. Methods: this was a cross-sectional survey among 620 women whose childbirth occurred in public (teaching) and private-for-profit mission hospitals in Ebonyi, Nigeria. Semi-structured, interviewer-administered questionnaires were used for data collection. Results: the mean age of the respondents was 29.86±4.4. Most had post-secondary education (71.0%), more than 4 antenatal visits (83.4%) and vaginal births (77.7%). Respondents with high economic status [adjusted odds ratio (aOR) 2.88; Confidence Interval (CI) 1.98-4.18], post-secondary education (aOR 1.73; CI 1.13-2.64) and urban residence (aOR 3.51; CI 2.19-5.61) were more likely to utilize public birthing facilities. In the private hospital, religion (78.4%) was the commonest reason for utilization while poor quality of services (61.9%) was the major cause of dissatisfaction. In the public hospital, the main reason for patronage was insurance enrolment (73.2%) while negative provider attitude (66.7%) led to dissatisfaction. In both facilities, majority (92%) were willing to recommend their birth facility to others. Conclusion: regardless of facility type, respondents were willing to recommend or reuse the health facility for subsequent obstetric care. Religion and insurance enrolment were the major reasons for choosing the private and public hospital respectively. Residence, educational and income status influenced birthing facility type used. We recommend improved quality of services in private hospitals and provision of insurance with improved provider attitude in public health facilities.


Assuntos
Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Comportamento de Escolha , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Hospitais Privados/normas , Hospitais Públicos/normas , Humanos , Recém-Nascido , Serviços de Saúde Materna/normas , Nigéria , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde , Fatores Socioeconômicos , Inquéritos e Questionários
6.
Pan Afr Med J ; 38: 247, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104295

RESUMO

Introduction: a significant proportion of pregnancy related deaths result from delay in decision to seek care and this often stems from failure to identify obstetric danger signs earlier. Early identification of these danger signs will therefore reduce maternal mortality. However, studies on obstetric danger signs awareness are lacking in Cameroon. The objective of this study was to assess the determinants of obstetric danger signs awareness of women at immediate postpartum period. This will inform ANC providers´ practice. Methods: between June and September 2019, women who delivered at the Buea Regional Hospital were interviewed within 24 hours following their delivery using a researcher-administered questionnaire that covered socio-demographic and obstetric variables. Data were entered into EpiData and analysis done using SPSS 16 and OpenEpi. Statistical significance was set at p-value < 0.05. Results: of the 532 participants, majority (230/532: 43.2%) were those aged 26-35; danger signs awareness rate was 73.3%. There was a statistically significant relation between age and awareness of obstetric danger signs which showed that older women were more aware than their younger counterparts (p=0.00). Other statistically significant determinants of danger sign awareness included occupation, level of education, parity, trimester of onset of antenatal visits and the number of visits before delivery (p<0.05). Multiparity (370/490: 75.5%) and grand multiparity (14/22: 63.6%) were more likely to be aware of obstetric danger signs than primiparous women (6/20: 30%). Similarly, those who started antenatal visits earlier (first or second trimester) and those who attended more visits were more likely to be aware of obstetric danger signs than their counterparts who started later or had lesser antenatal visits before delivery. The most reported danger signs were severe vaginal bleed (71.4%), fever (62.0%) and reduced fetal movement. Conclusion: conclusively, more focus should be placed on the sensitisation about obstetric danger signs when in contact with primiparous and younger parturient during ANC visits.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Complicações do Trabalho de Parto/epidemiologia , Período Pós-Parto , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Camarões , Estudos Transversais , Escolaridade , Feminino , Humanos , Mortalidade Materna , Pessoa de Meia-Idade , Paridade , Gravidez , Inquéritos e Questionários , Adulto Jovem
7.
Afr J Reprod Health ; 25(1): 90-100, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077115

RESUMO

We investigated the relationship between intended pregnancy and utilization of antenatal care services in Rwanda. Using Demographic and Health Survey 2014/2015, secondary data was obtained on maternal health services utilization. We performed stepwise logistic regression analysis to examine the effect of independent variables on women's early and late utilization, as well as their sustained use of antenatal services. Dependent and main independent variables included: first trimester visits, completed antenatal visits and intended pregnancy respectively. Of 5,944 women sampled; 56.6% had made early antenatal visits and 44% had completed 4 visits. Unintended pregnancies were less likely to make early antenatal visits and complete 4 antenatal visits. Religion and being in union had positive association with standard antenatal visits; while age (>24 years), grand multiparty, and poor economic status had negative association. Our results call for deeper sensitization on utilization of antenatal services and more use of contraception to reduce unintended pregnancies.


