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1.
Pan Afr Med J ; 33: 213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692660

RESUMO

Introduction: HIV self-testing could add a new approach to scaling up HIV testing with potential of being high impact, low cost, confidential, and empowering for users. Methods: Pregnant women attending antenatal clinics (ANC) and their male partners were recruited in 14 clinics in the eastern and central regions of Kenya and randomly allocated to intervention or control arms at a ratio of 1:1:1. Arm 1 received the standard of care, which involved invitation of the male partner to the clinic through word of mouth, arm 2 received an improved invitation letter, and arm 3 received the same improved letter and, two self-testing kits. Analysis was done using adjusted odds ratios (aOR) at 95% confidence intervals (CI) to calculate and determine effects of HIV self-testing in increasing uptake of male partner testing. Results: A total of 1410 women and 1033 men were recruited; 86% (1217) women and 79% (1107) couples were followed up. In arm 3, over 80% (327) of male partners took HIV test, compared to only 37% (133) in arm 2 and 28% (106) in arm one. There was a statistical significance between arm one and two (p-value=0.01) while arm three was statistically significant compared to arm two (p-value<0.001). Men in arm three were twelve times more likely to test compared to arm one (aOR 12.45 (95% CI 7.35, 21.08)). Conclusion: Giving ANC mothers test kits and improved male invitation letter increased the likelihood of male partner testing by twelve times. These results demonstrate that HIV self-test kits could complement routine HIV testing methods in the general population.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Cuidado Pré-Natal/métodos , Parceiros Sexuais , Adolescente , Adulto , Testes Diagnósticos de Rotina , Feminino , Humanos , Quênia , Masculino , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Adulto Jovem
2.
Pan Afr Med J ; 33: 305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31723372

RESUMO

Introduction: Every 90 seconds, a woman dies of complications related to pregnancy and childbirth, resulting in more than 340,000 maternal deaths a year. Antenatal care (ANC) and postnatal care (PNC) are significant determinants of maternal health and, particularly, safe motherhood. Antenatal care is an important predictor of safe delivery and provides health information and services that can improve the health of women and infants. mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. This study aimed at assessing the acceptable implementation modalities of mHealth intervention on pregnant Women in Dschang health district, West Region of Cameroon.ng ba. Methods: This was a cross sectional descriptive study in the Dschang health district, West region of Cameroon. Key informants were all pregnant women from 18 years and above and a total of 372 pregnant women were included. This study was carried out from March to July 2017. Results: Majority of the women, that is, 252(67.74%) were married, 117(31.45%) declaredtheir status as being single, while 3(0.81%) were devorced. Out of the 335 women that declared wanting an mHealth intervention, 41.79% of this number preferred SMS texts in the afternoon, 111(33.13%) in the evening, 46(13.73%) anytime and 38(11.34%) in the morning hours. A total of 83.33% women confirmed using telephone services. Conclusion: This study reveals that cell phones would be the acceptable medium of providing pregnancy and postpartum support to women in the Dschang health district. This is justified by the fact that a vast majority of women interviewed had access to a cell phone and referred to it as their desired and accepted means of communication.


Assuntos
Cuidado Pós-Natal/métodos , Cuidado Pré-Natal/métodos , Telemedicina/métodos , Adolescente , Adulto , Camarões , Telefone Celular , Estudos Transversais , Feminino , Humanos , Gravidez , Mensagem de Texto , Adulto Jovem
3.
Pan Afr Med J ; 33: 310, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31723373

RESUMO

Introduction: Hepatitis B virus (HBV) infection is a major health problem worldwide owing to its high prevalence and significant morbidity and mortality. There are about 2 billion people living with HBV worldwide and over 360 million chronic carriers. The purpose of this study was to assess the knowledge and practices of pregnant women and health care workers in the ANC and maternity units on HBV infection and its transmission. Methods: About 270 women attending ANC and 31 health care workers were selected by convenience sampling. They were evaluated using a structured questionnaire to assess their knowledge and practices on HBV prevention and transmission. Results: Pregnant women in the Limbe Health District demonstrated good knowledge but adopted poor practices whereas in the Muyuka Health District, pregnant women demonstrated poor knowledge and adopted poor practices regarding the mode of transmission and prevention of HBV infection. Health care workers in both the Limbe and Muyuka Health Districts however, demonstrated good knowledge and adopted good practices. Conclusion: There was a significant relationship between the knowledge and practice of pregnant women and health care workers on Hepatitis B prevention in the Muyuka Health District (P = 0.0006).


