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1.
Pan Afr Med J ; 33: 123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565114

RESUMO

Introduction: The proportion of antenatal attendants in Ghana who had at least four antenatal visits increased from 78% in 2008 to 87% in 2014. However, it is not known whether these visits followed the recommended timing of focused antenatal clinic attendance in Ghana. We sought to assess the adherence to the clinic schedule and its determinants in the Accra Metropolis. Methods: A cross-sectional study was conducted. Face-to-face interviews were conducted with postpartum women. Multiple logistic regression was used in the analysis of determinants of adherence to the recommended timing of clinic attendance. A p-value of <0.05 was considered statistically significant. Results: Among 446 focused antenatal care clinic attendants, 378 (84.8%) had four or more visits. Among these, 101 (26.7%) adhered to the recommended clinic schedule. Women who adhered were more likely to have had education up to Junior High School [AOR=3.31, 95%CI (1.03-10.61)] or Senior High School [AOR=4.47, 95%CI (1.14-17.51)], or have history of abortion [(AOR=3.36, 95%CI (1.69-7.96)]. For every week increase in gestational age at booking at the antenatal clinic, respondents were 34% less likely to complete all four antenatal visits at the recommended times. [(AOR=0.66, 95% (0.60-0.73)]. Conclusion: Majority of women receiving focused antenatal care in the Accra Metropolis have four or more visits but only about a quarter of them adhered to the recommended clinic schedule. Having high school education, history of abortion and early initiation of antenatal care were predictors of adherence to clinic schedule. Women should be educated on early initiation of antenatal care to enhance adherence.


Assuntos
Idade Gestacional , Cooperação do Paciente/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Estudos Transversais , Escolaridade , Feminino , Gana , Humanos , Entrevistas como Assunto , Modelos Logísticos , Gravidez , Fatores de Tempo , Adulto Jovem
2.
Pan Afr Med J ; 33: 133, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558932

RESUMO

This study aims to analyze the epidemiological, clinical, therapeutic and anatomopathologic features of urogenital fistulas. We conducted a retrospective study of patients with urogenital fistulas admitted to the department of general surgery and gynecology and obstetrics between January 1, 2014 and December 30, 2015, including the first 5 fistula repair campaigns organized by the Fistula Mali project. Urogenital fistulas account for 19.53% of all urologic disorder treated during our daily practice. The median age at first marriage was 16.57 years. The majority of our patients (96.70%) was illiterate and self-employed, coming from rural areas (85.36%). Obstructed labour was the dominant etiology, with 91.50% of stillborn children. The patients were primiparous women (43.33%) and, among them, 53.60% received no prenatal care. The divorce rate associated with the disease was 7.30%. Most patients underwent simple fistulorraphy, of whom 121 underwent lower fistulorraphy, 26 upper fistulorraphy and 3 mixed fistulorraphy. Outcomes were satisfactory in 65.33% patients and poor in 34.66% of patients. Patients with type I and type V obstetric fistulas had the highest healing rate compared to patients with type IV fistulas. Urogenital fistulas are a real public health problem. Treatment is mainly based on surgery and prognosis is compromised by the narrowness of the surgical field, the complexity of the lesions and the condition of the surrounding tissue. The focus must be on the implementation of women's socio economic development programs and on emergency obstetric care access. The research and discussion should continue to facilitate the development of a standard classification.


Assuntos
Complicações do Trabalho de Parto/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Fístula Vesicovaginal/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Mali , Pessoa de Meia-Idade , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores Socioeconômicos , Resultado do Tratamento , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia , Adulto Jovem
3.
Rev Saude Publica ; 53: 76, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31553379

RESUMO

OBJECTIVE: To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil. METHODS: This was an ecological study covering all Brazilian municipalities evaluated by the second cycle of the National Program for Access and Quality Improvement in Primary Care, 2013-2014. The dependent variables were based on prenatal care access: prenatal care appointments, and HIV and syphilis tests during prenatal care. The independent variables were compared with demographic and social characteristics. Bivariate analysis was performed assessing the three outcomes with the independent variables. Variables with significant associations in this bivariate analysis were fit in a Poisson multiple regression analysis with robust variance to obtain adjusted estimates. RESULT: Poisson regression analysis showed a statistically significant association with the variables "less than eight years of study" [prevalence ratio (PR) = 1.31; 95%CI 1.19-1.45; p < 0.001] and "participants of the cash transfer program" (PR = 0.80; 95%CI 0.72-0.88; p < 0.001) for the outcome of "having less than six prenatal care appointments" and individual variables. A statistically significant association was found for "participants of the cash transfer program" (PR = 1.43; 95%CI 1.19-1.72; p < 0.001) regarding the outcome from the comparison between HIV testing absence during prenatal care and demographic and social characteristics. The absence of syphilis testing during prenatal care, and demographic and social characteristics presented a statistically significant association for the education level variable "less than eight years of study" (PR =1.75; 95%CI 1.56-1.96; p < 0.001) and "participants of the cash transfer program" (PR = 1.21, 95%CI 1.07-1.36; p < 0.001). CONCLUSIONS: The individual factors were associated with prenatal care appointments and HIV and syphilis tests in Brazilian pregnant women. They show missed opportunities for diagnosing HIV and syphilis infection during prenatal care and indicate weaknesses in the quality of maternal health care services to eliminate mother-to-child transmission.