Assuntos
Intenção , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez não Planejada/psicologia , Gravidez não Desejada/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Saúde Materna , Gravidez , Ruanda , Fatores Socioeconômicos , Adulto Jovem
8.
Afr J Reprod Health ; 25(1): 129-137, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077119

RESUMO

Miscarriage is a common adverse pregnancy outcome in childbearing and an increasing global reproductive health problem. This study explored 1) the national prevalence of the first trimester (≤12 weeks) miscarriage among women (15-49 years) in Ghana, and 2) the influence of first-trimester antenatal care (ANC) visits on miscarriage risk. A cross-sectional study using the Demographic Health Survey (DHS- 2017) on maternal health in Ghana was conducted. We used a nationally representative subsample of (7,846) women with no or early ANC visit of the initial sample (25,062). Women with late ANC visit (≥12 weeks) and those who were never pregnant or had not given birth at the time of the survey were excluded from this analysis. We performed multivariable Poisson regression to estimate miscarriage risk (RR), its associated risk factors, and national prevalence. The national first-trimester miscarriage prevalence was 19.1%. Increasing maternal age and urban residence were significantly associated with the risk of first- trimester miscarriage (p <0.001) while early ANC visits lower the risk of miscarriage by 43% (p=0.0246). We found that first trimester ANC visit decreases miscarriage risk in Ghana and highlights the important role of early ANC visits in reducing miscarriages.


Assuntos
Aborto Espontâneo/epidemiologia , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Aborto Espontâneo/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Idade Materna , Gravidez , Primeiro Trimestre da Gravidez , Características de Residência , População Rural , População Urbana , Adulto Jovem
9.
Diabetes Res Clin Pract ; 176: 108853, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33961900

RESUMO

AIMS: Iron supplementation has been recommended for healthy pregnancy, but concerns have been raised regarding the potential adverse effects. We sought to examine the impact of periconceptional iron supplement use on subsequent gestational diabetes mellitus (GDM) risk. METHODS: Participants (N = 5101) with information on periconceptional micronutrient supplementation and diagnosis of GDM were involved. Information on iron supplementation and general characteristics were collected at enrollment and follow-up visits. GDM was diagnosed by oral glucose tolerance tests (OGTT) conducted at 24-28 weeks of gestation. Robust Poisson regression model was used to estimate the relative risks (RRs) and 95% confidence intervals (CI) for the effect of iron supplement use on GDM. RESULTS: 10.5% of the participants were diagnosed with GDM and the incidence was significantly higher in users with iron >30 mg/d for more than 3 months (Iron >30-L) than in nonusers. Adjusted RRs (95% CI) were 1.53 (1.21, 1.93) in Iron >30-L group, 1.14 (0.80, 1.61) in users with iron >30 mg/d for<3 months (Iron > 30-S) and 1.15 (0.86, 1.54) in users with iron ≤30 mg/d for any duration (Iron ≤30) respectively, compared to nonusers. This link in Iron >30-L group was even stronger (adjusted RR: 1.70, 95% CI: 1.25, 2.31) when restricting the analysis among primiparous and iron-replete participants without family history of diabetes. There were no significant differences in birth outcomes among groups. CONCLUSIONS: Periconceptional iron supplementation >30 mg/d for long-term was associated with increased GDM risk. The need and safety of prophylactic iron supplement in iron-replete pregnant women should be reconsidered.


Assuntos
Anemia Ferropriva/prevenção & controle , Diabetes Gestacional/epidemiologia , Ferro/uso terapêutico , Complicações Hematológicas na Gravidez/prevenção & controle , Adulto , Anemia Ferropriva/epidemiologia , Quimioprevenção/métodos , Quimioprevenção/estatística & dados numéricos , China/epidemiologia , Estudos de Coortes , Diabetes Gestacional/etiologia , Suplementos Nutricionais , Feminino , Teste de Tolerância a Glucose , Humanos , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Complicações Hematológicas na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
10.
Midwifery ; 99: 103013, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33957520

