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1.
S Afr Med J ; 110(7): 671-677, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880346

RESUMO

BACKGROUND: Despite substantial progress in reducing pregnancy-related preventable morbidity and mortality, these remain unacceptably high in developing countries. In 2016, the World Health Organization (WHO) revised recommendations for antenatal care (ANC) from a 4-visit model to a minimum of 8 ANC contacts to reduce perinatal mortality further and improve women's experience of care. The guidelines also recommend that the first ANC visit (ANC-1) should occur during the first trimester. OBJECTIVES: To describe the uptake of routine ANC and its associated factors in South Africa (SA) prior to the 2016 WHO recommendations, when the country recommended 4 ANC visits, to bring to light potential challenges in achieving the current recommendations. METHODS: Secondary data analyses were performed from 3 facility-based, cross-sectional national surveys, conducted to measure 6-week mother-to-child transmission of HIV and coverage of related interventions in SA. These surveys recruited mother-infant pairs attending selected public primary healthcare facilities for their infants' 6-week immunisation in 2010, 2011 -2012 and 2012 -2013. Quantitative questionnaires were used to gather sociodemographic and antenatal-to-peripartum information from Road to Health cards and maternal recall. The inclusion criteria for this secondary assessment were at least 1 ANC visit, the primary outcome being uptake of ≥4 ANC visits. A multivariable logistic regression model was used to: (i) identify maternal factors associated with ANC visits; and (ii) establish whether receiving selected ANC activities was associated with frequency or timing of ANC-1. RESULTS: Of the 9 470, 9 646 and 8 763 women who attended at least 1 ANC visit, only 47.5% (95% confidence interval (CI) 45.4 -49.6), 55.6% (95% CI 53.2 -58.0) and 56.7% (95% CI 54.3 -59.1) adhered to ≥4 ANC visits, while 36.0% (95% CI 34.5 -37.5), 43.5% (95% CI 42.0 -45.1) and 50.8% (95% CI 49.3 -52.2) attended ANC-1 early (before 20 weeks' gestation) in 2010, 2011 -2012 and 2012 -2013, respectively. Multiparity and lower socioeconomic status were significantly associated with non-adherence to the 4-visit ANC recommendation, while a later survey year, higher education, being married, >19 years old, HIV-positive, planned pregnancy and knowing how HIV is transmitted vertically were strongly related to ≥4 ANC visits. The number of women who received selected ANC activities increased significantly with survey year and ≥4 ANC visits, but was not associated with timing of ANC-1. CONCLUSIONS: Despite increases in the uptake of ≥4 ANC visits and early ANC-1 rates between 2010 and 2013, these practices remain suboptimal. Adhering to ≥4 ANC visits improved coverage of selected ANC activities, implying that strengthening efforts to increase the uptake of ANC from at least 4 to 8, could improve overall outcomes.


Assuntos
Infecções por HIV/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Fatores Etários , Estudos Transversais , Escolaridade , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Estado Civil , Paridade , Cooperação do Paciente , Gravidez , Classe Social , África do Sul/epidemiologia
2.
Isr Med Assoc J ; 9(22): 467-471, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32954690

RESUMO

BACKGROUND: The World Health Organization classified coronavirus disease-19 (COVID-19) as a pandemic and recommends strict restrictions regarding most aspects of daily activities. OBJECTIVES: To evaluate whether the pandemic has changed the prenatal care and pregnancy outcome in pregnant women without COVID-19. METHODS: The authors conducted a cross-sectional study to describe changes in outpatient clinic visits and to compare the rates of cesarean and instrumental deliveries between two periods of time: March-April 2020 (during the COVID-19 outbreak) with March-April of the preceding year, 2019. RESULTS: During the COVID-19 outbreak, visits to obstetric triage, gynecologic triage, high-risk clinic, and ultrasound units decreased by 36.4%, 34.7%, 32.8%, and 18.1%, respectively. The medical center experienced a 17.8% drop in the total number of births (610 births) compared with March and April 2019 (742 births). During the outbreak women were more likely to be nulliparous (33.3% vs. 27.6%, P = 0.02) and present with hypertensive disorders during pregnancy (7.5% vs. 4%, P = 0.005) or gestational diabetes (13% vs. 10%, P = 0.03). More epidural analgesia was used (83.1% vs. 77.1%, P = 0.006). There were more operative vaginal deliveries during the outbreak (16.7% vs. 6.8%, P = 0.01). All other maternal and neonatal outcomes were comparable between the two periods. CONCLUSIONS: The medical facility experienced a major decline in all aspects of the routine obstetrics activities during the time of the pandemic. The higher rate of operative vaginal deliveries among nulliparous may be associated with the pandemic effect on the rate of high-risk patients.