Assuntos
Infecções por HIV/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Sífilis Congênita/diagnóstico , Distribuição por Idade , Brasil/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Distribuição de Poisson , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Prevalência , Atenção Primária à Saúde/métodos , Qualidade da Assistência à Saúde , Análise de Regressão , Fatores Socioeconômicos , Sífilis Congênita/epidemiologia
4.
Pan Afr Med J ; 33: 66, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448028

RESUMO

Introduction: Unattended pregnancies are characterized by significant morbidity maternal and morbidity and mortality fetal. This study aims to determine the frequency of unattended pregnancies, to describe the socio-demographic profile and to assess the maternal and fetal outcomes during childbirth among women who did not attend antenatal care (ANC) in the city of Lubumbashi. Methods: It was an analytical cross-sectional study of maternal pregnancy from December 2013 to May 2014 in 10 maternity hospitals in Lubumbashi. Women who did not receive ANC were compared to women who had followed them (ANC≥4). Maternal socio-demographic parameters, maternal and perinatal morbidity and mortality were analyzed. Results: We found that the frequency of no pregnancy monitoring was 21.23% and the mean number of antenatal visits was 2.6 ± 1.9. An analysis of the relationship between ANC and socio-demographic characteristics of women who were delivered shows that the lack of follow-up was 2.29 times higher for adolescent girls than for adult women (OR=2.29 [1.54-3.41]), 4 times higher for women living alone than for women living in unions (OR=4.00 [2.05-7.79]) and 4.08 times higher for women with low levels of education (illiterate or primary) than among those with a high level of education (OR=4.08 [3.08-5.40]). Compared to those who followed them well, we did not find that women who did not attend ANC had a high risk of obstetric emergency (OR = 1.90 [1.26-2.95]), rupture of membranes fetal admission (OR=1.31 [1.02-1.68]), fetal mal presentation (OR=1.89 [1.03-3.44]), caesarean delivery (OR=1.78 [1.21-2.63]), eclampsia (OR=3.00 [1.09-8.70]), uterine rupture (OR=4.76 [1.00-47.19]) and anemia (OR=2.33 [1.06-5.13]). Rates of preterm birth (OR = 1.93 [1.33-2.80]), post-maturity (OR=1.47 [1.00-2.30]), low birth weight (OR=2.33 [1.56-3.46]), neonatal depression (OR=3.89 [2.52-6.02]), neonatal transfer (OR=1.60 [1.11-2.32]) and perinatal mortality (OR=2.70 [1.59-4.57]) were significantly higher in neonates from women with prenatal consultations than in those with well followed. Conclusion: Our study shows that the lack of follow-up of ANC is associated with high maternal morbidity and high perinatal morbidity and mortality in our environment.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Cesárea/estatística & dados numéricos , Estudos Transversais , República Democrática do Congo/epidemiologia , Escolaridade , Feminino , Maternidades , Humanos , Recém-Nascido , Mortalidade Perinatal , Gravidez , Adulto Jovem
5.
Rev Saude Publica ; 532019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432932

RESUMO

OBJECTIVE: To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state. METHODS: Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals. RESULTS: Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34-0.71), with high education level (OR = 0.42; 95%CI 0.31-0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41-0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42-0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18-0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66-0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed. CONCLUSIONS: Antepartum peregrination suffers interference from the mother's socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/provisão & distribução , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Equidade em Saúde , Humanos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Gravidez , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
6.
BMC Public Health ; 19(1): 1094, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409306

