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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
2.
Bratisl Lek Listy ; 120(9): 690-694, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31475556

RESUMO

AIM: Severe acute maternal morbidity (SAMM) is a state of the woman, when she nearly died, but survived. The aim of study was to find out the exact incidence of SAMM in Slovakia, establishment of functional surveillance system and improve quality of health care. MATERIALS AND METHODS: The regular annual analyses of SAMM cases in Slovakia from January 1st 2012 to December 31st 2016. Observed SAMM included: peripartum haemorrhage, peripartum hysterectomy, uterine rupture, abnormally invasive placenta, HELLP syndrome, eclampsia, sepsis, transport to intensive care unit or anaesthesiology and non-fatal amniotic fluid embolism. RESULTS: The response rate of questionnaires was 84.8 %. The overall confirmed incidence of SAMM was 6.35/1,000 births (95% CI 6.03-6.67). The most often causes of SAMM were: peripartum haemorrhage (2.1/1,000 births), transport to intensive care unit or anaesthesiology (1.46/1,000 births), peripartum hysterectomy (0.84/1,000 births) and HELLP syndrome (0.63/1,000 births). The average age of women with SAMM was 30.3 years (14-46) and average parity was 1.16 (0-15). CONCLUSION: The incidence of SAMM and especially incidence of peripartum haemorrhage and peripartum hysterectomy in Slovakia is one of the highest in Europe. To decrease incidence and improve management and outcome of patients, regular audit of SAMM is needed (Tab. 3, Fig. 2, Ref. 30).


Assuntos
Saúde Materna/estatística & dados numéricos , Morbidade/tendências , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Hemorragia , Humanos , Histerectomia , Pessoa de Meia-Idade , Período Periparto , Placenta Acreta , Gravidez , Sepse , Eslováquia , Ruptura Uterina , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-31487782

RESUMO

Having good health-related quality of life (HRQoL) is essential, particularly for women after childbirth. However, little is known about its determinants. We aimed to identify the determinants of HRQoL after childbirth in a large community sample in the Netherlands. We have included 4312 women in the present study. HRQOL was assessed by a 12-Item Short Form Survey (SF-12) at around two months after childbirth; Physical and Mental Component Summary scores were calculated. Information on 27 potential determinants of HRQoL was collected through questionnaires and medical records. Multivariate linear regression models were applied to assess significant determinants of physical and mental HRQoL. Our study showed that older maternal age, shorter time since childbirth, elective/emergency cesarean delivery, loss of energy, maternal psychopathology, and the hospital admission of the infant were significantly associated with worse physical HRQoL (p < 0.05); older maternal age, non-western background, low household income, loss of energy, and maternal psychopathology were significantly associated with worse mental HRQoL (p < 0.05). We identified multiple determinants of suboptimal physical and mental HRQoL after childbirth. In particular, maternal psychopathology after childbirth was profoundly associated with mental HRQoL. These women may need support. We therefore call for awareness among health care professionals.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Gravidez/estatística & dados numéricos , Qualidade de Vida/psicologia , Adulto , Feminino , Humanos , Países Baixos , Parto
4.
BMC Health Serv Res ; 19(1): 645, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492134

RESUMO

BACKGROUND: Maternal and perinatal mortality is a major public health concern across the globe and more so in low and middle-income countries. In Kenya, more than 6000 maternal deaths, and 35,000 stillbirths occur each year. The Government of Kenya abolished user fee for maternity care under the Free Maternity Service policy, in June of 2013 in all public health facilities, a move to make maternity services accessible and affordable, and to reduce maternal and perinatal mortality. METHOD: An observational retrospective study was carried out in 3 counties in Kenya. Six maternal health output indicators were observed monthly, 2 years pre and 2 years post- policy implementation. Data was collected from daily maternity registers in 90 public health facilities across the 3 counties all serving an estimated population of 3 million people. Interrupted Time Series Analysis (ITSA) with a single group was used to assess the effects of the policy. Standard linear regression using generalized least squares (gls) model, was used to run the results for each of the six variables of interest. Absolute and relative changes were calculated using the gls model coefficients. RESULTS: Significant sustained increase of 89, 97, and 98% was observed in the antenatal care visits, health facility deliveries, and live births respectively, after the policy implementation. An immediate and significant increase of 27% was also noted for those women who received Emergency Obstetric Care (EmONC) services in either the level 5, 4 and 3 health facilities. No significant changes were observed in the stillbirth rate and caesarean section rate following policy implementation. CONCLUSION: After 2 years of implementing the Free Maternity Service policy in Kenya, immediate and sustained increase in the use of skilled care during pregnancy and childbirth was observed. The study suggest that hospital cost is a major expense incurred by most women and their families whilst seeking maternity care services and a barrier to maternity care utilization. Overall, Free Maternity Service policy, as a health financing strategy, has exhibited the potential of realizing the full beneficial effects of maternal morbidity and mortality reduction by increasing access to skilled care.