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Hepatite B/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Adolescente , Adulto , Camarões , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos , Inquéritos e Questionários , Adulto Jovem
4.
Medicine (Baltimore) ; 98(41): e17521, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593123

RESUMO

BACKGROUND: Previous studies have neglected to report the specific action of different probiotic genera in preterm infants. To evaluate the efficacy and safety of specific probiotic genera, we performed a network meta-analysis (NMA) to identify the best prevention strategy for necrotizing enterocolitis in preterm infants. METHODS: MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials had been searched for randomized control trials reporting the probiotics strategy for premature infants. RESULTS: We identified 34 eligible studies of 9161 participants. The intervention in the observation group was to add probiotics for feeding: Lactobacilli in 6 studies; Bifidobacterium in 8 studies; Bacillus in 1 study; Saccharomyces in 4 studies and probiotic mixture in 15 studies. This NMA showed a significant advantage of probiotic mixture and Bifidobacterium to prevent the incidence of necrotizing enterocolitis in preterm infants. A probiotic mixture showed effectiveness in reducing mortality in preterm infants. CONCLUSION: The recent literature has reported a total of 5 probiotic strategies, including Bacillus, Bifidobacterium, Lactobacillus, Saccharomyces, and probiotic mixture. Our thorough review and NMA provided a piece of available evidence to choose optimal probiotics prophylactic strategy for premature infants. The results indicated that probiotic mixture and Bifidobacterium showed a stronger advantage to use in preterm infants; the other probiotic genera failed to show an obvious effect to reduce the incidence of NEC, sepsis and all-cause death. More trials need to be performed to determine the optimal probiotic treatment strategy to prevent preterm related complications.


Assuntos
Enterocolite Necrosante/tratamento farmacológico , Enterocolite Necrosante/prevenção & controle , Doenças do Recém-Nascido/prevenção & controle , Probióticos/uso terapêutico , Bifidobacterium/fisiologia , Enterocolite Necrosante/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Prematuro , Lactobacillus/fisiologia , Placebos/administração & dosagem , Cuidado Pré-Natal/métodos , Probióticos/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Sepse/epidemiologia , Sepse/mortalidade , Resultado do Tratamento
5.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593290

RESUMO

Due to a low level of understanding of mechanisms involved in spontaneous preterm delivery there is a lack of reliable biomarkers. Existing biomarkers have a low positive predictive value but a high negative predictive value. Use of tests with high negative predictive value will reduce unnecessary interventions and hospitalization of women with threatening preterm delivery. When given to the right pregnant women, antenatal corticosteroid treatment are still the most important obstetrical intervention and reduces both neonatal mortality and short- and long-term morbidity.Several ongoing national Swedish multicenter studies may increase the understanding of the roles of cervical length, preeclampsia screening and magnesium sulfate dosage in the context of preterm delivery in a Nordic setting. Major development has been achieved in prediction and prevention of preterm preeclampsia at the cost of a 10% screen positive rate.


Assuntos
Nascimento Prematuro , Corticosteroides/administração & dosagem , Biomarcadores/análise , Cerclagem Cervical , Medida do Comprimento Cervical , Colo do Útero/anatomia & histologia , Feminino , Fibronectinas/análise , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Sulfato de Magnésio/administração & dosagem , Pessários , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/prevenção & controle , Nascimento Prematuro/terapia , Cuidado Pré-Natal/métodos , Progesterona/administração & dosagem , Suécia , Tocolíticos/administração & dosagem
6.
Rev Saude Publica ; 53: 85, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31576945

RESUMO

Group prenatal care is an alternative model of care during pregnancy, replacing standard individual prenatal care. The model has shown maternal benefits and has been implemented in different contexts. We conducted a narrative review of the literature in relation to its effectiveness, using databases such as PubMed, EBSCO, Science Direct, Wiley Online and Springer for the period 2002 to 2018. In addition, we discussed the challenges and solutions of its implementation based on our experience in Mexico. Group prenatal care may improve prenatal knowledge and use of family planning services in the postpartum period. The model has been implemented in more than 22 countries and there are challenges to its implementation related to both supply and demand. Supply-side challenges include staff, material resources and organizational issues; demand-side challenges include recruitment and retention of participants, adaptation of material, and perceived privacy. We highlight specific solutions that can be applied in diverse health systems.


