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2.
Int J Gynaecol Obstet ; 148 Suppl 1: 16-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943183

RESUMO

OBJECTIVE: To determine obstetric fistula knowledge among prenatal attendees and midwives in Mfantsiman municipality, Ghana. METHODS: An analytical cross-sectional study was conducted among prenatal clinic attendees and midwives in Mfantsiman municipality from March to April, 2016. Women were selected by systematic sampling and consenting midwives were recruited. Respondents were interviewed using a pretested structured questionnaire. Data were analyzed using the χ2 test and Poisson regression with a robust error variance to generate relative risks (RRs) with 95% confidence intervals (CIs). P<0.05 was considered statistically significant. RESULTS: Altogether, 393 prenatal attendees and 45 midwives were studied. Mean age of attendees was 28.1 ± 7.1 years. About 29% of prenatal attendees knew of, 37.2% had poor knowledge of, and 56.6% had some misconceptions about obstetric fistula. Women who had attained some level of education (P trend=0.001), were employed (adjusted RR 4.92; 95% CI, 1.98-12.21), or had given birth before (P trend=0.01) were more likely to have heard of obstetric fistula. All midwives knew of obstetric fistula and its preventive measures; however, up to 73.3% had some misconceptions about it. CONCLUSION: Educating prenatal attendees and organizing regular refresher courses on obstetric fistula for midwives should be a priority in the municipality.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Tocologia/educação , Fístula Vesicovaginal/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Gana , Humanos , Complicações do Trabalho de Parto/terapia , Gravidez , Cuidado Pré-Natal/normas , Inquéritos e Questionários , Adulto Jovem
3.
Presse Med ; 48(12): 1422-1430, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679895

RESUMO

Pulmonary hypertension in pregnant women is associated with high mortality and morbidity despite significant improvement in prognosis. Women with pulmonary arterial hypertension (PAH) should be still advised against pregnancy and advised on effective contraceptive methods. Pregnancy may be manageable in women with well controlled PAH or mild pulmonary hypertension (sPAP<50mmHg). When women with PAH choose to continue their pregnancy, they need: management by a multidisciplinary team in an expert centre; continuation or early introduction of targeted PAH therapy; early planned delivery.


Assuntos
Complicações Cardiovasculares na Gravidez , Parto Obstétrico/métodos , Parto Obstétrico/normas , Aconselhamento Diretivo/métodos , Feminino , Humanos , Mortalidade Materna , Cuidado Pré-Concepcional/métodos , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , /terapia , Fatores de Risco , Vasodilatadores/uso terapêutico
4.
BMC Health Serv Res ; 19(1): 851, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31747914

RESUMO

BACKGROUND: Over time, the Brazilian health system, a growing country, has been developing to ensure good accessibility to health goods and services. This development is focusing on the principle of universality of access and completeness of health care. In this context, we aimed to evaluate the completeness of care and universality of access for women in their pregnancy and puerperal period in Ceará, Brazil. METHODS: A descriptive, cross-sectional study based on a quantitative approach, using information collected from the database of the regulation system of the state of Ceará and data from the Prenatal Monitoring System. The research population comprised of 1701 women who delivered a baby in an obstetric reference unit in the Health Macro-Region of Cariri, Ceará, Brazil from January to December 2015. RESULTS: There was a high rate of cesarean delivery (49.7%) and a high waiting time for access to high-risk delivery (32.6%) and neonatal intensive care unit (72.9%). There was also a low percentage (41.1%) of pregnant women undergoing an adequate number of prenatal consultations, dental care (20%), educational activities (15%), visits to the maternity ward (0.1%), laboratory tests of the third trimester (29.2%) and puerperal consultation (37.9%). CONCLUSIONS: It was concluded that the Maternal and Child Health Policy, especially the Rede Cegonha, which is still under development, does not ensure access and completeness of care for women during the prenatal, delivery, and puerperal periods, thus violating their reproductive rights. The results of this study allow a critical analysis by the academia and health managers in search of strategies to improve the services of Rede Cegonha in Brazil.