Assuntos
Cesárea/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Analgesia Epidural/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Surtos de Doenças , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Gravidez , Complicações na Gravidez/epidemiologia , Centros de Atenção Terciária
3.
Malawi Med J ; 32(1): 45-51, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32733659

RESUMO

Background: Intermittent presumptive treatment in pregnancy (IPTp) of malaria using sulfadoxine-pyrimethamine (SP) was introduced in Nigeria in 2005 to reduce the burden of malaria in pregnancy. By 2013, 23% of reproductive aged women surveyed received SP for malaria prevention in their last pregnancy of the past 5 years. This paper highlights geographic and socio-economic variations and inequities in accessing and using SP for malaria prophylaxis in pregnancy in Nigeria, as well as client-related and service delivery determinants. Methods: Secondary data from 2013 Nigeria demographic and health survey (DHS) was used. Sample of 38,948 eligible women were selected for interview using stratified three-stage cluster design. Data obtained from the individual recode dataset was used for descriptive and logistic regression analysis of factors associated with SP use in pregnancy was performed. Independent variables were age, media exposure, region, place of residence, wealth index, place of antenatal care (ANC) attendance and number of visits. Results: Women in the upper three wealth quintiles were 1.33 - 1.80 times more likely to receive SP than the poorest (CI: 1.15-1.56; 1.41-1.97; 1.49-2.17). Women who received ANC from public health facilities were twice as likely (inverse of OR 0.68) to use SP in pregnancy than those who used private facilities (CI: 0.60-0.76). Those who attended at least 4 ANC visits were 1.46 times more likely to get SP prophylaxis (CI: 1.31-1.63). Using the unadjusted odds ratio, women residing in rural areas were 0.86 times less likely to use SP compared to those in urban areas. Conclusions: Inequities in access to and use of SP for malaria prophylaxis in pregnancy exist across sub-population groups in Nigeria. Targeted interventions on the least covered are needed to reduce existing inequities and scale-up IPTp of malaria.


Assuntos
Antimaláricos/administração & dosagem , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde , Malária/prevenção & controle , Complicações Parasitárias na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Pirimetamina/administração & dosagem , Sulfadoxina/administração & dosagem , Adolescente , Adulto , Antimaláricos/uso terapêutico , Combinação de Medicamentos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Nigéria , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Complicações Parasitárias na Gravidez/tratamento farmacológico , Pirimetamina/uso terapêutico , Sulfadoxina/uso terapêutico , Adulto Jovem
4.
PLoS One ; 15(7): e0234575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645002

RESUMO

INTRODUCTION: Improving maternal health is a global public health challenge especially in sub-Saharan Africa. The optimum utilisation of antenatal care (ANC) by pregnant women is known to improve maternal health outcomes. Maternal morbidity and mortality rates in Ghana remain unacceptably high, particularly in rural settings where skilled delivery care often times is disproportionally low. This study assessed factors associated with optimum utilisation of antenatal care in rural Ghana. METHODS: A cross-sectional design was applied to collect data among eligible participants between October 2018 and January 2019. A total of 322 women who gave birth and attended the postnatal clinic were recruited for the study. Consecutive sampling was employed in recruiting participants. The associations between the dependent variables (ANC service utilisation and knowledge of ANC) and independent variables (socio-demographic characteristics) were examined using ordinary least squares logistic regression at 95% confidence interval in STATA version 14.0. RESULTS: Of the 322 participants, 69.0% reported utilising at least four or more times ANC services. Determinants of women attending ANC for four or more times was significantly associated with age [OR = 4.36 (95%CI: 2.16-8.80), p<0.001], educational level [OR = 10.18 (95%CI: 3.86-26.87), p<0.001], and insured with National Health Insurance Scheme [OR = 3.42 (95%CI: 1.72-6.82), p<0.001]. Not married [OR = 0.65 (0.39-1.09), p = 0.011] or divorced [OR = 0.33 (95%CI: 0.13-0.83), p = 0.019] was negatively associated with utilisation of four or more ANC services. The majority (79.0%) of the participants had a good level of knowledge regarding antenatal care. CONCLUSION: Although the majority of women in this study had good knowledge of ANC services, a significant number of them did not complete the recommended number of ANC visits for at least four times during a normal pregnancy. Awareness and further education to reproductive-age women on the significant role adequate ANC attendance plays in advancing health and well-being require further investments, particularly among rural women in Ghana.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/tendências , Adulto , Estudos Transversais , Parto Obstétrico , Feminino , Gana/epidemiologia , Humanos , Serviços de Saúde Materna , Pessoa de Meia-Idade , Parto , Gestantes , Cuidado Pré-Natal/estatística & dados numéricos , População Rural , Fatores Socioeconômicos
5.
PLoS One ; 15(7): e0236080, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667942

RESUMO

BACKGROUND: Exclusive breastfeeding (EBF) means that an infant should be breastfed only for the first six months of life to achieve optimal child development and to prevent infant morbidity and mortality. The aim of this analysis was to determine the individual-, household-, and community-level factors associated with EBF practice in Bangladesh. METHODS: A total of 1,440 women-child pairs data were analysed extracted from 2011 and 2014 Bangladesh Demographic and Health Survey. Multilevel logistic regression models were used separately for individual-, household-, and community level factors to identify the different level of factors associated with EBF practice. RESULTS: Around 61% women in Bangladesh practiced EBF with significant variation across several individual-, household-, and community-level factors. At the individual level, higher odds of EBF practice was found among mothers' received higher number of antenatal care and lower age of child. Mothers' higher education and engagement in formal jobs were found negatively associated with EBF practice. At the community level, higher odds of EBF was found among women live in Barishal, Dhaka, and Rajshahi divisions, and resided in the community with moderate level of female education, higher level of fertility, and higher use of antenatal and delivery care. CONCLUSIONS: One in every three children in Bangladesh do not breastfeed exclusively which needs special attention for the policymakers. In this case, educated women engaged in income generating activities and women did not use antenatal care should be given priority. At the community level, priority should be given for the women's resides in the community with lower level of antenatal and delivery healthcare services use.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Mães/psicologia , Mães/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Bangladesh , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez
6.
Niger J Clin Pract ; 23(7): 928-933, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620721

