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1.
Dan Med J ; 68(9)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34477096

RESUMO

INTRODUCTION: Although women rarely die during pregnancy and childbirth in Denmark, keeping track of the maternal mortality rate and causes of death is vital in identifying learning points for future management of critical illness among obstetric patients and in pinpointing risk factors. METHODS: We identified maternal deaths between 2002 and 2017 by linking four Danish national health registers, using death certificates and reports from hospitals. An audit group then categorised each case by cause of death before identifying any suboptimal care and learning points, which may serve as a foundation for national guidelines and educational strategies. RESULTS: Seventy women died during pregnancy or within six weeks of a pregnancy in the study period. The most frequent causes of death were cardiovascular disease (n = 14), hypertensive disorder (n = 10), suicide (n = 10) and thromboembolism (n = 7). Suboptimal care was identified in 30 of the 70 cases. CONCLUSIONS: Mortality from some of the most important causes of death decreased during the study period. No deaths from preeclampsia or thrombosis, two of the leading causes of death, were identified after 2011. In 2015-2017, suicide was the main cause of maternal death, which indicates that a stronger focus on vulnerability in pregnancy and childbirth is essential. Among the 70 deaths, 34% were potentially avoidable, indicating that it is essential continuously to focus on how to reduce severe maternal morbidity and mortality. FUNDING: none TRIAL REGISTRATION. not relevant.


Assuntos
Doenças Cardiovasculares , Morte Materna , Complicações na Gravidez , Suicídio , Causas de Morte , Estado Terminal , Feminino , Humanos , Morte Materna/etiologia , Mortalidade Materna , Gravidez
2.
Cien Saude Colet ; 26(9): 4069-4086, 2021 Sep.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34586261

RESUMO

Mortality indicators for Brazilians aged between 10 and 24 years old were analyzed. Data were obtained from the Global Burden of Disease (GBD) 2019 Study, and absolute numbers, proportion of deaths and specific mortality rates from 1990 to 2019 were analyzed, according to age group (10 to 14, 15 to 19 and 20 to 24 years), sex and causes of death for Brazil, regions and Brazilian states. There was a reduction of 11.8% in the mortality rates of individuals aged between 10 and 24 years in the investigated period. In 2019, there were 13,459 deaths among women, corresponding to a reduction of 30.8% in the period. Among men there were 39,362 deaths, a reduction of only 6.2%. There was an increase in mortality rates in the North and Northeast and a reduction in the Southeast and South states. In 2019, the leading cause of death among women was traffic injuries, followed by interpersonal violence, maternal deaths and suicide. For men, interpersonal violence was the leading cause of death, especially in the Northeast, followed by traffic injuries, suicide and drowning. Police executions moved from 77th to 6th place. This study revealed inequalities in the mortality of adolescents and young adults according to sex, causes of death, regions and Brazilian states.


Assuntos
Morte Materna , Suicídio , Adolescente , Adulto , Brasil/epidemiologia , Causas de Morte , Criança , Feminino , Carga Global da Doença , Humanos , Masculino , Mortalidade , Violência , Adulto Jovem
3.
Pan Afr Med J ; 39: 134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527150

RESUMO

Introduction: the novel coronavirus disease (COVID-19) pandemic has challenged health systems around the world. This study was designed to describe the socio-demographic characteristics of pregnant women with COVID-19 infection, the common clinical features at presentation and the pregnancy outcome at the University of Benin Teaching Hospital, Edo State, Nigeria. Methods: a cross-sectional analytical study of all confirmed cases of COVID-19 infection from April to September 2020. Results: out of 69 suspected cases that were tested, 19 (28.4%) were confirmed with COVID-19 infection. The common presenting complaints were fever (68.4 %), cough (57.9 %), sore throat (31.6%), malaise (42.1%), loss of taste (26.3%), anosmia (21.1%), and difficulty with breathing (10.6%). In terms of treatment outcome, 57.9% delivered while 36.8% recovered with pregnancy on-going, and 1 (5.3%) maternal death. Of the 11 women who delivered, 45.4% had vaginal deliveries and 54.6 % had Caesarean section. The mean birth weight was 3.1kg and most of the neonates (81.8%) had normal Apgar scores at birth. There was 1 perinatal death from prematurity, birth asphyxia, and intrauterine growth restriction. The commonest diagnosed co-morbidity of pregnancy was preeclampsia and it was significantly associated with severe COVID-19 disease requiring oxygen supplementation (P = 0.028). Conclusion: the clinical symptoms of COVID-19 in pregnancy are similar to those described in the non-pregnant population. It did not seem to worsen the maternal or foetal pregnancy outcome. The occurrence of preeclampsia is significantly associated with severe COVID-19 infection requiring respiratory support.


