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1.
PLoS One ; 15(1): e0228440, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999784

RESUMO

INTRODUCTION: In Nepal, a substantial proportion of women still deliver their child at home. Disparities have been observed in utilisation of institutional delivery and skilled birth attendant services. We performed a disaggregated analysis among marginalised and non-marginalised women to identify if different factors are associated with home delivery among these groups. MATERIALS AND METHODS: This study used data from the 2016 Nepal Demographic and Health Survey. It involves the analysis of 3,837 women who had experienced at least one live birth in the five years preceding the survey. Women were categorised as marginalised and non-marginalised based on ethnic group. Bivariate and multivariable logistic regression analysis were performed to identify factors associated with home delivery. RESULTS: A higher proportion of marginalised women delivered at home (47%) than non-marginalised women (26%). Compared to non-marginalised women (35%), a larger proportion of marginalised women (64%) felt that it was not necessary to give birth at health facility. The multivariable analysis indicated an independent association of having no or basic education, belonging to middle, poorer and the poorest wealth quintile, residing in Province 2 and not having completed of four antenatal care visits per protocol with home delivery among both marginalised and non-marginalised women. Whereas residing in a rural area, residing in Province 7, and at a distance of >30 minutes to a health facility were factors independently associated with home delivery only among marginalised women. CONCLUSION: We conclude that poor education, poor economic status, non-completion of four ANC visits and belonging to Province 2 particularly determined either group of women to deliver at home, whereas residing in rural areas, living far from health facility, and belonging to Province 7 determined marginalised women to deliver at home. Preventing mothers from delivering at home would thus require focusing on specific geographical areas besides considering wider socio-economic determinants.


Assuntos
Parto Domiciliar/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Marginalização Social/psicologia , Adolescente , Adulto , Parto Obstétrico/psicologia , Parto Obstétrico/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde/etnologia , Parto Domiciliar/estatística & dados numéricos , Humanos , Idade Materna , Serviços de Saúde Materna , Pessoa de Meia-Idade , Análise Multivariada , Nepal/epidemiologia , Gravidez , Cuidado Pré-Natal/psicologia , Fatores Socioeconômicos , Adulto Jovem
2.
Afr J AIDS Res ; 18(4): 332-340, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31779576

RESUMO

HIV testing rates remain stubbornly low among men - a crucial target population for reaching the ambitious global and regional goals of the HIV programme. In an era of declining donor funding, identifying cost-effective strategies to increase testing rates amongst men remains paramount. Antenatal care is an effective entry-point for the delivery of HIV testing services for women, and partner testing presents an important opportunity to reach their male partners. We present the results of a discrete choice experiment in Uganda, examining preferences among 824 pregnant women and 896 male partners regarding service delivery characteristics of HIV testing. Both men and women preferred nurse administered testing to self-testing (OR = 0.835; p < 0.001), oral testing over a finger-prick test (OR = 1.176; p < 0.001) and testing with a partner over testing alone (OR = 1.230; p < 0.001). Men had a preference for testing at home compared to testing at a clinic (OR = 1.099; p = 0.024), but women were indifferent regarding the testing location. The cost of testing had the biggest effect on preferences. Free testing was preferred over a cost of US$2.90 (OR = 0.781; p < 0.001) or US$2.00 (OR = 0.670; p < 0.001). Offering an incentive of US$3.40 increased men's preferences compared to a free test (OR = 1.168; p < 0.001), although this did not affect women's preferences. Partner testing linked to antenatal care is a potential strategy to increase testing coverage among men, particularly given the preference for partner testing - provided costs to clients remain low. Future cost-effectiveness evaluations should investigate the economic impact of reaching men using these strategies.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/psicologia , Preferência do Paciente/estatística & dados numéricos , Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Parceiros Sexuais/psicologia , Adulto , Instituições de Assistência Ambulatorial , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Gravidez , Cuidado Pré-Natal/psicologia , Uganda/epidemiologia
3.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31748253