Assuntos
Serviços de Saúde Materna/economia , Cesárea/economia , Cesárea/estatística & dados numéricos , Parto Obstétrico/economia , Parto Obstétrico/estatística & dados numéricos , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Instalações de Saúde/economia , Instalações de Saúde/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Quênia/epidemiologia , Saúde Materna/economia , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Mortalidade Perinatal , Gravidez , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Natimorto/epidemiologia
5.
BMC Pregnancy Childbirth ; 19(1): 260, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337348

RESUMO

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


Assuntos
Ansiedade/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , População Rural/estatística & dados numéricos , Adulto , Tomada de Decisões , Feminino , Gana , Humanos , Masculino , Saúde Materna/estatística & dados numéricos , Mães , Gravidez , Cuidado Pré-Natal/psicologia , Pesquisa Qualitativa
7.
BMC Pregnancy Childbirth ; 19(1): 233, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277596

RESUMO

BACKGROUND: Grand multiparity is a major public health concern especially among developing countries and has been associated with higher risk of adverse maternal and fetal outcomes compared with women of lesser parity. There is a dearth of evidence on this subject in Cameroon, especially in the rural areas. We therefore carried out this study to document the prevalence and maternal and fetal delivery outcomes of grand multiparity in a rural Cameroonian setting. METHODS: We conducted a retrospective chart review of delivery records from two health facilities (the Oku District Hospital and Kevu Integrated Health Centre) in the Oku Health District over a period of eight years. Data was entered into and analyzed using Epi-Info version 7.0.8.3. The Chi-squared or Fisher's exact test was used to compare categorical variables. The threshold of statistical significance was set at 5%. RESULTS: A total of 1755 delivery records met our inclusion criteria. The overall prevalence of grand multiparity was 27.0%. We found no significant difference in the rate of selected maternal and fetal delivery outcomes between grand multiparous women and those with lesser parity (p-value> 0.05). However, grand multiparous women were less likely to develop second-fourth degree perineal tears compared to their counterparts with lesser parity (odds ratio = 0.3, 95% confidence interval = 0.2-0.7, p = 0.001). CONCLUSION: Our study depicts a high prevalence of grand multiparous delivery in this rural community. With the exception of severe perineal tear, grand multipara and their babies are as likely to develop adverse delivery outcomes as their counterparts with lesser parity. There is also the need to enhance existing government policies on reproductive health in rural areas.


Assuntos
Saúde Materna/estatística & dados numéricos , Paridade , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Saúde da População Rural/estatística & dados numéricos , Adolescente , Adulto , Camarões/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
8.
Glob Health Action ; 12(1): 1619155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31159680

RESUMO

Background: Globally, opportunities to validate government reports through external audits are rare, notably in India. A cross-sectional maternal health study in Uttar Pradesh, India's most populous state, compares government administrative data and externally collected data on maternal health service indicators. Objectives: Our study aims to determine the level of concordance between government-reported health facility data compared to externally collected health facility data on the same maternal healthcare quality indicators. Second, our study aims to explore whether the level of agreement between government administrative data versus the externally collected data differs by level of facility or by type of maternal health service. Methods: Facility assessment surveys were administered to key health staff by government-hired enumerators from January 2017 to March 2017 at nearly 750 government health facilities across UP. The same survey was re-conducted by external data collectors from August 2017 to October 2017 at 40 of the same facilities. We conduct comparative analyses of the two datasets for agreement among the same measures of maternal healthcare quality. Results: The findings indicate concordance between most indicators across government administrative data and externally collected health facility data. However, when stratified by facility-level or service type, results suggest significant over-reporting in the government administrative data on indicators that are incentivized. This finding is consistent across all levels of facilities; however, the most significant disparities appear at higher-level facilities, namely District Hospitals. Conclusion: This study has a number of important programmatic and policy implications. Government administrative health data have the potential to be highly critical in informing large-scale quality improvements in maternal healthcare quality, but its credibility must be readily verifiable and accessible to politicians, researchers, funders, and most importantly, the public, to improve the overall health, patient experience, and well-being of women and newborns.