Assuntos
Acesso aos Serviços de Saúde/normas , Serviços de Saúde Materna/normas , Adulto , Brasil , Cesárea/estatística & dados numéricos , Criança , Estudos Transversais , Feminino , Política de Saúde , Humanos , Assistência Médica/normas , Cuidado Pós-Natal/normas , Período Pós-Parto/fisiologia , Gravidez , Complicações na Gravidez/terapia , Gestantes , Cuidado Pré-Natal/normas , Encaminhamento e Consulta , Direitos Sexuais e Reprodutivos/normas , Adulto Jovem
5.
BMC Health Serv Res ; 19(1): 684, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590662

RESUMO

BACKGROUND: This study aimed to assess the quality of antenatal care (ANC) women received in Migori county, Kenya-including both service provision and experience dimensions-and to examine factors associated with each dimension. METHODS: We used survey data collected in 2016 in Migori county from 1031 women aged 15-49 who attended ANC at least once in their most recent pregnancy. ANC quality service provision was measured by nine questions on receipt of recommended ANC services, and experience of care by 18 questions on information, communication, dignity, and facility environment. We summed the responses to the individual items to generate ANC service provision and experience of care scores. We used both linear and logistic regression to examine predictors. RESULTS: The average service provision score was 10.9 (SD = 2.4) out of a total of 16. Most women received some recommended services once, but not at the frequency recommended by the Kenyan Ministry of Health. About 90% had their blood pressure measured, and 78% had a urine test, but only 58 and 14% reported blood pressure monitoring and urine test, respectively, at every visit. Only 16% received an ultrasound at any time during ANC. The average experience score is 27.3 (SD = 8.2) out of a total score of 42, with key gaps demonstrated in communication. About half of women were not educated on pregnancy complications. Also, about one-third did not often understand the purposes of tests and medicines received and did not feel able to ask questions to the health care provider. In multivariate analysis, women who were literate, employed, and who received all their ANC in a health center had higher experiences scores than women who were illiterate (coefficient = 1.52, CI:0.26,2.79), unemployed (coefficient = 2.73, CI:1.46,4.00), and received some ANC from a hospital (coefficient = 1.99, CI: 0.84, 3.14) respectively. The wealthiest women had two times higher odds of receiving an ultrasound than the poorest women (OR = 2.00, CI:1.20,3.33). CONCLUSION: Quality of ANC is suboptimal in both service provision and experience domains, with disparities by demographic and socioeconomic factors and facility type. More efforts are needed to improve quality of ANC and to eliminate the disparities.


Assuntos
Assistência à Saúde/normas , Complicações na Gravidez/terapia , Cuidado Pré-Natal/normas , Qualidade da Assistência à Saúde , Adolescente , Adulto , Feminino , Humanos , Quênia , Modelos Logísticos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Saúde da População Rural , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
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.
BMC Pregnancy Childbirth ; 19(1): 339, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533640

RESUMO

BACKGROUND: There is broad agreement that antenatal care (ANC) interventions, skilled attendance at birth and management of complications arising after delivery are key strategies that can tackle the high burden of maternal mortality in sub-Saharan Africa. In Kenya, utilisation rate of these services has remained low despite a government policy on free maternal care. The present study sought to understand what factors are leading to the low healthcare seeking during pregnancy, child birth and postnatal period in Siaya County in Kenya. METHODS: Six Focus Group Discussions were conducted with 50 women attending ANC in 6 public primary healthcare facilities. Participants were drawn from a sample of 200 women who were eligible participants in a Conditional Cash Transfer project aimed at increasing utilization of healthcare services during pregnancy and postnatal period. Interviews were conducted at the health facilities, recorded, transcribed and analysed using thematic analysis. RESULTS: Multiple factors beyond the commonly reported distance to health facility and lack of transportation and finances explained the low utilization of services. Emergent themes included a lack of understanding of the role of ANC beyond the treatment of regular ailments. Women with no complicated pregnancies therefore missed or went in late for the visits. A missed health visit contributed to future missed visits, not just for ANC but also for facility delivery and postnatal care. The underlying cause of this relationship was a fear of reprimand from the health staff and denial of care. The negative attitude of the health workers explained the pervasive fear expressed by the participants, as well as being on its own a reason for not making the visits. The effect was not just on the woman with the negative experience, but spiraled and affected the decision of other women and their social networks. CONCLUSIONS: The complexity of the barriers to healthcare visits implies that narrow focused solutions are unlikely to succeed. Instead, there should broad-based solutions that focus on the entire continuum of maternal care with a special focus on ANC. There is an urgent need to shift the negative attitude of healthcare workers towards their clients.