RESUMO

OBJECTIVE: Evaluation of the mental health of pregnant women during the early and peak stages of the Covid-19 outbreak DESIGN: Online survey PARTICIPANTS: Pregnant women over the age of 18 years with no mental disorder during the pre-pregnancy period (N = 729). MEASUREMENTS AND FINDINGS: Mental disorders were assessed using the "Depression Anxiety Stress Scale" and social support was determined using the "Multidimensional Perceived Social Support Scale." Pregnant women had moderate levels of anxiety and depression and mild levels of stress. Anxiety, depression, and stress of moderate or high severity was reported in 62.2%, 44.6%, and 32.2% of the women, respectively. Pregnant women who lost their jobs during the pandemic period showed a 3-fold increase in the risk of anxiety, a 6-fold increase in the risk of depression, and a 4.8-fold increase in the risk of stress. An increase in the perception of social support has protective effects against all three mental disorders during pregnancy. In pregnant women with at least one obstetric risk, the risk of antenatal anxiety is 2 times higher than that in women with no risk. Similarly, women with a chronic physical illness before pregnancy have a higher risk of anxiety during pregnancy than healthy women. Financial strain has predictive value for anxiety and depression, and advanced age is a predictor for depression. KEY CONCLUSIONS: The incidence of mental disorders in pregnant women during the pandemic period was much higher than that during the pre-pandemic period. The high frequency of antenatal mental disorders can lead to an increase in the frequency of obstetric and maternal complications in the short and long term. IMPLICATIONS FOR PRACTICE: Early detection of inadequate social support and economic difficulties of pregnant women during the pandemic period is recommended for protecting their mental health. Pregnant women should have easy access to psychosocial support, and they should be provided obstetric counseling during the pandemic conditions.


Assuntos
Ansiedade , COVID-19 , Depressão , Complicações na Gravidez , Estresse Psicológico , Desemprego/psicologia , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/prevenção & controle , COVID-19/epidemiologia , COVID-19/psicologia , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/prevenção & controle , Feminino , Inquéritos Epidemiológicos , Humanos , Saúde Materna , Saúde Mental/tendências , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/psicologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , SARS-CoV-2 , Apoio Social , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Estresse Psicológico/prevenção & controle , Turquia/epidemiologia
11.
Reprod Health ; 18(1): 90, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941205

RESUMO

BACKGROUND: Antenatal care (ANC) clinics remain important entry points to HIV care for pregnant women living with HIV-including adolescents. Prior knowledge of their HIV status at ANC enrollment is crucial to providing services for prevention of mother-to-child transmission (PMTCT) of HIV. We examined known HIV status of pregnant adolescents and women in other age groups at ANC enrollment. METHODS: A descriptive study of routinely reported PMTCT data from 419 facilities in Eswatini, Ethiopia, and Mozambique, from January through December 2018 was conducted. We assessed knowledge of HIV status by country for three age groups: adolescents aged 15-19 years, young women aged 20-24 years, and older women aged 25-49 years. We report HIV prevalence and proportions of known and newly diagnosed HIV infections in women, by age group and country. The data were summarized by frequencies and proportions, including their 95% confidence intervals. RESULTS: Among the facilities examined, 52 (12.4%) were in Eswatini, 63 (15.0%) in Ethiopia, and 304 (72.6%) in Mozambique. Across three countries, 488,121 women attended a first ANC visit and 23,917 (4.9%) were HIV-positive. Adolescents constituted 22% of all ANC attendees, whereas young and older women represented 33% and 45%, respectively. HIV prevalence was lowest among adolescents than in other age groups in Eswatini (adolescents 11.9%, young 24.2% and older 47.3%), but comparable to young women in Ethiopia (adolescents 1.6%, young 1.6% and older 2.2%) and Mozambique (adolescents 2.5%, young 2.5% and older 5.8%), However, in each of the three countries, lower proportions of adolescents knew their HIV-positive status before ANC enrollment compared to other age groups: in Eswatini (adolescents 51.3%, young 59.9% and older 79.2%), in Ethiopia (adolescents 42.9%, young 63.7% and older 75.2%), and in Mozambique (adolescents 16.4%, young 33.2% and older 45.6%). CONCLUSION: Overall, adolescents made up nearly one-quarter of the women examined and had the least knowledge of their HIV status at ANC enrollment. Their HIV prevalence and known HIV-positive status varied widely across the countries examined. Adolescent-friendly sexual and reproductive health, and PMTCT services, before pregnancy, are needed to improve knowledge of HIV status and support pregnant adolescents and their infants. Antenatal care (ANC) clinics are important for HIV testing of pregnant adolescents, who may not know their HIV-positive status at the first ANC visit. We describe data on pregnant adolescents and women in other age groups in ANC services to examine their prior HIV status at ANC enrollment across three African countries. We examined data from 419 PMTCT sites in Eswatini, Ethiopia, and Mozambique from January-December 2018, to evaluate HIV testing results for adolescents, young and older women aged 15-19, 20-24 and 25-49 years, respectively. We report the number of women living with HIV and the proportions of known and newly identified women living with HIV, by age-group and country. Across three countries, 488,121 women attended ANC and 23,917 (4.9%) were living with HIV. Adolescents constituted 22% of all ANC attendees, whereas young and older women represented 33% and 45%, respectively. HIV prevalence in each country compared to other age groups was lowest and varied among adolescents from 11.9% in Eswatini, to 1.6% in Ethiopia and to 2.5% in Mozambique. Also, fewer adolescents knew their HIV-positive status before ANC enrollment compared to young and older women from 51.3% in Eswatini, 42.9% in Ethiopia to only 16.4% in Mozambique. Pregnant adolescents made up nearly one-quarter of all ANC attendees; a majority of them had no previously known HIV-positive status. Adolescent-friendly, sexual and reproductive health services, before pregnancy and in PMTCT services, are needed to support pregnant adolescents and their infants.