RESUMO

BACKGROUND: Prenatal and infancy home-visiting by nurses is promoted as a means of improving maternal life-course, but evidence of long-term effects is limited. We hypothesized that nurse-visitation would lead to long-term reductions in public-benefit costs, maternal substance abuse and depression, and that cost-savings would be greater for mothers with initially higher psychological resources. METHODS: We conducted an 18-year follow-up of 618 out of 742 low-income, primarily African-American mothers with no previous live births enrolled in an randomized clinical trial of prenatal and infancy home visiting by nurses. We compared nurse-visited and control-group women for public-benefit costs, rates of substance abuse and depression, and examined possible mediators of intervention effects. RESULTS: Nurse-visited women, compared with controls, incurred $17 310 less in public benefit costs (P = .03), an effect more pronounced for women with higher psychological resources ($28 847, P = .01). These savings compare with program costs of $12 578. There were no program effects on substance abuseor depression. Nurse-visited women were more likely to be married from child age 2 through 18 (19.2% vs 14.8%, P = .04), and those with higher psychological resources had 4.64 fewer cumulative years rearing subsequent children after the birth of the first child (P = .03). Pregnancy planning was a significant mediator of program effects on public benefit costs. CONCLUSIONS: Through child age 18, the program reduced public-benefit costs, an effect more pronounced for mothers with higher psychological resources and mediated by subsequent pregnancy planning. There were no effects on maternal substance abuse and depression.


Assuntos
Serviços de Assistência Domiciliar/tendências , Visita Domiciliar/tendências , Saúde Materna/tendências , Mães , Enfermeiros de Saúde Comunitária/tendências , Cuidado Pré-Natal/tendências , Adulto , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Mães/psicologia , Pobreza/tendências , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia , Fatores de Tempo
4.
BMC Pregnancy Childbirth ; 19(1): 338, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533655

RESUMO

BACKGROUND: Pregnant women who are at risk of preterm birth are often stressed, anxious and depressed because of worries and fears related to the health of the unborn baby, their own health and uncertainty about the future. Only a few studies have assessed the types of psychological support that would relieve these stress symptoms among women with high-risk pregnancies. The aim of this study was to describe 1) how women at risk of preterm birth experienced an interactive 3/4-dimensional (3/4D) ultrasound examination, and 2) their need for psychological support during the antenatal period. METHODS: This qualitative study was conducted at one university hospital in Finland in 2017. Women with a singleton pregnancy of 26-32 gestational weeks (gwks) were included in the study. The interactive 3/4D ultrasound included a joint observation of the baby, based on the mother's wishes, with an obstetrician and psychologist. After the examination, the experiences were explored with a semi-structured interview. The data was analyzed using inductive thematic analysis. RESULTS: The women enjoyed the fact that the staff were focused on her fetus and genuinely present during the session and also enabled the women to actively participate. Watching the baby and her/his activities made the baby more concrete and relieved their concerns. The need for additional psychological support varied individually. CONCLUSIONS: Interactive ultrasound examination is an interesting way to awaken mental images, increase attachment, and reduce stress. The results imply that an interactive way of jointly looking at the fetus supports pregnant women at risk of preterm birth and may be useful in clinical practice.


Assuntos
Gravidez de Alto Risco/psicologia , Nascimento Prematuro/psicologia , Cuidado Pré-Natal , Estresse Psicológico , Ultrassonografia Pré-Natal , Adulto , Feminino , Finlândia , Idade Gestacional , Humanos , Imageamento Tridimensional , Gravidez , Gestantes/psicologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia , Pesquisa Qualitativa , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/psicologia
5.
BMC Pregnancy Childbirth ; 19(1): 340, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533657

RESUMO

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


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Gestantes , Cuidado Pré-Natal , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Gravidez não Planejada/psicologia , Gestantes/educação , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Fatores Socioeconômicos , Fatores de Tempo
6.
Afr J Prim Health Care Fam Med ; 11(1): e1-e7, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31368318

