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2.
Ann Acad Med Singap ; 49(9): 677-683, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33241257

RESUMO

The WHO declared the coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020. Lessons from SARS epidemic led Singapore to develop stringent infection control protocols in preparation for future pandemics. However, unlike SARS, COVID-19 appears to be more transmissible and is predicted to continue for longer. As of 14 June 2020, there have been 40,197 positive cases with 26 deaths in Singapore, and KK Women's and Children's Hospital (KKH) has managed a total of 73 cases. Obstetrics ultrasound is an indispensable medical service and must continue to operate during a pandemic. A key balance must be struck between keeping patients and healthcare workers safe while being able to provide quality and prompt obstetric care. Our Antenatal Diagnostic Centre (ADC) in KKH developed new strategies to adapt to the pandemic when the national Disease Outbreak Response System Condition (DORSCON) was raised from yellow to orange on 7 February 2020. In this paper, we discuss our clinical workflow to reduce the risk of transmission amongst patients and staff while minimising disruption to our services.


Assuntos
/prevenção & controle , Assistência à Saúde/métodos , Admissão e Escalonamento de Pessoal , Cuidado Pré-Natal/métodos , Ultrassonografia Pré-Natal/métodos , Amniocentese , /transmissão , Amostra da Vilosidade Coriônica , Assistência à Saúde/organização & administração , Feminino , Fetoscopia , Maternidades , Humanos , Isolamento de Pacientes , Equipamento de Proteção Individual , Gravidez , Cuidado Pré-Natal/organização & administração , Singapura
3.
Rev Saude Publica ; 54: 100, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33146323

RESUMO

OBJECTIVE: To estimate the adequacy of health care during pregnancy and the postpartum period in puerperal women and newborn users of the Unified Health System and verify the factors associated with greater adequacy. METHODS: We used data obtained in the hospital interview, the prenatal card and the first telephone interview of 12,646 women participating in the study Nascer no Brasil (Birth in Brazil), conducted in 2011 and 2012. In the first stage of the analysis, the sociodemographic and obstetric characteristics of women and the estimation of adequacy of prenatal and postpartum care indicators are described. In the second stage, the cascade of care for actions related to puerperal women and their newborns is presented. Finally, maternal factors associated with the adequacy of the line of care are verified by means of multiple logistic regression. RESULTS: Only two of the four prenatal indicators were considered satisfactory: initiation up to the 16th week of pregnancy and adequate number of appointments. The guidance on which maternity to go for delivery, as well as the guidance to perform the puerperal appointment and the performance of the heel prick test have reached partial level of adequacy. The puerperal appointment, the first routine appointment of the newborn and the obtaining of the heel prick test results presented unsatisfactory adequacy. In the joint analysis of indicators regarding the effective use of services, only 1.5% of mothers and their babies received all recommended health care. Multiparous women living in the North, Northeast and Midwest, with lower schooling, presented the lowest chances of continuity of care. CONCLUSIONS: The indicators evaluated indicate that almost all women and their children presented partial and disjointed care, showing that the coordination of care is still a challenge in the health care of women and children in the puerperal pregnancy period.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde Materna , Período Pós-Parto , Cuidado Pré-Natal , Adolescente , Adulto , Brasil , Criança , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração , Adulto Jovem
4.
PLoS One ; 15(10): e0240631, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057414

RESUMO

BACKGROUND: Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. OBJECTIVE: To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. METHOD: We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). RESULTS: The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10th and 25th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10th and 25th quantiles, but a negative association in the upper tail (75th and 90th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. CONCLUSION: PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of antenatal or child consultations benefited the most by participating in PMAQ, which suggests that PMAQ might motivate worse performing health providers to catch up.


Assuntos
Cuidado do Lactente/organização & administração , Programas Nacionais de Saúde/organização & administração , Cuidado Pré-Natal/organização & administração , Atenção Primária à Saúde/organização & administração , Reembolso de Incentivo , Brasil , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Humanos , Lactente , Cuidado do Lactente/economia , Recém-Nascido , Programas Nacionais de Saúde/economia , Gravidez , Cuidado Pré-Natal/economia , Atenção Primária à Saúde/economia , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde
6.
Pan Afr Med J ; 36: 146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874410

RESUMO

This was a cross-sectional study describing HIV testing uptake and ART initiation for pregnant women and HIV-exposed infants after one-off clinical mentorship training in 2013 for nurses in 56 peripheral health-facilities, Zimbabwe. Between 2014-2018, 92% of 106411 pregnant women were HIV tested and 98% of HIV-positive women initiated antiretroviral therapy (ART). There were 15846 HIV-exposed infants, of whom 96% had dried blood spots collected for virologic diagnosis and 51% of those diagnosed HIV-positive initiated ART. In conclusion, this one-off clinical mentorship training in 2013 was associated with consistently high HIV testing and ART initiation in pregnant women and their children.