Assuntos
Infecções por HIV/epidemiologia , Teste de HIV/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Essuatíni/epidemiologia , Etiópia/epidemiologia , Feminino , Infecções por HIV/transmissão , Humanos , Moçambique/epidemiologia , Gravidez , Prevalência , Adulto Jovem
12.
BMC Pregnancy Childbirth ; 21(1): 397, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34020600

RESUMO

BACKGROUND: Coronavirus disease is now a global concern with the non-availability of antiviral treatment and attacks all groups of the population. Hence, applying preventive measures is the most critical intervention to control the infection. Pregnant women are particularly susceptible to respiratory pathogens because of their immunosuppressive state and physiological adaptive change during pregnancy. Therefore, this study was aimed to assess knowledge and practice to prevent coronavirus disease and its associated factors among pregnant women in Debre Tabor Town. METHODS: Community-based cross-sectional study was conducted among 422 participants from May 25-June 15, 2020. A simple random sampling technique was employed. Data were collected by face-to-face interview using a structured and pre-tested questionnaire and analysis using SPSS version 23. Bivariable and multivariable logistic regression analysis was carried out and p-value < 0.05 at 95% CI were considered as statistically significant. RESULTS: Overall 46.8 and 47.6% of women were knowledgeable and had good practice to prevent coronavirus respectively. Women's age (15-24 years) (AOR = 4.85, 95% CI: 1.34-5.42), educational status (AOR:3.70; 95% CI: 1.16-5.40) being civil servant (AOR:2.84; 95% CI: 1.55-5.21), wanted pregnancy (AOR:3.37; 95% CI: 1.20-9.45), antenatal care follow-up (AOR:2.07; 95% CI: 1.03-4.13) were significantly associated with COVID-19 knowledge, whereas educational status (AOR:3.78; 95% CI: 1.19-5.11), number of children (AOR:2.89; 95% CI: 1.29-6.45) and knowledge (AOR:8.42;95% CI: 4.50-15.85), were also found to be statistically significant with practice. CONCLUSIONS: Most of the participants had poor knowledge and inappropriate practice. Increasing health education programs via different media, coordinated and combined efforts of authorities and all individuals will be needed to battles the spread of the infection.


Assuntos
COVID-19/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Inquéritos e Questionários/normas , Adolescente , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Estudos Transversais , Escolaridade , Etiópia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Logísticos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , SARS-CoV-2/genética , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
13.
Pan Afr Med J ; 38: 201, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995807