RESUMO

BACKGROUND: Men have a lot of influence on their partners' and children's health. However, studies have shown their involvement in antenatal care (ANC) and postnatal care (PNC) is relatively low owing to several factors. AIM: To explore the barriers to men's involvement in ANC and PNC in Butula sub-county, western Kenya. SETTING: Butula sub-county, Busia county, western Kenya. METHODS: A mixed methods study design, descriptive in nature, was used to collect both quantitative and qualitative data. A total of 96 men were selected to participate in the surveys. Also, four focus group discussions and four key informant interviews were conducted. RESULTS: We found out that some men still participate in ANC and PNC despite the barriers. The perception that maternal health is a women's domain and existence of alternative traditional maternal services were key cultural barriers. The men's nature of work, low income and expenses incurred at ANC/PNC clinics were significant economic barriers. The lack of services targeting men, provider attitude, non-invitation to the clinic, time spent at the clinic and lack of privacy at the clinics were key facility-based barriers. CONCLUSION: A myriad of cultural, economic and health-facility barriers hinder men from active involvement in ANC and PNC. Awareness creation among men on ANC and PNC services and creating a client-friendly environment at the clinics is key in enhancing their involvement. This should be a concerted effort of all stake holders in maternal health services, as male involvement is a strong influencer to their partners' and children's health outcomes.


Assuntos
Homens/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cuidado Pós-Natal/psicologia , Cuidado Pré-Natal/psicologia , Parceiros Sexuais/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Quênia , Masculino , Saúde Materna , Percepção , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários
7.
BMC Pregnancy Childbirth ; 19(1): 299, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419964

RESUMO

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


Assuntos
Alcoolismo/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Complicações na Gravidez/diagnóstico , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Diagnóstico Pré-Natal/psicologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/psicologia , Austrália , Feminino , Fidelidade a Diretrizes , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/psicologia , Cuidado Pré-Natal/normas , Diagnóstico Pré-Natal/normas , População Rural , Inquéritos e Questionários , Adulto Jovem
8.
Sex Reprod Healthc ; 21: 87-94, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31395239

RESUMO

BACKGROUND: Positive birth experiences lead to better postnatal functioning, and influence mode of delivery choice for subsequent pregnancies. Healthcare workers can influence the birth experience through relevant support and care. This study seeks to explore the experience of Sierra Leonean women in relation to ante-natal, intrapartum and post-partum care with special reference to their experience of caesarean section. METHODS: In November 2016, individual semi structured interviews were performed with sixteen women of varying age from different geographical areas, levels of schooling, and parity. The interviews were analysed by systematic text condensation. RESULTS: During interviews, participants mentioned a fear of dying or losing their baby. This fear was managed by praying and putting trust in a higher power. However, placing trust in healthcare workers was also described by some participants. Moreover, the present study demonstrates that women experienced a great deal of pain and discomfort after the caesarean section was performed, and that they found it difficult to return to expected activities. This was managed by a large amount of practical assistance from their social network. Healthcare workers were described as providing medicines, advice, and practical care. Negative experiences in which healthcare workers took money for medicines and refused to help women were also described. CONCLUSIONS: This study indicates that women locate resources to cope with pain and fear within themselves, while also utilising extended support from social networks and healthcare workers. This confirms that women from all backgrounds in Sierra Leone have access to resources for health and well-being.


Assuntos
Cesárea/psicologia , Cuidado Pós-Natal/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Adaptação Psicológica , Adulto , Cesárea/efeitos adversos , Medo , Feminino , Humanos , Controle Interno-Externo , Entrevistas como Assunto , Relações Enfermeiro-Paciente , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/psicologia , Relações Médico-Paciente , Gravidez , Pesquisa Qualitativa , Serra Leoa , Apoio Social
9.
Inquiry ; 56: 46958019870967, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31434525

RESUMO

We explored the particularities of the Healthy Baby Prenatal Benefit (HBPB), an unconditional cash transfer program for low-income pregnant women in Manitoba, Canada, which aims to connect recipients with prenatal care and community support programs, and help them access healthy foods during pregnancy. While previous studies have shown associations between HBPB and improved birth outcomes, here we focus on how the intervention contributed to positive outcomes. Using a case study design, we collected data from government and program documents and interviews with policy makers, academics, program staff, and recipients of HBPB. Key informants identified using evidence and aligning with government priorities as key facilitators to the implementation of HBPB. Program recipients described how HBPB helped them improve their nutrition, prepare for baby, and engage in self-care to moderate the effect of stressful life events. This study provides important contextualized evidence to support government decision making on healthy child development policies.