RESUMO

Background: Short inter-pregnancy interval (IPI) is a potential risk factor for adverse pregnancy outcomes. Previous reports from sub-Sahara Africa documented increasing incidence of short IPI but evidence is lacking in its effect on pregnancy outcome. Aim: The study aimed to determine the effect of short IPI on pregnancy outcome in Nigeria. Subjects and Methods: It was a prospective cohort study of 271 pregnant women receiving antenatal care in a tertiary hospital in Nigeria. For every eligible woman with short IPI (<18 months) recruited; a suitable control with IPI ≥18 months was selected. Statistical analysis was both inferential and descriptive using the statistical package for social sciences version 24 (SPSS Inc. Chicago, Illinois, USA) for windows. A P value of less than 0.05 was considered statistically significant. Results: Incidence of maternal anemia was higher in women with short IPI than control (RR: 2.091; 95% CI: 1.4433.031; P < 0.001). Other maternal and perinatal outcome measures including premature rupture of membranes, preterm labor/delivery, pregnancy induced hypertension, third trimester bleeding, postpartum hemorrhage, and inadequate gestational weight gain did not show any significant association with short IPI (P > 0.05). Conclusion: Short IPI is associated with anemia in pregnancy in Nigeria. Public health campaigns for improvement in uptake of family planning services and breastfeeding may help reduce the incidence of short IPI and anemia in low income countries.


Assuntos
Intervalo entre Nascimentos , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Anemia/epidemiologia , Estudos de Coortes , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Incidência , Recém-Nascido , Nigéria/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Pobreza , Gravidez , Estudos Prospectivos
7.
PLoS Med ; 17(7): e1003089, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32649668

RESUMO

INTRODUCTION: Inequalities in maternal and newborn health persist in many high-income countries, including for women of refugee background. The Bridging the Gap partnership programme in Victoria, Australia, was designed to find new ways to improve the responsiveness of universal maternity and early child health services for women and families of refugee background with the codesign and implementation of iterative quality improvement and demonstration initiatives. One goal of this 'whole-of-system' approach was to improve access to antenatal care. The objective of this paper is to report refugee women's access to hospital-based antenatal care over the period of health system reforms. METHODS AND FINDINGS: The study was designed using an interrupted time series analysis using routinely collected data from two hospital networks (four maternity hospitals) at 6-month intervals during reform activity (January 2014 to December 2016). The sample included women of refugee background and a comparison group of Australian-born women giving birth over the 3 years. We describe the proportions of women of refugee background (1) attending seven or more antenatal visits and (2) attending their first hospital visit at less than 16 weeks' gestation compared over time and to Australian-born women using logistic regression analyses. In total, 10% of births at participating hospitals were to women of refugee background. Refugee women were born in over 35 countries, and at one participating hospital, 40% required an interpreter. Compared with Australian-born women, women of refugee background were of similar age at the time of birth and were more likely to be having their second or subsequent baby and have four or more children. At baseline, 60% of refugee-background women and Australian-born women attended seven or more antenatal visits. Similar trends of improvement over the 6-month time intervals were observed for both populations, increasing to 80% of women at one hospital network having seven or more visits at the final data collection period and 73% at the other network. In contrast, there was a steady decrease in the proportion of women having their first hospital visit at less than 16 weeks' gestation, which was most marked for women of refugee background. Using an interrupted time series of observational data over the period of improvement is limited compared with using a randomisation design, which was not feasible in this setting. CONCLUSIONS: Accurate ascertainment of 'harder-to-reach' populations and ongoing monitoring of quality improvement initiatives are essential to understand the impact of system reforms. Our findings suggest that improvement in total antenatal visits may have been at the expense of recommended access to public hospital antenatal care within 16 weeks of gestation.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adolescente , Adulto , Feminino , Maternidades/estatística & dados numéricos , Humanos , Recém-Nascido , Análise de Séries Temporais Interrompida , Idade Materna , Gravidez , Segundo Trimestre da Gravidez , Melhoria de Qualidade , Fatores Socioeconômicos , Vitória/epidemiologia , Adulto Jovem
8.
PLoS One ; 15(7): e0235538, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628700