Assuntos
Educação Continuada em Enfermagem/métodos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Tutoria/métodos , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Instalações de Saúde/estatística & dados numéricos , Humanos , Ciência da Implementação , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/prevenção & controle , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Triagem Neonatal/métodos , Triagem Neonatal/normas , Papel do Profissional de Enfermagem , Participação do Paciente , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/organização & administração , Cuidado Pré-Natal/normas , Medicina Preventiva/métodos , Medicina Preventiva/organização & administração , Medicina Preventiva/normas , Avaliação de Programas e Projetos de Saúde , Zimbábue/epidemiologia
7.
Am J Obstet Gynecol ; 223(5): 709-714, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32888923

RESUMO

Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4 to 6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetrical specialists to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. Although implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are available in routine gynecologic practice. Using a multidisciplinary approach with pelvic floor physical therapists, nurses, advanced practice providers, and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment.


Assuntos
Canal Anal/lesões , Lacerações/terapia , Obstetrícia , Distúrbios do Assoalho Pélvico/terapia , Modalidades de Fisioterapia , Cuidado Pós-Natal/organização & administração , Cuidado Pré-Natal/organização & administração , Parto Obstétrico/efeitos adversos , Dispareunia/terapia , Incontinência Fecal/terapia , Feminino , Humanos , Lacerações/etiologia , Equipe de Assistência ao Paciente , Diafragma da Pelve/lesões , Distúrbios do Assoalho Pélvico/etiologia , Prolapso de Órgão Pélvico/terapia , Dor Pélvica/terapia , Períneo/lesões , Período Periparto , Gravidez , Encaminhamento e Consulta , Incontinência Urinária/terapia
8.
Int J Health Plann Manage ; 35(6): 1306-1310, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32869363

RESUMO

Throughout the world as health systems are being prepared to deal with the SARS-CoV-2 outbreak which will affect the management of HIV, diabetes, mental health and mainly maternal healthcare systems. As all efforts are focused on understanding the epidemiology, clinical features, transmission patterns, and management of the COVID-19 outbreak, there has been very little concern expressed over the effects on maternal health services. It is highly likely that the present situation may exacerbate maternal mortality in suburban and rural areas. The present situation requires governments and NGOs to make necessary arrangements to support people with prenatal and postnatal care.


Assuntos
/epidemiologia , Serviços de Saúde Materna/organização & administração , /prevenção & controle , Feminino , Humanos , Mortalidade Materna , Paquistão/epidemiologia , Assistência Perinatal/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração
9.
BMC Health Serv Res ; 20(1): 814, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32867837

RESUMO

BACKGROUND: Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. METHODS: A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines. DISCUSSION: This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.


Assuntos
Serviços de Saúde do Indígena/organização & administração , Hiperglicemia/terapia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/organização & administração , Adulto , Feminino , Programas Governamentais , Pessoal de Saúde , Humanos , Hiperglicemia/diagnóstico , Programas de Rastreamento , Serviços de Saúde Materna , Assistência Médica , Northern Territory , Grupo com Ancestrais Oceânicos , Gravidez , Gravidez em Diabéticas/diagnóstico , Gravidez em Diabéticas/epidemiologia , Melhoria de Qualidade , Queensland , Encaminhamento e Consulta
10.
Int J Gynaecol Obstet ; 151 Suppl 1: 37-44, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32894588