Assuntos
Confiabilidade dos Dados , Coleta de Dados/métodos , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
9.
PLoS One ; 14(5): e0216027, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31071125

RESUMO

BACKGROUND: Maternal mortality rates are still unacceptably high in many countries, indicating violation of women´s human right to life and health. Access to adequate information about maternal health rights and available services are essential aspects of realizing women´s right to accessible health care. This study aimed at assessing awareness of the right to access maternal health services among women who had recently given birth, and the association between such awareness and the utilization of maternal health services in two districts in Tanzania. METHODS: This study was cross sectional in design. Interviews were conducted with women who gave birth within one year prior to the survey in two different district councils (DC) namely Hai DC and Morogoro DC, selected purposively based on the earlier reported rates of maternal mortality. We used a two-stage cluster sampling to select the study sample. Analysis employed Chi-square test and Logistic regression. RESULTS: A total of 547 respondents were interviewed. Only a third (34.4%) reported to be aware of their right to access maternal health services. Main sources of information on maternal health rights were the media and health care providers. Occupation and education level showed a statistically significant association with awareness of access rights. Hai DC had higher proportion of women aware of their access rights compared to Morogoro DC. Women who were aware of their right of access were almost 5 times more likely to use skilled birth attendants compared to those who were not (AOR 4.61 95% CI: 2.14-8.57). CONCLUSION AND RECOMMENDATIONS: Awareness of the right to access maternal health services was low in the studied population. To increase awareness and hence uptake of Pregnancy care and skilled birth attendants at delivery we recommend the government and partners to prioritize provision of information, communication and education on women´s human rights, including the right to access maternal health services, especially to women in rural areas.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , População Rural/estatística & dados numéricos , Direitos da Mulher/estatística & dados numéricos , Adulto , Conscientização , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Mortalidade Materna , Parto , Cuidado Pré-Natal/estatística & dados numéricos , Reprodução , Fatores Socioeconômicos , Tanzânia , Adulto Jovem
10.
PLoS One ; 14(5): e0217342, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31125387

RESUMO

BACKGROUND: This study aimed to assess how maternal mental health mediates the association between childhood socio-economic conditions at birth and subsequent child behavioural and emotional problem scores. METHODS: Analysis of the Wirral Child Health and Development Study (WCHADS), a prospective epidemiological longitudinal study of the early origins of child mental health (n = 664). Household income at 20-weeks gestation, a measure of socio-economic conditions (SECs) in pregnancy, was the main exposure. The outcome measure was externalising and internalising problems, as measured by the Child Behaviour Checklist at 5 years. We assessed the association of household income with child behavioural outcomes in sequential linear models adjusting for maternal mental health in the pre- and post- natal period. RESULTS: Children of mothers in more disadvantaged households had higher scores for externalising behaviour with a difference of 3.6 points comparing the most affluent to the most disadvantaged families (the socio-economic (SEC) gap). In our regression model adjusting for baseline confounders, comparing children of mothers in the most disadvantaged households to the least disadvantaged, we found that most disadvantaged children scored 45 percentage points (95% CI 9, 93) higher for externalising problems, and 42% of this difference was explained in the fully adjusted model. Adjusting for prenatal maternal depressive symptomology attenuated the SEC gap in externalising problems by about a third, rendering the association non-significant, whilst adjusting for pre- and post-natal maternal mental health attenuated the SEC gap by 42%. There was no significant relationship between household income and internalising problems. CONCLUSION: Social disadvantage is associated with higher child externalising behaviour problems score at age 5, and about 40% of this was explained by maternal perinatal mental health. Policies supporting maternal mental health in pregnancy are important to address the early emergence of inequalities in child mental health.