RESUMO

Introduction: even though newborn health is apriority agenda in Ethiopia, neonates' risk of dying is unacceptable and one of the ten countries which accounts to two-third of global neonatal death. The magnitude and risk of death in the referral care facility was not well studied in the study area. This study was aimed to estimate neonatal death and its determinant. Methods: a prospective cohort study was conducted from November 2016 to January 2018 among neonates admitted to Dilla University Referral Hospital Neonatal Intensive Care Unit. We generated descriptive statistics and Cox-proportional hazard model to identify independent risk factors of neonatal death. Results: we identified 913 neonates with 6836 person-days of follow-up. Overall, 11.6% (n = 106) deaths of neonates were recorded. The estimated hazard ratios of neonatal death were higher among neonates whose mothers did not attend ANC follow up (HR=3.23), delivery assisted by TBA (HR=2.19), and maternal age ≥ 30 years at birth (HR=2.04). Urban residence [HR=0.54], family size of ≤ 3 (HR=0.47) and family size of 4 - 6 (HR=0.49), absence of abortion (HR=0.55), absence of illness during pregnancy (HR=0.47), iron folate intake (HR=0.29), birth weight ≥ 2500 grams (HR=0.43) were found to be protective factors. Conclusion: neonatal death at referral neonatal intensive care unit was relatively high. Early management of complications, improving quality of services at neonatal intensive care unit and ensuring maternal continuum of care are recommended to increase survival of neonates. Besides, maternal and neonatal health-related factors were among the independent risk factors that need to design context-based policy and interventions.


Assuntos
Unidades de Terapia Intensiva Neonatal , Morte Perinatal , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Estudos de Coortes , Etiópia , Feminino , Seguimentos , Hospitais Universitários , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Prospectivos , Fatores de Proteção , Fatores de Risco , Adulto Jovem
14.
PLoS Negl Trop Dis ; 15(4): e0009282, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33914732

RESUMO

BACKGROUND: Soil transmitted helminths (STH) are a common infection among pregnant women in areas with poor access to sanitation. Deworming medications are cheap and safe; however, the health benefit of deworming during pregnancy is not clear. METHODS / PRINCIPAL FINDINGS: We created a retrospective cohort of more than 800,000 births from 95 Demographic and Health Survey datasets to estimate the impact of deworming medicine during routine antenatal care (ANC) on neonatal mortality and low birthweight. We first matched births on the probability of receiving deworming during ANC. We then modeled the birth outcomes with the matched group as a random intercept to estimate the effect of deworming during antenatal care after accounting for various risk factors. We also tested for effect modification of soil transmitted helminth prevalence on the impact of deworming during ANC. Receipt of deworming medication during ANC was associated with a 14% reduction in the risk of neonatal mortality (95% confidence interval = 10-17%, n = 797,772 births), with no difference between high and low transmission countries. In low transmission countries, we found an 11% reduction in the odds of low birth weight (95% confidence interval = 8-13%) for women receiving deworming medicine, and in high transmission countries, we found a 2% reduction in the odds of low birthweight (95% confidence interval = 0-5%). CONCLUSIONS / SIGNIFICANCE: These results suggest a substantial health benefit for deworming during ANC that may be even greater in countries with low STH transmission.


Assuntos
Anti-Helmínticos/uso terapêutico , Helmintíase/tratamento farmacológico , Complicações Parasitárias na Gravidez/tratamento farmacológico , Cuidado Pré-Natal/estatística & dados numéricos , Solo/parasitologia , Adolescente , Adulto , Estudos Transversais , Feminino , Saúde Global , Helmintíase/epidemiologia , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Prevalência , Estudos Retrospectivos , Adulto Jovem
15.
BMC Pregnancy Childbirth ; 21(1): 270, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794794