RESUMO

BACKGROUND: Attending antenatal care (ANC) early contribute to better birth outcomes. Studies have shown that many pregnant women in Sub-Saharan Africa do not initiate ANC early (i.e. in the first trimester). This study determined the gestational age of pregnancy at first ANC attendance. It also explored factors that influence initiation of ANC. METHODS: This cross-sectional study, conducted in Ghana, used mixed methods to collect data from women aged 15-45 years who delivered 6 months prior to the study. Crosstabs, chi-square test and logistic regression were used to analyse quantitative data. Also, 33 participants were engaged in focus group discussions (FGDs). Thematic content analysis was used to develop themes from the data. RESULTS: Of the 431 participants, 8.9, 8, 25.4, 45.3 and 10.7% started ANC in the first, second, third, fourth and fifth months of pregnancy respectively. Formal education, employment and number of living children were predictors of initiating ANC early; by 12 weeks of gestation. Women who attained primary, junior high, secondary education and above had 5.6, 57.5 and 163.2 higher odds respectively of initiating ANC in the first trimester compared to women with no education (p ≤ 0.05). Women with two, three and four to nine living children were 4.1, 3 and 3.5 times respectively more likely to access ANC early compared to primigravidae women. However, women with five or more children and primigravidae women are more likely to initiate ANC late; after 12 weeks gestation. The FGD data also show that most of the participants initiated ANC late. Two themes: visible signs of pregnancy and or sickness influence ANC attendance in the first trimester. The themes that explain late initiation of ANC are: healthy, do not value the benefits of early ANC attendance, desire to avoid embarrassment associated with the pregnancy, unplanned pregnancy, indirect cost of accessing ANC and traditional rites and practices. CONCLUSION: Contextual factors influence ANC initiation. Investment in female education, intensification of health promotion activities by health workers, non-governmental organisations, community and religious leaders to sensitise communities on the benefits of initiating ANC at the onset of pregnancy is needed to improve first trimester attendance.


Assuntos
Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , População Rural , Adolescente , Adulto , Estudos Transversais , Feminino , Grupos Focais , Idade Gestacional , Gana , Humanos , Pessoa de Meia-Idade , Gravidez , Primeiro Trimestre da Gravidez , População Rural/estatística & dados numéricos , Adulto Jovem
7.
Medicine (Baltimore) ; 98(33): e16822, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415400

RESUMO

Fetal cardiovascular malformations is widely focused and screened, but the accuracy of screening is not satisfactory. In this study, we compared the types of congenital heart malformation, accompanying diseases and fetal outcomes in the first and second trimesters of pregnancy to clarify the advantage of early screening.From January 2013 to June 2018, 230 fetuses were diagnosed with congenital heart malformations using ultrasound method in Qilu Hospital of Shandong University, and divided into 2 groups:the first trimester fetuses (group A) and the second trimester fetuses (group B). In addition, we collected and organized medical data of 347 cases diagnosed with congenital heart disease during 1998 to 2005 (group C). We compared the spectrum of congenital heart disease, associated comorbidities and outcome of fetuses diagnosed with congenital heart disease.There were differences in the types and incidence of cardiac malformations between the first and second trimesters of pregnancy. The number of cases of non-cardiac malformation, congenital heart disease with single ventricular circulation, fetal intrauterine death and premature pregnancy termination was significantly lower in the late stage (group A and group B) than that in the early stage (group C). More patients were screened for trisomy 21, 18, 13 syndromes and Turner syndrome in group A than group B (P <.001). More fetuses with a 22q11 deletion were screened in group B than group C.Early pregnancy screening using ultrasound diagnosis is very important for fetuses with congenital heart disease.


Assuntos
Feto/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Ultrassonografia Pré-Natal/estatística & dados numéricos , Aberrações Cromossômicas/estatística & dados numéricos , Feminino , Cardiopatias Congênitas/embriologia , Cardiopatias Congênitas/genética , Humanos , Incidência , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos
8.
BJOG ; 126 Suppl 4: 14-20, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257693

RESUMO

OBJECTIVE: To analyse the aetiology of stillbirth and its changing trends in a single tertiary care referral institute of northern India over a 10-year period (2007-2016). DESIGN: Retrospective study. SETTING: Tertiary care hospital in the north of India. SAMPLE: Medical records of all mothers who delivered a stillborn at the institute. METHODS: Data was collected from monthly and annual perinatal audits and causes of stillbirths were classified using Simplified CODAC classification. Annual reduction rate was calculated by linear regression analysis and Cusick test for the changing trends over 9 years. MAIN OUTCOME MEASURES: Of 54 160 births, 3678 babies were stillborn. Over 9 years, the annual stillbirth rate has reduced significantly from 73.6 to 62.0 per 1000 total births with an average annual reduction rate of 1%. The most common causes of stillbirths were hypertensive disorders of pregnancy (27.6%), antepartum haemorrhage (19.5%), and congenital anomalies (9.3%). CONCLUSION: The annual reduction rate (1%) of stillbirth remains low. The aetiology of stillbirths remains unchanged over a 10-year period and hypertensive disorder of pregnancy remains the single most preventable cause of stillbirth. TWEETABLE ABSTRACT: Analysis of stillbirths over a 10-year period in an Indian institute showed a high but declining trend with annual reduction rate of 1%.