RESUMO

BACKGROUND: Early or timely initiation of antenatal care and regular visits based on the schedule have a tremendous effect on both maternal and fetal health. Despite the paramount benefits of early initiation of ANC within the first 12 weeks of pregnancy, women still do not have adequate and equal access to high-quality early antenatal care. OBJECTIVE: To determine the prevalence and factors associated with delayed first ANC booking in Ethiopia. METHOD: A secondary data analysis was conducted using the 2016 Ethiopian demographic and health survey data. All reproductive age women who gave birth in the five years preceding the survey and who had ANC visit for their last child were included in this study. The total weighted sample size analyzed was 4,741. Due to the hierarchical nature of the EDHS data, Multi-level logistic regression model was used to identify the individual and community level factors associated with delayed first ANC booking. RESULT: In this study, the prevalence of delayed first ANC booking was 67.31% [95% CI: 65.96% to 68.63%]. Women with secondary and higher education [Adjusted Odd Ratio (AOR) = 0.78; 95%CI: 0.61, 0.99] and [AOR = 0.61; 95%CI: 0.44, 0.83] respectively had lower odds of delayed first ANC booking. But woman who were multiparous and grand multiparous [AOR = 1.21; 95%CI: 1.01, 1.45] and [AOR = 1.50; 95%CI: 1.16, 1.93] respectively, women with the last pregnancy wanted no more [AOR = 1.52; 95%CI: 1.10, 2.09], a woman who was living in the rural area [AOR = 1.66; 95%CI: 1.25, 2.21], and a woman who was living in large central regions and small peripheral regions [AOR = 2.76; 95%CI: 2.20, 3.47] and [AOR = 2.70; 95%CI: 2.12, 3.45] respectively had higher odds of delayed first ANC booking. CONCLUSION: Despite the documented benefits of early antenatal care initiation, late ANC booking is still predominant in Ethiopia as highlighted by this study. Maternal education, parity, wanted the last child, residence and region were significantly associated with delayed first ANC booking. Therefore, taking special attention for these high-risk groups could decrease delayed first ANC booking and this intern decreases maternal and fetal health problems by identifying and intervene early.


Assuntos
Análise Multinível , Cuidado Pré-Natal/estatística & dados numéricos , Reprodução , Adolescente , Adulto , Etiópia , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/psicologia , Prevalência
9.
PLoS One ; 15(6): e0233590, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484815

RESUMO

BACKGROUND: Children living with HIV remain undiagnosed due to missed opportunities along the prevention of mother-to-child HIV transmission cascade. This study addresses programmatic gaps in the cascade by describing pregnancy and HIV-related services received by mothers of children newly identified as HIV-positive through active case finding. METHODS: This was a prospective observational cohort (2017-2018) of HIV-positive children <15 years of age newly diagnosed at study facilities and/or surrounding communities in Kenya and Uganda. At enrollment, caregivers were interviewed about maternal and child health and HIV history. Child medical and laboratory information was abstracted at two months post-diagnosis. Descriptive summary statistics were calculated; associations between selected factors and child age at HIV diagnosis were evaluated using generalized estimating equations. RESULTS: 174 HIV-positive children (median age 2.4 years) were enrolled. Among maternal caregivers, 110/132 (83.3%) attended antenatal care and 60 (45.5%) reported testing HIV-negative in antenatal care. Of 41 and 56 women known to be HIV-positive during pregnancy and breastfeeding respectively, 17 (41.5%) and 15 (26.8%) did not receive antiretroviral drugs. Despite known maternal HIV-positive status during pregnancy, 39% of these children were not diagnosed until after two years of age; children were diagnosed at younger ages in Uganda (p = 0.0074) and if mother was the caregiver (p<0.0001). The most common HIV testing points identifying children were outpatient (44.3%) and maternal/child health departments (29.9%). Nearly all children initiated antiretroviral therapy within two weeks of diagnosis. CONCLUSIONS: Multiple missed opportunities for HIV prevention and delays in HIV testing of HIV-exposed children were identified in newly diagnosed children. Findings support critical prevention messaging and retesting of HIV-negative women during pregnancy and breastfeeding, strengthening HIV treatment initiation and follow-up systems and interventions to ensure HIV-positive women receive lifelong antiretroviral therapy throughout the cascade, and broader implementation of community case finding so children not engaged in care receive testing services.


Assuntos
Infecções por HIV/diagnóstico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Programas de Rastreamento/organização & administração , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cuidado Pré-Natal/organização & administração , Adulto , Fármacos Anti-HIV/uso terapêutico , Criança , Pré-Escolar , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Quênia/epidemiologia , Masculino , Programas de Rastreamento/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/estatística & dados numéricos , Lacunas da Prática Profissional , Estudos Prospectivos , Uganda/epidemiologia , Adulto Jovem
10.
Natl Vital Stat Rep ; 69(3): 1-11, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32510315

RESUMO

Objectives-This report presents data on recent trends for three sexually transmitted infections (STIs)-chlamydia, gonorrhea, and syphilis-reported among women giving birth in the United States from 2016 through 2018, and rates by selected characteristics for 2018. Methods-Data are from birth certificates and are based on 100% of births registered in the United States for 2016, 2017, and 2018. Birth certificate data on infections during pregnancy are recommended to be collected from the mother's medical records (1). Mothers are to be reported as having an infection if there is a confirmed diagnosis or documented treatment for the infection in their medical record (2). Results-Among women giving birth in 2018, the overall rates of chlamydia, gonorrhea, and syphilis were 1,843.9, 310.2, and 116.7 per 100,000 births, respectively. The rates for these STIs increased 2% (chlamydia), 16% (gonorrhea), and 34% (syphilis) from 2016 through 2018. In 2018, rates of chlamydia and gonorrhea decreased with advancing maternal age, whereas those for syphilis decreased with maternal age through 30-34 years and then increased for women aged 35 and over. In 2018, rates of all three STIs were highest for non-Hispanic black women, women who smoked during pregnancy, women who received late or no prenatal care, and women for whom Medicaid was the principal source of payment for the delivery. Among women aged 25 and over, rates of each of the STIs decreased with increasing maternal education.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto , Declaração de Nascimento , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/etnologia , Grupos de Populações Continentais/estatística & dados numéricos , Parto Obstétrico/economia , Escolaridade , Feminino , Gonorreia/epidemiologia , Gonorreia/etnologia , Humanos , Idade Materna , Medicaid/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/etnologia , Cuidado Pré-Natal/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/etnologia , Fumar/epidemiologia , Fumar/etnologia , Sífilis/epidemiologia , Sífilis/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
11.
Cent Eur J Public Health ; 28(2): 143-148, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32592560