Assuntos
Parto Obstétrico , Parto Domiciliar/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pós-Natal , Cuidado Pré-Natal , Adulto , Atitude do Pessoal de Saúde , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Quênia/epidemiologia , Mortalidade Materna , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/organização & administração , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Pesquisa Qualitativa , Melhoria de Qualidade
8.
BMC Pregnancy Childbirth ; 19(1): 340, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533657

RESUMO

BACKGROUND: Timely initiation of antenatal care can avoid pregnancy related problems and save lives of mothers and babies. In developing nations, however, only half of the pregnant mothers receive the recommended number of antenatal care visits, and start late in their pregnancy. Thus, the study was conducted to assess the magnitude of timely initiation of antenatal care and factors associated with the timing of antenatal care attendance in Axum in which studies regarding this issue are lacking. METHODS: An institution based cross-sectional study mixed with qualitative approach was conducted. A total of 386 pregnant women were selected using systematic sampling technique for the quantitative study. In addition, 18 participants were selected purposively for the qualitative part. The quantitative data were collected using structured interviewer administered questionnaire while the qualitative data were collected using an open-ended interview guide. Quantitative data were analyzed using SPSS version 22 and the qualitative data were analyzed using Atlas software. Multi-variable logistic regression was used to control the effect of confounders. RESULTS: The magnitude of timely attendance of antenatal care was 27.5% (95% CI: 23-32%). Unintended pregnancy (AOR = 2.87; CI 95%: 1.23-6.70), maternal knowledge (AOR = 2.75; CI 95%: 1.07-7.03), educational status of the women (AOR = 2.62; CI 95%: 1.21-5.64), perceived timing of antenatal care (AOR = 3.45; CI 95%: 1.61-7.36), problem in current pregnancy (AOR = 3.56; CI 95%: 1.52-8.48) and advice from significant others (AOR =2.33; CI 95%: 1.10-4.94) were found significantly associated with timely booking of antenatal care. CONCLUSION: The magnitude of timely attendance of antenatal care is low. Educational status, maternal knowledge, unintended pregnancy, problem in current pregnancy, perceived timing of antenatal care, and advise from significant others were the significant factors for timing of antenatal care. Therefore more effort should be done to increase the knowledge of mothers about importance of antenatal care and timely ante natal care booking.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Gestantes , Cuidado Pré-Natal , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Gravidez não Planejada/psicologia , Gestantes/educação , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Fatores Socioeconômicos , Fatores de Tempo
9.
BMC Res Notes ; 12(1): 600, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533858

RESUMO

OBJECTIVE: Obstetric violence is an often overlooked obstacle to quality maternal health care service utilization. In the study setting, there was limited evidence on obstetric violence. Hence, this study aimed at assessing the prevalence and associated factors of obstetric violence among women who gave birth in Gondar University Specialized Comprehensive Hospital, Northwest Ethiopia. RESULTS: A total of 409 women had been participated in the study with a response rate of 100%. Three in four (75.1%) women reported that they had been subjected to at least one form of obstetric violence during labor and delivery with 95% CI (70.9-79.0). The reported forms of obstetric violence include non-consented care-260 (63.6%), non-dignified care-226 (55.3%), physical abuse-192 (46.9%), non-confidential care-132 (32.3%, neglected care-52 (12.7%) and discriminated care-38 (9.3%). On the contrary, none of the respondent had reported detention for failure to pay in the hospital. The multivariable logistic regression analysis demonstrated that urban residents (AOR = 1.89; 95% CI 1.11, 3.22) and primary school attendants (AOR = 0.49; 95% CI 0.27, 0.91) were significantly associated with experiencing obstetric violence. This study indicated the high prevalence of obstetric violence. Thus, interventions need to be undertaken by taking the reported forms of obstetric violence and participants' sociodemographic status in to account.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Hospitais Especializados , Trabalho de Parto , Serviços de Saúde Materna/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Violência/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/normas , Gravidez , Cuidado Pré-Natal/normas , Prevalência , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
10.
BMC Pregnancy Childbirth ; 19(1): 327, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488080

