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1.
BMC Health Serv Res ; 19(1): 719, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31639001

RESUMO

BACKGROUND: Despite improvements in recent years, Ethiopia faces a high burden of maternal morbidity and mortality. Antenatal care (ANC) may reduce maternal morbidity and mortality through the detection of pregnancy-related complications, and increased health facility-based deliveries. Midwives and community-based Health Extension Workers (HEWs) collaborate to promote and deliver ANC to women in these communities, but little research has been conducted on the professional working relationships between these two health providers. This study aims to generate a better understanding of the strength and quality of professional interaction between these two key actors, which is instrumental in improving healthcare performance, and thereby community health outcomes. METHODS: We conducted eleven in-depth interviews with midwives from three rural districts within Jimma Zone, Ethiopia (Gomma, Kersa, and Seka Chekorsa) as a part of the larger Safe Motherhood Project. Interviews explored midwives' perceptions of strengths and weaknesses in ANC provision, with a focus as well on their engagement with HEWs. Thematic content analysis using Atlas.ti software was used to analyse the data using an inductive approach. RESULTS: Midwives interacted with HEWs throughout three key aspects of ANC promotion and delivery: health promotion, community outreach, and provision of ANC services to women at the health centre and health posts. While HEWs had a larger role in promoting ANC services in the community, midwives functioned in a supervisory capacity and provided more clinical aspects of care. Midwives' ability to work with HEWs was hindered by shortages in human, material and financial resources, as well as infrastructure and training deficits. Nevertheless, midwives felt that closer collaboration with HEWs was worthwhile to enhance service provision. Improved communication channels, more professional training opportunities and better-defined roles and responsibilities were identified as ways to strengthen midwives' working relationships with HEWs. CONCLUSION: Enhancing the collaborative interactions between midwives and HEWs is important to increase the reach and impact of ANC services and improve maternal, newborn and child health outcomes more broadly. Steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening.


Assuntos
Promoção da Saúde/organização & administração , Tocologia/organização & administração , Cuidado Pré-Natal , Adulto , Atitude do Pessoal de Saúde , Etiópia/epidemiologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Recém-Nascido , Gravidez , Cuidado Pré-Natal/organização & administração , População Rural
2.
BMC Health Serv Res ; 19(1): 756, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655588

RESUMO

BACKGROUND: Village Health and Nutrition Days (VHNDs) are a cornerstone of the Government of India's strategy to provide first-contact primary health care to rural areas. Recent government programmes such as the Janani Suraksha Yojana (JSY) and Mission Indradhanush (MI) have catalysed important changes impacting VHNDs. To learn how VHNDs are currently being delivered, we assessed the fidelity of services provided as compared to government norms in a priority district of Uttar Pradesh. METHODS: We fielded a cross-sectional study of VHNDs to provide a snapshot of health services functioning. Process evaluation data were collected via administrative sources, non-participant observation using a standardised form, and structured questionnaires. Questionnaires were designed using a framework to assess implementation fidelity. Key respondents were VHND participants, front-line workers involved in VHND delivery, and VHND non-participants (pregnant women due for antenatal care or children due for vaccination as per administrative records). Results were summarised as counts, frequencies, and proportions. RESULTS: In the 30 villages randomly selected for inclusion, 36 VHNDs were scheduled but four (11.1%) were cancelled and one VHND was not surveyed. Vaccination and antenatal care were offered at 96.8% (30/31) and child weighing at 83.9% (26/31) of VHNDs. Other normed services were infrequently provided or completely absent. Health education and promotion were particularly weak; institutional delivery was the only topic discussed in a majority of VHNDs. The true proportion of any serious problem impeding vaccine delivery was 47.2% (17/36), comprising 4 VHND cancellations and 13 VHNDs experiencing vaccine shortages. Of the 13 incidents of vaccine shortage, 11 related to an unexpected global shortage of injectable polio vaccine (IPV). Over the 31 VHNDs, 37.8% (171 of the 452 scheduled beneficiaries) did not participate. Analysis of missed opportunities for vaccination highlighted inaccuracies in beneficiary identification and tracking and demand side-factors. CONCLUSIONS: The transformative potential of VHNDs to improve population health is only partially being met. A core subset of high-priority services for antenatal care, institutional delivery, and vaccination associated with high-priority government programmes (JSY, MI) is now being provided quite successfully. Other basic health promotion and prevention services are largely not provided, constituting a critical missed opportunity.


Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Serviços de Saúde Materno-Infantil/organização & administração , Serviços de Saúde Rural/organização & administração , Saúde da População Rural/estatística & dados numéricos , Adulto , Criança , Transtornos da Nutrição Infantil/epidemiologia , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Índia/epidemiologia , Masculino , Gravidez , Cuidado Pré-Natal/organização & administração , Inquéritos e Questionários , Vacinação
3.
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
4.
Artigo em Inglês | MEDLINE | ID: mdl-31500358

RESUMO

Within Canada, several specialized multi-service prevention programs work with highly vulnerable pregnant and early parenting women with substance use issues. Experiences of trauma, mental health, poverty, and other factors associated with the social determinants of health complete the picture. Program evaluations have demonstrated their value, but less has been said as to women's reasons for choosing to seek help from these programs, what they were hoping to gain, or what difference they believe has occurred as a result. The Co-creating Evidence project is a multi-year (2017-2020) national evaluation of holistic programs serving women at high risk of having an infant with prenatal alcohol or substance exposure. The evaluation uses a mixed methods design involving quarterly program output and "snapshot" client data, as well as in-person, semi-structured interviews and questionnaires with clients, program staff, and program partners. This article presents findings from interviews with women regarding why they sought help, how they used the services, and what they perceived to be the most significant change in their lives as a result. Obtaining help with substance use was the top theme for what women hoped to get from their participation in their program; however, women's reasons were often intertwined. Additional motivations included wanting information, support or assistance with: child welfare; pregnancy; housing; getting connected to health care or prenatal care; and opportunities for peer support. With respect to the most significant life change, themes included: reduced substance use; improved housing; stronger mother-child connection; and improved wellness and social connections. Findings demonstrated that vulnerable, marginalized pregnant and parenting women who are using substances will seek help when health and social care services are configured in such a way as to take into consideration and address their unique roles, responsibilities, and realities.


Assuntos
Poder Familiar/psicologia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Alcoolismo/terapia , Canadá , Feminino , Habitação , Humanos , Motivação , Gravidez , Avaliação de Programas e Projetos de Saúde
5.
BMC Health Serv Res ; 19(1): 538, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370854

RESUMO

BACKGROUND: Antenatal care (ANC) provides a range of critical health services during pregnancy that can improve maternal and neonatal health outcomes. In Mozambique, only half of women receive four or more ANC visits, which are provided for free at public health centers by maternal and child health (MCH) nurses. Waiting time has been shown to contribute to negative client experiences, which may be a driver of low maternity care utilization. A recent pilot study of a program to schedule ANC visits demonstrated that scheduling care reduces waiting time and results in higher rates of complete ANC. This study aims to explore client experiences with waiting time for ANC in standard practice and care and after the introduction of appointment scheduling. METHODS: This study uses a series of qualitative interviews to unpack client experiences with ANC waiting time with and without scheduled care, in order to better understand the impact of waiting time on client experiences. Thirty-eight interviews were collected in May to June 2017 at three pilot study clinics in southern Mozambique, with a focus on two paired intervention and comparison facilities sharing similar facility characteristics. Data were analyzed using inductive thematic analysis methods using NVivo software. RESULTS: Clients described strong motivations to seek ANC, pointing to the need to address convenience of care, and highlighted direct and indirect costs of seeking care that were exacerbated by long waiting times. Direct costs include time and transport costs of going to the clinic, while indirect costs include being unable to fulfill household and work obligations. Other barriers to complete ANC utilization of four or more visits include transport costs, negative provider experiences, and delayed ANC initiation, which limit the potential number of clinic contacts. CONCLUSIONS: Findings demonstrate that the scheduling intervention improves the client experience of seeking care by allowing women to both seek ANC and fulfill other productive obligations. Innovation in healthcare delivery should consider adapting models that minimize waiting times.


Assuntos
Atitude Frente a Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cuidado Pré-Natal/organização & administração , Listas de Espera , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Moçambique , Projetos Piloto , Gravidez , Pesquisa Qualitativa , Adulto Jovem
6.
Reprod Health ; 16(1): 100, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291968

