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1.
Hu Li Za Zhi ; 67(5): 82-88, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-32978769

RESUMO

Retinopathy of prematurity (ROP) is a disorder affecting the development of retinal blood vessels in preterm infants. Eye screening examinations are important to the early detection and treatment of ROP. However, several studies have associated eye examinations with pain, stress, and negative physiological effects. Developmental care has been provided as part of neonatal care in recent decades, and some studies indicate that this care positively affects pain scores, stress response, and recovery time during ROP eye screenings. In this article, five elements of developmental care that are applicable for preterm infants undergoing eye examinations for ROP are highlighted and described. These five elements include environmental modifications (e.g., provide a quite environment and dim room lighting), positioning (e.g., offer a nest or positing support and promote the infant to achieve neuromotor development), oxygen delivery (provide adequate oxygen support according to clinical conditions), approach and interaction (e.g., talk softly to infants and gently touch them before the eye examination), and cue-based individual care (e.g., soothe infants, give them a short break or soother based on observations of needs and cue-based behavior). Effectively addressing these five elements may minimize the pain, stress, and energy consumption during ROP eye screenings and provide individualized care that is comfortable, supportive, and promotes the healthy development of preterm infants.


Assuntos
Cuidado do Lactente/métodos , Exame Físico/métodos , Retinopatia da Prematuridade/diagnóstico , Desenvolvimento Infantil , Humanos , Recém-Nascido , Recém-Nascido Prematuro
5.
Lancet Child Adolesc Health ; 4(10): 750-760, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32735783

RESUMO

Background Increasing numbers of neonates are undergoing painful procedures in low-income and middle-income countries, with adequate analgesia seldom used. In collaboration with a multi-disciplinary team in Kenya, we aimed to establish the first evidence-based guidelines for the management of routine procedure-related neonatal pain that consider low-resource hospital settings. METHODS: We did a systematic review by searching MEDLINE, Embase, CINAHL, and CENTRAL databases for studies published from Jan 1, 1953, to March 31, 2019. We included data from randomised controlled trials using heart rate, oxygen saturation (SpO2), premature infant pain profile (PIPP) score, neonatal infant pain scale (NIPS) score, neonatal facial coding system score, and douleur aiguë du nouveau-né scale score as pain outcome measures. We excluded studies in which neonates were undergoing circumcision or were intubated, studies from which data were unextractable, or when pain was scored by non-trained individuals. We did a narrative synthesis of all studies, and meta-analysis when data were available from multiple studies comparing the same analgesics and controls and using the same outcome measures. 17 Kenyan health-care professionals formed our clinical guideline development panel, and we used the Grading of Recommendations, Assessment, Development and Evaluation framework and the panel's knowledge of the local health-care context to guide the guideline development process. This study is registered with PROSPERO, CRD42019126620. FINDINGS: Of 2782 studies assessed for eligibility, data from 149 (5%) were analysed, with 80 (3%) of these further contributing to our meta-analysis. We found a high level of certainty for the superiority of breastfeeding over placebo or no intervention (standardised mean differences [SMDs] were -1·40 [95% CI -1·96 to -0·84] in PIPP score and -2·20 [-2·91 to -1·48] in NIPS score), and the superiority of oral sugar solutions over placebo or no intervention (SMDs were -0·38 [-0·61 to -0·16] in heart rate and 0·23 [0·04 to 0·42] in SpO2). We found a moderate level of certainty for the superiority for expressed breastmilk over placebo or no intervention (SMDs were -0·46 [95% CI -0·87 to -0·05] in heart rate and 0·48 [0·20 to 0·75] in SpO2). Therefore, the panel recommended that breastfeeding should be given as first-line analgesic treatment, initiated at least 2 min pre-procedure. Given contextual factors, for neonates who are unable to breastfeed, 1-2 mL of expressed breastmilk should be given as first-line analgesic, or 1-2 mL of oral sugar (≥10% concentration) as second-line analgesic. The panel also recommended parental presence during procedures with adjunctive provision of skin-to-skin care, or non-nutritive sucking when possible. INTERPRETATION: We have generated Kenya's first neonatal analgesic guidelines for routine procedures, which have been adopted by the Kenyan Ministry of Health, and have shown a framework for clinical guideline development that is applicable to other low-income and middle-income health-care settings. FUNDING: Wellcome Trust Research Programme, and the Africa-Oxford Initiative.