RESUMO

OBJECTIVES: We examined the utilisation, equity and determinants of full antenatal care (ANC), defined as 4 or more antenatal visits, at least one tetanus toxoid (TT) injection and consumption of iron folic acid (IFA) for a minimum of 100 days, in India. METHODS: We analysed a sample of 190,898 women from India's National Family Health Survey 4. Concentration curves and concentration index were used to assess equity in full ANC utilisation. Multivariable logistic regression model was used to examine the factors associated with full ANC utilisation. RESULTS: In India, 21% of pregnant women utilised full ANC, ranging from 2.3-65.9% across states. Overall, 51.6% had 4 or more ANC visits, 30.8% consumed IFA for atleast 100 days, and 91.1% had one or more doses of tetanus toxoid. Full ANC utilisation was inequitable across place of residence, caste and maternal education. Registration of pregnancy, utilisation of government's Integrated Child Development Services (ICDS) and health insurance coverage were associated with higher odds of full ANC utilisation. Lower maternal education, lower wealth quintile(s), lack of father's participation during antenatal visits, higher birth order, teenage and unintended pregnancy were associated with lower odds of full ANC utilisation. CONCLUSIONS: Full ANC utilisation in India was inadequate and inequitable. Although half of the women did not receive the minimum recommended ANC visits, the utilisation of TT immunisation was almost universal. The positive association of full ANC with ICDS utilisation and child's father involvement may be leveraged for increasing the uptake of full ANC. Strategies to address the socio-demographic factors associated with low and inequitable utilisation of full ANC are imperative for strengthening India's maternal health program.


Assuntos
Saúde da Família , Equidade em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Gestantes , Cuidado Pré-Natal , Adolescente , Adulto , Feminino , Equidade em Saúde/organização & administração , Equidade em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Seguro Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Gestantes/educação , Gestantes/etnologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Melhoria de Qualidade , Fatores Socioeconômicos
11.
BMC Pregnancy Childbirth ; 19(1): 330, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500581

RESUMO

BACKGROUND: In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable. MATERIAL AND METHODS: Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries. RESULTS: Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p = 0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head. CONCLUSION: All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.


Assuntos
Apresentação Pélvica , Cesárea , Parto Obstétrico , Complicações do Trabalho de Parto , Morte Perinatal/prevenção & controle , Cuidado Pré-Natal , Adulto , Estudos de Casos e Controles , Cesárea/métodos , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Humanos , Recém-Nascido , Determinação de Necessidades de Cuidados de Saúde , Noruega/epidemiologia , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/mortalidade , Complicações do Trabalho de Parto/cirurgia , Mortalidade Perinatal , Guias de Prática Clínica como Assunto , Gravidez , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Melhoria de Qualidade
12.
Health Res Policy Syst ; 17(1): 76, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31391057

RESUMO

BACKGROUND: WHO has recognised the need to ensure that guideline processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. Along with decision-making criteria that require findings from effectiveness reviews, WHO is increasingly using evidence derived from qualitative evidence syntheses (QES) to inform the values, acceptability, equity and feasibility implications of its recommendations. This is the first in a series of three papers examining the use of QES in developing clinical and health systems guidelines. METHODS: WHO convened a group of methodologists involved in developing recent (2010-2018) guidelines that were informed by QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. Our aim in this paper is to (1) describe and discuss how the findings of QES can inform the scope of a guideline and (2) develop findings for key guideline decision-making criteria. RESULTS: QES resulted in the addition of new outcomes that are directly relevant to service users, a stronger evidence base for decisions about how much effective interventions and related outcomes are valued by stakeholders in a range of contexts, and a more complete database of summary evidence for guideline panels to consider, linked to decisions about values, acceptability, feasibility and equity. CONCLUSIONS: Rigorously conducted QES can be a powerful means of improving the relevance of guidelines, and of ensuring that the concerns of stakeholders, at all levels of the healthcare system and from a wide range of settings, are taken into account at all stages of the process.