RESUMO

OBJECTIVE: In most indicators of the way of life, the Roma community is generally different from the majority population and dominant culture. The objective of the study was to describe factors affecting the health of the Roma living in Slovakia, with an emphasis on the sexual and reproductive health of Roma women, and report on the results of analysis of high-risk pregnancies of Roma women in the district of Rimavská Sobota, Slovakia. METHODS: A retrospective study of medical documentation was used. The results were analyzed using the absolute and relative frequencies. Statistical methods were used. RESULTS: A total of 1,256 high-risk pregnancies were analyzed, of which 622 (49.52%) were in Roma women. The average age of Roma respondents was lower by 5 years compared to non-Roma. The age of Roma women at the first pregnancy was statistically significantly lower compared to non-Roma (p < 0.001). The Roma respondents achieved statistically significantly lower levels of education than non-Roma. There was a demonstrably higher number of pregnancies as well as a higher number of artificial and spontaneous abortions per Roma woman. These results were statistically significant. For Roma women, pregnancy began to be risky demonstrably earlier than for non-Roma (p < 0.001). There was a statistically significant difference in attending prenatal counselling. Roma women attended prenatal counselling statistically significantly less frequently than non-Roma (p < 0.001). A significant statistical dependence was found between attending prenatal counselling and the onset of pregnancy problems in Roma women. There was no significant difference in the incidence of other diseases associated with high-risk pregnancy among Roma and non-Roma respondents. CONCLUSION: The findings indicate that Roma women are exposed to health problems in the area of sexual and reproductive health in Slovakia. In the approach to the Roma, it is essential to focus on improving accessibility to health care, prevention, knowledgeableness and effectively preventing, eradicating and strongly penalizing all forms of discrimination in access to health care, especially for Roma women, who are more likely to receive health care.


Assuntos
Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/etnologia , Gravidez de Alto Risco/etnologia , Cuidado Pré-Natal/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Reprodutiva/etnologia , Roma/etnologia , Adolescente , Adulto , Feminino , Humanos , Paridade , Gravidez , Complicações na Gravidez/etnologia , Estudos Retrospectivos , Fatores de Risco , Eslováquia/epidemiologia , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Adulto Jovem
12.
BJOG ; 127(10): 1229-1240, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32583536

RESUMO

OBJECTIVES: To investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID-19 outbreak. DESIGN: Cross-sectional study. SETTING: Two cities in China--Wuhan (epicentre) and Chongqing (a less affected city). POPULATION: A total of 1947 pregnant women. METHODS: We collected demographic, pregnancy and epidemic information from our pregnant subjects, along with their attitudes towards COVID-19 (using a self-constructed five-point scale). The Self-Rating Anxiety Scale (SAS) was used to assess anxiety status. Obstetric decision-making was also evaluated. The differences between cities in all of the above factors were compared and the factors that influenced anxiety levels were identified by multivariable analysis. MAIN OUTCOME MEASURES: Anxiety status and its influencing factors. Obstetric decision-making. RESULTS: Differences were observed between cities in some background characteristics and women's attitudes towards COVID-19 in Wuhan were more extreme. More women in Wuhan felt anxious (24.5 versus 10.4%). Factors that influenced anxiety also included household income, subjective symptom and attitudes. Overall, obstetric decisions also revealed city-based differences; these decisions mainly concerned hospital preference, time of prenatal care or delivery, mode of delivery and infant feeding. CONCLUSIONS: The outbreak aggravated prenatal anxiety and the associated factors could be targets for psychological care. In parallel, key obstetric decision-making changed, emphasising the need for pertinent professional advice. Special support is essential for pregnant mothers during epidemics. TWEETABLE ABSTRACT: The COVID-19 outbreak increased pregnant women's anxiety and affected their decision-making.