Assuntos
Política de Saúde , Mães/psicologia , Pobreza , Cuidado Pré-Natal/economia , Pessoal Administrativo/organização & administração , Canadá , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Cuidado Pré-Natal/psicologia , Determinantes Sociais da Saúde , Apoio Social
10.
BMC Pregnancy Childbirth ; 19(1): 310, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455264

RESUMO

BACKGROUND: Globally in 2017 neonatal death accounted for 46% of under-five deaths. Nepal is among the developing countries which has a high number of neonatal deaths. The rates are high among poor socio-economic groups, marginalized, as well as people living in remote areas of Nepal. This paper, thus tries to examine the utilization pattern and maternal, household, and health service factors affecting underprivileged ethnic groups in Midwest Nepal. METHODS: A cross-sectional mixed method study was conducted from September 2017 to April 2018 in Bardiya district. Quantitative data were collected from a household survey of women who gave live births within the last 12 months prior to data collection (n = 362). Interviews were also undertaken with 10 purposively selected key informants. Logistic regression model was used to determine the factors associated with essential neonatal care utilization. Thematic analysis was undertaken on the qualitative data. RESULTS: Overall, neonatal care utilization was 58.6% (53.3-63.7%), with big variations seen in the coverage of selected neonatal care components. Factors such as birth order (2.059, 1.13-3.75), ethnicity (2.28, 1.33-3.91), religion (2.37, 1.03-5.46), perceived quality of maternal and neonatal services (2.66, 1.61-4.39) and awareness on immediate essential newborn cares (2.22, 1.28-3.87) were identified as the determining factors of neonatal care utilization. CONCLUSIONS: The coverage of birth preparedness and complication readiness, adequate breastfeeding, and postnatal care attendance were very low as compared to the national target for each component. The determinants of essential neonatal care existed at maternal, household as well as health facility level and included ethnicity, religion, perceived quality of maternal and neonatal services, birth order and awareness on immediate essential newborn care. Appropriate birth spacing, improving the quality of maternal and neonatal services at health facilities and raising mother's level of awareness about neonatal care practices are recommended.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto , Intervalo entre Nascimentos , Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Estudos Transversais , Grupos Étnicos/psicologia , Características da Família , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Nepal , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cuidado Pós-Natal/psicologia , Gravidez , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Populações Vulneráveis/psicologia , Adulto Jovem
11.
Niger J Physiol Sci ; 34(1): 43-48, 2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31449270

RESUMO

Cognitive deficits among pregnant women have been reported, though the evidence is equivocal. Cognitive dysfunction during pregnancy may have negative consequences on maternal and child health.  Yet, very little is known about cognitive function of pregnant women in general and primi gravidae in particular in the area under study. This study aimed to evaluate cognitive function among primi gravidae. About 120 primi gravidae were studied in a large urban hospital in Kano. Mini-Mental State Examination (MMSE) was used to evaluate cognitive function; socio-demographic and clinical data were obtained. Data were processed using IBM SPSS statistics version 20.0. Significant values of P were those < 0.05. The median age of the primi gravidae was 20.0 (3) years; 80 % of them had secondary school education, 88.3 % were in their third trimester of pregnancy and 42.5 % did not have any medical complaints at the time of presentation. The median MMSE score of the primi gravidae was 22.00 (19.0), indicating mild cognitive impairment. Majority of the women (88.3%) had either mild (58.3%) or severe (30%) cognitive dysfunction. The cognitive dysfunction was influenced by level of education (X2 = 11.961, P = 0.003) and type of presenting complaints (X2 = 13.514, P = 0.036). There was significant association between the mild cognitive impairment and level of education (X2 = 11.426, P = 0.022).   This study concluded that the primi gravidae had mild cognitive impairment; with majority (88.3%) of them having cognitive dysfunction, which was significantly associated with level of educational attainment and was influenced by the level of education and presenting complaints.