Assuntos
Medicina Baseada em Evidências/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Guias de Prática Clínica como Assunto/normas , Pesquisa Qualitativa , Organização Mundial da Saúde/organização & administração , Aborto Induzido/normas , Comunicação , Tomada de Decisões , Medicina Baseada em Evidências/normas , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde/normas , Humanos , Serviços de Saúde Materno-Infantil/normas , Cuidado Pré-Natal/normas , Papel Profissional , Revisão Sistemática como Assunto , Vacinação/métodos
13.
Health Res Policy Syst ; 17(1): 74, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31391071

RESUMO

BACKGROUND: This is the third in a series of three papers describing the use of qualitative evidence syntheses (QES) to inform the development of clinical and health systems guidelines. WHO has recognised the need to improve its guideline methodology to ensure that decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable to end users. In addition to the standard data on effectiveness, WHO guidelines increasingly use evidence derived from QES to provide information on acceptability and feasibility and to develop important implementation considerations. METHODS: WHO convened a group drawn from the technical teams involved in formulating recent (2010-2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. As members of WHO guideline technical teams, our aim in this paper is to explore how we have used findings from QES to develop implementation considerations for these guidelines. RESULTS: For each guideline, in addition to using systematic reviews of effectiveness, the technical teams used QES to gather evidence of the acceptability and feasibility of interventions and, in some cases, equity issues and the value people place on different outcomes. This evidence was synthesised using standardised processes. The teams then used the QES to identify implementation considerations combined with other sources of information and input from experts. CONCLUSIONS: QES were useful sources of information for implementation considerations. However, several issues for further development remain, including whether researchers should use existing health systems frameworks when developing implementation considerations; whether researchers should take confidence in the evidence into account when developing implementation considerations; whether qualitative evidence that reveals implementation challenges should lead guideline panels to make conditional recommendations or only point to implementation considerations; and whether guideline users find it helpful to have challenges pointed out to them or whether they also need solutions. Finally, we need to explore how QES findings can be incorporated into derivative products to aid implementation.


Assuntos
Medicina Baseada em Evidências/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Guias de Prática Clínica como Assunto/normas , Pesquisa Qualitativa , Organização Mundial da Saúde/organização & administração , Aborto Induzido/normas , Comunicação , Tomada de Decisões , Medicina Baseada em Evidências/normas , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde/normas , Humanos , Serviços de Saúde Materno-Infantil/normas , Cuidado Pré-Natal/normas , Papel Profissional , Revisão Sistemática como Assunto , Vacinação/métodos
14.
Health Res Policy Syst ; 17(1): 75, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31391119

RESUMO

BACKGROUND: WHO has recognised the need to improve its guideline methodology to ensure that guideline decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. To help achieve this, WHO guidelines now typically enhance intervention effectiveness data with evidence on a wider range of decision-making criteria, including how stakeholders value different outcomes, equity, gender and human rights impacts, and the acceptability and feasibility of interventions. Qualitative evidence syntheses (QES) are increasingly used to provide evidence on this wider range of issues. In this paper, we describe and discuss how to use the findings from QES to populate decision-making criteria in evidence-to-decision (EtD) frameworks. This is the second in a series of three papers that examines the use of QES in developing clinical and health system guidelines. METHODS: WHO convened a writing group drawn from the technical teams involved in its recent (2010-2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. RESULTS: We describe a step-wise approach to populating EtD frameworks with QES findings. This involves allocating findings to the different EtD criteria (how stakeholders value different outcomes, equity, acceptability and feasibility, etc.), weaving the findings into a short narrative relevant to each criterion, and inserting this summary narrative into the corresponding 'research evidence' sections of the EtD. We also identify areas for further methodological research, including how best to summarise and present qualitative data to groups developing guidelines, how these groups draw on different types of evidence in their decisions, and the extent to which our experiences are relevant to decision-making processes in fields other than health. CONCLUSIONS: This paper shows the value of incorporating QES within a guideline development process, and the roles that qualitative evidence can play in integrating the views and experiences of relevant stakeholders, including groups who may not be otherwise represented in the decision-making process.