Assuntos
Cuidado do Lactente/métodos , Método Canguru/métodos , Manejo da Dor/métodos , Dor/prevenção & controle , Analgésicos/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Quênia , Masculino , Dor/tratamento farmacológico , Flebotomia/efeitos adversos , Guias de Prática Clínica como Assunto , Punções/efeitos adversos
6.
PLoS One ; 15(6): e0234252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32511258

RESUMO

Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make cross-setting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.


Assuntos
Cuidado do Lactente/métodos , Saúde Materna , Feminino , Humanos , Recém-Nascido , Medição de Risco
8.
J Perinatol ; 40(7): 987-996, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32439956

RESUMO

There is limited information about newborns with confirmed or suspected COVID-19. Particularly in the hospital after delivery, clinicians have refined practices in order to prevent secondary infection. While guidance from international associations is continuously being updated, all facets of care of neonates born to women with confirmed or suspected COVID-19 are center-specific, given local customs, building infrastructure constraints, and availability of protective equipment. Based on anecdotal reports from institutions in the epicenter of the COVID-19 pandemic close to our hospital, together with our limited experience, in anticipation of increasing numbers of exposed newborns, we have developed a triage algorithm at the Penn State Hospital at Milton S. Hershey Medical Center that may be useful for other centers anticipating a similar surge. We discuss several care practices that have changed in the COVID-19 era including the use of antenatal steroids, delayed cord clamping (DCC), mother-newborn separation, and breastfeeding. Moreover, this paper provides comprehensive guidance on the most suitable respiratory support for newborns during the COVID-19 pandemic. We also present detailed recommendations about the discharge process and beyond, including providing scales and home phototherapy to families, parental teaching via telehealth and in-person education at the doors of the hospital, and telehealth newborn follow-up.


Assuntos
Infecções por Coronavirus , Cuidado do Lactente/métodos , Pandemias , Pneumonia Viral , Cuidado Pós-Natal/organização & administração , Complicações Infecciosas na Gravidez , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Prática Clínica Baseada em Evidências , Feminino , Humanos , Cuidado do Lactente/organização & administração , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Triagem/métodos , Triagem/organização & administração
9.
Sante Publique ; HS1(S1): 105-111, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32374089

RESUMO

INTRODUCTION: Driven by international programs specifically targeting neonatal survival, a set of recommended care practices is being promoted in West Africa. Using data from a multi-centered anthropological study, we enquire as to how local practices integrate the recommendations disseminated by these programs. METHOD: The surveys were conducted in rural localities in five countries: Benin, Burkina Faso, Mali, Mauritania, and Togo. In every site, the investigations combined ethnography of newborn care and in-depth interviews in maternity homes and homes. RESULTS: The care of newborns is based on a set of local social representations and logics, where medical recommendations are integrated heterogeneously. In maternity wards, health professionals face difficulties in implementing recommended practices, and make various conciliations when faced with local material and social constraints. In private homes, the "messages" promoting life-saving care for newborns punctuate conversations, but lead to various interpretations and variations in care. DISCUSSION: The irregular integration of medical recommendations in neonatal care is analyzed around three areas: the divergence of intentions around the birth, the dissonances between the recommended care and the local conceptions of the newborn, the influence of intra-family power relations. Considering the complexity of the changes in neonatal care, we argue for the implementation of programs that respect local cultures, and for health professionals to skillfully accommodate conflicting constraints.


Assuntos
Atitude do Pessoal de Saúde , Cuidado do Lactente/métodos , População Rural , Cordão Umbilical , África Ocidental , Antropologia Cultural , Benin , Feminino , Fidelidade a Diretrizes , Guias como Assunto , Humanos , Recém-Nascido , Gravidez , Inquéritos e Questionários
10.
Sante Publique ; HS1(S1): 17-27, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32374091