Assuntos
COVID-19/complicações , Parto Obstétrico/estatística & dados numéricos , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Adulto , COVID-19/fisiopatologia , COVID-19/terapia , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Recém-Nascido , Morte Materna/estatística & dados numéricos , Nigéria , Oxigênio/administração & dosagem , Pré-Eclâmpsia/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
4.
Lancet Glob Health ; 9(9): e1181-e1182, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34332700
5.
BMC Public Health ; 21(1): 1536, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380436

RESUMO

BACKGROUND: Maternal mortality ratio is an important indicator to evaluate the health status in developing countries. Previous studies on maternal mortality ratio in China were limited to certain areas or short periods of time, and there was a lack of research on correlations with public health funding. This study aimed to assess the trends in the maternal mortality ratio, the causes of maternal death, and the correlations between maternal mortality ratio and total health financing composition in China from 1990 to 2019. METHODS: Data in this longitudinal study were collected from the China Health Statistics Yearbooks (1991-2020) and China Statistical Yearbook 2020. Linear regression analysis was used to assess the trends in the maternal mortality ratio in China. Pearson correlation analysis was used to assess the correlations between national maternal mortality ratio and total health financing composition. RESULTS: The yearly trends of the national, rural and urban maternal mortality ratio were - 2.290 (p < 0.01), - 3.167 (p < 0.01), and - 0.901 (p < 0.01), respectively. The gap in maternal mortality ratio between urban and rural areas has narrowed. Obstetric hemorrhage was the leading cause of maternal death. The mortalities ratios for the main causes of maternal death all decreased in China from 1990 to 2019. The hospital delivery rate in China increased, with almost all pregnant women giving birth in hospitals in 2019. Government health expenditure as a proportion of total health expenditure was negatively correlated with the maternal mortality ratio (r = - 0.667, p < 0.01), and out-of-pocket health expenditure as a proportion of total health expenditure was positively correlated with the maternal mortality ratio (r = 0.516, p < 0.01). CONCLUSION: China has made remarkable progress in improving maternal survival, especially in rural areas. The maternal mortality ratio in China showed a downward trend over time. To further reduce the maternal mortality ratio, China should take effective measures to prevent obstetric hemorrhage, increase the quality of obstetric care, improve the efficiency and fairness of the government health funding, reduce income inequality, and strengthen the medical security system.


Assuntos
Morte Materna , Mortalidade Materna , China/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Gravidez , População Rural
6.
J Health Care Poor Underserved ; 32(3): 1173-1180, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421022

RESUMO

Despite medical advances, maternal deaths in the U.S. are more common than in nearly all other developed nations. In addition, racial disparities have continued to widen. Driving our rates are maternal deaths from trauma such as homicide, suicide, and drug overdose. Here we discuss limitations of existing practices in prenatal and postpartum care in preventing maternal deaths. We then outline three simple yet novel strategies for changing care to prevent traumatic cases of maternal mortality.