Assuntos
Medicina Baseada em Evidências/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Guias de Prática Clínica como Assunto/normas , Pesquisa Qualitativa , Organização Mundial da Saúde/organização & administração , Aborto Induzido/normas , Comunicação , Tomada de Decisões , Medicina Baseada em Evidências/normas , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde/normas , Humanos , Serviços de Saúde Materno-Infantil/normas , Cuidado Pré-Natal/normas , Papel Profissional , Revisão Sistemática como Assunto , Vacinação/métodos
15.
BMC Health Serv Res ; 19(1): 551, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387583

RESUMO

BACKGROUND: During pregnancy, childbirth and puerperium, women receive care from a range of health professionals, particularly midwives. To assess the current situation of maternity care for women with physical disabilities in Austria, this study investigated the perceptions and experiences of health professionals who have provided care for women with disabilities during pregnancy, childbirth and postpartum. METHODS: The viewpoints of the participating health professionals were evaluated by means of semistructured interviews followed by an inductive qualitative content analysis of the interview transcripts, as proposed by Mayring. RESULTS: Four main categories emerged from the inductive content analysis: (i) structural conditions and accessibility, (ii) interprofessional teamwork and cooperation, (iii) action competence, and (iv) diversity-sensitive attitudes. According to the participating health professionals, the structural conditions were frequently not suitable for providing targeted group-oriented care services. Additionally, a shortage of time and staff resources also limited the necessary flexibility of treatment measures in the care of mothers with physical disabilities. The importance of interprofessional teamwork for providing adequate care was highlighted. The health professionals regarded interprofessionalism as an instrument of quality assurance and team meetings as an elementary component of high-quality care. On the other hand, the interviewees perceived a lack of action competence that was attributed to a low number of cases and a corresponding lack of experience and routine. Regarding diversity-sensitive attitudes, it became apparent that the topic of mothers with physical disabilities in care posed challenges to health professionals that influenced their natural handling of the interactions. CONCLUSION: The awareness of one's own attitudes towards diversity, in the perinatal context in particular, influences professional security and sovereignty as well as the quality of care of women with disabilities. There is a need for optimization in the support and care of women with physical disabilities during pregnancy, childbirth and puerperium.


Assuntos
Atitude do Pessoal de Saúde , Pessoas com Deficiência , Pessoal de Saúde/psicologia , Cuidado Pré-Natal/normas , Adolescente , Adulto , Áustria , Feminino , Humanos , Relações Interprofissionais , Pessoa de Meia-Idade , Tocologia , Mães/psicologia , Complicações do Trabalho de Parto/terapia , Gravidez , Complicações na Gravidez/terapia , Transtornos Puerperais/terapia , Pesquisa Qualitativa , Adulto Jovem
16.
Obstet Gynecol Surv ; 74(8): 481-489, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31418450

RESUMO

Importance: Physical activity during pregnancy can offer many maternal and fetal health benefits. Objective: The aim was to summarize American, Canadian, and international recommendations published recently on physical activity during pregnancy to aid health care providers in their delivery of advice on the topic. Evidence Acquisition: A descriptive review of 3 national guidelines and 1 international guideline on physical activity during pregnancy was conducted. The guidelines included the 2019 Canadian recommendations, the 2018 United States' Physical Activity Guidelines for Americans (second edition), the 2015 (reaffirmed in 2017) American College of Obstetrics and Gynecology guideline, and the 2016-2018 International Olympic Committee recommendations for recreational and elite athletes. Results: For apparently healthy women, under the guidance of their health care provider, moderate-intensity physical activity using both aerobic and muscle conditioning activities is recommended. The guidelines recommended at least 150 min/wk spread throughout the week (Canada, United States) or at least 20 to 30 min/d (American College of Obstetrics and Gynecology). Conclusions and Relevance: This summary of 4 recent guidelines can facilitate use of updated recommendations by health care providers regarding physical activity during pregnancy. More detailed evidence-based guidelines on physical activity during postpartum are needed.