RESUMO

BACKGROUND: Appropriate antenatal care improves pregnancy outcomes. Routine antenatal care is provided at primary care facilities in rural India and women at-risk of poor outcomes are referred to advanced centres in cities. The primary care facilities include Sub-health centres, Primary health centres, and Community health centres, in ascending order of level of obstetric care provided. The latter two should provide basic and comprehensive obstetric care, respectively, but they provide only partial services. In such scenario, the management and referrals during pregnancy are less understood. This study assessed rural providers' perspectives on management and referrals of antenatal women with high obstetric risk, or with complications. METHODS: We surveyed 147 health care providers in primary level public health care from poor and better performing districts from two states. We assessed their knowledge, attitudes and practices regarding obstetric care, referral decisions and pre-referral treatments provided for commonly occurring obstetric high-risk conditions and complications. RESULTS: Staff had sub-optimal knowledge of, and practices for, screening common high-risk conditions and assessing complications in pregnancy. Only 31% (47/147) mentioned screening for at least 10 of the 16 common high-risk conditions and early complications of pregnancy. Only 35% (17/49) of the staff at Primary health centres, and 51% (18/35) at Community health centres, mentioned that they managed these conditions and, the remaining staff referred most of such cases early in pregnancy. The staff mentioned inability to manage childbirth of women with high-risk conditions and complications. Thus in absence of efficient referral systems and communication, it was better for these women to receive antenatal care at the advanced centres (often far) where they should deliver. There were large gaps in knowledge of emergency treatment for obstetric complications in pregnancy and pre-referral first-aid. Staff generally were low on confidence and did not have adequate resources. Nurses had limited roles in decision making. Staff desired skill building, mentoring, moral support, and motivation from senior officers. CONCLUSION: The Indian health system should improve the provision of obstetric care by standardising services at each level of health care and increasing the focus on emergency treatment for complications, appropriate decision-making for referral, and improving referral communication and staff support.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/normas , Serviços de Saúde Materna/normas , Complicações do Trabalho de Parto/prevenção & controle , Cuidado Pré-Natal/organização & administração , Qualidade da Assistência à Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Humanos , Gravidez , População Rural , Inquéritos e Questionários
7.
PLoS One ; 14(7): e0218163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31260473

RESUMO

BACKGROUND: Over the past 15 years, scaling up of cost effective interventions resulted in a remarkable decline of under-five mortality rates (U5MR) in sub-Saharan Africa. However, the reduction shows considerable heterogeneity. We estimated the association of child, maternal, and household interventions with U5MR in Burkina Faso at national and subnational levels and identified the regions with least effective interventions. METHODS: Data on health-related interventions and U5MR were extracted from the Burkina Faso Demographic and Health Survey (DHS) 2010. Bayesian geostatistical proportional hazards models with a Weibull baseline hazard were fitted on the mortality outcome. Spatially varying coefficients were considered to assess the geographical variation in the association of the health interventions with U5MR. The analyses were adjusted for child, maternal, and household characteristics, as well as climatic and environmental factors. FINDINGS: The average U5MR was as high as 128 per 1000 ranging from 81 (region of Centre-Est) to 223 (region of Sahel). At national level, DPT3 immunization and baby post-natal check within 24 hours after birth had the most important association with U5MR (hazard rates ratio (HRR) = 0.89, 95% Bayesian credible interval (BCI): 0.86-0.98 and HRR = 0.89, 95% BCI: 0.86-0.92, respectively). At sub-national level, the most effective interventions are the skilled birth attendance, and improved drinking water, followed by baby post-natal check within 24 hours after birth, vitamin A supplementation, antenatal care visit and all-antigens immunization (including BCG, Polio3, DPT3, and measles immunization). Centre-Est, Sahel, and Sud-Ouest were the regions with the highest number of effective interventions. There was no intervention that had a statistically important association with child survival in the region of Hauts Bassins. INTERPRETATION: The geographical variation in the magnitude and statistical importance of the association between health interventions and U5MR raises the need to deliver and reinforce health interventions at a more granular level. Priority interventions are DPT3 immunization, skilled birth attendance, baby post-natal visits in the regions of Sud-Ouest, Sahel, and Hauts Bassins, respectively. Our methodology could be applied to other national surveys, as it allows an incisive, data-driven and specific decision-making approach to optimize the allocation of health interventions at subnational level.


Assuntos
Mortalidade da Criança/tendências , Controle de Doenças Transmissíveis/estatística & dados numéricos , Doenças Transmissíveis/mortalidade , Assistência à Saúde/organização & administração , Mortalidade Infantil/tendências , Cuidado Pré-Natal/organização & administração , Adolescente , Adulto , Teorema de Bayes , Burkina Faso/epidemiologia , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/epidemiologia , Assistência à Saúde/economia , Parto Obstétrico/estatística & dados numéricos , Água Potável/análise , Características da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Vacinação em Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Modelos de Riscos Proporcionais , Saneamento/métodos , Saneamento/estatística & dados numéricos , Fatores Socioeconômicos , Vitamina A/administração & dosagem
8.
Glob Health Action ; 12(1): 1630100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31290377

RESUMO

Background: HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved. Objective: To obtain insights into the attitudes of HCPs in the context of HIV and PMTCT-related care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa. Methods: A qualitative study was conducted in a public tertiary-level hospital. Fourteen semi-structured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward. Results: HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child's health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs. Conclusion: We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Fatores Etários , Emigrantes e Imigrantes/psicologia , Feminino , Grupos Focais , Humanos , Lactente , Entrevistas como Assunto , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pós-Natal/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração , Relações Profissional-Paciente , Pesquisa Qualitativa , África do Sul , Adulto Jovem
9.
Implement Sci ; 14(1): 64, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215450