Assuntos
Morte Materna , Complicações na Gravidez , Suicídio , Feminino , Homicídio , Humanos , Morte Materna/prevenção & controle , Mortalidade Materna , Gravidez , Complicações na Gravidez/prevenção & controle , Suicídio/prevenção & controle
7.
Am J Public Health ; 111(9): 1673-1681, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34383557

RESUMO

Objectives. To better understand racial and ethnic disparities in US maternal mortality. Methods. We analyzed 2016-2017 vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths that had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. We examined racial and ethnic disparities both overall and by primary cause. Results. The maternal mortality rate for non-Hispanic Black women was 3.55 times that for non-Hispanic White women. Leading causes of maternal death for non-Hispanic Black women were eclampsia and preeclampsia and postpartum cardiomyopathy with rates 5 times those for non-Hispanic White women. Non-Hispanic Black maternal mortality rates from obstetric embolism and obstetric hemorrhage were 2.3 to 2.6 times those for non-Hispanic White women. Together, these 4 causes accounted for 59% of the non-Hispanic Black‒non-Hispanic White maternal mortality disparity. Conclusions. The prominence of cardiovascular-related conditions among the leading causes of confirmed maternal death, particularly for non-Hispanic Black women, necessitates increased vigilance for cardiovascular problems during the pregnant and postpartum period. Many of these deaths are preventable.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Morte Materna/etiologia , Mortalidade Materna/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Gravidez , Fatores de Risco , Estados Unidos
8.
Am J Public Health ; 111(9): 1696-1704, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34410825

RESUMO

Objectives. To examine associations between state-level variation in abortion-restricting policies in 2015 and total maternal mortality (TMM), maternal mortality (MM), and late maternal mortality (LMM) from 2015 to 2018 in the United States. Methods. We derived an abortion policy composite index for each state based on 8 state-level abortion-restricting policies. We fit ecological state-level generalized linear Poisson regression models with robust standard errors to estimate 4-year TMM, MM, and LMM rate ratios and 95% confidence intervals (CIs) associated with a 1-unit increase in the abortion index, adjusting for state-level covariates. Results. States with the higher score of abortion policy composite index had a 7% increase in TMM (adjusted rate ratio [ARR] = 1.07; 95% CI = 1.02, 1.12) compared with states with lower abortion policy composite index, after we adjusted for state-level covariates. Among individual abortion policies, states with a licensed physician requirement had a 51% higher TMM (ARR = 1.51; 95% CI = 1.15, 1.99) and a 35% higher MM (ARR = 1.35; 95% CI = 1.09, 1.67), and states with restrictions on Medicaid coverage of abortion care had a 29% higher TMM (ARR = 1.29; 95% CI = 1.03, 1.61). Conclusions. Restricting access to abortion care at the state level may increase the risk for TMM.


Assuntos
Aborto Induzido/mortalidade , Aborto Legal/mortalidade , Comportamento Contraceptivo/estatística & dados numéricos , Morte Materna/estatística & dados numéricos , Aborto Legal/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Humanos , Mortalidade Materna/tendências , Governo Estadual , Estados Unidos
9.
BMC Infect Dis ; 21(1): 678, 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34256733

RESUMO

BACKGROUND: In this case report, we presented a rare case of maternal death with massive vulvar edema and Covid-19 diagnosis. CASE PRESENTATION: The case was a 20-year-old woman who was referred to with pain and massive vulvar edema by passing 7 days from her labor. The laboratory tests showed leukocytosis, lymphopenia, and elevated C-reactive protein levels. The high-resolution computed tomography was in favor of Covid-19 changes. Finally, she died because of respiratory distress, ON the 8th day postpartum. CONCLUSION: Given the increasing prevalence of Covid-19, it is important and vital to be aware of its potential complications and then to try prevent and manage them, especially during high-risk periods such as pregnancy and postpartum.


Assuntos
COVID-19/complicações , Edema/complicações , Edema/diagnóstico por imagem , Morte Materna , Período Pós-Parto , SARS-CoV-2/genética , Doenças da Vulva/complicações , Doenças da Vulva/diagnóstico por imagem , COVID-19/sangue , COVID-19/virologia , Teste para COVID-19/métodos , Evolução Fatal , Feminino , Humanos , Linfopenia , Gravidez , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
10.
Ethiop J Health Sci ; 31(1): 35-42, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34158750