RESUMO

INTRODUCTION: Driven by international programs specifically targeting neonatal survival, a set of recommended care practices is being promoted in West Africa. Using data from a multi-centered anthropological study, we enquire as to how local practices integrate the recommendations disseminated by these programs. METHOD: The surveys were conducted in rural localities in five countries : Benin, Burkina Faso, Mali, Mauritania, and Togo. In every site, the investigations combined ethnography of newborn care and in-depth interviews in maternity homes and homes. RESULTS: The care of newborns is based on a set of local social representations and logics, where medical recommendations are integrated heterogeneously. In maternity wards, health professionals face difficulties in implementing recommended practices, and make various conciliations when faced with local material and social constraints. In private homes, the "messages" promoting life-saving care for newborns punctuate conversations, but lead to various interpretations and variations in care. DISCUSSION: The irregular integration of medical recommendations in neonatal care is analyzed around three areas: the divergence of intentions around the birth, the dissonances between the recommended care and the local conceptions of the newborn, the influence of intra-family power relations. Considering the complexity of the changes in neonatal care, we argue for the implementation of programs that respect local cultures, and for health professionals to skillfully accommodate conflicting constraints.


Assuntos
Cuidado do Lactente/métodos , África Ocidental , Antropologia , Feminino , Guias como Assunto , Pessoal de Saúde , Humanos , Recém-Nascido , Gravidez , Sobrevida
11.
Sante Publique ; HS1(S1): 29-43, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32374092

RESUMO

INTRODUCTION: In Sub-Saharan Africa, despite the establishment of many health care programs, neonatal mortality rates remain extremely high. From a medical point of view, the main causes are obstetric, along with diarrhea and pneumonia. Understanding how these risks and pathogenic situations are constructed cannot be achieved without observing, analyzing, and understanding the underlying gestures and meaning systems. METHOD: Rather than describing obvious inequalities in the access to health care, our study aimed at questioning the different actors' operational capacities and at considering what is actually possible to improve in the most common healthcare situations. More specifically, how are births, neonatal care, and popular practices carried out in the first days of the lives of these newborns? In five countries of West Africa, a "multi-sited" anthropological study was carried out to observe the first weeks of newborns. This study not only allowed for the methodical identification of care interactions at and around childbirth in peripheral health care services, but also the popular practices related to the socialization of the child in family settings. RESULTS: Our fieldwork investigations show that neonatal risk corresponds to the combination of several sets of behavior. In obstetric services, for reasons linked to the symbolic status of the child as much as to a certain idea of the obstetric profession, the newborn remains marginal in the preoccupations of the midwives. This results in many dysfunctions (not warming the child, leaving the child in a drafty area, not feeding the child…) which constitute discontinuous risk factors.In the village and in the family, the newborn is at the center of many social practices - baths, rituals, ingestions of various "protective" products, period of seclusion, baptism… - which not only aim at conferring an identity and including the infant in the social group, but also build a set of infectious risks.Finally, while health actions build a translation space, no preventive dialogue has been established by healthcare personnel to inform people about the risks associated with certain social practices.Overall, these longitudinal follow-ups of newborns, as well as precise observations and interviews conducted with the actors on their reasons for acting, have made it possible to analyze the attitudes, gestures and social behaviors that constitute the concrete causes of neonatal risk. DISCUSSION: Describing the practices that newborns "benefit from" during their first days is essential to concretely identify and analyze the risks and reasons for high neonatal mortality. The empirical and documented approach of anthropology is essential to carry out these studies. But, more importantly, this qualitative approach must be implemented in vivo and in situ in the health services and during the training of health personnel to create a reflexivity of the caregivers and to initiate professional practices concerned with newborns. In the same way, our studies open the way for precise and documented dialogues with families which will enable the indispensable follow-up care for the newborns and ensure adapted preventive care and coherence in the care provided by the healthcare structures, the families, and the collectivities.


Assuntos
Cuidado do Lactente/métodos , Mortalidade Infantil , Assistência Perinatal , África Ocidental , Antropologia , Criança , Parto Obstétrico , Feminino , Humanos , Lactente , Recém-Nascido , Serviços de Saúde Materna , Tocologia , Gravidez
12.
Sante Publique ; HS1(S1): 45-52, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32374093