RESUMO

BACKGROUND: In addition to their more traditional clinical role, midwives are expected to perform various health promotion practice behaviours (HePPBes) such as informing pregnant women about the benefits of physical activity during pregnancy and asking women about their alcohol consumption. There is evidence to suggest several barriers exist to performing HePPBes. The aim of the study was to investigate the barriers and facilitators midwives perceive to undertaking HePPBes. METHODS: The research compromised of two studies. Study 1: midwives based in a community setting (N = 11) took part in semi-structured interviews underpinned by the theoretical domains framework (TDF). Interviews were analysed using a direct content analysis approach to identify important barriers or facilitators to undertaking HePPBes. Study 2: midwives (N = 505) completed an online questionnaire assessing views on their HePPBes including free text responses (n = 61) which were coded into TDF domains. Study 2 confirmed and supplemented the barriers and facilitators identified in study 1. RESULTS: Midwives' perceived a multitude of barriers and facilitators to carrying out HePPBes. Key barriers were requirements to perform an increasing amount of HePPBes on top of existing clinical work load, midwives' cognitive resources, the quality of relationships with pregnant women, a lack of continuity of care and difficulty accessing appropriate training. Key facilitators included midwives' motivation to support pregnant women to address their health. Study 1 highlighted strategies that midwives use to overcome the barriers they face in carrying out their HePPBes. CONCLUSIONS: Despite high levels of motivation to carry out their health promotion practice, midwives perceive numerous barriers to carrying out these tasks in a timely and effective manner. Interventions that support midwives by addressing key barriers and facilitators to help pregnant women address their health behaviours are urgently needed.


Assuntos
Consumo de Bebidas Alcoólicas , Exercício , Promoção da Saúde/organização & administração , Tocologia , Cuidado Pré-Natal/organização & administração , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Escócia , Inquéritos e Questionários
10.
Reprod Health ; 16(1): 90, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248425

RESUMO

BACKGROUND: The Preterm Birth Initiative-Rwanda is conducting a 36-cluster randomized controlled trial of group antenatal and postnatal care. In the context of this trial, we collected qualitative data before and after implementation. The purpose was two-fold. First, to inform the design of the group care program before implementation and second, to document women's experiences of group care at the mid-point of the trial to make ongoing programmatic adjustments and improvements. METHODS: We completed 8 focus group discussions among women of reproductive age before group care implementation and 6 focus group discussions among women who participated in group antenatal care and/or postnatal care at 18 health centers that introduced the model, approximately 9 months after implementation. RESULTS: Before implementation, focus group participants reported both enthusiasm for the potential for support and insight from a group of peers and concern about the risk of sharing private information with peers who may judge, mock, or gossip. After implementation, group care participants reported benefits including increased knowledge, peer support, and more satisfying relationships with providers. When asked about barriers to group care participation, none of them cited concern about privacy but instead cited lack of financial resources, lack of cooperation from a male partner, and long distances to the health center. Finally, women stated that the group care experience would be improved if all participants and providers arrived on time and remained focused on the group care visit throughout. DISCUSSION: These results are consistent with other published reports of women's perceptions of group antenatal care, especially increased pregnancy- and parenting-related knowledge, peer support, and improved relationships with health care providers. Some results were unexpected, especially the consequences of staff allocation patterns that resulted in providers arriving late for group visits or having to leave during group visits to attend to other facility services, which diminished women's experiences of care. CONCLUSION: Group antenatal and postnatal care provide compelling benefits to women and families. If the model requires the addition of human resources at the health center, intensive reminder communications, and large-scale community outreach to benefit the largest number of pregnant and postnatal mothers, those additional resources required must be factored into any future decision to scale a group care model. TRIAL REGISTRATION: This trial is registered at clinicaltrials.gov as NCT03154177 .


Assuntos
Grupos Focais , Pessoal de Saúde/psicologia , Implementação de Plano de Saúde/estatística & dados numéricos , Planejamento em Saúde/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/organização & administração , Mulheres/psicologia , Adolescente , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gravidez , Pesquisa Qualitativa , Ruanda , Mulheres/educação , Adulto Jovem
11.
Rev Gaucha Enferm ; 40: e20180233, 2019 Jun 06.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31188973

RESUMO

OBJECTIVE: To analyze the repercussions of using the Birth Plan in the parturition process from the national and international scientific production. METHODS: Integrative literature review performed in the LILACS, PUBMED, CINAHL and SciELO, comprising 13 articles published in English, Spanish and Portuguese, in the period from 2008 through 2018. RESULTS: The construction of the Birth Plan during prenatal influences positively the process of parturition and maternal-fetal outcomes. Unrealistic expectations can cause dissatisfaction with the experience of childbirth. Care providers play a central role in supporting its planning and fulfillment. CONCLUSIONS: The analyzed publications justify the clinical implementation of the Birth Plan, once it represents an intensifying technology of humanized care and maternal satisfaction. There are still some challenges related to the use of this instrument concerning women's adherence and professional support to improve the fulfillment of the Birth Plans.