RESUMO

BACKGROUND: In most of the sub-Sahara African countries, use of herbal medications is widely practiced during pregnancy or delivery for various reasons despite uncertainties on their pharmacological profiles. Use of unregistered herbal medicines has the potential of causing adverse health effects to the mother and the newborn, thus deterring achievement of Sustainable Development Goal 3, which aims to "ensure healthy lives and promote well-being for all at all ages". One of the targets is on reduction of morbidity and mortality among mothers and newborns. This study investigated use of herbal medicines and predictors of usage during pregnancy or delivery as a forgotten exposure towards understanding some of the challenges in achieving Sustainable Development Goal 3. METHODS: This cross-sectional quantitative study gathered information from women who delivered a live-born baby in the preceding two years. Using a two-stage-sampling technique, women attending reproductive, maternal and child health clinics in Tabora were selected and interviewed. Proportions were compared using chi-square test and Poisson regression analysis was performed to determine independent correlates of herbal medicine use. RESULTS: Of 340 recruited women, 208 [61.2 %; 95 % confidence interval: 55.4, 66.3 %] used herbal medicines during pregnancy or delivery. Major reasons for use included accelerating labour, 81 (38.9 %) and reducing labour pains, 58 (27.9 %). Women who made less than four antenatal visits had a 24 % higher adjusted prevalence ratio of using herbal medicines as compared to those who had at least four visits [adjusted prevalence ratio:1.24; 95 % confidence interval: 1.02, 1.50, p = 0.03]. Furthermore, the adjusted prevalence ratio of using herbal medicines was 35 % higher among women who were not discouraged by health care providers against their use as compared to those who were discouraged (adjusted prevalence ratio: 1.35; 95 % confidence interval: 1.13, 1.60, p = 0.01). CONCLUSIONS: Use of herbal medicines during pregnancy or delivery among women in Tanzania is common. Independent predictors of herbal medicine use were number of antenatal visits and stance of maternity health care providers on their use. Comprehensive investigations on the magnitude, patterns and predictors of use of herbal medicines during pregnancy or delivery are warranted.


Assuntos
Medicina Tradicional Africana/estatística & dados numéricos , Fitoterapia/estatística & dados numéricos , Cuidado Pré-Natal/métodos , Desenvolvimento Sustentável , Adolescente , Adulto , Estudos Transversais , Feminino , Objetivos , Humanos , Recém-Nascido , Trabalho de Parto , Nascido Vivo , Medicina Tradicional Africana/efeitos adversos , Pessoa de Meia-Idade , Fitoterapia/efeitos adversos , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Tanzânia , Adulto Jovem
16.
BMC Pregnancy Childbirth ; 21(1): 274, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794803

RESUMO

BACKGROUND: The information on birth plan (BP) usage in Spanish hospitals is scant. AIM: To identify the percentage of pregnant women presenting a BP at five hospitals in Spain, the reasons why some women failed to do so and how BP presentation relates to obstetric outcomes and selected pain relief methods. METHODS: In this descriptive, multi-centre study, data were retrospectively collected. During the postpartum visits at primary healthcare centres in various health districts in Barcelona (Catalonia, Spain), a data collection sheet about obstetric outcomes and analgesia was administered to 432 mothers who had completed a BP during their pregnancies. The main outcome was the rate of BP presentation to the hospital. The sociodemographic and obstetric characteristics and pain relief measures were compared to identify any differences between mothers who presented a BP and those who did not. RESULTS: A total of 422 (99.7%) women were studied; 51.2% of women (95% confidence interval (CI): 46.4-55.9) had presented a BP. The main reason for not presenting a BP was because the hospital midwives did not request them (61.2%). No differences were observed in BP presentation according to age, the country of origin, education, employment or hospital. Mothers who presented a BP were more likely to start breastfeeding in the birthing room (82.4% vs. 73.3%; p = 0.024). Epidural analgesia was the most common method used for pain relief (88.9%), and women who presented a BP attempted to use concomitant non-pharmacological methods more often (50.5% vs. 38.8%; p = 0.012). CONCLUSION: Almost half of the mothers failed to present a BP, usually because midwives did not request it.


Assuntos
Tomada de Decisões , Parto Obstétrico/efeitos adversos , Preferência do Paciente , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Analgesia Obstétrica/estatística & dados numéricos , Comunicação , Aconselhamento , Feminino , Hospitais/estatística & dados numéricos , Humanos , Tocologia/organização & administração , Tocologia/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/organização & administração , Estudos Retrospectivos , Espanha
17.
BMC Pregnancy Childbirth ; 21(1): 290, 2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33838658

