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1.
N C Med J ; 81(1): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908328

RESUMO

In working to improve the health of North Carolinians, a critical focus starts with our mothers and infants and their surrounding communities. North Carolina's perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context of lifelong physical and mental health of our citizens, offer areas for improvement and policy implications. In addition, the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This issue of the NCMJ highlights the state of perinatal health in North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our parents, children, and families; and how we as a state and as a community can come together to improve the safety and experience of giving birth in North Carolina and beyond.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Mortalidade Materna/tendências , North Carolina/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia
4.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 826-832, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874472

RESUMO

Objective: To analyze risk factors, cardiovascular complications, time of death, gestational age of delivery and offspring outcomes in the maternal deaths with cardiovascular diseases (CVD). Methods: Totally 4 112 cases of pregnant women with CVD in Shanghai obstetric heart disease intensive care unit within 26 years (from January 1993 to December 2018) were collected, and 20 maternal deaths within these cases were analyzed retrospectively. Results: (1) Among the 20 deaths, structural heart diseases accounted for 90% (18/20), pregnancy induced heart diseases was 10% (2/20) while there was no dysfunctional heart disease. The mortality of pregnant women with CVD was 0.486% (20/4 112). (2) The following risk factors were common in these women, getting pregnant without counselling (95%, 19/20) , New York Heart Association classⅢ or Ⅳcardiac function (70%, 14/20), complicated with pulmonary hypertension (75%, 15/20) and prior heart events (60%, 12/20). And 85% (17/20) deaths occurred in puerperium, 15% (3/20) occurred before labor,while no death occurred during labor. And 65% (13/20) deaths died due to heart failure, 20% (4/20) deaths were due to pulmonary hypertension crisis, 5% (1/20) died on sudden cardiac arrest, rupture of aortic dissection and sudden death, respectively. Conclusions: Women with CVD should get pregnant after strict evaluation. Pulmonary hypertension is one of the most severe contraindications to pregnancy, especially in patients with moderate to severe pulmonary hypertension. The puerperium period is a critical period that threatens the safety of these patients. Since heart failure is the most common cause of death, it is necessary to prevent and treat heart failure and to monitor heart function dynamically, especially in those with structural abnormal heart diseases. Moreover, it is also of importance to standardize antenatal care and to identify the severity of heart diseases in time.


Assuntos
Doenças Cardiovasculares/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Morte Materna , Mortalidade Materna , Complicações Cardiovasculares na Gravidez/etiologia , Adulto , Causas de Morte , China/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Mortalidade Materna/tendências , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco
5.
Afr Health Sci ; 19(2): 1833-1840, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656465

RESUMO

Despite the fact that about 94% of pregnant women attend ANC, 95% deliver at health facilities and 99% deliveries are assisted by skilled birth attendants in Botswana, the national Maternal Mortality Rate is still high. Objectives: To determine the trend of MMR at Princess Marina and Nyangabwe referral hospitals before and after EMOC training. Methods: Retrospective longitudinal quantitative study design was used to collect data on maternal deaths. Demographic characteristics, maternal death causes, gestation at ANC registration and pregnancy risks were collected for the period before EMOC training and after training, analysed and compared. Descriptive statistics and frequency tables were used. Findings: Maternal deaths were 33 and 41 before and after EMOC training respectively. Majority of the maternal deaths, 78.8% and 70.7% before and after EMOC training respectively occurred among young women in the reproductive ages. Eclampsia was the commonest cause of maternal death before EMOC between training & and 58% and 66% of maternal deaths before and after EMOC training respectively occurred among women who had attended ANC services four or more times. Conclusion: Maternal deaths at the hospitals remained similar during the two periods. Qualitative studies are needed to determine why EMOC training has not resulted in significant reduction in MMR in Botswana.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Mortalidade Materna/tendências , Complicações do Trabalho de Parto/mortalidade , Complicações na Gravidez/mortalidade , Adulto , Parto Obstétrico/métodos , Feminino , Hospitais , Humanos , Estudos Longitudinais , Serviços de Saúde Materna/organização & administração , Complicações do Trabalho de Parto/etnologia , Gravidez , Gestantes , Encaminhamento e Consulta , Estudos Retrospectivos
6.
Int Health ; 11(5): 353-357, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31529113