Assuntos
Disfunção Cognitiva/diagnóstico , Número de Gestações , Ambulatório Hospitalar , Complicações na Gravidez/diagnóstico , Cuidado Pré-Natal/métodos , Adolescente , Adulto , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Feminino , Número de Gestações/fisiologia , Humanos , Testes de Estado Mental e Demência , Nigéria/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/psicologia , Cuidado Pré-Natal/psicologia , Adulto Jovem
12.
BJOG ; 126 Suppl 4: 50-57, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257691

RESUMO

OBJECTIVE: To assess the effectiveness of a counselling intervention in antenatal care settings for pregnant women who report domestic violence. DESIGN: Pre-experimental study with pretest-posttest design. SETTINGS: Two public hospitals in Mumbai, India. SAMPLE: In all, 2778 pregnant women accessing antenatal care (ANC) in the hospitals from February to November 2016 were approached for study participation; 2515 women consented. These women were screened by trained counsellors for domestic violence during pregnancy (domestic violence during pregnancy). Domestic violence during pregnancy was reported by 16.2% (408) of women. Of these, 155 women sought counselling services. Post-intervention analyses were carried out with 142 women at 6 weeks post-delivery; 13 women were not contactable. METHODS: The 442 women who reported domestic violence during pregnancy were provided a minimum of two counselling sessions by trained counsellors during their ANC visits. A counselling intake form was used to collect pre- and post-intervention data. MAIN OUTCOME MEASURES: Prevalence of domestic violence during pregnancy, change in women's ability to cope, safety, and health. RESULTS: Prevalence of domestic violence during pregnancy (16.1%) was comparable to those of common obstetric complications routinely screened for during ANC. In all, 60-65% women reported cognitive changes such as recognising impact of violence and need to speak out against it. In all, 50.7% women took action at the individual level to address domestic violence during pregnancy. This change was not statistically significant (P-value 0.193). Of the women studied, 35.9% adopted at least one safety measure, and 84% of the women reported better health status post-intervention. CONCLUSIONS: Routine enquiry and counselling for domestic violence during pregnancy are effective in improving women's ability to cope, safety, and health. FUNDING: This study was funded by The John D. and Catherine T. MacArthur Foundation. TWEETABLE ABSTRACT: Improving coping strategies, safety and health of pregnant women who reported domestic violence by providing counselling in antenatal care setting.


Assuntos
Aconselhamento , Violência Doméstica/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Terapia Cognitivo-Comportamental/métodos , Violência Doméstica/prevenção & controle , Violência Doméstica/estatística & dados numéricos , Família/psicologia , Feminino , Humanos , Índia/epidemiologia , Projetos Piloto , Período Pós-Parto/psicologia , Gravidez , Complicações na Gravidez/psicologia , Adulto Jovem
13.
BMC Public Health ; 19(1): 895, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286930

RESUMO

BACKGROUND: It is recommended that Antenatal Care (ANC) be initiated within the first trimester of pregnancy for essential interventions, such folic acid supplementation, to be effective. In Tanzania, only 24% of mothers attend their first ANC appointment during their first trimester. Studies have shown that women who have had contact with a health worker are more likely to attend their first antenatal care appointment earlier in pregnancy. Community health workers (CHWs) are in an opportune position to be this contact. This study explored CHW experiences with identifying women early in gestation to refer them to facility-based antenatal care services in Morogoro, Tanzania. METHODS: This qualitative study employed 10 semi-structured focus group discussions, 5 with 34 CHWs and 5 with 34 recently delivered women in three districts in Morogoro, Tanzania. A thematic analytical approach was used to identify emerging themes among the CHW and RDW responses. RESULTS: Study findings show CHWs play a major role in identifying pregnant women in their communities and linking them with health facilities. Lack of trust and other factors, however, affect early pregnancy identification by the CHWs. They utilize several methods to identify pregnant women, including: asking direct questions to households when collecting information on the national census, conducting frequent household visits and getting information about pregnant women from health facilities. CONCLUSIONS: We present a framework for the interaction of factors that affect CHWs' ability to identify pregnant women early in gestation. Further studies need to be conducted investigating optimal workload for CHWs, as well as reasons pregnant women might conceal their pregnancies.