Assuntos
Transtornos do Comportamento Infantil/epidemiologia , Saúde da Criança , Saúde Materna , Saúde Mental , Adolescente , Adulto , Sintomas Afetivos/epidemiologia , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Saúde Materna/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Gravidez , Estudos Prospectivos , Fatores Socioeconômicos , Adulto Jovem
11.
BMC Health Serv Res ; 19(1): 336, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133032

RESUMO

BACKGROUND: Health service and health outcome data collection across many low- and middle-income countries (LMICs) is, to date largely paper-based. With the development and increased availability of reliable technology, electronic tablets could be used for electronic data collection in such settings. This paper describes our experiences with implementing electronic data collection methods, using electronic tablets, across different settings in four LMICs. METHODS: Within our research centre, the use of electronic data collection using electronic tablets was piloted during a healthcare facility assessment study in Ghana. After further development, we then used electronic data collection in a multi-country, cross-sectional study to measure ill-health in women during and after pregnancy, in India, Kenya and Pakistan. All data was transferred electronically to a central research team in the UK where it was processed, cleaned, analysed and stored. RESULTS: The healthcare facility assessment study in Ghana demonstrated the feasibility and acceptability to healthcare providers of using electronic tablets to collect data from seven healthcare facilities. In the maternal morbidity study, electronic data collection proved to be an effective way for healthcare providers to document over 400 maternal health variables, in 8530 women during and after pregnancy in India, Kenya and Pakistan. CONCLUSIONS: Electronic data collection provides an effective platform which can be used successfully to collect data from healthcare facility registers and from patients during health consultations; and to transfer large quantities of data. To ensure successful electronic data collection and transfer between settings, we recommend that close attention is paid to study design, data collection, tool design, local internet access and device security.


Assuntos
Computadores de Mão/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Adulto , Estudos Transversais , Coleta de Dados/instrumentação , Utilização de Equipamentos e Suprimentos , Feminino , Gana , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Índia , Quênia , Paquistão , Pobreza , Gravidez
12.
Int J Equity Health ; 18(1): 55, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971254

RESUMO

BACKGROUND: A consensus is developing on interventions to improve newborn survival, but little is known about how to reduce socioeconomic inequalities in newborn mortality in low- and middle-income countries. Participatory learning and action (PLA) through women's groups can improve newborn survival and home care practices equitably across socioeconomic strata, as shown in cluster randomised controlled trials. We conducted a qualitative study to understand the mechanisms that led to the equitable impact of the PLA approach across socioeconomic strata in four trial sites in India, Nepal, Bangladesh, and Malawi. METHODS: We conducted 42 focus group discussions (FGDs) with women who had attended groups and women who had not attended, in poor and better-off communities. We also interviewed six better-off women and nine poor women who had delivered babies during the trials and had demonstrated recommended behaviours. We conducted 12 key informant interviews and five FGDs with women's group facilitators and fieldworkers. RESULTS: Women's groups addressed a knowledge deficit in poor and better-off women. Women were engaged through visual learning and participatory tools, and learned from the facilitator and each other. Facilitators enabled inclusion of all socioeconomic strata, ensuring that strategies were low-cost and that discussions and advice were relevant. Groups provided a social support network that addressed some financial barriers to care and gave women the confidence to promote behaviour change. Information was disseminated through home visits and other strategies. The social process of learning and action, which led to increased knowledge, confidence to act, and acceptability of recommended practices, was key to ensuring behaviour change across social strata. These equitable effects were enabled by the accessibility, relevance, and engaging format of the intervention. CONCLUSIONS: Participatory learning and action led to increased knowledge, confidence to act, and acceptability of recommended practices. The equitable behavioural effects were facilitated by the accessibility, relevance, and engaging format of the intervention across socioeconomic groups, and by reaching-out to parts of the population usually not accessed. A PLA approach improved health behaviours across socioeconomic strata in rural communities, around issues for which there was a knowledge deficit and where simple changes could be made at home.


Assuntos
Equidade em Saúde , Promoção da Saúde , Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , População Rural/estatística & dados numéricos , África , Ásia , Feminino , Grupos Focais , Avaliação do Impacto na Saúde , Humanos , Recém-Nascido , Gravidez , Pesquisa Qualitativa , Fatores Socioeconômicos
13.
PLoS One ; 14(3): e0213058, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30822317