Assuntos
Estrutura de Grupo , Cuidado Pré-Natal/métodos , Feminino , Humanos , México , Modelos Organizacionais , Gravidez , Cuidado Pré-Natal/normas , Reprodutibilidade dos Testes
7.
Pan Afr Med J ; 33: 137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558935

RESUMO

Introduction: Malaria is a life threatening disease caused by the Plasmodium parasite, transmitted through the bites of infected female anopheles' mosquitoes. According to the latest WHO data published in 2017, malaria deaths in Cameroon reached 9.161 deaths accounting for 4.14% of total deaths. The age adjusted death rate is 29.11 per 100,000 and Cameroon is ranked the 30th in the world with a high prevalence of malaria. The aim of this study was therefore, to access the knowledge of the modes of transmission and prevention of malaria among pregnant women attending Antenatal Clinic (ANC) at the Nkwen Health Center, Bamenda. Methods: This was a cross-sectional hospital based survey study. The researchers recruited 51 eligible women in the Nkwen Health Centre and used a validated and pre-tested questionnaires to collect data. Collected data were entered into Excel and analysed using descriptive statistics and the results presented in tables and figures. Results: Sixty four percent of the women have basic knowledge about the mode of malaria transmission. Thirty six percent of the women had little knowledge about malaria transmission modes and the possible dangers of the disease. Conclusion: Slightly above 50% of pregnant women have basic knowledge on the modes of malaria transmission. Lack of knowledge regarding the modes of malaria transmission can be one of the reasons why there is still quite a high level of malaria prevalence among pregnant women attending ANC at the Nkwen Health Center, Bamenda. There is therefore, a need to educate women on malaria transmission modes.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Malária/prevenção & controle , Complicações Parasitárias na Gravidez/prevenção & controle , Cuidado Pré-Natal/métodos , Adolescente , Adulto , Camarões , Estudos Transversais , Feminino , Humanos , Malária/epidemiologia , Malária/transmissão , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Prevalência , Inquéritos e Questionários , Adulto Jovem
8.
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
9.
Matern Child Health J ; 23(12): 1604-1612, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541375

RESUMO

INTRODUCTION: Nearly half of all women gain above gestational weight gain (GWG) recommendations. This study assessed the feasibility and efficacy of a pilot behavioral intervention on GWG and physical activity behaviors. METHODS: Women (n = 45) 14-20 weeks gestation enrolled in a behavioral intervention. Physicians 'prescribed' the intervention to low risk patients. The intervention included self-monitoring, support, and optional walking groups. Process evaluation measures regarding usage and acceptability of study components were obtained. Physical activity was objectively measured at baseline and 35 weeks. The percentage of participants with appropriate GWG was calculated. Control data was obtained from the same clinic where participants were recruited. RESULTS: Overall, the intervention was acceptable to participants; attrition was low (6.7%), weekly contact was high (87%), and self-monitoring was high (Fitbit worn on 82% of intervention weeks; weekly weighing on 81%). Facebook (40% of weeks) and study website use (19%) was low, as was walking group attendance (7% attended a single group). Participants reported a lack of discussions about the study with their physician. Results showed no significant difference between intervention and control participants in the percentage who gained excess weight (p = 0.37). There was a significant decrease in moderate-to-vigorous physical activity in intervention participants (p < 0.0001). DISCUSSION: Continued efforts for promoting physical activity and appropriate GWG are needed. Although acceptable, the intervention was not efficacious. Trainings for, or input from prenatal healthcare providers on how to best encourage and support patients' engagement in healthy behaviors, such as PA, are warranted.