RESUMO

OBJECTIVE: To evaluate the reliability and utility of the FIGO Nutrition Checklist to identify dietary and nutritional inadequacy in early pregnancy by comparing it against nutritional indicators and dietary quality indices (Dietary Approaches to Stop Hypertension [DASH] score, Mediterranean Diet Score [MDS], and Dietary Quality Index-International [DQI-I]), derived by a locally validated food frequency questionnaire (FFQ). METHODS: A prospective cohort study of healthy Chinese pregnant women randomly recruited between September 2017 and April 2018 at their first antenatal appointment. Women completed the FIGO Nutrition Checklist (translated into Chinese) and the FFQ. Spearman correlation was performed to examine association between the Checklist and dietary quality indices or food and nutrient intakes, calculated based on dietary data from the FFQ. RESULTS: Of 160 participants, 156 (97.5%) completed both the FIGO Nutrition Checklist and FFQ and were included. There were 148 (95%) women who reported at least one suboptimal dietary behavior using the Checklist. Checklist score was significantly associated with dietary quality indices (DASH ρ=0.344, P<0.001; DQI-I ρ=0.304, P<0.001; MDS ρ=0.164, P=0.041). The Checklist question on fruit/vegetables was significantly associated with fiber, vitamin C, and fruit and vegetable intake as calculated from the FFQ (0.325 ≤ ρ ≤0.441, P<0.001). The question on dairy intake was significantly associated with intake of calcium, milk and dairy products captured via FFQ (0.576 ≤ ρ ≤0.655, P<0.001). CONCLUSION: This study supports the use of the FIGO Nutrition Checklist to identify women with suboptimal dietary quality in early pregnancy.


Assuntos
Lista de Checagem/normas , Dieta Saudável/normas , Fenômenos Fisiológicos da Nutrição Materna , Adulto , Ingestão de Energia/fisiologia , Feminino , Humanos , Gravidez , Cuidado Pré-Natal/organização & administração , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas
11.
Pan Afr Med J ; 37: 1, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32983319

RESUMO

Introduction: despite the Mozambican Ministry of Health's efforts to deliver family planning to all girls of childbearing age, the adolescent pregnancy rate remains high. The Adolescent and Youth Friendly Service (AYFS), integrated into overall primary health care programs throughout the country, aims to reverse this situation. Our study objective was to assess this health care service's quality in its location in Marrere Health Centre, Nampula, northern Mozambique, using clients' perspective. Methods: we implemented a descriptive cross-sectional quantitative study sampling 124 individuals, who had recently accessed the AYFS at Marrere Health Centre. Data were collected through a questionnaire using a 5-point Likert scale in questions regarding satisfaction level (i.e. always, most times, sometimes, few times, never) and additional open answer questions to gain greater specific understanding. Results: a total of 126 users of the AYFS were evaluated, all from the Emacua ethnic-linguistic group. 85 (67%) were adolescents (<19 years), 78.2% female. The mean age was 17.6 years. We found an average of 0.54 pregnancies per woman and 87 participants (69%) never had a pregnancy; of 39 (31%) who had been pregnant, 17 (44%) were able to report the date of the first prenatal visit, on average performed at week 16 (2nd trimester), though with 9 (53%) having performed it during the first trimester. Spontaneous and induced abortions were reported respectively in 4 and 34 cases, respectively, and none with adolescents. The "overall satisfaction" rate was more frequent in both groups, being answered by 93.8% of youth and adults (>= 19 years) and 72.0% of adolescents, a statistically significant difference between the two groups (p <0.05). Conclusion: while most users are satisfied with the services there was, however, some sharp criticism. Health professionals' practice with the protocol varied, and there were significant deficiencies in information and communication with users. Open communication within families and information reinforcement about sexual and reproductive health and male participation in family planning were found to be in need of strengthening. Our recommendations include reinforcing health professional's training to protect adolescents and young people' sexual health, an important strategy in primary health care to achieve universal health coverage.


Assuntos
Serviços de Planejamento Familiar/organização & administração , Gravidez na Adolescência/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/epidemiologia , Adolescente , Adulto , Criança , Estudos Transversais , Serviços de Planejamento Familiar/normas , Feminino , Humanos , Masculino , Moçambique , Satisfação do Paciente/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/organização & administração , Atenção Primária à Saúde/normas , Saúde Sexual , Inquéritos e Questionários , Adulto Jovem
12.
Washington; Organización Panamericana de la Salud; ago. 13, 2020. 8 p.
Não convencional em Espanhol | LILACS | ID: biblio-1117103

RESUMO

Estudios y resultados de la vigilancia de COVID-19 publicados recientemente indicaron un mayor riesgo de la mujer embarazada de presentar formas graves de COVID-19 y por ende de ser hospitalizadas y admitidas a Unidades de Cuidados Intensivos. La Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS) solicita a los Estados Miembros a redoblar esfuerzos para asegurar el acceso a los servicios de atención prenatal, así como también a implementar medidas preventivas para reducir la morbilidad y mortalidad asociada a la COVID-19 en todos los niveles del sistema de salud, manteniendo los logros y el compromiso de reducir la mortalidad materna y perinatal.