Assuntos
Causas de Morte , Natimorto/epidemiologia , Adulto , Feminino , Doenças Fetais/epidemiologia , Idade Gestacional , Humanos , Índia/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
9.
BMC Public Health ; 19(1): 896, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286907

RESUMO

BACKGROUND: Early initiation of breastfeeding (EIBF) reduces the risk of neonatal mortality. Previous studies from India have documented some factors associated with EIBF. However, those studies used data with limited sample size that potentially affect the application of the evidence. Additionally, the effectiveness of national breastfeeding programmes requires up-to-date analysis of new and robust EIBF data. The present study aimed to investigate the prevalence and determinants of EIBF in India and determine to what extent these factors differ by a mother's residence in the rural or urban area. METHODS: This study used information from a total weighted sample of 94,401 mothers from the 2015-2016 India National Family Health Survey. Multivariate logistic regression was used to investigate the association between the study factors and EIBF in India and rural-urban populations, after adjusting for confounders and sampling weight. RESULTS: Our analysis indicated that 41.5% (95% confidence interval (CI): 40.9-42.5, P < 0.001) of Indian mothers initiated breastfeeding within 1-h post-birth, with similar but significant different proportions estimated for those who resided in rural (41.0, 95% CI: 40.3-41.6, P < 0.001) and urban (42.9, 95% CI: 41.7-44.2, P < 0.001) areas. Mothers who had frequent health service contacts and those with higher educational attainment reported higher EIBF practice. Multivariate analyses revealed that higher educational achievement, frequent antenatal care visits and birthing in a health facility were associated with EIBF in India and rural populations (only health facility birthing for urban mothers). Similarly, residing in the North-Eastern, Southern, Eastern and Western regions were also associated with EIBF. Birthing through caesarean, receiving delivery assistance from non-health professionals and residing in rural areas of the Central region were associated with delayed EIBF in all populations. CONCLUSION: We estimated that more than half of Indian mothers delayed breastfeeding initiation, with different rural-urban prevalence. Key modifiable factors (higher maternal education and frequent health service contacts) were associated with EIBF in India, with notable difference in rural-urban populations. Our study suggests that targeted and well-coordinated infant feeding policies and interventions will improve EIBF for all Indian mothers.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Mães/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores de Tempo , População Urbana/estatística & dados numéricos , Adulto , Escolaridade , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Modelos Logísticos , Análise Multivariada , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Fatores Socioeconômicos
10.
BMC Public Health ; 19(1): 924, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291919

RESUMO

BACKGROUND: In Eritrea, facility delivery rates show great discrepancy within urban centers. This study was conducted in Akordet, a multi-cultural lowland town of Gash-Barka Region, aiming at assessing the factors influencing facility delivery. METHODS: A community based analytical cross-sectional study was conducted among a total of 282 mothers who gave birth within the 2 years preceding the data collection time. Data collection was carried out by going house-to-house and interviewing the mothers using a structured closed ended questionnaire. Bivariate and multivariate logistic regressions were used to determine the magnitude of the relationship between place of delivery and the explanatory variables (Religion, Ethnicity, Mother's educational level, Husband's Educational level, Place of delivery preceding last pregnancy, Birth order of last child, Any complications during previous delivery, First ANC Visit during last pregnancy, Number of ANC visits during last pregnancy and Any complication during last pregnancy.). For this study, p-value ≤0.05 was considered as statistically significant. RESULTS: The rate of facility delivery in this setting was found to be 82.3%. Almost all (96.1%) the mothers had at least one ANC visit during their last pregnancy, with the majority (59.7%) visiting ANC clinics during second trimester for the first time. Mothers whose educational level is junior and above (AOR 8.8, CI: 1.18-65.64), whose husband's educational level is junior and above (AOR 3.92, CI: 1.03-14.54), who gave birth in health facility before the last pregnancy (AOR 8.16, CI: 3.41-19.48), and those who had complications during last pregnancy (AOR 2.24, CI: 1.04-4.82) were more likely to deliver in a health facility. Mothers whose last child's birth order was 4th -6th were less likely (AOR 0.24, CI: 0.090.62) to deliver at health facility. CONCLUSIONS: Early initiation of ANC and regularity in attendance should be emphasized. Health educations given to pregnant mothers should try to persuade the mothers that each pregnancy and ensuing delivery is unique. Empowering the community in general and women in particular by increasing the level of participation in education might payoff in high level of facility delivery.