RESUMO

INTRODUCTION: Policy directions in the health sector are based on research which provides insight into implemented actions and helps to formulate improvement recommendations for health. In Cameroon, an innovative experience of anthropological research on newborn health was followed by a process of appropriating findings by the Ministry of Public Health aiming at improving the quality of care. We suggest reporting this Cameroonian experience of interdisciplinary collaboration and involved research. METHOD: Coinciding with the anthropological study on newborn care in hospital maternities and at home conducted by researchers in the field of anthropology from December 2016 to June 2017, a process of appropriating findings was carried out. This article accurately describes this process both at the peripheral level, during "reflexive returns" in investigated maternity hospitals, and at the central level within the framework of work conducted by the study's steering committee. It reports on the changes that have taken place as a result of the study both at the level of health structures and at the level of national policies and strategies with a view to improving the quality of newborns care. RESULTS: The output of this process is twofold. At the peripheral level, activities of "reflexive returns" led to in situ changes of some harmful practices detrimental to the survival of the newborn, such as inappropriate use of the cradle in the birth room and lack of knowledge relative to the fight against hypothermia through the practice of skin-to-skin contact. At central level, changes concerned communication and strengthening policies and strategies of newborn care. CONCLUSION: The contribution of anthropology in the production evidence-based data is of paramount importance for the implementation of strategies to improve the quality of neonatal care. It opens up new perspectives for the sustainable improvement of the quality of care for newborns.


Assuntos
Antropologia , Cuidado do Lactente/métodos , Saúde do Lactente , Camarões , Comunicação , Feminino , Humanos , Recém-Nascido , Gravidez , Saúde Pública
13.
Sante Publique ; HS1(S1): 53-67, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32374095

RESUMO

OBJECTIVE: This ethnographic work seeks to understand the construction of gender and generational social relationships around the health of the newborn in both the care setting and in the family setting. METHOD: An immersion of several weeks made it possible to collect data on the most common perceptions and practices that shape the daily lives of the various actors involved in the health of the newborn. The data was collected using participant observation, semi-structured interviews. Much additional data was collected through informal interviews. RESULTS: In health institutions, people who play the role of caregiver are usually women. They come most often from the husband's family and are engaged in a role that can be assimilated to "care". In most cases, the involvement of husbands concerns the transport of the woman to the health center, the transport of food, the administrative procedures, the payment of prescriptions. In a family environment, caring for the newborn also follows sexual logic as well as generational logic that shows a better integration of biomedicine guidelines by young women. However, the data from the survey showed that men's involvement and women's involvement can not be defined according to a dual separation between masculine and feminine roles because social relations are constructed according to many other variables. CONCLUSION: The health of the newborn is at the center of several normative registers that try to influence it in their own way. This necessarily plural reality often escapes public health programs.


Assuntos
Cuidado do Lactente/métodos , Saúde do Lactente , Relações Interpessoais , População Rural , Apoio Social , Cônjuges , Feminino , Humanos , Recém-Nascido , Masculino , Mali
14.
Sante Publique ; HS1(S1): 81-91, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32374098

RESUMO

INTRODUCTION: In Mauritania, as in other West African countries, a series of actions has been taken to combat neonatal mortality. Considering the mixed success of these programs, we wondered how health workers are investing in neonatal care. METHOD: An anthropological study was carried out in a locality in the Senegal River Valley. The surveys consisted of an ethnography of a health center, which resulted in detailed observations of care and interviews with health workers. RESULTS: Our observations reveal that in the crucial minutes and hours following a normal birth, the attention of caregivers tends to turn away from the newborn. Recommended care such as keeping warm, examining and monitoring the newborn is not provided, while early breast-feeding occurs in a fluctuating manner. The newborn is quickly handed over to the family. Newborn care is thus "forgotten", both in the sequence of actions around childbirth and in the collective distribution of professional responsibilities. DISCUSSION: Newborn care at birth remains poorly medicalized. We analyze the least involvement of health workers with newborns in two aspects : the perception of the uncertainty of neonatal survival, and the predominance of local childbearing. We are making proposals to put the spotlight back on the newborn in order to promote a better quality of neonatal care.