Assuntos
Parto Obstétrico , Parto , Preferência do Paciente , Autonomia Pessoal , Cuidado Pré-Natal/organização & administração , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Medicina Baseada em Evidências , Feminino , Humanos , Medicalização , Parto/psicologia , Satisfação Pessoal , Gravidez , Cuidado Pré-Natal/psicologia , Pesquisa Qualitativa
12.
Health Policy Plan ; 34(4): 307-315, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31155655

RESUMO

Mobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients' perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.


Assuntos
Agentes Comunitários de Saúde , Cuidado Pré-Natal/métodos , Smartphone , Telemedicina/métodos , Adolescente , Adulto , Aconselhamento/métodos , Aconselhamento/organização & administração , Feminino , Humanos , Pessoa de Meia-Idade , Enfermeiras Obstétricas , Enfermeiras e Enfermeiros , Gravidez , Cuidado Pré-Natal/organização & administração , População Rural , Tanzânia , Telemedicina/normas
13.
Cochrane Database Syst Rev ; 6: CD012392, 2019 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-31194903

RESUMO

BACKGROUND: Antenatal care (ANC) is a core component of maternity care. However, both quality of care provision and rates of attendance vary widely between and within countries. Qualitative research can assess factors underlying variation, including acceptability, feasibility, and the values and beliefs that frame provision and uptake of ANC programmes.This synthesis links to the Cochrane Reviews of the effectiveness of different antenatal models of care. It was designed to inform the World Health Organization guidelines for a positive pregnancy experience and to provide insights for the design and implementation of improved antenatal care in the future. OBJECTIVES: To identify, appraise, and synthesise qualitative studies exploring:· Women's views and experiences of attending ANC; and factors influencing the uptake of ANC arising from women's accounts;· Healthcare providers' views and experiences of providing ANC; and factors influencing the provision of ANC arising from the accounts of healthcare providers. SEARCH METHODS: To find primary studies we searched MEDLINE, Ovid; Embase, Ovid; CINAHL, EbscoHost; PsycINFO, EbscoHost; AMED, EbscoHost; LILACS, VHL; and African Journals Online (AJOL) from January 2000 to February 2019. We handsearched reference lists of included papers and checked the contents pages of 50 relevant journals through Zetoc alerts received during the searching phase. SELECTION CRITERIA: We included studies that used qualitative methodology and that met our quality threshold; that explored the views and experiences of routine ANC among healthy, pregnant and postnatal women or among healthcare providers offering this care, including doctors, midwives, nurses, lay health workers and traditional birth attendants; and that took place in any setting where ANC was provided.We excluded studies of ANC programmes designed for women with specific complications. We also excluded studies of programmes that focused solely on antenatal education. DATA COLLECTION AND ANALYSIS: Two authors undertook data extraction, logged study characteristics, and assessed study quality. We used meta-ethnographic and Framework techniques to code and categorise study data. We developed findings from the data and presented these in a 'Summary of Qualitative Findings' (SoQF) table. We assessed confidence in each finding using GRADE-CERQual. We used these findings to generate higher-level explanatory thematic domains. We then developed two lines of argument syntheses, one from service user data, and one from healthcare provider data. In addition, we mapped the findings to relevant Cochrane effectiveness reviews to assess how far review authors had taken account of behavioural and organisational factors in the design and implementation of the interventions they tested. We also translated the findings into logic models to explain full, partial and no uptake of ANC, using the theory of planned behaviour. MAIN RESULTS: We include 85 studies in our synthesis. Forty-six studies explored the views and experiences of healthy pregnant or postnatal women, 17 studies explored the views and experiences of healthcare providers and 22 studies incorporated the views of both women and healthcare providers. The studies took place in 41 countries, including eight high-income countries, 18 middle-income countries and 15 low-income countries, in rural, urban and semi-urban locations. We developed 52 findings in total and organised these into three thematic domains: socio-cultural context (11 findings, five moderate- or high-confidence); service design and provision (24 findings, 15 moderate- or high-confidence); and what matters to women and staff (17 findings, 11 moderate- or high-confidence) The third domain was sub-divided into two conceptual areas; personalised supportive care, and information and safety. We also developed two lines of argument, using high- or moderate-confidence findings:For women, initial or continued use of ANC depends on a perception that doing so will be a positive experience. This is a result of the provision of good-quality local services that are not dependent on the payment of informal fees and that include continuity of care that is authentically personalised, kind, caring, supportive, culturally sensitive, flexible, and respectful of women's need for privacy, and that allow staff to take the time needed to provide relevant support, information and clinical safety for the woman and the baby, as and when they need it. Women's perceptions of the value of ANC depend on their general beliefs about pregnancy as a healthy or a risky state, and on their reaction to being pregnant, as well as on local socio-cultural norms relating to the advantages or otherwise of antenatal care for healthy pregnancies, and for those with complications. Whether they continue to use ANC or not depends on their experience of ANC design and provision when they access it for the first time.The capacity of healthcare providers to deliver the kind of high-quality, relationship-based, locally accessible ANC that is likely to facilitate access by women depends on the provision of sufficient resources and staffing as well as the time to provide flexible personalised, private appointments that are not overloaded with organisational tasks. Such provision also depends on organisational norms and values that overtly value kind, caring staff who make effective, culturally-appropriate links with local communities, who respect women's belief that pregnancy is usually a normal life event, but who can recognise and respond to complications when they arise. Healthcare providers also require sufficient training and education to do their job well, as well as an adequate salary, so that they do not need to demand extra informal funds from women and families, to supplement their income, or to fund essential supplies. AUTHORS' CONCLUSIONS: This review has identified key barriers and facilitators to the uptake (or not) of ANC services by pregnant women, and in the provision (or not) of good-quality ANC by healthcare providers. It complements existing effectiveness reviews of models of ANC provision and adds essential insights into why a particular type of ANC provided in specific local contexts may or may not be acceptable, accessible, or valued by some pregnant women and their families/communities. Those providing and funding services should consider the three thematic domains identified by the review as a basis for service development and improvement. Such developments should include pregnant and postnatal women, community members and other relevant stakeholders.