Assuntos
Comportamento de Escolha , Parto Obstétrico/estatística & dados numéricos , Mães/psicologia , Adolescente , Adulto , Estudos Transversais , Eritreia , Feminino , Humanos , Mães/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
11.
Pan Afr Med J ; 33: 21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312337

RESUMO

Introduction: globally, intrapartum stillbirth accounts for 1 million deaths of babies annually, representing approximately one-third of global stillbirth toll. Intrapartum stillbirth occurs due to causes ranging from maternal medical and obstetric conditions; access to quality obstetric care services during pregnancy; and types, timing and quality of intrapartum care. Different medical conditions including hypertensive & metabolic disorders, infections and nutritional deficiencies during pregnancy are among risk factors of stillbirth. Ethiopia remains one of the 10 high-burden stillbirth countries with estimated rate of more than 25 per 1000 births. Methods: a case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 23 public health facilities of Addis Ababa during the period July 1, 2010 - June 30, 2015 was conducted. Data was collected from charts of all cases of intrapartum stillbirth meeting the inclusion criteria and randomly selected charts of controls in two to one (2:1) control to case ratio. Results: chronic medical conditions including diabetes, cardiac and renal diseases were less prevalent (1%) among the study population whereas only 6% of women experienced hypertensive disorder during the pregnancy in review. Moreover, 6.5% of the study population had HIV infection where being HIV negative was protective against intrapartum stillbirth (aOR 0.37, 95% CI 0.18-0.78). Women with non-cephalic foetal presentation during last ANC visit were three times more at risk of experiencing intrapartum stillbirth whereas singleton pregnancy had strong protective association against intrapartum stillbirth (p<0.05). Conclusion: untreated chronic medical conditions, infection, poor monitoring of foetal conditions and multiple pregnancy are among important risk factors for intrapartum stillbirth.


Assuntos
Infecções por HIV/epidemiologia , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Natimorto/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal/normas , Fatores de Proteção , Fatores de Risco , Adulto Jovem
12.
Rev Lat Am Enfermagem ; 27: e3058, 2019 Jul 18.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31340338

RESUMO

OBJECTIVE: to evaluate the process and outcome indicators of the prenatal care developed in primary care, comparing traditional care models and the Family Health Strategy. METHOD: this is a cohort study, conducted with an intentional sample of 273 mothers/babies from the neonatal period and followed up for one year. Donabedian evaluation was adopted and data were discussed based on the Social Determination of Health. The independent variable was the care model. The dependent variables in the process evaluation were related to the quality of prenatal care and to the quality score created and the evaluation of the outcome, to the conditions of birth and the first year of life. The evaluation of the process was performed by estimating the relative risk and the evaluation of the outcome was performed by the Cox Multiple Regression Model. RESULTS: lower income and risk of the low prenatal quality score were identified in the Family Health Units, where there were more puerperium consultation and health education actions. There was no difference in outcome indicators. CONCLUSION: possibly the best quality of prenatal care was able to minimize negative socioeconomic effects found in family health, so the outcome indicators were similar in both models of the primary care.


Assuntos
Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Brasil , Saúde da Criança , Saúde da Família , Feminino , Humanos , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Fatores Socioeconômicos , Saúde da Mulher , Adulto Jovem
13.
Malar J ; 18(1): 229, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288835

RESUMO

BACKGROUND: Intermittent preventive treatment during pregnancy (IPTp) is a highly-recommended intervention to prevent maternal and neonatal complications associated with malaria infection. Despite fairly high antenatal care (ANC) coverage in Tanzania, low IPTp uptake rates represent a gap in efforts to decrease complications attributed to malaria in pregnancy. The objective of this study was to examine if availability, readiness and managing authority are associated with uptake of IPTp during ANC. METHODS: Data for this analysis come from a cross-sectional survey, the Tanzania Service Provision Assessment conducted between 2014 and 2015. Principal component analysis was used to create scores for availability of malaria services and readiness for the provision of services. Generalized estimating equation models with logit link and the binomial distribution assessed factors that impact the uptake of IPTp by pregnant women attending ANC. RESULTS: Higher fraction of women in their third trimester than second (68% versus 49%, OR = 2.6; 95% CI (2.1-3.3)), had received at least one dose of IPTp. There was a wide variation in the availability and readiness of malaria services provision and diagnostic tools by managing authorities. Public facilities were more likely than private to offer malaria rapid diagnostic test, and more providers at public facilities than private diagnosed and/or treated malaria. Women who attended facilities where direct observation therapy was practiced were more likely to have received at least one dose of IPTp (64% versus 46% who received none; p < 0.001). Women who attended ANC at a facility with a high readiness score were more likely to take IPTp than those attending facilities with low readiness scores (OR = 2.1; 95% CI (1.4-3.3)). Reported stock out on the day of interview was negatively associated with IPTp uptake (OR 0.09; 95% CI 0.07-0.1). CONCLUSION: Readiness of health facilities to provide malaria related services, the number of ANC visits and gestational age were associated with uptake of IPTp among women attending ANC. There are disparities in malaria service availability and readiness across geographical location and managing authorities. These findings could be used to assist the malaria programme and policymakers to appropriately decide when planning for malaria service deliveries and interventions.