RESUMO

BACKGROUND: Research suggests that women's experience of antenatal care is an important component of high-quality antenatal care. Person-centered antenatal care (PCANC) reflects care that is both respectful of, and responsive to, the preferences, needs, and values of pregnant women. Little is known in Rwanda about either the extent to which PCANC is practiced or the factors that might determine its use. This is the first study to quantitatively examine the extent of and the factors associated with PCANC in Rwanda. METHODS: We used quantitative data from a randomized control trial in Rwanda. A total of 2150 surveys were collected and analyzed from 36 health centers across five districts. We excluded women who were less than 16 years old, were referred to higher levels of antenatal care or had incomplete survey responses. Both bivariate and multivariate logistic regression analyses were used to test the hypothesis that certain participant characteristics would predict high PCANC. RESULTS: PCANC level was found to be sub-optimal with one third of women leaving antenatal care (ANC) with questions or confused and one fourth feeling disrespected. In bivariate analysis, social support, greater parity, being in the traditional care (control group), and being from Burera district significantly predict high PCANC. Additionally, in the multivariate analysis, being in the traditional care group and the district in which women received care were significantly associated with PCANC. CONCLUSIONS: This quantitative analysis indicates sub-optimal levels of PCANC amongst our study population in Rwanda. We find lower levels of PCANC to be regional and defined by the patient characteristics parity and social support. Given the benefits of PCANC, improvements in PCANC through provider training in Rwanda might promote an institutional culture shift towards a more person-centered model of care.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Estudos Multicêntricos como Assunto , Paridade , Assistência Centrada no Paciente/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde/organização & administração , Ensaios Clínicos Controlados Aleatórios como Assunto , Ruanda , Fatores Socioeconômicos , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
18.
Matern Child Health J ; 25(6): 881-891, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33900516

RESUMO

OBJECTIVE: High maternal and neonatal mortality rates in developing regions like Pakistan are linked to low rates of institutional deliveries. One way to improve rates of institutional deliveries is through improving institutional delivery service satisfaction in women. The aim of this research is to identify which factors influence delivery service satisfaction during the period of COVID-19 and which socio-demographic characteristics of women are associated with greater fear of catching COVID-19 during institutional deliveries. METHODS: A total of 190 women who had given birth between May to June, 2020, were sampled from two private and two public sector hospitals in Lahore, Pakistan. A standardized tool was modified for use and a combination of descriptive statistics and multivariate regression was applied. RESULTS: The results reveal that a majority of women, at 74.7%, are afraid of contracting COVID-19; specifically, women delivering at public hospitals, those who are illiterate or semi-literate, with more than four children, with low household income, and who are unemployed. Regression models are used to identify factors related to higher satisfaction, including the following: (i) pre-delivery care (explanatory power of R2 = 0.651); (ii) during delivery care (R2 = 0.716); (iii) after delivery care for women (R2 = 0.525); and (iv) after delivery care for newborn (R2 = 0.780). The main areas which influence satisfaction include the following: service quality of staff and administration; maintenance of hygiene and sanitation; involvement in decision-making; provision of necessary information; and advice for breastfeeding, immunization and family planning. CONCLUSIONS FOR PRACTICE: Based on our findings, we recommend improved regulation of delivery services in both public and private hospitals and increased protection for disadvantaged women groups to maintain service quality during the pandemic.


Assuntos
COVID-19/psicologia , Saúde da Criança , Parto Obstétrico/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Saúde Materna , Satisfação Pessoal , Adulto , Feminino , Humanos , Paquistão , Cuidado Pré-Natal/estatística & dados numéricos , SARS-CoV-2
19.
JAMA ; 325(20): 2076-2086, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-33914014