Assuntos
Pessoal de Saúde , Acesso aos Serviços de Saúde , Gestantes , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde , Atitude do Pessoal de Saúde , Cultura , Países Desenvolvidos , Países em Desenvolvimento , Feminino , Fraude , Custos de Cuidados de Saúde , Ambiente de Instituições de Saúde , Pessoal de Saúde/psicologia , Humanos , Admissão e Escalonamento de Pessoal , Período Pós-Parto , Gravidez , Gestantes/psicologia , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/organização & administração , Pesquisa Qualitativa , Fatores Sexuais
14.
Int J Gynaecol Obstet ; 146(1): 126-131, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31058318

RESUMO

After the declaration of the Millennium Development Goals in 2000 by the United Nations, many stakeholders allocated financial resources to "global maternal health." Research to expand care and improve delivery of maternal health services has exponentially increased. The present article highlights an overview, namely 10 of the health system, clinical, and technology-based advancements that have occurred in the past three decades in the field of global maternal health. The list of topics has been selected through the cumulative clinical and public health expertise of the authors and is certainly not exhaustive. Rather, the list is intended to provide a mapping of key topics arranged from broad to specific that span from the global policy level to the level of individual care. The list of health system, clinical, and technology-based advancements include: (10) Millennium Development Goals and Sustainable Development Goals; (9) Development of clinical training programs, including the potential for subspecialty development; (8) Prenatal care expansion and potential; (7) Decentralized health systems, including the use of skilled birth attendants; (6) Antiretroviral therapy for HIV; (5) Essential medicines; (4) Vaccines; (3) mHealth/eHealth; (2) Ultrasonography; and (1) Obstetric hemorrhage management. With the Sustainable Development Goals now underway, the field must build upon past successes to sustain maternal and neonatal well-being in the future global health agenda.


Assuntos
Saúde Global/normas , Saúde Materna/normas , Cuidado Pré-Natal/organização & administração , Feminino , Humanos , Mortalidade Materna , Tocologia/organização & administração , Mortalidade Perinatal , Gravidez , Desenvolvimento Sustentável , Nações Unidas
15.
J Clin Nurs ; 28(17-18): 3330-3338, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31091340