Assuntos
Antimaláricos/uso terapêutico , Assistência à Saúde/estatística & dados numéricos , Malária/prevenção & controle , Complicações Parasitárias na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Malária/parasitologia , Pessoa de Meia-Idade , Gravidez , Complicações Parasitárias na Gravidez/parasitologia , Tanzânia , Adulto Jovem
14.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 1032-1048, jul.-set. 2019. tab, graf
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005788

RESUMO

Objetivo: Analisar as internações por condições sensíveis à atenção primária, relacionadas às doenças do pré-natal e do parto no país após a implementação da Rede Cegonha. Metodologia: Estudo descritivo, retrospectivo, realizado a partir da consulta de dados secundários disponibilizados por meio do Departamento de Informática do Sistema Único de Saúde (SUS), durante os anos de 2011 a 2013. Resultados: No período estudado houve um acréscimo de 5.606 casos de internações por condições sensíveis à atenção primária relacionadas às doenças do pré-natal e parto a nível nacional, sendo que a região de maior destaque foi a sudeste com 44.384 hospitalizações. Esta pesquisa apresentou um índice crescente de internações por condições sensíveis à atenção primária por doenças relacionadas ao pré-natal e parto mesmo com a regulamentação da Rede Cegonha. Considerações finais: O aumento das internações demonstra os desafios a serem enfrentados pela atenção primária, visando à redução de adversidades consideradas evitáveis


Objective: To analyze hospitalizations for conditions sensitive to primary care, related to prenatal and childbirth diseases in the country after implementation of the Stork Network. Methodology: a descriptive, retrospective study, carried out based on the consultation of secondary data made available through the Department of Informatics of the Unified Health System, during the years 2011 to 2013. Results: During the study period there were an increase of 5,606 cases of hospitalizations due to conditions sensitive to primary care related to prenatal and childbirth diseases at the national level, and the most prominent region was the Southeast with 44,384 hospitalizations. This research presented an increasing index of hospitalizations for conditions sensitive to primary care due to prenatal and delivery related illnesses even with the regulation of the Stork Network. Final considerations: The increase in hospitalizations demonstrates the challenges to be faced by primary care, aiming to reduce adversities considered avoidable


Objetivo: Analizar las internaciones por condiciones sensibles a la atención primaria, relacionadas a las enfermedades del prenatal y parto en el país después de la implementación de la Red Cigüeña. Metodología: estudio descriptivo, retrospectivo, realizado a partir de la consulta de datos secundarios disponibles a través del Departamento de Informática del Sistema Único de Salud, durante los años de 2011 a 2013. Resultados: En el período estudiado hubo un aumento de 5.606 casos de internaciones por condiciones sensibles a la atención primaria relacionada con las enfermedades del prenatal y parto a nivel nacional, siendo que la región de mayor destaque fue al sureste con 44.384 hospitalizaciones. Esta investigación presentó um índice creciente de internaciones por condiciones sensibles a la atención primaria por enfermedades relacionadas al prenatal y parto incluso con la reglamentación de la Red Cigüeña. Consideraiones finales: El aumento de las internaciones demuestra los desafíos a ser enfrentados por la atención primaria, visando la reducción de adversidades consideradas evitables


Assuntos
Humanos , Feminino , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Avaliação em Saúde/estatística & dados numéricos , Serviços de Saúde da Mulher , Complicações do Trabalho de Parto/epidemiologia
15.
BMC Public Health ; 19(1): 838, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248393

RESUMO

BACKGROUND: Improving maternal and child health (MCH) remains a serious challenge for many developing countries. Geographical accessibility from a residence to the nearest health facility is suspected to be an important obstacle hampering the use of appropriate services for MCH especially in Sub-Sharan African countries. In Burkina Faso, a landlocked country in the Sahel region of West Africa, women's use of proper healthcare services during pregnancy and childbirth is still low. This study therefore assessed the impact of geographical access to health facilities on maternal healthcare utilization in Burkina Faso. METHODS: We used the Burkina Faso demographic and health survey (DHS) 2010 dataset, with its sample of 10,364 mothers aged 15-49 years. Distance from residential areas to the closest health facility was measured by merging the DHS dataset with Geographic Information System data on the location of health centers in Burkina Faso. Multivariate logistic regressions were conducted to estimate the effects of distance on maternal healthcare utilization. RESULTS: Regression results revealed that the longer the distance to the closest health center, the less likely it is that a woman will receive appropriate maternal healthcare services. The estimates show that one kilometer increase in distance to the closest health center reduces the odds that a woman will receive four or more antenatal care by 0.05 and reduces by 0.267 the odds that she will deliver her baby with the assistance of a skilled birth attendant. CONCLUSIONS: Improving geographical access to health facilities increases the use of appropriate healthcare services during pregnancy and childbirth. Investment in transport infrastructure should be a prioritized target for further improvement in MCH in Burkina Faso.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Burkina Faso , Parto Obstétrico/estatística & dados numéricos , Feminino , Geografia , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Adulto Jovem
16.
Glob Health Action ; 12(1): 1556573, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154990