RESUMO

Background: There is conflicting data on the rate and trends of maternal mortality in Ethiopia. There is no previous study done on the magnitude and trends of maternal death at Saint Paul's Hospital, an institution providing the largest labor and delivery services in Ethiopia. The objective of this study is to determine the magnitude, causes and contributing factors for maternal deaths in the institution. Methods: We conducted a retrospective review of maternal deaths from January 2016 to December 2017. Data were analyzed using SPSS version 20. Results: The maternal mortality ratio of the institution was 228.3 per 100,000 live births. Direct maternal death accounted for 90% (n=36) of the deceased. The leading causes of the direct maternal deaths were hypertensive disorders of pregnancy (n=13, 32.5%), postpartum hemorrhage (n=10, 25%), sepsis (n=4, 10%), pulmonary thromboembolism (n=3, 7.5%) and amniotic fluid embolism (n=3, 7.5%). Conclusion: The maternal mortality ratio was lower than the ratios reported from other institutions in Ethiopia. Hypertensive disorders of pregnancy and malaria were the leading cause of direct and indirect causes of maternal deaths respectively. Embolism has become one of the top causes of maternal death in a rate like the developed nations. This might show the double burden of embolism and other causes of maternal mortality that developing countries might be facing.


Assuntos
Morte Materna , Complicações na Gravidez , Causas de Morte , Etiópia/epidemiologia , Feminino , Humanos , Morte Materna/etiologia , Mortalidade Materna , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária
14.
Cad Saude Publica ; 37(6): e00215020, 2021.
Artigo em Português | MEDLINE | ID: mdl-34105623

RESUMO

Abortion is still a public health problem in Brazil and is among the leading causes of maternal death. Socially vulnerable women have the greatest risk of death from abortion. The Brazilian Ministry of Health determined mandatory investigation of deaths of childbearing-age women with discussion of maternal deaths by Maternal Mortality Committees, aimed at identifying failures in management of cases that led to or determined the deaths. In the city of Rio de Janeiro, this structure is organized in a Municipal Committee and ten Regional Commissions for Prevention and Control of Maternal Mortality. The objective was to analyze the recommendations by the Regional Commissions on deaths from induced abortion. We carried out a descriptive study of recommendations by the Regional Commissions on deaths from induced abortion in women living in the city of Rio de Janeiro from 2011 to 2016. Case selection used the classification of the Guidelines for Epidemiological Surveillance of Maternal Death for deaths from abortion. Recommendations were classified according to two points: "recipients and content" and "performance of abortion and related factors". The recommendations were predominantly technical and biomedical, without correlating the deaths to social, cultural, and economic issues. Taboo topics such as voluntary termination of pregnancy and search for changes in standards that would promote women's right to health were missing. Regional Commissions exercise an important activity and are a step forward in the fight against maternal mortality, but their recommendations only contribute partially to reducing mortality from induced abortion.


Assuntos
Aborto Induzido , Morte Materna , Brasil/epidemiologia , Cidades , Feminino , Humanos , Mortalidade Materna , Gravidez
15.
Afr J Reprod Health ; 25(1): 56-66, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34077111

RESUMO

Maternal death is a major global health issue with the highest impact in low-income countries. Despite some modest decline in the maternal mortality rates in Ghana since the 1990's, this has been below expectation. The aim of this study was to describe the trends and contributory factors to maternal mortality at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We performed a retrospective chart review of all maternal deaths at KBTH from 2015 to 2019. Data were analyzed using SPSS version 23. A p-value of <0.05 was considered statistically significant. Over the period, there were 45,676 live births, 276 maternal deaths and a maternal mortality ratio of 604/100,000 live births (95% CI: 590/100,000 - 739/100,000). The leading causes of maternal death were hypertensive disorders (37.3%), hemorrhage (20.6%), Sickle cell disease (8.3%), sepsis (8.3%), and pulmonary embolism (8.0%). Significant factors associated with maternal mortalities at the KBTH were: women with no formal education [AOR 3.23 (CI: 1.73- 7.61)], women who had less than four antenatal visits [AOR 1.93(CI: 1.23-3.03)], and emergency cesarean section [AOR 3.87(CI: 2.51-5.98)]. Hypertensive disorders remain the commonest cause of the high maternal mortality at KBTH. Formal education and improvement in antenatal visits may help prevent these deaths.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Morte Materna/estatística & dados numéricos , Mortalidade Materna , Complicações na Gravidez/mortalidade , Adolescente , Adulto , Causas de Morte , Feminino , Gana/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Morte Materna/etnologia , Paridade , Gravidez , Estudos Retrospectivos , Adulto Jovem
16.
CMAJ Open ; 9(2): E539-E547, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34021011