Assuntos
Terapia Comportamental/métodos , Exercício , Ganho de Peso na Gestação , Comportamentos Relacionados com a Saúde , Obesidade/prevenção & controle , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Viabilidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Obesidade/terapia , Projetos Piloto , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Saúde Pública , Fatores de Risco , Ganho de Peso , Adulto Jovem
10.
Pan Afr Med J ; 33: 101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489079

RESUMO

Introduction: Despite the effectiveness of intermittent preventive treatment in pregnancy using sulphadoxine-pyrimethamine (IPTp-SP), the uptake and coverage in southwest Nigeria are low. We assessed the factors influencing utilisation of IPTp-SP. Methods: A multistage sampling technique was used to select 400 pregnant women from six primary healthcare centers in Oyo State. Data on socio-demographic characteristics, knowledge, attitude towards IPTp-SP and its utilisation were obtained using a semi-structured questionnaire. Data were analyzed using SPSS software. Focus group discussions (FGD) and key informant interviews (KII) were held for pregnant women and healthcare workers and analysed thematically. Results: Mean age of respondents was 27.2 (SD ± 5.5) years. Mean gestational age was 29.5 weeks (SD ± 5.4). Overall, 320 (80.0%) took SP, of which 152 (47.5%) took 2 doses and 112 (35.0%) took under directly observed therapy (DOT). We found that early booking for ANC, more than two visits to ANC (adjusted odds ratio (aOR) = 5.6; 95% CI: 1.2 - 26.6), good knowledge on IPTp (aOR = 9.3; 95% CI: 5.4 - 16.0), positive attitude towards IPTp (aOR = 2.1; 95% CI: 1.5 - 2.9) and being employed (aOR = 1.4; 95% CI: 1.1 - 1.7) were factors associated with IPTp-SP utilisation. The FGD and KII revealed that IPTp-SP drugs were mostly taken at home due to stock out. Conclusion: Late ANC booking with stock out of IPTp-SP drugs was responsible for its low utilisation. There is need to encourage pregnant women to book early for ANC. Adherence to the practice of DOT scheme is recommended to improve IPTp-SP utilisation.


Assuntos
Antimaláricos/administração & dosagem , Malária/prevenção & controle , Complicações Parasitárias na Gravidez/prevenção & controle , Pirimetamina/administração & dosagem , Sulfadoxina/administração & dosagem , Adulto , Terapia Diretamente Observada , Combinação de Medicamentos , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Nigéria , Gravidez , Cuidado Pré-Natal/métodos , Atenção Primária à Saúde/métodos , Inquéritos e Questionários , Adulto Jovem
11.
Women Birth ; 32(5): 437-448, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326383

RESUMO

BACKGROUND: Good quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AIM: To explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. METHODS: This qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FINDINGS: No overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. CONCLUSION: A foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.


Assuntos
Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Grupo com Ancestrais Oceânicos/etnologia , Cuidado Pré-Natal/métodos , Adulto , Austrália , Feminino , Pessoal de Saúde , Disparidades em Assistência à Saúde , Humanos , Grupo com Ancestrais Oceânicos/psicologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Parto , Gravidez , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
12.
Pan Afr Med J ; 32: 211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312323

RESUMO

Introduction: Brachial plexus birth injury is one of the challenges associated with maternal delivery, with varying prevalence between countries. Brachial plexus birth injury poses negative health implications to children and also has socio-economic implications on families and the community as a whole. To treat brachial plexus birth injury, a multi-disciplinary treatment approach is recommended. Brachial plexus birth palsy (BPBP) is categorised into two-upper plexus injury (Erb's palsy) and lower plexus injury (Klumpke's palsy). These categories present with various degrees of injuries, with less severe injuries responding well to treatment and in most instances may resolve on their own, but serious and complicated injuries will require a multi-disciplinary treatment approach to treat and/or manage. Effective treatment and management depends on adequate knowledge of the disease condition. These include the risk factors and prevalence of brachial plexus birth palsy within a particular population at a specific period in time. The aim of this study was to determine the risk factors and the prevalence of a hospital based brachial plexus birth palsy within a five-year period (2013-2017). Methods: A five-year retrospective study design was used. The study involved selection of all clients' diagnosed with brachial plexus birth palsy, where their gender, birth weight, complications at birth, type of brachial plexus suffered, mothers' diabetes status, mother's age, birth attendant, side of affectation, presentation at birth and mode of delivery were recorded. Results: The prevalence rate of brachial plexus birth palsy was 14.7% out of a total of three hundred and twenty (320) cases reviewed over the study period in the Volta Regional Hospital. Erb's palsy was found to be the modal type of BPBP in this population (93.6%). Conclusion: There is the need to provide a nationwide education on the risk factors that predispose babies to brachial plexus birth palsy. There is also the need for frequent antenatal visit by pregnant women; this will help in the provision of best antenatal history, diagnostic investigation in determining the birth weight and safe mode of delivery.