Assuntos
Feminino , Gravidez , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/mortalidade , Cuidado Pré-Natal/organização & administração , Infecções por Coronavirus/epidemiologia , Serviços de Saúde Materno-Infantil/organização & administração , Pandemias/prevenção & controle , Betacoronavirus , América/epidemiologia
13.
Semin Perinatol ; 44(7): 151278, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32792263

RESUMO

In the spring of 2020, expeditious changes to obstetric care were required in New York as cases of COVID-19 increased and pandemic panic ensued. A reduction of in-person office visits was planned with provider appointments scheduled to coincide with routine maternal blood tests and obstetric ultrasounds. Dating scans were combined with nuchal translucency assessments to reduce outpatient ultrasound visits. Telehealth was quickly adopted for selected prenatal visits and consultations when deemed appropriate. The more sensitive cell-free fetal DNA test was commonly used to screen for aneuploidy in an effort to decrease return visits for diagnostic genetic procedures. Antenatal testing guidelines were modified with a focus on providing evidence-based testing for maternal and fetal conditions. For complex pregnancies, fetal interventions were undertaken earlier to avoid serial surveillance and repeated in-person hospital visits. These rapid adaptations to traditional prenatal care were designed to decrease the risk of coronavirus exposure of patients, staff, and physicians while continuing to provide safe and comprehensive obstetric care.


Assuntos
Assistência à Saúde/métodos , Cuidado Pré-Natal/métodos , Telemedicina/métodos , Ultrassonografia Pré-Natal/métodos , Feminino , Humanos , Cidade de Nova Iorque , Teste Pré-Natal não Invasivo/métodos , Gravidez , Cuidado Pré-Natal/organização & administração , Telemedicina/organização & administração
14.
Semin Perinatol ; 44(7): 151276, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32798093

RESUMO

The COVID-19 pandemic has posed challenges for medical education and patient care, which were felt acutely in obstetrics due to the essential nature of pregnancy care. The mobilization of health professions students to participate in obstetric service-learning projects has allowed for continued learning and professional identify formation while also providing a motivated, available, and skilled volunteer cohort to staff important projects for obstetric patients.


Assuntos
Assistência à Saúde/organização & administração , Obstetrícia/organização & administração , Cuidado Pós-Natal/organização & administração , Cuidado Pré-Natal/organização & administração , Estudantes de Ciências da Saúde , Voluntários , Estágio Clínico , Feminino , Humanos , Cidade de Nova Iorque , Portais do Paciente , Equipamento de Proteção Individual/provisão & distribução , Gravidez , Estudantes de Medicina , Estudantes de Enfermagem , Estudantes de Saúde Pública , Telemedicina/organização & administração , Telefone
15.
PLoS One ; 15(7): e0236269, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697791

RESUMO

BACKGROUND: Suicide is one of the most common causes of death among female adolescents. A greater risk is seen among adolescent mothers who become pregnant outside marriage and consider suicide as the solution to unresolved problems. We aimed to investigate the factors associated with suicidal behavior among adolescent pregnant mothers in Kenya. METHODS: A total of 27 Focus Group Discussions (FGDs) and 8 Key Informant Interviews (KIIs) were conducted in a rural setting (Makueni County) in Kenya. The study participants consisted of formal health care workers and informal health care providers (traditional birth attendants and community health workers), adolescent and adult pregnant and post-natal (up to six weeks post-delivery) women including first-time adolescent mothers, and caregivers (husbands and/or mothers-in-law of pregnant women) and local key opinion leaders. The qualitative data was analyzed using Qualitative Solution for Research (QSR) NVivo version 10. RESULTS: Five themes associated with suicidal behavior risk among adolescent mothers emerged from this study. These included: (i) poverty, (ii) intimate partner violence (IPV), (iii) family rejection, (iv) social isolation and stigma from the community, and (v) chronic physical illnesses. Low economic status was associated with hopelessness and suicidal ideation. IPV was related to drug abuse (especially alcohol) by the male partner, predisposing the adolescent mothers to suicidal ideation. Rejection by parents and isolation by peers at school; and diagnosis of a chronic illness such as HIV/AIDS were other contributing factors to suicidal behavior in adolescent mothers. CONCLUSION: Improved social relations, economic and health circumstances of adolescent mothers can lead to reduction of suicidal behaviour. Therefore, concerted efforts by stakeholders including family members, community leaders, health care workers and policy makers should explore ways of addressing IPV, economic empowerment and access to youth friendly health care centers for chronic physical illnesses. Prevention strategies should include monitoring for suicidal behavior risks during pregnancy in both community and health care settings. Additionally, utilizing lay workers in conducting dialogue discussions and early screening could address some of the risk factors and reduce pregnancy- related suicide mortality in LMICs.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Violência por Parceiro Íntimo/psicologia , Gravidez na Adolescência/psicologia , Gestantes/psicologia , Suicídio/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente/economia , Feminino , Grupos Focais , Recursos em Saúde/organização & administração , Humanos , Violência por Parceiro Íntimo/prevenção & controle , Quênia/epidemiologia , Pobreza , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/organização & administração , Pesquisa Qualitativa , Medição de Risco , Fatores de Risco , População Rural/estatística & dados numéricos , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Adulto Jovem
16.
BMC Health Serv Res ; 20(1): 664, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680503