Assuntos
Atitude do Pessoal de Saúde , Aleitamento Materno , Cuidado do Lactente/métodos , Parto , Assistência Perinatal/métodos , Qualidade da Assistência à Saúde , África Ocidental , Antropologia Cultural , Feminino , Humanos , Lactente , Cuidado do Lactente/psicologia , Mortalidade Infantil , Recém-Nascido , Mauritânia , Relações Enfermeiro-Paciente , Gravidez , Senegal
15.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(5): 498-502, 2020 May 06.
Artigo em Chinês | MEDLINE | ID: mdl-32388949

RESUMO

Newborn death accounts for half of under 5 child death in China. Decreasing neonatal mortality and improving health status of children at early stage of life have great significance on public health. This is also a solution to accomplish the goal of "ending preventable newborn deaths" of the 2030 Agenda for Sustainable Development. According to the World Health Organization, many causes leading to newborn deaths can be prevented and avoided by simple interventions. "Early Essential Newborn Care (EENC) " is a package of simple interventions that include early mother to child skin to skin contact, delayed umbilical cord clamping, breast feeding, kangaroo mother care for preterm, neonatal resuscitation, and infection identifying and treatment. These prioritized evidence-based interventions can improve the content and quality of newborn health care, which are bound to be promoted and implemented throughout the country. Future research should be conducted to explore solutions to solve difficulties and challenges of EENC implementation.


Assuntos
Cuidado do Lactente/métodos , Mortalidade Infantil , Método Canguru , China , Assistência à Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doença Infecciosa
16.
PLoS One ; 15(5): e0233411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469891

RESUMO

OBJECTIVE: The aim of this project was to determine revenues and costs over time to assess the sustainability of the Baby Bridge program. METHODS: The Baby Bridge program was developed to promote timely, consistent and high quality early therapy services for high-risk infants following neonatal intensive care unit (NICU) discharge. Key features of the Baby Bridge program were defined as: 1) having the therapist establish rapport with the family while in the NICU, 2) scheduling the first home visit within one week of discharge and continuing weekly visits until other services commence, 3) conducting comprehensive assessments to inform targeted interventions by a skilled, single provider, and 4) using a comprehensive therapeutic approach while collaborating with the NICU medical team and community therapy providers. The Baby Bridge program was implemented with infants hospitalized in an urban Level IV NICU from January 2016 to January 2018. The number of infants enrolled increased gradually over the first several months to reach the case-load capacity associated with one full-time therapist by mid-2017. Costs of the therapists delivering Baby Bridge services, travel, and equipment were tracked and compared with claim records of participants. The operational cost of Baby Bridge programming at capacity was estimated based on the completed and anticipated claims and reimbursement of therapy services as a means to inform possible scale-ups of the program. RESULTS: In 2016, the first year of programming, the Baby Bridge program experienced a loss of $26,460, with revenue to the program totaling $11,138 and expenses totaling $37,598. In 2017, the Baby Bridge program experienced a net positive income of $2,969, with revenues to the program totaling $53,989 and expenses totaling $51,020. By Spring 2017, 16 months after initiating Baby Bridge programming, program revenue began to exceed cost. It is projected that cumulative revenue would have exceeded cumulative costs by January 2019, 3 years following implementation. Net annual program income, once scaled up to capacity, would be approximately $16,308. DISCUSSION: There were initial losses during phase-in of Baby Bridge programming associated with operating far below capacity, yet the program achieved sustainability within 16 months of implementation. These costs related to implementation do not consider the potential cost reduction due to mitigated health burden for the community and families, particularly due to earlier receipt of therapy services, which is an important area for further inquiry.


Assuntos
Assistência à Saúde/métodos , Cuidado do Lactente/métodos , Recém-Nascido Prematuro , Custos e Análise de Custo , Assistência à Saúde/economia , Feminino , Custos de Cuidados de Saúde , Serviços Hospitalares de Assistência Domiciliar/economia , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Missouri , Alta do Paciente
17.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312908

RESUMO

The American Academy of Pediatrics (AAP) believes that current data show that hospitals and accredited birth centers are the safest settings for birth in the United States. The AAP does not recommend planned home birth, which has been reported to be associated with a twofold to threefold increase in infant mortality in the United States. The AAP recognizes that women may choose to plan a home birth. This statement is intended to help pediatricians provide constructive, informed counsel to women considering home birth while retaining their role as child advocates and to summarize appropriate care for newborn infants born at home that is consistent with care provided for infants born in a medical care facility. Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care consistent with that highlighted in this statement, which is more completely described in other publications from the AAP, including Guidelines for Perinatal Care and the Textbook of Neonatal Resuscitation All health care clinicians and institutions should promote communications and understanding on the basis of professional interaction and mutual respect.