Assuntos
Parto Obstétrico/métodos , Paralisia do Plexo Braquial Neonatal/epidemiologia , Cuidado Pré-Natal/métodos , Peso ao Nascer , Feminino , Gana/epidemiologia , Humanos , Recém-Nascido , Masculino , Paralisia do Plexo Braquial Neonatal/etiologia , Paralisia do Plexo Braquial Neonatal/fisiopatologia , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
13.
BJOG ; 126 Suppl 4: 21-26, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257695

RESUMO

OBJECTIVE: To study the changes in the rates of perinatal mortality, birth asphyxia, and caesarean sections in relation to interventions implemented over the past 18 years, in a tertiary centre in South India. DESIGN: Retrospective study. SETTING: Labour and maternity unit of a tertiary centre in South India. POPULATION OR SAMPLE: Women who gave birth between 2000 and 2018. METHODS: Information from perinatal audits, chart reviews, and data retrieved from the electronic database were used. Interventions implemented during this time period were audits and training, obstetric re-organisation, and minor changes in staffing and infrastructure. MAIN OUTCOME MEASURES: Main outcome measures were perinatal mortality rate, birth asphyxia rate, and caesarean section rate. RESULTS: Perinatal mortality rate decreased from 44 per 1000 births in 2000 to 16.4 per 1000 births in 2018 (P < 0.001). The rates of babies born with birth asphyxia requiring admission to the neonatal unit decreased from 24 per 1000 births in 2001 to 0.7 per 1000 births in 2018 (P < 0.00001). The overall caesarean section rate was maintained close to 30%. CONCLUSION: In a large tertiary hospital in South India, with 14 000 deliveries per year, a policy of rigorous audits of stillbirths and birth asphyxia, electronic fetal monitoring, and the introduction of standardised criteria for trial of scar, reduced the perinatal mortality and the rate of babies born with birth asphyxia over the past 18 years, without an increase in the caesarean section rate. TWEETABLE ABSTRACT: Rigorous perinatal audits with training in fetal cardiotocography, decreased birth asphyxia, without a major increase in caesarean rates.


Assuntos
Asfixia Neonatal/epidemiologia , Cesárea/estatística & dados numéricos , Mortalidade Perinatal , Cuidado Pré-Natal/normas , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Asfixia Neonatal/prevenção & controle , Cardiotocografia/métodos , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Período Periparto , Gravidez , Cuidado Pré-Natal/métodos , Estudos Retrospectivos
14.
Rev Bras Enferm ; 72(3): 692-699, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269134

RESUMO

OBJECTIVE: to discuss the benefits of using high-risk prenatal case management. METHOD: a qualitative, convergent care study with six high-risk pregnant women, performed in a municipality in the south of Brazil. Data were produced by case management from April to August of 2017 through observation-participant. Analysis followed the processes of Convergent Care Research: apprehension, synthesis, theorization and transfer. RESULTS: case management identified important elements in the care of pregnant women, which denoted a greater complexity to the cases; was shown as a relevant space for nurses to act, because it is an intervention that requires knowledge and specific skills. FINAL CONSIDERATIONS: case management provides differentiated management in complex cases, facilitates the flow between health services, concretizing the comprehensiveness and equity of the care. It was found, in the convergence between research and care, that participants were benefited by case management.