RESUMO

Background: Health insurance (HI) has been introduced to achieve universal health coverage. In Viet Nam, mandatory HI for the poor and the minorities has been strengthened since 2012. Objective: The study explored affordability and healthcare-seeking behaviour for delivery and antenatal care (ANC) among the poor and ethnic minority women after HI-reform in rural Northwestern Viet Nam. Methods: A cross-sectional study was conducted in 2014 in Luong Son District, where the ethnic Muong live. Stratified simple random sampling was used to select 315 participants who had delivered a baby in the previous year. Results: The HI coverage was 72.7% (229/315) and 30.9% of the mothers were living on less than USD 1.25 per household person per day. HI enrolment was predicted by ethnic minority status (Muong, aOR 18.3, 95% CI 6.4-52.6), rather than the household income. More than 80% of majority and minority respondents selected the institution by their trust in the quality of its care. The institutional delivery was 100%, irrespective of HI status. The out-of-pocket expenses for normal delivery were significantly smaller for the insured than the uninsured (p < 0.001). The total cost of normal delivery proved to be a catastrophic payment (households spending > 5% of annual household income) for 17.6% and 31.7% of the insured and uninsured, respectively. The average number of ANC visits was more than four times for all quartiles, irrespective of the mothers' HI status; however, all quartiles demonstrated more frequent visits to private clinics than commune health centres (public facility). Conclusions: The results indicated that Vietnamese HI reform reduced the economic burden for both the poor and ethnic minorities in rural villages. However, further HI reforms should consider ways to reduce the catastrophic payments, fix the role of private facilities for appropriate resource mobilisation, and enhance the move towards universal health coverage.


Assuntos
Parto Obstétrico/economia , Parto Obstétrico/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Gestantes , População Rural/estatística & dados numéricos , Vietnã
17.
J Glob Health ; 9(1): 010415, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31217959

RESUMO

Background: The global development community has increasingly come to frame preventable maternal mortality and morbidity principally as a violation of women's basic human rights, necessitating a human rights-based approach to be appropriately addressed. In this article, we explore how human rights are understood and perceived in relation to maternal health at the local level in rural Bangladesh. This is essential given the momentum at the global level to promote rights and apply rights-based approaches to maternal health. Methods: A community-based, cross-sectional household survey was conducted in three upazilas (sub-districts) of Brahmanbaria district, Bangladesh in 2018. A total of 1367 women with a birth outcome in the past 12 months were interviewed. Descriptive statistics were used to report the awareness and perceptions of human rights related to maternal health. Multiple logistic regression was used to identify the associations between awareness and perceptions of human rights and background characteristics and, finally, with the use of skilled maternal health services. Results: Over two-thirds of women reported that they were aware that women have human rights related to maternal health. However, less than 10% were able to mention at least three specific human rights related to maternal health. Half of the women mentioned husbands as duty-bearers, while only 20% mentioned the government as a duty-bearer. One-third of women reported that they are able to realize their rights related to maternal health satisfactorily. Awareness and perceptions of human rights related to maternal health were significantly associated with higher educational attainment and wealth status. They were also associated with increased use of antenatal care. Conclusions: These findings suggest that interventions promoting the awareness of human rights related to maternal health would be appropriate within the communities of rural Bangladesh as part of a broader human rights-based approach to improving maternal health.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Direitos Humanos , Saúde Materna , População Rural , Mulheres/psicologia , Adolescente , Adulto , Bangladesh , Estudos Transversais , Feminino , Humanos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
18.
BMC Public Health ; 19(1): 583, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096959

RESUMO

BACKGROUND: With Bangladesh's adoption of the third Sustainable Development Goal to reduce maternal mortality, the impetus for Bangladesh to continue to improve uptake of maternal healthcare is strong. METHODS: Using a propensity-score matched analysis, the present study utilized data from the 2014 Bangladesh Demographic Health survey to examine the impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery. RESULTS: The results revealed a significant and positive impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery after matching treated and untreated mothers on included socio-demographic characteristics. CONCLUSIONS: Implementation of policies to provide at least four antenatal care visits may serve as an effective strategy to increase SBA use and institutional delivery in Bangladesh, which could contribute to the reduction of maternal mortality.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Bangladesh , Parto Obstétrico/métodos , Feminino , Inquéritos Epidemiológicos , Humanos , Mortalidade Materna , Gravidez , Pontuação de Propensão
19.
BMC Public Health ; 19(Suppl 1): 606, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31138228