RESUMO

BACKGROUND: In the UK Early Pregnancy Assessment Units (EPAUs) are usually situated alongside hospital maternity and gynaecology services. In June 2018, the Oxford EPAU relocated from the John Radcliffe Hospital to a community clinic. This is to our knowledge, the UK's first community-based EPAU. This change was inspired by our patient feedback describing the co-location of the EPAU with maternity services as distressing. METHODS: Following the introduction of the community EPAU we developed a database to capture information on the patients seen in the clinic. This is a retrospective observational study of a single cohort of patients attending the clinic over an 8 month period. Data was collected from 1st July 2018 to 28th February 2019. This data included clinical, safety and patient experience outcomes. RESULTS: Two thousand nine hundred and twenty patient episodes were recorded, 1,932 were new patients. Mean waiting time to be seen in clinic was 1.3 days. When miscarriage was confirmed 48.6% chose conservative management, 19.9% chose medical management, and 31.5% chose surgical management. The mean rate of ambulance transfers to hospital was 3.1 per month. Of all patients seen in EPAU 32 had unplanned admissions, which accounted for 2.7% of all patients seen in EPAU. Patient feedback questionnaires have been consistently positive. CONCLUSION: The development of a community EPAU has improved services to allow care closer to home in an environment separate from maternity care. Our data shows that a community EPAU can deliver timely, good quality patient care, is safe, and a service valued by patients. Further research is indicated to evaluate the cost-effectiveness of community EPAUs and the long term safety and effectiveness of care.


Assuntos
Aborto Espontâneo/terapia , Serviços de Saúde Comunitária , Serviços de Saúde Materna , Cuidado Pré-Natal/organização & administração , Bases de Dados Factuais , Feminino , Humanos , Avaliação de Resultados da Assistência ao Paciente , Transferência de Pacientes/estatística & dados numéricos , Gravidez , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Inquéritos e Questionários , Reino Unido
17.
PLoS One ; 15(6): e0233590, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484815

RESUMO

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


Assuntos
Infecções por HIV/diagnóstico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Programas de Rastreamento/organização & administração , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cuidado Pré-Natal/organização & administração , Adulto , Fármacos Anti-HIV/uso terapêutico , Criança , Pré-Escolar , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Quênia/epidemiologia , Masculino , Programas de Rastreamento/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/estatística & dados numéricos , Lacunas da Prática Profissional , Estudos Prospectivos , Uganda/epidemiologia , Adulto Jovem
18.
BMC Public Health ; 20(1): 820, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487065