RESUMO

At least 800 women die each day during pregnancy or birth and more than 15 000 babies each day are stillborn or die in the first month of life. Almost all of these deaths occur in low- and middle-income countries. Many more women and babies are known to suffer morbidity as a result of pregnancy and childbirth. However, reliable estimates of the burden of physical, psychological and social morbidity and comorbidity during and after pregnancy are not available. Although there is no single intervention or 'magic bullet' that would reduce mortality and improve health, there are evidence-based care packages which are defined and agreed internationally. A functioning health system with care available and accessible for everyone at all times is required to ensure women and babies survive and thrive.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Mortalidade Infantil/tendências , Mortalidade Materna/tendências , Morbidade/tendências , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez
7.
BMC Health Serv Res ; 19(1): 611, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470854

RESUMO

BACKGROUND: This paper examines perinatal death reporting and reviews in Bungoma county, Kenya, where substantial progress has been made, providing important insights for wider scale up to other contexts. METHODS: Quantitative methods were used to analyse trends in perinatal death reporting and reviews between 2014 and 2017 throughout Kenya based on data from the District Health Information System. Qualitative methods helped further understand the success of perinatal death reporting and review in Bungoma county through focus group discussions and individual interviews at 5 hospitals and 1 health centre. Thematic analysis was used to draw out codes for the analysis. RESULTS: Only 13 of the 47 counties in Kenya conduct perinatal death reviews. In 2017, the year after the perinatal death review system was introduced, only 3.6% of perinatal deaths were reviewed in Kenya. Bungoma county has made the greatest strides in Kenya, reviewing 59% of the perinatal deaths that occurred within the county in 2017. Bungoma accounted for 51% of all the perinatal deaths reviewed in Kenya. Factors contributing to the success in Bungoma include harmonisation of facility based perinatal reporting tools with the national level; prioritising the need to document and report mortalities; tailoring continual medical education and supportive supervision visits to needs identified from the review; and better documentation and referral processes. Supportive management and administrative staff have also helped drive forward implementation of actions and increased health staff motivation to reduce perinatal deaths and improve quality of care. CONCLUSIONS: Successful implementation of perinatal death reviews requires clear delineation of roles and responsibilities for action, which are routinely monitored to track implementation progress. As in other low-income settings, Bungoma county has demonstrated that in Kenya, perinatal death reviews can be effectively implemented and sustained, through a focus on learning, solution-oriented responses, influencing those in a power to act, accountability for results, and observable quality of care improvements.


Assuntos
Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Assistência à Saúde/tendências , Saúde da Família , Feminino , Grupos Focais , Hospitais/estatística & dados numéricos , Hospitais/tendências , Humanos , Quênia/epidemiologia , Morte Perinatal , Gravidez
8.
BMC Res Notes ; 12(1): 500, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409378

RESUMO

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal morbidity and mortality, especially in low-resource settings. Identifying mothers and babies at greatest risk of complications would enable intervention to be targeted to those most likely to benefit from them. However, current risk prediction models have a wide range of sensitivity (42-81%) and specificity (87-92%) indicating that improvements are needed. Furthermore, no predictive models have been developed or evaluated in Zimbabwe. This proposal describes a single centre retrospective cross-sectional study which will address the need to further develop and test statistical risk prediction models for adverse maternal and neonatal outcomes in low-resource settings; this will be the first such research to be carried out in Zimbabwe. Data will be collected on maternal demographics characteristics, outcome of prior pregnancies, past medical history, symptoms and signs on admission, results of biochemical and haematological investigations. Adverse outcome will be defined as a composite of maternal morbidity and mortality and perinatal morbidity and mortality. Association between variables and outcomes will be explored using multivariable logistic regression. Critically, new risk prediction models introduced for our clinical setting may reduce avoidable maternal and neonatal morbidity and mortality at local, national, regional and international level.