RESUMO

BACKGROUND: Low birth weight continues to be a main cause of child morbidity and mortality. Low birth weight can cause complications in adult life, and is therefore a public health concern. In this study, we determined the maternal factors that contribute to low birth weight (LBW) deliveries in Tshwane District, South Africa. METHODS: We conducted a case control study of 1073 randomly selected mothers who delivered babies in four hospitals in the district. We reviewed antenatal and maternity registers to obtain information about the mothers and their offspring. We fitted a multiple logistic regression to examine relationships between possible factors associated with LBW. RESULTS: From the total sample of mothers (n = 1073), 77% (n = 824) were adult women, aged 20 to 35 years. Of the adult mothers, 38.54% (n = 412) delivered low birth weight (LBW) infants. The mean gestational age and weight of all infants at birth was 37.16 weeks (SD 2.92) and 2675.48 grams (SD 616.16) respectively. LBW was associated with prematurity, odds ratio (OR) 7.15, 95% confidence interval (CI) 5.18 to 9.89; premature rupture of membranes OR 7.33, 95% CI 2.43 to 22.12 and attending fewer than five antenatal care (ANC) visits OR 1.30, 95% CI 1.06 to 1.61. Male infants were less likely to be LBW, in this population. CONCLUSION: Women who attended fewer than five ANC visits were predisposed to give birth to low birth weight babies. Mothers should be encouraged to attend ANC visits to detect adverse events like premature rupture of membranes and premature labour timeously.


Assuntos
Peso ao Nascer , Saúde Materna/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Gravidez , Distribuição Aleatória , África do Sul
14.
Biomed Res Int ; 2019: 7596165, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30895195

RESUMO

Aim: To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and maternal and perinatal outcomes associated with labor analgesia. Methods: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then divided into two groups: those who received and those who did not receive analgesia for labor/delivery. We further compared maternal characteristics and maternal and perinatal outcomes between these two groups. Results: From 314,623 women originally included in WHO-MCS, 9,788 developed SMM and delivered vaginally, 601 (6.1%) with analgesia and 9,187 (93.9%) without analgesia. Women with SMM were more likely to receive analgesia than those who did not experience SMM. Global distribution of SMM was similar; however, the use of analgesia was less prevalent in Africa. Higher maternal education, previous cesarean section, and nulliparity were factors associated with analgesia use. Analgesia was not an independent factor associated with an increase of severe maternal outcome (Maternal Near Miss + Maternal Death). Conclusions: The overall use of analgesia for vaginal delivery is low but women with SMM are more likely to receive analgesia during labor. Social conditions are closely linked with the likelihood of having analgesia during delivery and such a procedure is not associated with increased adverse maternal outcomes. Expanding the availability of analgesia in different levels of care should be a concern worldwide.


Assuntos
Analgesia/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Internacionalidade , Trabalho de Parto/fisiologia , Saúde Materna/estatística & dados numéricos , Mortalidade Materna , Inquéritos e Questionários , Organização Mundial da Saúde , Adulto , Feminino , Humanos , Análise Multivariada , Gravidez , Resultado da Gravidez , Prevalência , Adulto Jovem
15.
PLoS One ; 14(3): e0213006, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901325

RESUMO

BACKGROUND: Trials have examined on the benefits of vitamin D supplementation in pregnant women. OBJECTIVE: This review aimed to evaluate whether oral vitamin D supplements, when given to pregnant women with gestational diabetes mellitus (GDM), would improve maternal and neonatal outcomes, compared with no treatment or placebo. METHOD: We performed a systematic review following Cochrane methodology, and randomized trials were included where pregnant women with GDM received vitamin D supplementation versus placebo/no treatment or vitamin D and calcium versus placebo/no treatment. Primary outcomes were preeclampsia, preterm birth, cesarean delivery, gestational hypertension, and adverse events related to vitamin D supplementation. The search strategies were applied to the following databases: MEDLINE, Embase, LILACS, and CENTRAL. Similar outcomes in at least two trials were plotted using Review Manager 5.3 software. The quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: The total of 1224 references were identified, eleven trials were potentially eligible, and six were included in this review (totaling 456 women). The meta-analysis of frequency of cesarean deliveries did not show significant differences between groups, none of the trials evaluated the remaining primary outcomes. For secondary outcomes, our results suggest that vitamin D supplementation in pregnant women with GDM may reduce newborn complications such as hyperbilirubinemia, polyhydramnios (RR: 0.40, 95% CI: 0.23 to 0.68; RR: 0.17, 95% CI: 0.03 to 0.89; respectively), and the need for maternal or infant hospitalization (RR: 0.13; 95% CI: 0.02 to 0.98; RR: 0.40, 95% CI: 0.23 to 0.69). However, the evidence was of low or very low quality. CONCLUSION: We did not find moderate or high quality evidence indicating that vitamin D supplementation, when compared with placebo, improves glucose metabolism, adverse maternal and neonatal outcomes related to GDM in pregnant women.