Assuntos
Parto Domiciliar/métodos , Cuidado do Lactente/métodos , Pediatria/métodos , Assistência Perinatal/métodos , Feminino , Parto Domiciliar/normas , Humanos , Cuidado do Lactente/normas , Recém-Nascido , Pediatria/normas , Assistência Perinatal/normas , Gravidez , Ressuscitação/métodos , Ressuscitação/normas
19.
Artigo em Inglês | MEDLINE | ID: mdl-32121288

RESUMO

BACKGROUND: Newborn mortality in Cambodia remains high, with sepsis and complications of delayed care-seeking important contributing factors. Intervention study objectives were to improve infection control behavior by staff in health centers; improve referral of sick newborns; increase recognition of danger signs, and prompt care-seeking at an appropriate health facility; and appropriate referral for sick newborns by mothers and families of newborn infants. METHODS: The stepped-wedge cluster-randomized controlled trial took place in rural Cambodia from February 2015 to November 2016. Sixteen clusters consisted of public health center catchment areas serving the community. The intervention included health center staff training and home visits to mothers by community health volunteers within 24 hours of birth and on days 3 and 7 after delivery, including assessment of newborns for danger signs and counselling mothers. The trial participants included women who had recently delivered a newborn who were visited in their homes in the first week, as well as health center staff and community volunteers who were trained in newborn care. Women in their last trimester of pregnancy greater than 18 years of age were recruited and were blinded to their group assignment. Mothers and caregivers (2494) received counseling on handwashing practices, breastfeeding, newborn danger signs, and prompt, appropriate referral to facilities. RESULTS: Health center staff in the intervention group had increased likelihood of hand washing at recommended key moments when compared with the control group, increased knowledge of danger signs, and higher recall of at least three hygiene messages. Of mother/caregiver participants at 14 days after delivery, women in the intervention group were much more likely to know at least three danger signs and to have received messages on care-seeking compared with controls. CONCLUSIONS: The intervention improved factors understood to be associated with newborn survival and health. Well-designed training, followed by regular supervision, enhanced the knowledge and self-reported behavior of health staff and health volunteers, as well as mothers' own knowledge of newborn danger signs. However, further improvement in newborn care, including care-seeking for illness and handwashing among mothers and families, will require additional involvement from broader stakeholders in the community.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Promoção da Saúde/métodos , Visita Domiciliar/estatística & dados numéricos , Cuidado do Lactente/métodos , Saúde do Lactente/estatística & dados numéricos , Mães/educação , População Rural/estatística & dados numéricos , Adolescente , Adulto , Camboja , Área Programática de Saúde/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Adulto Jovem
20.
Isr Med Assoc J ; 22(3): 148-153, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147978

RESUMO

BACKGROUND: Opposition to neonatal Hepatitis B vaccination is a growing trend in Israel. OBJECTIVES: To assess the sociodemographic factors and attitudes associated with non-vaccination of term singleton newborns. METHODS: This prospective, pair-matched, controlled trial was conducted in a tertiary university-affiliated hospital. Data on maternal sociodemographic parameters, delivery, and infant care practices were gathered. Knowledge and references of Hepatitis B virus (HBV) vaccination, vaccination schedule, and health government policies were assessed. A follow-up telephone survey was completed at the age of 7 weeks postpartum regarding vaccine catch-up rate. RESULTS: Mothers in the study group were mostly Jewish white middle class married multiparous women with some higher education. Hepatitis B serology was not tested in most. Higher rates of rooming-in and exclusive breastfeeding were observed. Knowledge about HBV was stated, multiple sources of information were significantly associated with newborn non-vaccination. Many objected to the timing of the vaccine and its necessity. Multiple medical encounters are viewed as missed opportunities. CONCLUSIONS: Multiple sources of vaccine information are associated with non-vaccination. Medical encounters prior and post-delivery should be used for vaccination education and may improve vaccination coverage.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Vacinas contra Hepatite B/uso terapêutico , Cuidado do Lactente/métodos , Educação de Pacientes como Assunto/métodos , Vacinação/estatística & dados numéricos , Adulto , Feminino , Humanos , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Israel , Masculino , Gravidez , Estudos Prospectivos
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