Assuntos
Modelos Estatísticos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/mortalidade , Adulto , Estudos Transversais , Países em Desenvolvimento , Feminino , Hospitais , Humanos , Recém-Nascido , Modelos Logísticos , Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Pré-Eclâmpsia/economia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Zimbábue
9.
BJOG ; 126(13): 1612-1621, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31410966

RESUMO

OBJECTIVE: To assess the effectiveness of introducing condom-catheter uterine balloon tamponade (UBT) for postpartum haemorrhage (PPH) management in low- and middle-income settings. DESIGN: Stepped wedge, cluster-randomised trial. SETTING: Eighteen secondary-level hospitals in Uganda, Egypt and Senegal. POPULATION: Women with vaginal delivery from October 2016 to March 2018. METHODS: Use of condom-catheter UBT for PPH management was introduced using a half-day training and provision of pre-packaged UBT kits. Hospitals were randomised to when UBT was introduced. The incident rate (IR) of study outcomes was compared in the control (i.e. before UBT) and intervention (i.e. after UBT) periods. Mixed effects regression models accounted for clustering (random effect) and time period (fixed effect). MAIN OUTCOME MEASURES: Combined IR of PPH-related invasive surgery and/or maternal death. RESULTS: There were 28 183 and 31 928 deliveries in the control and intervention periods, respectively. UBT was used for 9/1357 and 55/1037 women diagnosed with PPH in control and intervention periods, respectively. PPH-related surgery or maternal death occurred in 19 women in the control period (IR = 6.7/10 000 deliveries) and 37 in the intervention period (IR = 11.6/10 000 deliveries). The adjusted IR ratio was 4.08 (95% confidence interval 1.07-15.58). Secondary outcomes, including rates of transfer and blood transfusion, were similar in the trial periods. CONCLUSIONS: Introduction of condom-catheter UBT in these settings did not improve maternal outcomes and was associated with an increase in the combined incidence of PPH-related surgery and maternal death. The lack of demonstrated benefit of UBT introduction with respect to severe outcomes warrants reflection on its role. TWEETABLE ABSTRACT: Stepped wedge trial shows UBT introduction does not reduce the combined incidence of PPH-related surgery or death.


Assuntos
Mortalidade Materna/tendências , Hemorragia Pós-Parto/terapia , Tamponamento com Balão Uterino/instrumentação , Adulto , Análise por Conglomerados , Preservativos , Egito , Feminino , Recursos em Saúde , Humanos , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Senegal , Uganda
10.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31300529

RESUMO

OBJECTIVES: We examined demographic characteristics and birth outcomes of infants with neonatal abstinence syndrome (NAS) and their mothers in Canada. METHODS: This retrospective, population-based, descriptive cross-sectional study of mother-infant dyads included all singleton live births in Canada (excluding Quebec), from 2005-2006 to 2015-2016 (N = 2 881 789). Demographic characteristics, NAS, and neonatal and maternal morbidities were identified from delivery hospitalization data (including diagnostic codes). The main composite outcomes were maternal and neonatal mortality and/or severe morbidity, including death and potentially life-threatening conditions in the mother and the infant, respectively. Logistic regression yielded adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: The study included 10 027 mother-infant dyads with NAS. The incidence of NAS increased from 0.20% to 0.51%. Maternal mortality was 1.99 vs 0.31 per 10 000 women in the NAS group versus the comparison group (aOR = 6.53; 95% CI: 1.59 to 26.74), and maternal mortality and/or severe morbidity rates were 3.10% vs 1.35% (aOR = 2.21; 95% CI: 1.97 to 2.49). Neonatal mortality was 0.12% vs 0.19% (aOR = 0.28; 95% CI: 0.15 to 0.53), and neonatal mortality and/or severe morbidity rates were 6.36% vs 1.73% (aOR = 2.27; 95% CI: 2.06 to 2.50) among infants with NAS versus without NAS. CONCLUSIONS: NAS incidence increased notably in Canada between 2005-2006 and 2015-2016. Infants with NAS had elevated severe morbidity, and their mothers had elevated mortality and severe morbidity. These results highlight the importance of implementing integrated care services to support the mother-infant dyad during childbirth and in the postpartum period.