Assuntos
Diabetes Gestacional/dietoterapia , Suplementos Nutricionais , Vitamina D/administração & dosagem , Cesárea/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/prevenção & controle , Saúde Materna/estatística & dados numéricos , Placebos/administração & dosagem , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
16.
Public Health ; 168: 76-82, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30708198

RESUMO

OBJECTIVE: The objective of this study was to examine the association between childhood injury and health outcomes among survivors and their mothers using a national survey in the United States (US). STUDY DESIGN: This was a longitudinal analysis of a nationally representative sample. METHODS: Secondary analysis of the 1997-2013 Medical Expenditure Panel Survey (MEPS) was performed. Children (aged 2-18 years) with or without injuries were followed up for two years. Injuries captured in the study were those associated with at least one hospitalization, emergency department visit, or office-based visit. Outcome measures were child and maternal general and mental health status. Multiple mixed-logistic regressions were used with suboptimal health defined as the response of poor or fair health versus good, very good, or excellent health. RESULTS: Of the 63,422 children analyzed, 3251 (4.9%) were injured, representing 3.6 million US children. Injured children were more likely to be male, white, and older than those without injuries (P < 0.01). About a fifth of injured children suffered head injuries. Injuries were strongly associated with suboptimal general and mental health status in children (adjusted odds ratios [AORs], 1.35 and 1.36, respectively, P < 0.05). Mothers of children with injuries were also more likely to report suboptimal mental health (AOR, 1.30, P < 0.05). CONCLUSION: Injuries among children are associated with lasting adverse effects in general and mental health. To improve health outcomes of pediatric injuries, further follow-up care may be needed to ensure that they return to pre-injury health levels. These results highlight the importance of primary prevention and the long-term impact of injuries on the health of children and their mothers.


Assuntos
Saúde da Criança/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Estados Unidos/epidemiologia
17.
PLoS One ; 14(2): e0210697, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726250

RESUMO

Efforts to mitigate public health concerns are showing encouraging results over the time but disparities across the geographic regions still exist within countries. Inadequate researches on the regional disparities of health indicators based on representative and comparable data create challenges to develop evidence-based health policies, planning and future studies in developing countries like Bangladesh. This study examined the disparities among districts on various maternal and child health indicators in Bangladesh. Cluster analysis-an unsupervised learning technique was used based on nationally representative dataset originated from Multiple Indicator Cluster Survey (MICS), 2012-13. According to our results, Bangladesh is classified into two clusters based on different health indicators with substantial variations in districts per clusters for different sets of indicators suggesting regional variation across the indicators. There is a need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization and improving the socioeconomic position of mothers, especially in disadvantaged regions. The cluster analysis approach is unique in terms of the use of health care metrics in a multivariate setup to study regional similarity and dissimilarity in the context of Bangladesh.


Assuntos
Saúde da Criança/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Saúde Materna/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Adulto , Bangladesh , Criança , Serviços de Saúde da Criança/organização & administração , Pré-Escolar , Análise por Conglomerados , Conjuntos de Dados como Assunto , Países em Desenvolvimento , Feminino , Política de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Serviços de Saúde Materna/organização & administração , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto Jovem
18.
Public Health ; 169: 14-25, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772525

RESUMO

OBJECTIVES: In an effort to provide recommendation for maximizing synergy between maternal, infant, and young children's nutrition and family planning in India, this study makes a comprehensive assessment of the effects of the planning of births in terms of timing, spacing and limiting childbearing on maternal and child health outcomes. STUDY DESIGN: This study used the latest National Family Health Survey data of India that is globally known as the Demographic and Health Survey. A robust two-stage systematic random sampling was used for selecting representative samples for measuring demographic and health indicators. METHODS: Maternal and child health outcomes are measured by body mass index (grouped as normal, underweight, and overweight) and anemia for mothers, and stunting, underweight, anemia, and under-five mortality for the children. Logistic regression and Cox proportional hazard models were applied. RESULTS: Women with a higher number of births and among those with first-order births with fewer than 2 years between marriage and first birth, the risk of being underweight and having anemia was significantly higher compared with their counterparts. In addition, the probability of being underweight and risk of stunting, anemia, and mortality was higher among the children from women with a higher number of births and with fewer than 3 years of spacing between births than that of their counterparts. CONCLUSIONS: The findings from this study support the importance of birth planning in improving maternal, child health, and nutritional outcomes. The proper planning of births could help to achieve the Sustainable Development Goal-3 of good health and well-being for all by 2030 in India, where a significant proportion of women still participate in early marriages, early childbearing, and a large number of births with close spacing.