Assuntos
Administração de Caso/tendências , Gestantes/psicologia , Cuidado Pré-Natal/métodos , Adulto , Brasil , Feminino , Humanos , Gravidez , Gravidez de Alto Risco , Pesquisa Qualitativa
15.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 968-975, jul.-set. 2019. il
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005817

RESUMO

Objetivo: Descrever o desenvolvimento de estratégias educativas utilizadas em um grupo educativo para gestantes. Métodos: Estudo descritivo, desenvolvido em Acarape/CE, no qual foram realizados oito encontros semanais no período de janeiro a março de 2015. Em cada encontro, foram realizadas dinâmicas de apresentação, exposição do tema proposto em forma de diálogo e atividades para fixação do conhecimento. Resultados: As mulheres foram muito receptivas demonstrando interesse e satisfação com as atividades. Algumas informações já eram de conhecimento das participantes e outras precisaram ser mais detalhadas, no intuito de fornecer subsídios para que elas pudessem se auto cuidar e cuidar de seus filhos com mais propriedade. Conclusão: A atividade oportunizou a reunião de primíparas e multíparas, sendo esta vivência recomendada e considerada muito apropriada ao compartilhamento de experiências, ao aprendizado e à promoção do cuidado na gestação e no puerpério


Objective: The study's purpose has been to describe the development of educational strategies used in an educational group for pregnant women. Methods: It is a descriptive study that was carried out during eight weekly meetings over the period from January to March 2015, in Acarape city, Ceará State. At each meeting, were performed dynamics of presentation; exhibition of the proposed theme in dialogues and activities towards the knowledge capturing process. Results: The women were very receptive showing both interest and satisfaction concerning the activities. The women were already aware of some information, nonetheless, other kinds of information needed to be more detailed in order to provide subsidies, so that women could self-care and care for their children in a better way. Conclusion: The activity provided an opportunity to meeting primiparous and multiparous women, and this experience was considered very appropriate to share experiences, and also to learn and promote the care during pregnancy and postpartum period


Objetivo: Describir el desarrollo de estratégias educativas utilizadas en um grupo educativo para mujeres embarazadas. Métodos: Estudio descriptivo, desarrollo en Acarape-Ce, donde se realizaron ocho reuniones semanales en el período de enero a marzo de 2015. En cada encuentro, se realizaron dinámicas de presentación, exposición del tema propuesto en diálogo y actividades para fijación del conocimiento. Resultados: Las mujeres fueran muy receptivas demonstrando interés y satisfacción con las actividades. Algunas informaciones ya eran conocidas por las mujeres y otras necesitaron ser más detalladas, con el fin de proporcionar subsidios para que las mujeres pudieran autocuidarse y cuidar de sus hijos con más propiedad. Conclusión: La actividad oportunizó la reunión de primíparas y multíparas, siendo esta vivencia recomendada y considerada muy apropriada al compartir experiências, al aprendizaje y la promoción del cuidado durante el embarazo y el puerpério


Assuntos
Humanos , Feminino , Gravidez , Cuidado Pré-Natal/métodos , Educação em Saúde/métodos , Serviços de Saúde Materno-Infantil , Cuidado Pré-Natal/tendências , Grupos de Autoajuda , Educação em Saúde/tendências , Promoção da Saúde
16.
Rev. Ciênc. Plur ; 5(1): 18-33, jun. 2019. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1007335

RESUMO

Introdução:A qualidade da assistência do parto indica um importante fator nas taxas de mortalidade infantil, pois os problemas decorrentes deste, quando realizado de forma inadequada, pode ter repercussão sobre o recém-nascido durante os primeiros dias de vida.Objetivo:Avaliar a qualidade da assistência do parto e a correlação comos indicadores de saúde da criança.Método:Trata-se de um estudo quantitativo e avaliativo dos indicadores de morbidade e mortalidade materno e infantil realizado nas Unidades Básicas de Saúde que integram a rede da Atenção Primária à Saúde (APS), do município de Santa Cruz, Rio Grande do Norte, Brasil. Com uma amostra de 200 mulheres mães de crianças menores de dois anos. Resultados:Foram entrevistadas mães com média de idade de 28,17 anos, com bebês com em média 10,42 meses de idade. 95,5% das mães afirmaram ter realizado o acompanhamento pré-natal. A maioria (60,5%) das mulheres classificou a assistência recebida no parto como boa; 74,5 % afirmaram que a criança foi colocada no peito após o parto; 90% dos binômios mãe-bebê estiverem juntos no quarto após o parto.Conclusões:Pode-se perceber que a assistência ao parto acontece de forma adequada e satisfatória, atendendo necessidades da maioria das entrevistadas. Porém ainda há uma necessidade de conscientização e qualificação dos profissionais de saúde, para que não ocorram situações indesejáveis na saúde materno-infantil e diminua as taxas de morbidade e mortalidade materna e neonatal (AU).