RESUMO

BACKGROUND: Partner notification is an essential component of sexually transmitted infection (STI) management. The process involves identifying exposed sex partner(s), notifying these partner(s) about their exposure to a curable STI, and offering counselling and treatment for the STI as a part of syndromic management or after results from an STI test. When implemented effectively, partner notification services can prevent the index patient from being reinfected with a curable STI from an untreated partner, reduce the community burden of curable STIs, and prevent adverse health outcomes in both the index patient and his or her sex partner(s). However, partner notification and treatment rates are often low. This study seeks to explore experiences and preferences related to partner notification and treatment for curable STIs among pregnant women receiving care in an antenatal clinic with integrated HIV and curable STI testing. Results are intended to inform efforts to improve partner notification and treatment rates in Southern Africa. METHODS: We conducted qualitative interviews among women diagnosed with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and/or Trichomonas vaginalis (TV) infection while seeking antenatal care in Gaborone, Botswana. Semi-structured interviews were used to obtain women's knowledge about STIs and their experiences and preferences regarding partner notification. RESULTS: Fifteen women agreed to participate in the study. The majority of women had never heard of CT, NG, or TV infections prior to testing. Thirteen out of 15 participants had notified partners about the STI diagnosis. The majority of notified partners received some treatment; however, partner treatment was often delayed. Most women expressed a preference for accompanying partners to the clinic for treatment. Experiences and preferences did not differ by HIV infection status. CONCLUSIONS: The integration of STI, HIV, and antenatal care services may have contributed to most women's willingness to notify partners. However, logistical barriers to partner treatment remained. More research is needed to identify effective and appropriate strategies for scaling-up partner notification services in order to improve rates of partners successfully contacted and treated, reduce rates of STI reinfection during pregnancy, and ultimately reduce adverse maternal and infant outcomes attributable to antenatal STIs.


Assuntos
Busca de Comunicante/estatística & dados numéricos , Complicações Infecciosas na Gravidez/psicologia , Autorrevelação , Parceiros Sexuais/psicologia , Adulto , África Austral/epidemiologia , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Botsuana/epidemiologia , Chlamydia trachomatis , Busca de Comunicante/métodos , Feminino , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Neisseria gonorrhoeae , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Pesquisa Qualitativa , Doenças Sexualmente Transmissíveis/microbiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Trichomonas vaginalis
20.
BMC Public Health ; 19(Suppl 1): 602, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31138289

RESUMO

BACKGROUND: Despite recent progress, there exist gaps in the prevention of vertical HIV transmission program access and uptake in Cameroon. Female sex workers (FSW), many of whom are mothers, are disproportionately affected by HIV and have specific barriers to HIV testing and treatment access. Testing for HIV-exposed infants is crucial in monitoring for incident infection and timely intervention. This study explores the level of early childhood testing and also associations between antenatal care (ANC) attendance and other factors and early childhood HIV testing among FSW in Cameroon. METHODS: FSW were recruited to participate in an integrated biobehavioral survey in Cameroon between December 2015 and October 2016. Women were included in these analyses if they were living with HIV and had at least one living child. Both univariate and multivariable logistic regression were used to look at predictors of a child being tested for HIV before age five. RESULTS: A total of 481/2255 FSW were eligible for these analyses as they were HIV seropositive and had at least one living child at the time of the study. Women included in these analyses had a median age of 35(IQR 30-41). Nearly 70% reported none of their children had been tested for HIV before age five (326/481), and 3.5%(17/481) reported one or more of their children had been diagnosed with HIV. ANC attendance (adjusted OR 2.12, 95% CI: [1.02, 4.55]), awareness of HIV status (aOR 3.70[2.30, 5.93]), pregnancy intentions (aOR 1.89[1.16, 3.08]), and higher education (aOR 2.17[1.01, 4.71]) were all independently associated with increased odds of women having a greater proportion of children tested for HIV before age five. Regional differences in early childhood testing were also observed. CONCLUSION: Vertical transmission of HIV remains a challenge in Cameroon, and HIV testing among children of FSW living with HIV was very low. ANC attendance and promotion of the mother's health were associated with increased child HIV testing. For women at high risk of HIV and for whom engagement in the health system is low, strategies to promote and ensure ANC attendance are essential for their health and the health of their children.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Filho de Pais Incapacitados/estatística & dados numéricos , Infecções por HIV/diagnóstico , Profissionais do Sexo/estatística & dados numéricos , Adulto , Camarões , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , HIV , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Modelos Logísticos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos
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