RESUMO

Importance: The outcomes of newborn infants of women testing positive for SARS-CoV-2 in pregnancy is unclear. Objective: To evaluate neonatal outcomes in relation to maternal SARS-CoV-2 test positivity in pregnancy. Design, Setting, and Participants: Nationwide, prospective cohort study based on linkage of the Swedish Pregnancy Register, the Neonatal Quality Register, and the Register for Communicable Diseases. Ninety-two percent of all live births in Sweden between March 11, 2020, and January 31, 2021, were investigated for neonatal outcomes by March 8, 2021. Infants with malformations were excluded. Infants of women who tested positive for SARS-CoV-2 were matched, directly and using propensity scores, on maternal characteristics with up to 4 comparator infants. Exposures: Maternal test positivity for SARS-CoV-2 in pregnancy. Main Outcomes and Measures: In-hospital mortality; neonatal resuscitation; admission for neonatal care; respiratory, circulatory, neurologic, infectious, gastrointestinal, metabolic, and hematologic disorders and their treatments; length of hospital stay; breastfeeding; and infant test positivity for SARS-CoV-2. Results: Of 88 159 infants (49.0% girls), 2323 (1.6%) were delivered by mothers who tested positive for SARS-CoV-2. The mean gestational age of infants of SARS-CoV-2-positive mothers was 39.2 (SD, 2.2) weeks vs 39.6 (SD, 1.8) weeks for comparator infants, and the proportions of preterm infants (gestational age <37 weeks) were 205/2323 (8.8%) among infants of SARS-CoV-2-positive mothers and 4719/85 836 (5.5%) among comparator infants. After matching on maternal characteristics, maternal SARS-CoV-2 test positivity was significantly associated with admission for neonatal care (11.7% vs 8.4%; odds ratio [OR], 1.47; 95% CI, 1.26-1.70) and with neonatal morbidities such as respiratory distress syndrome (1.2% vs 0.5%; OR, 2.40; 95% CI, 1.50-3.84), any neonatal respiratory disorder (2.8% vs 2.0%; OR, 1.42; 95% CI, 1.07-1.90), and hyperbilirubinemia (3.6% vs 2.5%; OR, 1.47; 95% CI, 1.13-1.90). Mortality (0.30% vs 0.12%; OR, 2.55; 95% CI, 0.99-6.57), breastfeeding rates at discharge (94.4% vs 95.1%; OR, 0.84; 95% CI, 0.67-1.05), and length of stay in neonatal care (median, 6 days in both groups; difference, 0 days; 95% CI, -2 to 7 days) did not differ significantly between the groups. Twenty-one infants (0.90%) of SARS-CoV-2-positive mothers tested positive for SARS-CoV-2 in the neonatal period; 12 did not have neonatal morbidity, 9 had diagnoses with unclear relation to SARS-CoV-2, and none had congenital pneumonia. Conclusions and Relevance: In a nationwide cohort of infants in Sweden, maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in some neonatal morbidities. Given the small numbers of events for many of the outcomes and the large number of statistical comparisons, the findings should be interpreted as exploratory.


Assuntos
COVID-19/complicações , Doenças do Recém-Nascido/etiologia , Complicações Infecciosas na Gravidez , Resultado da Gravidez , Adulto , Aleitamento Materno/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/mortalidade , Feminino , Idade Gestacional , Mortalidade Hospitalar , Humanos , Hiperbilirrubinemia/epidemiologia , Hiperbilirrubinemia/etiologia , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/mortalidade , Recém-Nascido Prematuro , Tempo de Internação/estatística & dados numéricos , Nascido Vivo/epidemiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Pontuação de Propensão , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Ressuscitação/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Suécia/epidemiologia
20.
Obstet Gynecol ; 137(5): 782-790, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33831924

RESUMO

OBJECTIVE: To compare the type, frequency, and timing of health care use among commercially insured postpartum and nonpostpartum women. METHODS: This retrospective cohort study used data from a large national commercial claims database. Women between 18 and 44 years of age who gave birth in 2016 (n=149,563) and women who were neither pregnant nor postpartum between 2015 and 2017 (n=2,048,831) (nonpostpartum) were included. We examined hospitalization, and preventive visits, problem visits, and emergency department (ED) visits among postpartum women during the early postpartum period (less than 21 days after childbirth), the postpartum period (21-60 days postpartum), and extended postpartum period (61-365 days after childbirth). Visits among nonpostpartum women were assessed during time periods of equivalent duration. RESULTS: Almost 24% of postpartum women had a problem visit in the early postpartum period, compared with 19.7% of nonpostpartum women (adjusted difference 4.8 percentage points [95% CI 4.6-5.0]). Approximately 3% of postpartum women had an early ED visit, more than double the percentage among nonpostpartum women (adjusted difference 2.3 percentage points [95% CI 2.2-2.4]). Both problem visits and ED visits among postpartum women remained elevated relative to nonpostpartum women during the postpartum and extended postpartum periods. Although postpartum women were more likely than nonpostpartum women to receive preventive care during the early and postpartum periods, only 43% of postpartum women had a preventive visit during the extended postpartum period, a rate 1.8 (95% CI -2.1 to -1.5) percentage points lower than that of nonpostpartum women. Adjusted hospitalization rates among postpartum women in the early (0.8%), postpartum (0.3%), and extended postpartum (1.4%) periods were higher than those of nonpostpartum women (0.1%, 0.2%, and 1.6%, respectively). CONCLUSIONS: Commercially insured postpartum women use more health care than nonpostpartum women, including inpatient care. Differences are largest in the early postpartum period and persist beyond 60 days postpartum.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Seguro Saúde , Serviços de Saúde Materna , Cuidado Pré-Natal/estatística & dados numéricos , Transtornos Puerperais/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Gravidez , Transtornos Puerperais/economia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
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