Assuntos
Ansiedade , Infecções por Coronavirus , Parto Obstétrico , Pandemias , Pneumonia Viral , Complicações na Gravidez , Gestantes/psicologia , Cuidado Pré-Natal , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/etiologia , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Estudos Transversais , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Parto Obstétrico/estatística & dados numéricos , Autoavaliação Diagnóstica , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Pesquisa Qualitativa
13.
PLoS One ; 15(6): e0233671, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584881

RESUMO

Growth faltering among children during the first five years of life is a common problem among low and middle-income countries. The purpose of this study was to determine the effect of a nutrient-rich, food-based supplement given to Vietnamese rural women prior to and/or during pregnancy on the growth of their infants during first 24 months of life and to identify maternal and newborn factors associated with the infant's growth. This prospective cohort study included 236 infants born to mothers who had received nutritional advice or a food supplement from pre-conception to term or from mid-gestation to term as part of a prior randomized controlled trial. Infant anthropometry and feeding information were monitored monthly and the infant weight for age Z-score (WAZ), length for age Z-score (LAZ), and weight for length Z-score (WLZ) were assessed at 6, 12, 18, and 24 months of age using mixed-effects regression modeling. Compared to the non-supplemented mothers, infants born to mothers receiving food supplementation from mid-gestation to term had significantly higher WLZ only at 18 months (p = 0.03) and did not differ in other outcomes. Supplementation from pre-conception to term did not affect infant growth at any time point during the first 24 months. In the entire study cohort, maternal height and gestational weight gain were positively associated with the infant's WAZ and LAZ from 6 to 24 months of age. Programs designed to improve gestational weight gain among women performing demanding physical work throughout a reproductive cycle may improve postnatal infant growth. Trial registration: Registered Clinical Trials.Gov: NCT01235767.


Assuntos
Desenvolvimento Infantil/fisiologia , Alimentos Fortificados/estatística & dados numéricos , Ganho de Peso na Gestação/fisiologia , Exposição Materna , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Aleitamento Materno , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mães/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/métodos , Estudos Prospectivos , População Rural/estatística & dados numéricos , Vietnã , Adulto Jovem
14.
Matern Child Health J ; 24(9): 1179-1188, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32557132

RESUMO

OBJECTIVES: (1) To compare the prevalence of antenatal admissions and mean length of stay among women with opioid-affected and non-opioid-affected deliveries; (2) examine predictors of admission; and (3) describe the most common discharge diagnoses in each group. METHODS: Using data from seven states in the State Inpatient Databases for varying years between 2009 and 2014, delivery hospitalizations among women 18 years of age and older were identified and classified as opioid-affected or non-opioid-affected. Antenatal admissions were linked to deliveries. The antenatal admission ratio and mean length of stay for each group were calculated; the percentage of deliveries in each group with no, any, one, two, or three or more antenatal admissions were compared with t-tests. Logistic regression models estimated odds of any antenatal admission, stratified by opioid-affected and non-opioid-affected deliveries. Frequencies were tabulated for the ten most common discharge diagnoses in each group. RESULTS: Of 2,684,970 deliveries, 14,765 were opioid-affected. Admissions among women with opioid-affected deliveries were more prevalent (26.4 per 100 deliveries) compared to 6.7 among women with non-opioid-affected deliveries and were associated with a 1.5-day longer mean length of stay. The presence of a behavioral health condition was associated with higher odds of antenatal admission in both groups, with a particularly strong association among women with opioid-affected deliveries. Six of the ten most common diagnoses for admissions prior to opioid-affected deliveries were behavioral health-related. CONCLUSIONS FOR PRACTICE: These results highlight the importance of addressing the large burden of behavioral health conditions among pregnant women, especially those with opioid dependence and abuse.


Assuntos
Analgésicos Opioides/administração & dosagem , Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Analgésicos Opioides/efeitos adversos , Estudos Transversais , Feminino , Humanos , Idade Materna , Gravidez , Complicações na Gravidez/diagnóstico , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia
15.
Int J Equity Health ; 19(1): 65, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398089

RESUMO

BACKGROUND: Although World Health Organization works to make vaccination service available to everyone everywhere by 2030, majority of the world's children have been unvaccinated and unprotected from vaccine-preventable diseases. In fact, evidences on factors contributing to changes in vaccination coverage across residential areas, wealth categories and over time have not been adequate. Therefore, this study aimed at investigating inequalities in vaccination status of children aged 12-23 months owing to variations in wealth status, residential areas and over time. METHODS: Maternal and child health service data were extracted from the 2011 and 2016 Ethiopian Demographic and Health Survey datasets. Then, multivariate decomposition analysis was done to identify the major factors contributing to differences in the rate of vaccination utilization across residences and time variations. Similarly, a concentration index and curve were also done to identify the concentration of child vaccination status across wealth categories. RESULTS: Among children aged 12-23 months, the prevalence of complete childhood vaccination status increased from 20.7% in rural to 49.2% in urban in 2011 and from 31.7% in rural to 66.8% in urban residences in 2016. The decomposition analyses indicated that 72% in 2011 and 70.5% in 2016 of the overall difference in vaccination status was due to differences in respondent characteristics. Of the changes due to the composition of respondent characteristics, such as antenatal care and place of delivery were the major contributors to the increase in complete childhood vaccination in 2011, while respondent characteristics such as wealth index, place of delivery and media exposure were the major contributors to the increase in 2016. Of the changes due to differences in coefficients, those of low wealth status in 2016 across residences significantly contributed to the differences in complete childhood vaccination. On top of that, from 2011 to 2016, there was a significant increment in complete childhood vaccination status and a 59.8% of the overall increment between the surveys was explained by the difference in composition of respondents. With regard to the change in composition, the differences in composition of ANC visit, wealth status, place of delivery, residence, maternal education and media exposure across the surveys were significant predictors for the increase in complete child vaccination over time. On the other hand, the wealth-related inequalities in the utilization of childhood vaccination status were the pro-rich distribution of health services with a concentration index of CI = 0.2479 (P-value < 0.0001) in 2011 and [CI = 0.1987; P-value < 0.0001] in 2016. CONCLUSION: A significant rural-urban differentials was observed in the probability of a child receiving the required childhood vaccines. Children in urban households were specifically more likely to have completed the required number of vaccines compared to the rural areas in both surveys. The effect of household wealth status on the probability of a child receiving the required number of vaccines are similar in the 2011 and 2016 surveys, and the vaccination status was high in households with high wealth status. The health policies aimed at reducing wealth related inequalities in childhood vaccination in Ethiopia need to adjust focus and increasingly target vulnerable children in rural areas. It is of great value to policy-makers to understand and design a compensation mechanism for the costs incurred by poor households. Special attention should also be given to rural communities through improving their access to the media. The findings highlight the importance of women empowerment, for example, through education to enhance childhood vaccination services in Ethiopia.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Serviços de Saúde da Criança/tendências , Disparidades nos Níveis de Saúde , Cobertura Vacinal/estatística & dados numéricos , Cobertura Vacinal/tendências , Adolescente , Adulto , Etiópia/epidemiologia , Características da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Análise Multivariada , Cuidado Pré-Natal/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos , Adulto Jovem
16.
Afr J Reprod Health ; 24(1): 97-105, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32358941