Introduction:The quality of delivery care indicates an important factor in the infant mortality rates, since the problems arising from it, when performed in an inappropriate way, can have repercussion on the newborn during the first days of life. Objective:To evaluate the quality of childbirth care and the correlation with child health indicators.Methods:This is a quantitative and evaluative study of the indicators of maternal and infant morbidity and mortality carried out at the Basic Health Units that integrate the Primary Health Care (PHC) network of the municipality of Santa Cruz, Rio Grande do Norte, Brazil. With a sample of 200 women mothers of children under two years.Results:Mothers with a mean age of 28.17 years were interviewed, with infants with a mean of 10.42 months of age. 95.5% of the mothers reported having had prenatal care. The majority (60.5%) of the women classified care received at delivery as good; 74.5% stated that the child was placed in the breast after delivery; 90% of the mother-baby binomials are together in the fourth postpartum.Conclusions:It can be noticed that the delivery assistance takes place adequately and satisfactorily, meeting the needs of the majority of the interviewees. However, there is still a need for awareness and qualification of health professionals, so that undesirable situations in maternal and child health do not occur and the rates of maternal and neonatal morbidity and mortality decrease (AU).


Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Cuidado Pré-Natal/métodos , Atenção Primária à Saúde , Avaliação em Saúde/métodos , Criança , Saúde Materno-Infantil , Parto , Brasil , Inquéritos e Questionários , Interpretação Estatística de Dados , Indicadores de Qualidade em Assistência à Saúde
17.
Pediatr Surg Int ; 35(8): 835-843, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31165248

RESUMO

PURPOSE: The aim of this study was to evaluate the indications and the clinical outcomes of the fetuses managed with ex utero intrapartum treatment (EXIT) procedures. METHODS: We retrospectively reviewed the medical records of all fetuses who underwent EXIT procedures between 2003 and 2018. RESULTS: EXIT procedures were performed in nine cases. The prenatal diagnosis of the neonates was congenital high airway obstruction syndrome in four cases, the neck masse in five cases. Although the airway management under the EXIT procedure was successful in eight cases, the airway management failed in one case. During the EXIT procedures, the airway was managed by endotracheal intubation in two cases, whereas six cases underwent tracheostomy. Six cases with fetal airway obstruction survived to discharge, whereas three cases died due to airway management failure or complications of the underlying disease. A case with a cervical teratoma underwent tumor resection the day after birth due to rapid enlargement of the neck mass. Long-term survival was achieved in five cases. CONCLUSIONS: We concluded that the EXIT procedure was effective and could be performed safely in the airway management of fetuses with suspected airway obstruction. The treatment strategy for the neck masses should be planned before birth.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Doenças Fetais/cirurgia , Intubação Intratraqueal/métodos , Cuidado Pré-Natal/métodos , Traqueostomia/métodos , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/diagnóstico , Feminino , Doenças Fetais/diagnóstico , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Útero
18.
Int J Gynaecol Obstet ; 146(3): 333-338, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31206635

RESUMO

OBJECTIVE: To determine the occurrence of and risk factors for fetomaternal hemorrhage (FMH) among pregnant women at Korle Bu Teaching Hospital in Accra, Ghana. METHODS: A prospective study of FMH among pregnant women without hemoglobinopathies in the second trimester attending prenatal care between October 2015 and May 2016 performed using the Kleihauer-Betke test. Volume of FMH was estimated; ABO and Rh blood groups of participants were determined. A data extraction form and structured questionnaire were used to collect demographic and clinical information, and data on risk factors. RESULTS: Of 151 participants, 32 (21.2%) had FMH. Almost 18% (n=27) had FMH at baseline (16-24 weeks), 10% (10/100) at 28-32 weeks, and 11.1% (11/99) at 34-37 weeks of pregnancy. Volume of FMH was less than 30 mL in 30 (19.9%) women, whereas it was greater than 30 mL in 2 (1.3%) women. No identifiable patient-specific factors were associated with occurrence of FMH. CONCLUSION: FMH is common among pregnant women in Ghana and can occur as early as 16 weeks, without identifiable risk factors. RhD negative women who may be pregnant with RhD positive fetuses should be screened early in pregnancy, not only at delivery, for occurrence of FMH.