RESUMO

BACKGROUND: Mobile Health (mHealth) is becoming an important tool to improve health outcomes in maternal, newborn and child health (MNCH). Studies of mHealth interventions, have demonstrated their effectiveness in improving uptake of recommended maternal services such as antenatal visits. However, evidence of impact on maternal health outcomes is still limited. METHODS: A pseudo-randomized controlled trial (single blind) was conducted to assess the impact of a voice-message based maternal intervention on maternal health knowledge, attitudes, practices and outcomes over time: Pregnancy (baseline/Time 1); Post-partum (Time 2) and when the infant turned one year old (Time 3). Women assigned to the mMitra intervention arm received gestational age- and stage-based educational voice messages via mobile phone in Hindi and Marathi, while those assigned to the control group did not. Both groups received standard care. RESULTS: Two thousand sixteen women were enrolled. Interviews were conducted with 1516 women in the intervention group and 500 women in the control group at baseline and post-partum. The intervention group performed significantly better than controls on four maternal health practice indicators: receiving the tetanus toxoid injection (OR: 1.6, 95% Confidence Interval (CI): 1.05-2.4, p = 0.028), consulting a doctor if spotting or bleeding (OR: 1.72, 95%CI: 1.07-2.75, p = 0.025), saving money for delivery expenses (OR: 1.79, 95%CI: 1.38-2.33, p = 0.0001), and delivering in hospital (OR: 2.5, 95%CI: 1.49-4.35, p = 0.001). The control group performed significantly better than the intervention group on two practice indicators: resting regularly during pregnancy (OR: 0.7, 95%CI: 0.54-0.88, p = 0.002) and having at-home deliveries attended by a skilled birth attendant (OR: 0.46, 95%CI: 0.23-0.91, p = 0.027). Both groups' knowledge improved from Time 1 to Time 2. Only one knowledge indicator, on seeking medical care during pregnancy, was statistically increased in the intervention group compared to controls. Anemia status at or near the time of delivery was unable to be assessed due to missing data from maternal health cards. CONCLUSIONS: This study provides evidence that in low-resource settings, mobile voice messages providing tailored and timed information about pregnancy can positively impact maternal health care practices proven to improve maternal health outcomes. Additional research is needed to assess whether voice messaging can motivate behavior change better than text messaging, particularly in low literacy settings. TRIAL REGISTRATION: The mMitra impact evaluation is registered with ISRCTN under Registration # 88968111, assigned on 6 September 2018 (See https://www.isrctn.com/ISRCTN88968111).


Assuntos
Serviços de Saúde Materna/organização & administração , Mães/educação , Educação de Pacientes como Assunto/organização & administração , Cuidado Pós-Natal/organização & administração , Gestantes/educação , Cuidado Pré-Natal/organização & administração , Telemedicina/organização & administração , Envio de Mensagens de Texto , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Lactente , Recém-Nascido , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Adulto Jovem
19.
Pan Afr Med J ; 35: 73, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32537076

RESUMO

Introduction: The improvement of maternal health is a health priority in many developing countries. The purpose of this study was to describe the contribution of a community project in the improvement of monitoring during pregnancy in a vulnerable rural commune in the Moroccan High Atlas. Methods: We conducted an action-research project incorporating an approach for community mobilization conducted in 2014. The project involving several participants such as social actors, local authorities, health professionals and students in medicine helped to ensure the monitoring of a cohort of 283 pregnant women. In the course of antenatal consultations, women were interviewed, assessed and participated in information sessions and education. The interviewers speaking berber were trained to data collection. Bivariate and descriptive statistical analyzes were carried out, with a threshold for significance of 5%. Results: The average age of patients was 27.1± 6.7 years. The majority of them was illiterate, without health coverage and with no career. Nearly 73.4% had no previous contact with the health care system (N = 252). Among 500 planned pregnancies, 56.6% of women were monitored, 30.4% consulted twice and 6.7% underwent three consultations out of a total of 407 antenatal consultations performed. Follow-up compliance by undergoing at least two consultations was 60.3%. Abnormality detection during pregnancy was significantly associated with monitoring (p = 0.04). Conclusion: The results reflect the importance of community engagement in the approach to complex health problems as maternal health.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Cuidado Pré-Natal/organização & administração , População Rural , Adulto , Feminino , Humanos , Entrevistas como Assunto , Alfabetização , Estudos Longitudinais , Saúde Materna , Marrocos , Gravidez , Adulto Jovem
20.
Hastings Cent Rep ; 50(3): 77-78, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596912

RESUMO

The Covid-19 pandemic has altered the shape of medicine, making in-person interactions risky for both patients and health care workers. Now, before scheduling in-person appointments or procedures, physicians are forced to reconsider if they are truly necessary. The pandemic has thus thrown into relief the difference between evidence-based medical care and traditional aspects of care that lack a strong evidentiary component. In this essay, we demonstrate how this has played out in prenatal care, as well as in other aspects of medical care, during the pandemic. The extent to which these changes will persist beyond the most emergent phases of the pandemic is not clear, though insurance reimbursement practices and patient expectations will be determining factors. One thing, however, is certain: the longer the pandemic continues, the more difficult it will be for providers and patients to return to pre-Covid norms.


Assuntos
Infecções por Coronavirus/epidemiologia , Prática Clínica Baseada em Evidências/organização & administração , Pneumonia Viral/epidemiologia , Cuidado Pré-Natal/organização & administração , Betacoronavirus , Humanos , Pandemias , Estados Unidos/epidemiologia
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