RESUMO

BACKGROUND: Accurate identification of maternal deaths is paramount for audit and policy purposes. Our aim was to determine the accuracy and completeness of data on maternal deaths in hospital and those recorded on a death certificate, and the level of agreement between the 2 data sources. METHODS: We conducted a retrospective population-based study using data for Ontario, Canada, from Apr. 1, 2002, to Dec. 31, 2015. We used Canadian Institute for Health Information (CIHI) databases to identify deaths during inpatient, emergency department and same-day surgery encounters. We captured Vital Statistics deaths in the Office of the Registrar General, Deaths (ORGD) data set. Deaths were considered within 42 days and within 365 days after a pregnancy outcome (live birth, miscarriage, ectopic pregnancy or induced abortion) for all multiple and singleton pregnancies. We calculated agreement statistics and 95% confidence intervals (CIs). RESULTS: Among 1 679 455 live births and stillbirths, 398 pregnancy-related deaths in the ORGD data set were mapped to a birth in CIHI databases, and 77 (16.2%) were not. Among 2 039 849 recognized pregnancies, 534 pregnancy-related deaths in the ORGD data set were linked to CIHI records, and 68 (11.3%) were not. Among live births and stillbirths, after pregnancy-related deaths in the ORGD data set not matched to a maternal death in the CIHI databases were removed, concordance measures between CIHI and ORGD records for maternal death within 42 days after delivery included a κ value of 0.87 (95% CI 0.82-0.91) and positive percent agreement of 0.88 (95% CI 0.83-0.94). The corresponding measures were similar for maternal death within 42 days after the end of a recognized pregnancy. When unlinked pregnancy-related deaths in the ORGD data set were retained, agreement measures declined for death within 42 days after a live birth or stillbirth (κ = 0.68, 95% CI 0.62-0.74). For maternal death within 365 days after a live birth or stillbirth, or after the end of a recognized pregnancy, the concordance statistics were generally favourable when unlinked pregnancy-related deaths in the ORGD data set were removed but were substantially declined when they were retained. INTERPRETATION: Maternal mortality cannot be ascertained solely with the use of hospital data, including beyond 42 days after the end of pregnancy. To improve linkage, we propose including health insurance numbers on provincial and territorial medical death certificates.


Assuntos
Declaração de Nascimento , Atestado de Óbito , Morte Materna , Mortalidade Materna/tendências , Complicações na Gravidez/mortalidade , Resultado da Gravidez/epidemiologia , Causas de Morte , Feminino , Sistemas de Informação Hospitalar/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Morte Materna/etiologia , Morte Materna/prevenção & controle , Morte Materna/estatística & dados numéricos , Registro Médico Coordenado/métodos , Ontário/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/normas , Gravidez , Melhoria de Qualidade , Estudos Retrospectivos , Natimorto/epidemiologia
18.
BMJ Glob Health ; 6(5)2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34020994

RESUMO

BACKGROUND: Since 2015, Tanzania has been implementing the Maternal Death Surveillance and Response (MDSR) system. The system employs interactions of health providers and managers to identify, notify and review maternal deaths and recommend strategies for preventing further deaths. We aimed to analyse perceptions and experiences of health providers and managers in implementing the MDSR system. METHODS: An exploratory qualitative study was carried out with 30 purposively selected health providers and 30 health managers in four councils from the Mtwara region between June and July 2020. Key informant interviews and focus group discussions were used to collect data. Inductive thematic analysis was used to analyse data. RESULTS: Two main themes emerged from this study: 'Accomplishing by ambitions' and 'A flawed system'. The themes suggest that health providers and managers have a strong desire to make the MDSR system work by making deliberate efforts to implement it. They reported working hard to timely notify, review death and implement action plans from meetings. Health providers and managers reported that MDSR has produced changes in care provision such as behavioural changes towards maternal care, increased accountability and policy changes. The system was however flawed by lack of training, organisational problems, poor coordination with other reporting and quality improvements systems, assigning blame and lack of motivation. CONCLUSION: The implementation of the MDSR system in Tanzania faces systemic, contextual and individual challenges. However, our results indicate that health providers and managers are willing and committed to improve service delivery to avoid maternal deaths. Empowering health providers and managers by training and addressing the flaws will improve the system and quality of care.