Assuntos
Agentes Comunitários de Saúde/psicologia , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Agendamento de Consultas , Feminino , Grupos Focais , Instalações de Saúde/estatística & dados numéricos , Humanos , Gravidez , Primeiro Trimestre da Gravidez/psicologia , Pesquisa Qualitativa , Medição de Risco , Tanzânia
14.
Reprod Health ; 16(1): 99, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286965

RESUMO

BACKGROUND: In Ethiopia, socio-economic inequalities in the utilization of antenatal care (ANC) have long been an obstacle to the country's effort in achieving universal coverage of the service. The study aimed to investigate socio-economic inequalities in the use of ANC services among recently-delivered women in Debre Brehan and surrounding areas, North East Ethiopia. METHODS: A community-based survey was carried out in Debre Brehan and surrounding areas in North East Ethiopia. Two-stage cluster sampling technique was followed to recruit study participants. Data was collected using interviewer-administered structured questionnaire from a sample of 412 mothers who gave birth in the 12 months prior to the study. The socio-economic inequalities were assessed by calculating a relative concentration index. Decomposition analysis was done to explain measured inequalities. Analysis was carried out in RStudio statistical environment using the 'decomp' package. RESULTS: The first ANC attendance has slight pro-poor concentration, with a relative concentration index of-0.128, and 95%CI -0.175, - 0.082.Socio-Economic Status (SES) of a household, educational level and occupation of a woman and her husband were the most important contributors to the measured inequality in ANC attendance. We found no SES-based inequality in the attendance of four or more ANC visits between the poor and rich. CONCLUSIONS: Attendance of the first ANC visit appeared to be slightly concentrated among women in the lower end of SES. The utilization of at least four ANC visits was found to be similar among the poor and rich. Population-based interventions that target all socio-economic groups are recommended to accelerate universal coverage of these process indicators.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Adulto , Etiópia , Feminino , Humanos , Mães/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/psicologia , População Rural , Inquéritos e Questionários , Adulto Jovem
15.
Nurs Womens Health ; 23(4): 351-356, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276629

RESUMO

This qualitative case study tells the story of one woman's experience of prenatal care through her own words and those of her mother, who is a nurse. Frequent sonograms, referral to a maternal-fetal medicine physician, and the unexpected recommendation to schedule an induction made this woman anxious about the well-being of her fetus, influenced her experience of pregnancy, and affected her developing identity as a mother. She felt neither cared for nor included as a partner in her own prenatal care. Although she reported feeling strong and capable in every other aspect of her life, she felt powerless to self-advocate with regard to her prenatal care experience. Ultimately, she asked her mother to accompany her to a prenatal appointment to advocate on her behalf.


Assuntos
Percepção , Gestantes/psicologia , Cuidado Pré-Natal/normas , Adulto , Feminino , Humanos , Trabalho de Parto/psicologia , Satisfação do Paciente , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia
16.
BMC Pregnancy Childbirth ; 19(1): 270, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357939

RESUMO

BACKGROUND: Postpartum depression (PPD) complicates maternal wellbeing, maternal-infant bonding, and cognitive function in children and woman's relationship with her partner. Clinical observations suggest a higher risk of postpartum depression among those women with pre-eclampsia and eclampsia compared to the general population. However, the evidence is inconsistent and not from settings similar to Tanzanian. This study aimed to determine the magnitude and risk factors for PPD among women diagnosed with pre-eclampsia or eclampsia at Muhimbili National Hospital (MNH), Tanzania. METHODS: This cross-sectional study was conducted among 390 women who had pre-eclampsia or eclampsia during pregnancy attending postnatal care clinic at MNH. PPD was assessed using Edinburg postnatal depression scoring scale (EPDS). Face to face interviews was conducted and data was analysed using descriptive and logistic regression analysis to address the two respective objectives. RESULTS: PPD was prevalent among 20.5% of women who had pre-eclampsia or eclampsia but varied with severity. Factors associated with PPD included young age (AOR = 10.13 95% CI 1.99-52.02), being a single mother (AOR = 3.18 95% CI 1.02-9.95), having a lower level of education (AOR = 3.83 95% CI 1.45-10.16), having a perinatal death (AOR = 5.14 95% CI 2.53-10.45), lack of family support (AOR = 7.06 95% CI 1.25-39.90), and experience of stressful event during pregnancy (AOR = 15.14 95% CI 2.38-96.19). CONCLUSION: One in five women with pre-eclampsia or eclampsia had PPD and the magnitude increased with the severity of the disease condition. To address PPD, efforts should be done to screen and provide treatment to pregnant women presenting with pre-eclampsia or eclampsia, especially those with young age, low education level, single marital status, perinatal loss, lack of family support, and those reported to have a stressful event during pregnancy.