Assuntos
Terapia por Exercício/normas , Exercício , Obstetrícia/normas , Guias de Prática Clínica como Assunto , Cuidado Pré-Natal/normas , Canadá , Feminino , Humanos , Gravidez , Estados Unidos
17.
BMC Pregnancy Childbirth ; 19(1): 299, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419964

RESUMO

BACKGROUND: Antenatal clinical guidelines recommend that during initial and subsequent antenatal visits all pregnant women: have their alcohol consumption assessed; be advised that it is safest not to consume alcohol during pregnancy and of the potential risks of consumption; and be offered referrals for further support if required. However, the extent to which pregnant women attending public antenatal services receive guideline recommended care at these visits, and the characteristics associated with its receipt, is unknown. The purpose of this study was to examine: 1) pregnant women's reported receipt of guideline recommended care addressing alcohol consumption during pregnancy; 2) characteristics associated with the receipt of care; and 3) pregnant women's acceptability of care. METHODS: From July 2017 - February 2018 a survey (telephone or online) was undertaken with 1363 pregnant women who had recently visited a public antenatal service in one health district in Australia. Receipt and acceptability of recommended care were assessed via descriptive statistics and associations via logistic regression analyses. RESULTS: At the initial antenatal visit, less than two thirds (64.3%) of pregnant women reported that they received an assessment of their alcohol consumption and just over one third (34.9%) received advice and referral appropriate to their self-reported level of alcohol consumption since pregnancy recognition. Less than 10% of women received such care at subsequent antenatal visits. Characteristics that significantly increased the odds of receiving all guideline elements at the initial antenatal visit included: less than university attainment (OR = 1.93; 95% CI:1.12, 3.34), not residing in an advantaged area (OR = 2.11; 95% CI:1.17, 3.79), first pregnancy (OR = 1.91; 95% CI:1.22, 2.99) and regional/rural service location (OR = 2.38; 95% CI:1.26, 4.48); and at subsequent visits: younger age (OR = 0.91; 95% CI:0.84, 0.99) and Aboriginal origin (OR = 3.17; 95% CI:1.22, 8.24). Each of the recommended care elements were highly acceptable to pregnant women (88.3-99.4%). CONCLUSIONS: Although care for alcohol consumption is both recommended by clinical guidelines and highly acceptable to pregnant women, its receipt in public antenatal services is suboptimal. There is a need and an opportunity for interventions to support antenatal care providers to routinely and consistently provide such care to all pregnant women.


Assuntos
Alcoolismo/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Complicações na Gravidez/diagnóstico , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Diagnóstico Pré-Natal/psicologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/psicologia , Austrália , Feminino , Fidelidade a Diretrizes , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/psicologia , Cuidado Pré-Natal/normas , Diagnóstico Pré-Natal/normas , População Rural , Inquéritos e Questionários , Adulto Jovem
18.
Rev Peru Med Exp Salud Publica ; 36(2): 178-187, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31460628