RESUMO

AIMS AND OBJECTIVES: To explore expectant and new parents' reasons not to participate in parental education (PE) groups in antenatal care or child health care. BACKGROUND: In Sweden, expectant and new parents are offered PE groups in antenatal care and in child health care. Although many parents feel unprepared for parenthood, an urgent task is to attract parents to attend the PE groups. DESIGN: A total of 915 parents with children aged 0 to 21 months answered a web questionnaire with open questions about (a) reasons not to participate; (b) anything that could change their mind; and (c) parenting support instead of PE groups. This was analysed using content analysis. The study follows the SRQR guidelines. RESULTS: Parents expressed private reasons for not attending PE groups. Some parents also asked for more heterogeneity regarding content and methods, as well as accommodation of parents' different interests. Other parents asked for like-minded individuals who were in similar situation to themselves. Lack of information or invitations from antenatal care or child health care, or that PE groups were unavailable, were additional reasons for not participating in groups. CONCLUSIONS: Reasons for not attending PE groups were multifaceted from personal, self-interested and norm-critical reasons, to that the groups were not available or that the parents were not aware of their existence. RELEVANCE TO CLINICAL PRACTICE: Parents of today are a diverse group with different interests and needs. Nevertheless, all parents need to feel included in a way that makes participation in PE groups relevant for them. Thus, it is important for leaders to be aware of structures and norms, and to be able to create a group climate and a pedagogy of acceptance where group members value each other's differences. However, to attract parents to participate in PE groups, it is necessary for clinical practice to work on individual, group and organisational levels.


Assuntos
Poder Familiar/psicologia , Pais/educação , Cuidado Pré-Natal/psicologia , Atitude Frente a Saúde , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pais/psicologia , Gravidez , Cuidado Pré-Natal/organização & administração , Pesquisa Qualitativa , Inquéritos e Questionários , Suécia
16.
Ann Intern Med ; 170(9_Suppl): S62-S69, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31060059

RESUMO

Background: Studies show that patients want to engage in cost-of-care conversations and factor costs into the formulation of care plans. Low-income patients are particularly likely to defer care because of costs, suggesting that cost-of-care conversations may be an important factor in health equity. Little guidance is available to clinicians and health systems for how to integrate effective cost-of-care conversations into clinical practice or to address specific cost needs of low-income patients. Objective: To develop a framework and tool to assist cost-of-care conversations with low-income patients during prenatal care. Design: A qualitative study using human-centered design methods. Setting: University medical center-based obstetrics-gynecology (ob-gyn) practice. Participants: 20 pregnant or recently postpartum women, 16 clinicians, and 8 support and executive staff. Results: Pregnant women accumulate substantial indirect costs that interfere with treatment adherence and stress patients and their relationships. Frequency and duration of appointments are primary drivers of indirect costs; the burden is exacerbated by not knowing these costs in advance and disproportionately affects low-income patients. Working with ob-gyn clinicians, staff, and patients, a paper-based tool was developed to help patients forecast treatment demands and indirect costs, and to help clinicians introduce and standardize cost conversations. Limitations: Data were collected from a small number of stakeholders in a single clinical setting that may not be generalizable to other settings. The tool has not been tested for effects on adherence or clinical outcomes. Conclusion: A communication tool that helps pregnant patients understand their care plan and anticipate indirect costs can promote cost-of-care conversations between clinicians and low-income patients. Primary Funding Source: Robert Wood Johnson Foundation.


Assuntos
Comunicação , Gastos em Saúde , Relações Médico-Paciente , Pobreza , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/organização & administração , Feminino , Humanos , Visita a Consultório Médico/economia , Gravidez , Pesquisa Qualitativa , Participação dos Interessados , Estados Unidos
18.
Clin Lab ; 65(4)2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30969067

RESUMO

BACKGROUND: Anemia, particularly pregnancy related iron deficiency anemia, increases the risk of maternal morbidity and mortality and the effects are more devastating in less developed and developing continents where pregnant women have low socioeconomic status. Thus, this study aimed to assess the prevalence and associated factors of anemia and iron deficiency anemia among pregnant women. METHODS: This institution based, cross-sectional study was conducted from January 1 to April 30, 2015 on a total of 217 pregnant women attending at University of Gondar Hospital, Northwest Ethiopia. A structured, pretested questionnaire was used to obtain sociodemographic information, nutritional factors, obstetrics and gynecological factors, and clinical condition. About 3 mL blood sample was collected for hemoglobin and serum ferritin deter-mination. Hgb concentrations and other RBC parameters were analyzed using a Cell Dyne 1800 hematology analyzer. Serum ferritin was measured by an automated Elecsys 1,020 using commercial kits. The data was entered to Epi info version 3.5.3 software and analyzed using SPSS 20. Frequency, proportion, and summery statistics was used to describe the study population in relation to study variables. Bi-variable and multi-variable statistical analysis was used. P-value < 0.05 was considered as statically significant. RESULTS: Out of 217 women enrolled in the study, 28 (12.9%) were found to be anemic with 75% mild, 21.4% moderate and 3.6% severe type of anemia. Anemia was more prevalent in the first (21%) and third (17.9%) trimesters. The overall prevalence of iron deficiency anemia was 3.2% (7/217) while from anemic pregnant women one fourth (25%) of them developed iron deficiency anemia. CONCLUSIONS: The overall prevalence of anemia was low and it was considered a mild public health problem. In this study, there were no statistically associated risk factors for anemia. Based on this finding, iron supplementation should be encouraged as a prophylactic measure.