Assuntos
Mortalidade Infantil/tendências , Mortalidade Materna/tendências , Síndrome de Abstinência Neonatal/diagnóstico , Síndrome de Abstinência Neonatal/mortalidade , Adolescente , Adulto , Canadá/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Morbidade , Síndrome de Abstinência Neonatal/epidemiologia , Gravidez , Estudos Retrospectivos , Adulto Jovem
11.
PLoS Med ; 16(7): e1002846, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31283770

RESUMO

BACKGROUND: The cesarean section (CS) rate has risen globally during the last two decades. Effective and feasible strategies are needed to reduce it. The aim of this study was to assess the CS rate change after a two-stage intervention package that was designed to reduce the overall CS rate in Guangzhou, China. METHODS AND FINDINGS: This intervention package was implemented by the Health Commission of Guangzhou Municipality in 2 stages (October 2010-September 2014 and October 2014-December 2016) and included programs for population health education, skills training for healthcare professionals, equipment and technical support for local healthcare facilities, and capacity building for the maternal near-miss care system. A retrospective repeated cross-sectional study was conducted to evaluate influences of the intervention on CS rates. A pre-intervention period from January 2008 to September 2010 served as the baseline. The primary outcome was the CS rate, and the secondary outcomes included maternal mortality ratio (MMR) and perinatal mortality rate (PMR), all obtained from the Guangzhou Perinatal Health Care and Delivery Surveillance System (GPHCDSS). The Cochran-Armitage test was used to examine the trends of the overall CS rate, MMR, and PMR across different stages. Segmented linear regression analysis was used to assess the change of the CS rate over the intervention period. A total of 1,921,932 records of births and 108 monthly CS rates from 2008 to 2016 were analyzed. The monthly CS rate declined across the intervention stages (Z = 75.067, p < 0.001), with an average rate of 42.4% at baseline, 39.8% at Stage 1, and 35.0% at Stage 2. The CS rate declined substantially among nulliparous women who delivered term singletons, with an accelerating decreasing trend observed across Stage 1 and Stage 2 (the difference in slopes: -0.09 [95% CI -0.16 to -0.02] between Stage 1 and baseline, p = 0.014; -0.11 [95% CI -0.20 to -0.02] between Stage 1 and Stage 2, p = 0.017). The CS rate in the remaining population increased during baseline and Stage 1 and subsequently decreased during Stage 2. The sensitivity analysis suggested no immediate impact of the universal two-child policy on the trend of the CS rate. The MMR (Z = -4.368, p < 0.001) and PMR (Z = -13.142, p < 0.001) declined by stage over the intervention period. One of the main limitations of the study is the lack of a parallel control group. Moreover, the influence of temporal changes in the study population on the CS rate was unknown. Given the observational nature of the present study, causality cannot be confirmed. CONCLUSIONS: Apparent decline in the overall CS rate was observed in Guangzhou, China, after the implementation of a two-stage intervention package. The decline was most evident among nulliparous women who delivered term singletons. Despite some limitations for causal inference, Guangzhou's experience in controlling the CS rate by implementing composite interventions with public health education and perinatal healthcare service improvement could have implications for other similar areas with high rates of CS.