RESUMO

OBJECTIVE: . To estimate the proportion of Peruvian women who received quality prenatal care (PNC) for their last childbirth in the last five years and to determine its associated factors. MATERIALS AND METHODS.: Analytical cross-sectional study of the 2017 Demographic and Family Health Survey. The proportion of quality PNC was calculated based on the number of PNC control visits. Bivariate and adjusted prevalence ratios (PRa) of quality PNC were estimated. RESULTS.: Data from 18,156 women were analyzed; 56.1% received quality PNC. Receiving more PNC visits increased the likelihood of receiving quality PNC (49.6% and 59.9% for six and eight control visits, respectively). Being from the highlands (PRa=0.85; 95% CI: 0.80-0.91), living in rural areas (PRa=0.94; 95% CI: 0.89-0.99), and belonging to a native ethnic group (PRa=0.72; 95% CI: 0.66-0.79) was associated with a lower likelihood of receiving quality PNC. Having completed high-school (PRa=1.16; 95% CI: 1.10-1.22) and higher education (PRa=1.15; 95% CI: 1.07-1.23), being from the 2nd wealth quintile (PRa=1.15; 95% CI: 1.08-1.22), 3rd quintile (PRa=1.18; 95% CI: 1.09-1.27), 4th quintile (PRa=1.16; 95% CI: 1.07-1.26), and 5th quintile (PRa=1.16; 95% CI: 1.05-1.28); being from the rest of the Coast (PRa=1.06; 95% CI: 1.00-1.12) and Jungle (PRa=1.31; 95% CI: 1.24-1.39); being enrolled in health insurance (PRa=1.24; 95% CI: 1.18-1.30); birth order 2-3 (PRa=1.10; 95% CI: 1.06-1.15) or ≥4 (PRa=1.20; 95% CI: 1.14-1.27), and having received PNC in the first trimester (PRa=1.20, 95% CI: 1.14-1.26) was related to an increased likelihood of receiving quality PNC. CONCLUSIONS: . Four out of ten women did not receive quality PNC, especially in women of native ethnicity or residents of the highlands or rural areas, groups that would require prioritization in maternal health strategies.


Assuntos
Serviços de Saúde Materna/normas , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde , Adolescente , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Peru , Gravidez , Cuidado Pré-Natal/normas , População Rural/estatística & dados numéricos , Adulto Jovem
19.
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
20.
BMC Pregnancy Childbirth ; 19(1): 221, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266468

RESUMO

BACKGROUND: Globally, anxiety and depression are the most common complications of the perinatal period (conception to 1 year postpartum). It is now recognised that anxiety and depression are more commonly found antenatally than postnatally and represent the greatest risk factor for developing postnatal depression. Research in this space has focused on treatment of postnatal depression, with limited attention paid to preventative strategies for women signalling distress, who are subthreshold for diagnosable illness. MAIN TEXT: The Edinburgh Postnatal Depression Scale (EPDS) was introduced in 1987 and has since been validated as a depression screening tool in the Australian and international setting. The EPDS has been embedded as a depression screening tool within a broader psychosocial assessment for women who receive their maternity care in the public system in Australia. Owing to perceived service restrictions, an EPDS score must reach a threshold of 13 or more to warrant specific assessment or intervention. Current policy frameworks focus on tertiary prevention models, and those women scoring 10 to 12, who could reasonably be considered as signalling distress or early signs of illness, are not currently offered intervention. The consequences of undetected or untreated perinatal mood or anxiety disorder (often co-morbid) include maternal psychological, social, occupational and physical dysfunction, and extend to deleterious infant and child life-course effects. This provides a strong justification to explore the role of preventative programs for women who are distressed. A range of low-resource, population-based interventions are available and effective. We explore the evidence for a selection of these programs. Further research is needed to decipher their effectiveness as a secondary prevention approach in women who are currently signalling distress during antenatal assessment. CONCLUSION: The burden of perinatal mood disorders, and their potential for prolonged impact, justify the exploration of preventatively-focused programs in women who signal distress during antenatal care.


Assuntos
Complicações na Gravidez/diagnóstico , Cuidado Pré-Natal/normas , Diagnóstico Pré-Natal/normas , Escalas de Graduação Psiquiátrica/normas , Encaminhamento e Consulta/normas , Adulto , Ansiedade/complicações , Ansiedade/diagnóstico , Austrália , Depressão/complicações , Depressão/diagnóstico , Feminino , Política de Saúde , Humanos , Saúde Mental , Saúde da População , Gravidez , Complicações na Gravidez/psicologia , Diagnóstico Pré-Natal/métodos , Fatores de Risco , Inquéritos e Questionários
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