RESUMO

Several factors affect the use of maternal health care services in developing countries. The aim was to describe the knowledge and attitudes of women in a rural area of the Moroccan High Atlas regarding aspects of maternal health, and to identify the determinants of use of maternal health care services. A cross-sectional study of 87 participants was conducted in a mountainous area near Marrakech utilizing two sampling methods (a door-to-door approach, and a mobile health caravan). Fisher test was used to compare two proportions, and the non-parametric Mann-Whitney test to compare two means (p value was 0.05). Median participants' age was 24 years old [15-60]. Findings indicated that husband's education (p=0.005), woman's age (p=0.011), awareness of warning signs during pregnancy (p=0.01) and use of health center for other purposes other than pregnancy (p=0.007) were important influencing factors for use of prenatal consultation services. Factors that influenced supervised birth outcomes were the age of the woman (p=0.013), her education (p=0.027) and a positive attitude towards monitoring her pregnancy by a health professional (p=0.006). To improve utilization rates for maternal health services, these factors must be considered when designing interventions that aim to improve the quality of these services in the community.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Saúde da População Rural , População Rural , Adolescente , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Marrocos , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Gestantes/etnologia , Determinantes Sociais da Saúde , Populações Vulneráveis , Adulto Jovem
17.
Afr J Reprod Health ; 24(1): 121-132, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32358944

RESUMO

In efforts to reduce maternal and neonatal mortality, it is recommended that all pregnant women be counseled on signs of pregnancy related complications and neonatal illness. In resource limited settings, such counselling may be task-shifted to lay health workers. We conducted a community-based cross-sectional survey of community health workers/volunteers in North and East Kamagambo of the Rongo Sub- County of Migori County, Kenya, between January-April 2018. A survey tool was administered through face-to-face interviews to investigate the level of knowledge of obstetric and neonatal danger signs among community health workers in North Kamagambo after one year of participation in the Lwala program, as well as to evaluate baseline knowledge of community health volunteers in East Kamagambo at the beginning of Lwala's expansion and prior to their receiving training from Lwala. The North Kamagambo group identified more danger signs in each category. The percentage of participants with adequate knowledge in the pregnancy, postpartum, and neonatal categories was significantly higher in North Kamagambo than in East Kamagambo. Sixty percent of participants in North Kamagambo knew 3 or more danger signs in 3 or more categories, compared to 24% of participants in East Kamagambo. Location in North Kamagambo (OR 2.526, p=0.03) and a shorter time since most recent training (OR 2.291, p=0.025) were associated with increased knowledge. Our study revealed varying levels of knowledge among two populations of lay health workers. This study highlights the benefit of frequent trainings and placing greater emphasis on identified gaps in knowledge of the labor and postpartum periods.


Assuntos
Competência Clínica , Agentes Comunitários de Saúde/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Complicações do Trabalho de Parto/prevenção & controle , Complicações na Gravidez/prevenção & controle , Adulto , Pesquisa Participativa Baseada na Comunidade , Estudos Transversais , Parto Obstétrico/efeitos adversos , Parto Obstétrico/psicologia , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Entrevistas como Assunto , Quênia , Gravidez , Gestantes , Cuidado Pré-Natal/estatística & dados numéricos , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , Inquéritos e Questionários
18.
Afr J Reprod Health ; 24(1): 143-151, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32358946

RESUMO

One intervention that is widely believed to reduce the high maternal mortality in resource-poor countries including Nigeria is delivery in health facilities under skilled birth attendance. However, the practice of non-facility delivery is still common in these countries. Curiously, women who attend ANC in health facilities are also among those who choose to deliver in a non-facility. This was a descriptive cross-sectional study conducted in Bali LGA of Taraba State, Nigeria. Multi-stage sampling technique was used to select 320 women of childbearing age who attended ANC and had had a recent delivery. The objective was to determine the factors associated with choice of non-facility delivery among women attending ANC in the area. Data analysis was done using EPI info computer software version 7.2.1.0 Most of the women (73.1%) delivered in a non-facility. Ethnicity and place of ANC were the predictors of non-facility delivery. The most common reason for non-facility delivery was that labour came without complications (58.8%). Prevalence of non-facility delivery in the area was disturbingly high. Strategies to discourage the practice should include providing adequate skilled personnel and equipment at all levels of healthcare. There should also be active engagement of the traditional and religious institutions in the area.