Assuntos
Transfusão Feto-Materna/epidemiologia , Adulto , Feminino , Transfusão Feto-Materna/sangue , Transfusão Feto-Materna/diagnóstico , Gana/epidemiologia , Humanos , Gravidez , Cuidado Pré-Natal/métodos , Estudos Prospectivos , Sistema do Grupo Sanguíneo Rh-Hr/sangue , Fatores de Risco
19.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31160512

RESUMO

OBJECTIVES: To develop a nationwide, evidence-based framework to support prenatal counseling in extreme prematurity, focusing on organization, decision-making, content, and style aspects. METHODS: A nationwide multicenter RAND-modified Delphi method study was performed between November 2016 and December 2017 in the Netherlands. Firstly, recommendations were extracted from literature and previous studies. Secondly, an expert panel (n = 21) with experienced parents, obstetricians, and neonatologists rated the recommendations on importance for inclusion in the framework. Thirdly, ratings were discussed in a consensus meeting. The final set of recommendations was approved and transformed into a framework. RESULTS: A total of 101 recommendations on organization, decision-making, content, and style were included in the framework, including tools to support personalization. The most important recommendations regarding organization were to have both parents involved in the counseling with both the neonatologist and obstetrician. The shared decision-making model was recommended for deciding between active support and comfort care. Main recommendations regarding content of conversation were explanation of treatment options, information on survival, risk of permanent consequences, impossibility to predict an individual course, possibility for multiple future decision moments, and a discussion on parental values and standards. It was considered important to avoid jargon, check understanding, and provide a summary. The expert panel, patient organization, and national professional associations (gynecology and pediatrics) approved the framework. CONCLUSIONS: A nationwide, evidence-based framework for prenatal counseling in extreme prematurity was developed. It contains recommendations and tools for personalization in the domains of organization, decision-making, content, and style of prenatal counseling.


Assuntos
Aconselhamento/normas , Pessoal de Saúde/normas , Lactente Extremamente Prematuro , Doenças do Prematuro/diagnóstico , Cuidado Pré-Natal/normas , Desenvolvimento de Programas/normas , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica/métodos , Aconselhamento/métodos , Técnica Delfos , Feminino , Humanos , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/terapia , Países Baixos/epidemiologia , Gravidez , Cuidado Pré-Natal/métodos , Desenvolvimento de Programas/métodos , Inquéritos e Questionários
20.
BMC Res Notes ; 12(1): 310, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151463

RESUMO

OBJECTIVES: Anemia remains a major public health problem in Ethiopia, which causes maternal and fetal severe consequences. In Tigrai, there are limited literatures on prevalence of anemia and associated factors among pregnant women. Thus, a hospital based cross-sectional study was conducted to determine the prevalence and associated factors of anemia in Adigrat General Hospital. Data was analyzed and computed using SPSS version 22. p value = 0.05 at 95% confidence interval was considered statistically significant. RESULTS: Overall prevalence of Anemia among the pregnant women attending Adigrat General Hospital was 7.9%. About 62.5% and 37.5% of the anemic women were with mild (Hgb: 10.0-10.9 g/d1) and moderate (Hgb: 7-9.9 g/dl) type respectively. Factors like, residing in rural areas increases risk of anemia by 6 times (AOR = 6, 95% CI 1.34, 27.6, p = 0.019), participants having current blood loss (AOR = 3.4, 95% CI 1.16, 10.2, p = 0.026), having history of recent abortion (AOR = 7.9, 95% CI 2.23, 28.1, p = 0.001) and gestational age in the third trimester (AOR = 4.9, 95% CI 1.39, 17.6, p = 0.013) were statistically associated with anemia. Generally, prevalence of anemia is found to be low in the study area. However, it should be given due attention. Therefore, strong endeavor is needed to control anemia among pregnant women by assessing different micronutrient deficiencies for further prevention.


Assuntos
Anemia/epidemiologia , Complicações Hematológicas na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , População Rural/estatística & dados numéricos , Adolescente , Adulto , Anemia/diagnóstico , Anemia/prevenção & controle , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Gerais , Humanos , Gravidez , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/prevenção & controle , Prevalência , Fatores de Risco , Adulto Jovem
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