Assuntos
Cesárea/tendências , Educação em Saúde/tendências , Assistência Perinatal/tendências , Padrões de Prática Médica/tendências , Adulto , Fortalecimento Institucional/tendências , Cesárea/efeitos adversos , Cesárea/mortalidade , China , Estudos Transversais , Feminino , Pessoal de Saúde/educação , Humanos , Recém-Nascido , Capacitação em Serviço/tendências , Mortalidade Materna/tendências , Educação de Pacientes como Assunto/tendências , Mortalidade Perinatal/tendências , Gravidez , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
13.
BMC Med ; 17(1): 104, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31155009

RESUMO

Reducing maternal mortality is a key focus of development strategies and one of the indicators used to measure progress towards achieving the Sustainable Development Goals. In the absence of medical certification of the cause of deaths that occur in the community, verbal autopsy (VA) methods are the only available means to assess levels and trends of maternal deaths that occur outside health facilities. The 2016 World Health Organization VA Instrument facilitates the identification of eight specific causes of maternal death, yet maternal deaths are often unsupervised, leading to sparse and generally poor symptom reporting to inform a reliable diagnosis using VAs. There is little research evidence to support the reliable identification of specific causes of maternal death in the context of routine VAs. We recommend that routine VAs are only used to capture the event of a maternal death and that more detailed follow-up interviews are used to identify the specific causes.


Assuntos
Autopsia/métodos , Entrevistas como Assunto , Morte Materna/etiologia , Mortalidade Materna/tendências , Vigilância da População/métodos , Estatísticas Vitais , Adolescente , Adulto , Autopsia/normas , Causas de Morte , Feminino , Humanos , Entrevistas como Assunto/métodos , Entrevistas como Assunto/normas , Morte Materna/prevenção & controle , Morte Materna/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez/epidemiologia , Desenvolvimento Sustentável , Comportamento Verbal , Organização Mundial da Saúde , Adulto Jovem
14.
BMC Public Health ; 19(1): 824, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242879

RESUMO

BACKGROUND: Reducing maternal mortality remains a global priority. In 2000, the United Nations Member States pledged to work towards a series of Millennium Development Goals (MDGs), in which the fifth target was to reduce maternal mortality ratio by 75% from 1990 to 2015. The Chinese government introduced Basic Public Health Service project in 2009 to the further improvement of maternal health services and reduction in maternal mortality. China had achieved the goal of MDG5 1 year ahead of the schedule in 2014, but the effects of the project on reducing maternal mortality were rarely evaluated with robust methods. METHODS: We conducted a longitudinal study on maternal mortality ratio by extracting mortality data from the National Maternal Mortality Surveillance System (1991-2016) and maternal health services measures from the China health statistic yearbook (2001-2016). We utilized the segmented linear regression model to assess changes and trends of maternal mortality ratio and maternal health services before and after the introduction of Basic Public Health Service project. Pearson correlation analysis was conducted to measure the strength of association between the maternal mortality ratio and maternal health services. RESULTS: The yearly trend change of national maternal mortality ratio was - 1.76 (p < 0.01) after the introduction of Basic Public Health Service project in 2009, while the yearly trend change of maternal health record establish rate, prenatal examination rate, postpartum visit rate was 0.77 (p < 0.01), 0.61 (p < 0.01) and 0.83 (p < 0.01) separately. The negative correlations were also found between national maternal mortality ratio and prenatal examination rate (r = - 0.95, p < 0.01), maternal health record establish rate (r = - 0.93, p < 0.01) and postpartum visit rate (r = - 0.92, p < 0.01). CONCLUSIONS: The Basic Public Health Service project was found to be associated with the improvements in the maternal health services and reduction in maternal mortality. The design and implementation of the project may serve as a positive example for other developing countries. Continued monitoring and assessment of project effects should be stressed.


Assuntos
Programas Governamentais , Morte Materna/prevenção & controle , Serviços de Saúde Materna/normas , Mortalidade Materna/tendências , Avaliação de Programas e Projetos de Saúde , United States Public Health Service/normas , China/epidemiologia , Países em Desenvolvimento , Feminino , Governo , Humanos , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Nações Unidas , Estados Unidos
15.
Manag Care ; 28(6): 46-47, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31188102

RESUMO

The U.S. rate is now higher than infant mortality rates in Antigua or Cuba. Furthermore, the overall U.S. rate masks significant disparities. The infant mortality rate of non-Hispanic black infants is 11.2 per 1,000 live births, which is comparable to the rate in Libya or Tunisia.