Assuntos
Morte Materna , Serviços de Saúde Materna , Feminino , Humanos , Morte Materna/prevenção & controle , Mortalidade Materna , Gravidez , Tanzânia/epidemiologia
19.
BMJ Open ; 11(5): e042840, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33986042

RESUMO

OBJECTIVES: To identify delays and associated factors for maternal deaths in Nepal. DESIGN: A cross-sectional case series study of maternal deaths. An integrated verbal and social autopsy tool was used to collect quantitative and qualitative information regarding three delays. We recorded death accounts and conducted social autopsy by means of community Focus Group Discussions for each maternal death; and analysed data by framework analysis. SETTING: Sixty-two maternal deaths in six districts in three provinces of Nepal. RESULTS: Nearly half of the deceased women (45.2%) were primiparous and one-third had no formal education. About 40% were from Terai/Madhesi and 30.6% from lower caste. The most common place of death was private hospitals (41.9%), followed by public hospitals (29.1%). Nearly three-fourth cases were referred to higher health facilities and median time (IQR) of stay at the lower health facility was 120 (60-180) hours. Nearly half of deaths (43.5%) were attributable to more than one delay while first and third delay each contributed equally (25.8%). Lack of perceived need; perceived cost and low status; traditional beliefs and practices; physically inaccessible facilities and lack of service readiness and quality care were important factors in maternal deaths. CONCLUSIONS: The first and third delays were the equal contributors of maternal deaths. Interventions related to birth preparedness, economic support and family planning need to be focused on poor and marginalised communities. Community management of quick transportation, early diagnosis of pregnancy risks, accommodation facilities near the referral hospitals and dedicated skilled manpower with adequate medicines, equipment and blood supplies in referral hospitals are needed for further reduction of maternal deaths in Nepal.


Assuntos
Morte Materna , Serviços de Saúde Materna , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Humanos , Mortalidade Materna , Nepal , Gravidez
20.
BMJ Open ; 11(5): e043783, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33958337

RESUMO

OBJECTIVE: To assess the functioning of maternal, perinatal, neonatal and child death surveillance and response (DSR) mechanisms at a health district level. DESIGN: A framework of elements covering analysis of causes of death, and processes of review and response was developed and applied to the smallest unit of coordination (subdistrict) to evaluate DSR functioning. The evaluation design was a descriptive qualitative case study, based on observations of DSR practices and interviews. SETTING: Rural South African health district (subdistricts and district office). PARTICIPANTS: A purposive sample of 45 front-line health managers and providers involved with maternal, perinatal, neonatal and child DSR. The DSR mechanisms reviewed included a system of real-time death reporting (24 hours) and review (48 hours), a nationally mandated confidential enquiry into maternal death and regular facility and subdistrict mortality audit and response processes. PRIMARY OUTCOME MEASURES: Functioning of maternal, perinatal, neonatal and child DSR. RESULTS: While DSR mechanisms were integrated into the organisational routines of the district, their functioning varied across subdistricts and between forms of DSR. Some forms of DSR, notably those involving maternal deaths, with external reporting and accounting, were more likely to trigger reactive fault-finding and sanctioning than other forms, which were more proactive in supporting evidence-based actions to prevent future deaths. These actions occurred at provider and system level, and to a limited extent, in communities. CONCLUSIONS: This study provides an empirical example of the everyday practice of DSR mechanisms at a district level. It assesses such practice based on a framework of elements and enabling organisational processes that may be of value in similar settings elsewhere.


Assuntos
Saúde da Criança , Morte Materna , Criança , Feminino , Humanos , Recém-Nascido , Mortalidade Materna , Gravidez , Pesquisa Qualitativa , Saúde da População Rural
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