Assuntos
Parto Obstétrico , Parto Domiciliar/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Trabalho de Parto , Governo Local , Nigéria , Gravidez , Gestantes , Inquéritos e Questionários
19.
Womens Health Issues ; 30(4): 292-298, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32417074

RESUMO

BACKGROUND: Researchers have examined predictors of Veterans Affairs (VA) service use by women veterans in general, but less is known about predictors of VA service use by pregnant veterans. This study examined characteristics associated with planned and actual VA service use by pregnant veterans. METHODS: This study includes data from 510 pregnant veterans enrolled in the Center for Maternal and Infant Outcomes Research in Translation Study. Women veterans completed phone interviews during their first trimester and at 3 months postpartum. The Center for Maternal and Infant Outcomes Research in Translation surveys assessed medical and mental health conditions, VA health care use, trauma history, and pregnancy complications. We conducted bivariate and multivariable logistic regression models assessing planned and actual use of VA services during pregnancy. RESULTS: Lifetime post-traumatic stress disorder (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.11-2.69) and history of military sexual trauma (OR, 1.85; 95% CI, 1.19-2.87) were significantly associated with planned VA service use in multivariable models. Lifetime diagnoses of anxiety (OR, 1.78; C.I., 1.15-2.75) were associated with an increased likelihood of actual VA use during pregnancy, whereas Hispanic ethnicity (OR, 0.59; 95% CI, 0.36-0.96), younger age (OR, 0.95; 95% CI, 0.91-0.99), and access to private health insurance (OR, 0.55; 95% CI, 0.37-0.84) were associated with a decreased likelihood of actual VA service use during pregnancy. CONCLUSIONS: Results emphasize the association between high-risk mental health characteristics and specific demographic characteristics with VA service use among pregnant veterans. Study findings highlight a continued need for women's health care at the VA, as well as the availability of VA providers knowledgeable about perinatal health issues, and informed community providers regarding women veterans' health.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/psicologia , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/psicologia , Adulto , Ansiedade , Feminino , Humanos , Saúde Mental , Militares/psicologia , Gravidez , Inquéritos e Questionários , Telefone , Estados Unidos , Veteranos/estatística & dados numéricos , Saúde dos Veteranos , Saúde da Mulher , Adulto Jovem
20.
PLoS One ; 15(4): e0232316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353021

RESUMO

BACKGROUND: Studies in sub-Saharan Africa indicated the overall prevalence of optimal breast feeding ranged between a lowest of 17.63% in East Africa and a highest of 46.37% in West Africa. It's estimated that 823,000 deaths of children could be prevented every year through optimal breastfeeding practices. However optimal breastfeeding practices is low in most setting of Ethiopia. Therefore, this study aimed to assess optimal breastfeeding practices and associated factors in Worabe town. METHOD: A community-based analytical cross-sectional study was conducted from April 15th-25th, 2018. A systematic sampling technique was applied on 347 sampled mothers who had children greater than or equal to 2 years old. The data was entered into EpiData (version 3.1) and subsequently exported to SPSS Statistics (version 22) for analysis. Descriptive statistics were used for presenting summary data using tables and graph. Bivariate and multi variable logistic regression analysis to identify were used to identify associated factors. The statistical significance was declared at P<0.05. RESULT: Optimal breastfeeding was exhibited by 42.1% of mothers. Government employees (AOR = 8.0; 95% CI: 1.7, 36.4), families with a household income of 1,500-3,000 Ethiopian birr (AOR = 4.6; 95% CI: 1.0, 20.1), individuals knowledgeable about optimal breastfeeding practices (AOR: 5.5 95% CI: 1.6, 18.1), individuals counselled about breastfeeding practices during postnatal follow-ups (AOR = 4.940, 95% CI: 1.313, 10.195), and individuals that had a caesarean section delivery (AOR = 4.2, 95% CI: 1.2, 14.1) had a higher chance of practicing optimal breastfeeding. However, mothers who did not attend or have access to antenatal care follow-ups (AOR = 0.1, 95% CI: 0.04, 0.5) were less likely to practice optimal breastfeeding. CONCLUSIONS: Less than half of mothers breastfed their children optimally. Factors that influenced this included knowledge of optimal breastfeeding practices, total household income, the woman's occupation, access to breastfeeding counselling during postnatal care follow-ups, access to antenatal care follow-ups, and mode of delivery. It is strongly recommended that optimal breastfeeding awareness programs through health education be done in collaboration with health extension workers, and zonal health offices.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Modelos Estatísticos , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Atitude Frente a Saúde , Aleitamento Materno/economia , Aleitamento Materno/etnologia , Cesárea/estatística & dados numéricos , Etiópia , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Cuidado Pós-Natal/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Educação Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos
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