Assuntos
Mortalidade Infantil/tendências , Mortalidade Materna/tendências , Humanos , Lactente , Estados Unidos/epidemiologia
16.
Reprod Health ; 16(1): 80, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31186045

RESUMO

BACKGROUND: Maternal and neonatal mortality is still very high at a global level, even though its reduction is a goal established among the Sustainable Development Goals by the United Nations. In order to improve prenatal care to address this challenge, this article proposes a strategy to detect and refer high risk pregnancies in rural setting through a portable ultrasound system combined with blood and urine strip tests. METHODS: The Healthy Pregnancy project was conceived as a single, explanatory and positivist case study, with a sample of ten thousand pregnant women attended by itinerant nurses of the Departments of Alta Verapaz and San Marcos. These nurses were trained and equipped with 31 portable ultrasound, and blood and urine tests to detect common obstetric pathology. Moreover, two obstetricians were responsible for remotely supervising the quality of prenatal care. Target communities were selected by the Health Directorates of the public health system from those that had the highest maternal mortality in previous years. RESULTS: The project attended to 10,108 women in 2 years and 3 months. 55 twin gestations (0.54%) were diagnosed. Non-cephalic presentation was found in 14.87% of the pregnant women attended from week 32 onwards. 20 patients were referred for non-evolutive gestation. An 11.08% prevalence of anemia was detected. Urine infections were diagnosed in 16.43% of the cases. Proteinuria was detected in 2.6% of patients, but only 17 of them presented high blood pressure and were therefore referred with a suspected pre-eclampsia. DISCUSSION: The results obtained indicate that an intervention of these characteristics makes it possible to improve the quality of care of rural pregnant women in low and middle-income countries. CONCLUSION: The results show that with suitable equipment, training, and supervision, the nursing staff in charge of care in rural areas can identify and refer most of the obstetric risks in time, which may contribute to the reduction of maternal mortality. TRIAL REGISTRATION: This research was not registered because it is a case study in which the assignment of the medical intervention was not at the discretion of the investigators.


Assuntos
Mortalidade Infantil/tendências , Serviços de Saúde Materna/normas , Mortalidade Materna/tendências , Enfermeiras e Enfermeiros/estatística & dados numéricos , Complicações na Gravidez/prevenção & controle , Gravidez de Alto Risco , Cuidado Pré-Natal/normas , Adolescente , Adulto , Feminino , Idade Gestacional , Guatemala/epidemiologia , Recursos em Saúde , Humanos , Lactente , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Ultrassonografia Pré-Natal/normas , Adulto Jovem
17.
PLoS One ; 14(5): e0215282, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31071112

RESUMO

BACKGROUND: The Maternal Mortality Ratio in Mozambique has stagnated at 405 deaths per 100,000 live births with virtually no progress over the last 15 years. Low Institutional Birth Rates (IBRs) levelling around 50% in many rural areas constitute one of the contributing reasons. Demand-side financing has successfully increased usage of maternal health services in other countries, but little information exists on in-kind incentives in rural Africa. The objective was to test the impact on Institutional Birth Rates of giving a USD 5.50 baby package incentive to every woman who came to give birth in a health centre in a rural, poor district of Cabo Delgado, Mozambique. METHODS AND FINDINGS: The intervention was implemented in one district in 2010 with the remaining 15 districts serving as controls. The total population in the 16 districts in 2006 was just under 1.5 million people. IBRs were observed from 2006 to 2013 (53 months before and 55 months after the intervention began). The non-intervention districts showed a slight increase, from a mean IBR of 0.39 (SD = 0.10) in 2006 to 0.67 (SD = 0.13) in 2014. The intervention district had a dramatic increase in IBRs within six months of the start of the intervention in 2010, which was sustained until the end of the study. Adjusting for the background increase and for confounders, including health facilities and health personnel per district, and taking clustering in districts into account, the estimated rate ratio of institutional births in the intervention district was 1.80 (95% CI 1.72, 1.89 p<0.001). CONCLUSION: Women were almost twice as likely to have an institutional birth following the introduction of the baby package.