Assuntos
Saúde da Criança/estatística & dados numéricos , Serviços de Planejamento Familiar , Saúde Materna/estatística & dados numéricos , Estado Nutricional , Adulto , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Índia , Lactente , Gravidez
19.
BMC Pregnancy Childbirth ; 19(1): 47, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30691397

RESUMO

BACKGROUND: The concern of all maternal health stakeholders is to improve maternal health and reduce maternal deaths to the barest minimum. This remains elusive in low and middle-income countries as the majority of factors that drive maternal deaths stem from the socio-cultural environment especially in rural settings. This study was aimed at finding out if knowledge on socio-cultural factors related to maternal mortality affects maternal health decisions in rural Ghana. METHODS: Community-based cross-sectional in design, the study involved 233 participants from 3 rural districts in the Greater Accra Region. Mixed-method of data collection was employed after informed consent. Quantitative data were analyzed using simple statistics, Fisher's Exact Test of independence and crude odds ratio were used to interpret the results, whilst the FGDs were recorded, transcribed and analyzed based on themes. RESULTS: Statistically, significant relationship exists between all the socio-cultural factors studied (Traditional Birth Attendants (TBAs), religious beliefs and practices, herbal concoctions, and pregnancy and childbirth-related taboos) and maternal health decisions (p = 0.001 for all the variables) with very strong associations between maternal health decisions and knowledge on pregnancy and childbirth related taboos, TBA patronage, and religious beliefs and practices (OR = 21.06; 13; 7.28 respectively). However, misconceptions on factors associated with maternal mortality deeply rooted in rural communities partly explain why maternal morbidity and mortality are persistent in Ghana. CONCLUSION: Meaningful and successful interventions on maternal mortality can only be achieved if misconceptions on causes of maternal mortality especially in rural areas of the country are tackled through mass education of communities. This should be done consistently over a long period of time for sustained behavioral change.


Assuntos
Saúde Materna/estatística & dados numéricos , Mortalidade Materna , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Causas de Morte , Estudos Transversais , Características Culturais , Feminino , Gana , Humanos , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Adulto Jovem
20.
J Glob Health ; 9(1): 010413, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30643636

RESUMO

Background: Despite improvement in recent decades, maternal and newborn mortality in Bangladesh remain high. A community-based intervention package was initiated in 2009 in Netrokona, a rural district in Bangladesh, to engage individuals, families and communities to improve maternal and newborn health. In this article, we present the effect of the intervention package on improvement of women's capacities with regard to maternal and newborn health, their husbands' capacities to effectively support them and use of skilled services during pregnancy, childbirth and after childbirth. Methods: We adopted a quasi-experimental design to evaluate the effect of the intervention package. A cross-sectional household survey was conducted in the intervention and comparison sites at baseline in 2014 and at endline in 2016. A total of 725 women were interviewed at baseline (intervention n = 444; comparison n = 281) and 737 at end-line (intervention n = 442; comparison n = 295). A total of 317 of their husbands were interviewed at baseline (intervention n = 178; comparison n = 139) and 731 at endline (intervention n = 440; comparison n = 291). Propensity score matching (1:1) was performed and the subsequent analysis was restricted among 235 matched women at baseline and 217 matched women at endline. Descriptive analyses were performed for the covariates for matching. Bivariate analyses between baseline and endline were done for reporting women and their husbands' knowledge regarding pregnancy and childbirth, birth preparedness and complication readiness practices and utilization of health services. Results: There was significant increase in awareness of danger signs during pregnancy, childbirth and following childbirth among women and their husbands, as well as increase in awareness of rights related to maternal and newborn health. There was also significant increase in birth preparedness and complication readiness practice among pregnant women and their husbands in the intervention site. Regarding use of skilled health services, there was significant increase in early initiation of antenatal care, attending at least one antenatal care contact and attending at least four antenatal care contacts. No notable improvement was observed in giving birth in the presence of skilled attendant or use of postnatal care. Conclusions: We conclude that the intervention package was effective in building the capacities of women and in engaging their husbands positively in maternal and newborn health. This may have translated into increased use of skilled care during pregnancy.


Assuntos
Serviços de Saúde Comunitária , Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , População Rural , Adolescente , Adulto , Bangladesh , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Masculino , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Avaliação de Programas e Projetos de Saúde , População Rural/estatística & dados numéricos , Adulto Jovem
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