Assuntos
Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/psicologia , Cuidado Pré-Natal/psicologia , Índice de Gravidade de Doença , Fatores Etários , Estudos Transversais , Feminino , Humanos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Fatores de Risco , Tanzânia/epidemiologia , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-31324060

RESUMO

South Sudan has a high maternal mortality ratio estimated at 800 deaths per 100,000 live births. Birth in health facilities with skilled attendants can lower this mortality. In this cross-sectional study, we determined the level and determinants of health facility utilization and skilled birth attendance in Jubek State, South Sudan. Mothers of children aged less than two years were interviewed in their homes. Multivariable regression analysis was performed to determine factors associated with health facility births. Only a quarter of the mothers had given birth at health facilities, 209/810 (25.8%; 95% CI 18.2-35.3) and 207/810 had a skilled birth attendant (defined as either nurse, midwife, clinical officer, or doctor). Factors positively associated with health facility births were four or more antenatal visits (adjusted odds ratio (AOR) 19; 95% CI 6.2, 61), secondary or higher education (AOR 7.9; 95% CI 3, 21), high socio-economic status (AOR 4.5; 95% CI 2.2, 9.4), and being primipara (AOR 2.9; 95% CI 1.5, 5.4). These findings highlight the need for efforts to increase health facility births in South Sudan.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Razão de Chances , Gravidez , Fatores Socioeconômicos , Sudão do Sul , Adulto Jovem
18.
BMC Pregnancy Childbirth ; 19(1): 260, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337348

RESUMO

BACKGROUND: Despite the many maternal healthcare policy programmes in Ghana such as free the antenatal care (ANC) and the fee-exemption policy under the National Health Insurance Scheme, among others, the country has yet to make substantial improvements in addressing low skilled care utilisation in pregnancy and delivery. From previous studies, maternal mortality has been linked to women's healthcare decision-making power at the household level in many low and middle-income countries. Thus, a pregnant women's ability to choose a healthcare provider, act on her preferences, and to be sufficiently financially empowered to take the lead in deciding on reproductive and pregnancy care has significant effects on service utilisation outcomes. Therefore, we explored rural community-level barriers to seeking care related to obstetric complications and delivery from the perspectives of mothers, youth, opinion leaders and healthcare providers in Nadowli-Kaleo and Daffiama-Bussie-Issa districts in the Upper West Region of Ghana. METHODS: This exploratory qualitative study was based on the narratives of women, health providers and community stakeholders regarding the expectant women's autonomy to decide and utilise maternal care. To achieve maximal diversity of responses, purposive sampling procedures were followed in selecting 16 health professionals, three traditional birth attendants and 240 community members (opinion leaders, youth and non-pregnant women) who participated in individual depth interviews and focus group discussions. RESULTS: Women's lack of autonomy to seek care without prior permission, perceived quality care of traditional birth attendants, stigmatisation of unplanned pregnancies and cultural beliefs associated with late disclosure of childbirth labour all delayed mothers timely use of skilled care in the study communities. These barriers compounded problems arising from communities that are geographically isolated from hospital care. CONCLUSIONS: Decisions about seeking maternal care were usually made by the expectant woman's husband and family without providing adequate support to pregnant women during the latter stages of pregnancy and delivery. We conclude that this is primarily a cultural issue. The study recommends a change in the approach to community-level health education campaigns for maximum impacts through the increased involvement of men and families in health service delivery and utilisation.