Assuntos
Morte Materna/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Morte Perinatal/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna , Mortalidade Materna/tendências , Moçambique/epidemiologia , Pobreza , Recompensa , Serviços de Saúde Rural , Adulto Jovem
18.
JMIR Mhealth Uhealth ; 7(5): e12879, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-31127719

RESUMO

BACKGROUND: Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. OBJECTIVE: This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). METHODS: For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. RESULTS: In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each 6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and r=0.79; P<.001 and P=.03, respectively). CONCLUSIONS: There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus support for HW training and ultimately improved maternal and neonatal health.


Assuntos
Sistemas de Apoio a Decisões Clínicas/normas , Telemedicina/instrumentação , Adulto , Sistemas de Apoio a Decisões Clínicas/instrumentação , Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Feminino , Gana , Humanos , Lactente , Mortalidade Infantil/tendências , Mortalidade Materna/tendências , Gravidez , Qualidade da Assistência à Saúde , Telemedicina/normas , Telemedicina/estatística & dados numéricos
19.
Crit Care Nurs Clin North Am ; 31(2): 177-193, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047092

RESUMO

The quality of maternal care in the United States is receiving increased attention due to rising rates of severe maternal morbidity and maternal mortality when compared with other developed countries. Many of these events are considered preventable. The lack of adoption of evidence-based maternal patient safety bundles and tool kits requires immediate attention. Maternal levels of care described by the American Congress of Obstetricians and Gynecologists requires increased focus so that women are in the appropriate facility to receive care. Perinatal care management, integrated behavioral health, and preconception care should be considered a preferred methodology to achieve optimal maternal outcomes.


Assuntos
Mortalidade Materna/tendências , Assistência Perinatal/normas , Melhoria de Qualidade/economia , Parto Obstétrico/economia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/prevenção & controle , Recém-Nascido , Pacotes de Assistência ao Paciente/economia , Pacotes de Assistência ao Paciente/normas , Segurança do Paciente/normas , Assistência Perinatal/métodos , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Cuidado Pré-Natal/métodos , Sepse/prevenção & controle
20.
PLoS One ; 14(5): e0217135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095635

RESUMO

OBJECTIVE: To evaluate the validity of WHO's near-miss approach in a low-resource, high maternal mortality setting. DESIGN: Prospective cohort study. SETTING: Mnazi Mmoja Hospital, the main referral hospital of Zanzibar, Tanzania, from 1 April 2017 until 31 December 2018. POPULATION: All women, pregnant or until 42 days after the end of pregnancy, admitted at Mnazi Mmoja Hospital, the tertiary referral hospital in Zanzibar. METHODS: Cases of maternal morbidity and mortality were evaluated according to WHO's near-miss approach. The approach's performance was determined by calculating its accuracy through sensitivity, specificity and positive and negative likelihood ratios. The approach's validity was assessed with Pearson's correlation coefficient between the number of organ dysfunction markers and risk of mortality. MAIN OUTCOMES MEASURES: Correlation between number of organ dysfunction markers and risk of mortality, sensitivity and specificity. RESULTS: 26,842 women were included. There were 335 with a severe maternal outcome: 256 maternal near-miss cases and 79 maternal deaths. No signs of organ dysfunction were documented in only 4 of the 79 cases of maternal death. The number of organ dysfunction markers was highly correlated to the risk of mortality with Pearson's correlation coefficient of 0.89. CONCLUSIONS: WHO's near-miss approach adequately identifies women at high risk of maternal mortality in Zanzibar's referral hospital. There is a strong correlation between the number of markers of organ dysfunction and mortality risk.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Mortalidade Materna/tendências , Near Miss/métodos , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/mortalidade , Feminino , Humanos , Incidência , Near Miss/estatística & dados numéricos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Tanzânia/epidemiologia , Organização Mundial da Saúde
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