Assuntos
Anemia Ferropriva/epidemiologia , Anemia/epidemiologia , Complicações Hematológicas na Gravidez/epidemiologia , Cuidado Pré-Natal/organização & administração , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Ferritinas/sangue , Hemoglobinas/análise , Humanos , Análise Multivariada , Pobreza , Gravidez , Prevalência , Controle de Qualidade , Risco , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
19.
Bull World Health Organ ; 97(3): 200-212, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30992633

RESUMO

Objective: To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania. Methods: We summarized national PMTCT policies and WHO guidance for 15 indicators across the cascades of maternal and infant care over 2013-2016. Two survey rounds were conducted (2013-2015 and 2015-2016) in 46 health facilities serving five health and demographic surveillance system populations. We administered structured questionnaires to facility managers to describe service delivery. We report the proportions of facilities implementing each indicator and the frequency and durations of stock-outs of supplies, by site and survey round. Findings: In all countries, national policies influencing the maternal and infant PMTCT cascade of care aligned with WHO guidelines by 2016; most inter-country policy variations concerned linkage to routine HIV care. The proportion of facilities delivering post-test counselling, same-day antiretroviral therapy (ART) initiation, antenatal care and ART provision in the same building, and Option B+ increased or remained at 100% in all sites. Progress in implementing policies on infant diagnosis and treatment varied across sites. Stock-outs of HIV test kits or antiretroviral drugs in the past year declined overall, but were reported by at least one facility per site in both rounds. Conclusion: Progress has been made in implementing PMTCT policy in these settings. However, persistent gaps across the infant cascade of care and supply-chain challenges, risk undermining infant HIV elimination goals.


Assuntos
Antirretrovirais/administração & dosagem , Aconselhamento/organização & administração , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Organização Mundial da Saúde , África ao Sul do Saara/epidemiologia , Feminino , Saúde Global , Guias como Assunto , Humanos , Lactente , Cuidado do Lactente/métodos , Recém-Nascido , Cuidado Pré-Natal/organização & administração , Vigilância em Saúde Pública , Fatores Socioeconômicos
20.
BMC Health Serv Res ; 19(1): 166, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871523

RESUMO

BACKGROUND: Nepal formulated a range of policies related to maternal and neonatal survival, especially after the year 2000. Nevertheless, Nepal's perinatal mortality remains high, particularly in disadvantaged regions. Policy analysis can uncover the underlying values, strategies and policy formulation processes that shape the potential to reduce in-country health inequities. This paper provides a critical account of the main policy documents relevant to perinatal survival in Nepal. METHODS: Six key policy documents covering the period 2000-2015 were reviewed using an adapted framework and were analyzed through qualitative content analysis. RESULTS: The analysis shows that the policies focused mainly on the system: improvement in provision of birthing facilities; targeting staff (Skilled Birth Attendants) and health service users by providing cash incentives to staff for bringing patients to services, and to users (pregnant women) to attend health institutions. Despite a growing focus on saving women and newborn babies, there is a poor policy focus and direction on preventing stillbirth. The policy documents were found to emphasize tensions between birthing at home and at health institutions on the one hand, and between strategies to provide culturally appropriate, woman-centered care in communities and medically orientated services on the other. Policies acknowledge the need to provide and address woman-centered care, equity, social inclusion, and a rights-based approach, and identify the community based approach as the mode of service delivery. Over and above this, all policy documents are aimed at the national level, and there is no specific policy direction for the separate ecological, cultural or geographic regions such as the mountainous region, which continues to exhibit higher mortality rates and has different cultural and demographic characteristics to the rest of Nepal. CONCLUSIONS: To better address the continuing high perinatal mortality rates, particularly in disadvantaged areas, national health policies should pay more attention to the inequity in healthcare access and in perinatal outcomes by integrating both stillbirth prevention and neonatal survival as policy agenda items. To ensure effective translation of policy into practice, it is imperative to tailor the strategies according to acknowledged policy values such as rights, inclusion and socio-cultural identity.


Assuntos
Assistência à Saúde Culturalmente Competente/organização & administração , Assistência Perinatal/organização & administração , Cuidado Pré-Natal/organização & administração , Feminino , Política de Saúde , Acesso aos Serviços de Saúde/organização & administração , Humanos , Recém-Nascido , Tocologia/organização & administração , Nepal , Enfermeiras Obstétricas/provisão & distribução , Assistência Centrada no Paciente/organização & administração , Mortalidade Perinatal , Formulação de Políticas , Gravidez
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