Assuntos
Ansiedade/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , População Rural/estatística & dados numéricos , Adulto , Tomada de Decisões , Feminino , Gana , Humanos , Masculino , Saúde Materna/estatística & dados numéricos , Mães , Gravidez , Cuidado Pré-Natal/psicologia , Pesquisa Qualitativa
19.
Nurs Womens Health ; 23(4): 299-308, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31251934

RESUMO

OBJECTIVE: To evaluate the information that women with low-risk pregnancies received during the prenatal period about latent labor and the early-labor lounge (ELL) and their subsequent use of the ELL. DESIGN: Cross-sectional design with survey. SETTING/LOCAL PROBLEM: Community hospital in the northeastern United States with a low-risk cesarean birth rate of 33%, which exceeds the national target rate of 23.9%. PARTICIPANTS: Low-risk, nulliparous, pregnant women with a term singleton vertex fetus at hospital admission (N = 67). INTERVENTION/MEASUREMENTS: An electronic survey was administered before hospital discharge following birth. The survey assessed prenatal education, use of the ELL, admission characteristics, and birth satisfaction. Descriptive analysis was used. RESULTS: Nearly half (43.9%) of the women surveyed used the ELL. ELL users received prenatal care (72.3%), knew signs of active labor (93.1%), and had a cesarean birth rate of 7.1%. Significantly greater proportions of women prenatally cared for by midwives reported knowledge of the signs of early labor (100% vs. 80%; χ2 = 4.4, p = .04) and of the availability of the ELL (18.2% vs. 70.6%; χ2 = 15.2, p < .001). A range of activities were offered in the ELL, and at least 75% of women indicated that all activities were helpful during latent labor. Birth satisfaction scores, measured on a scale of 0 to 40, with 40 indicating greatest satisfaction, ranged from 22 to 35 among ELL participants. CONCLUSION: An ELL is a care innovation that hospitals can consider for providing support to women with low-risk pregnancies during the latent phase of labor. Women who used the ELL reported feeling that it provided guidance and support. An ELL is a woman-centered option for delayed admission.


Assuntos
Arquitetura Hospitalar/normas , Trabalho de Parto/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Inquéritos e Questionários
20.
BMC Pregnancy Childbirth ; 19(1): 203, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208355

RESUMO

BACKGROUND: An adequate number of prenatal consultations is beneficial to the health of the mother and fetus. Guidelines recommend an average of 5-14 consultations. Daily practice, however, shows that some women attend the midwifery practice more frequently. This study examined factors associated with frequent attendance in midwifery-led care. METHODS: We conducted a cross-sectional study in a large midwifery practice in the Netherlands among low-risk women who started prenatal care in 2015 and 2016. Based on Andersen's behavioral model, we collected data on potential determinants from the digital midwifery's practice database. Prenatal healthcare utilization was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and numbers of visits. Logistic regression models were fitted to estimate the likelihood of frequent attendance compared to the recommended number of visits, adjusted for all relevant factors. Separate models were fitted on the non-referred and the referred group of obstetric-led care, as referral was found to be an effect modifier. RESULTS: The prevalence of frequent attendance was 23% (243/1053), mainly caused by worries and/or vague complaints (44%; 106/243). Among non-referred women, 53% (560/1053), frequent attendance was associated with consultation with an obstetrician (OR = 3.99 (2.35-6.77)) and exposure to sexual violence (OR = 2.17 (1.11-4.24)). Among the referred participants, 47% (493/1053), frequent attendance was associated with a consultation with an obstetrician (OR = 2.75 (1.66-4.57)), psychosocial problems in the past or present (OR = 1.85 (1.02-3.35) or OR = 2.99 (1.43-6.25)), overweight (OR = 1.88 (1.09-3.24)), and deprived area (OR = 0.50 (0.27-0.92)). CONCLUSION: Our exploratory study indicates that the determinants of frequent attendance in midwifery-led care differs between non-referred and referred women. Underlying causes for frequent attendance was mainly because of non-medical reasons. IMPLICATION FOR PRACTICE: A trustful midwife-client relationship is known to be needed for clients such as frequent attenders to share more detailed, personal stories in case of vague complaints or worries, which is necessary to identify their implicit needs.


Assuntos
Sobremedicalização/estatística & dados numéricos , Tocologia , Gestantes/psicologia , Cuidado Pré-Natal , Carência Psicossocial , Delitos Sexuais , Adulto , Estudos Transversais , Feminino , Humanos , Tocologia/métodos , Tocologia/normas , Países Baixos/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia , Delitos Sexuais/psicologia , Delitos Sexuais/estatística & dados numéricos , Determinantes Sociais da Saúde
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