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1.
BMJ Open ; 10(12): e044197, 2020 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-33376182

RESUMO

AIM: To explore indigenous communities' responses to the COVID-19 pandemic and its consequences for maternal and neonatal health (MNH) care in the Peruvian Amazon. METHODS: Mamás del Río is a community-based, MNH programme with comprehensive supervision covering monthly meetings with community health workers (CHW), community leaders and health facilities. With the onset of the lockdown, supervisors made telephone calls to discuss measures against COVID-19, governmental support, CHW activities in communities and provision of MNH care and COVID-19 preparedness at facilities. As part of the programme's ongoing mixed methods evaluation, we analysed written summaries of supervisor calls collected during the first 2 months of Peru's lockdown. RESULTS: Between March and May 2020, supervisors held two rounds of calls with CHWs and leaders of 68 communities and staff from 17 facilities. Most communities banned entry of foreigners, but about half tolerated residents travelling to regional towns for trade and social support. While social events were forbidden, strict home isolation was only practised in a third of communities as conflicting with daily routine. By the end of April, first clusters of suspected cases were reported in communities. COVID-19 test kits, training and medical face masks were not available in most rural facilities. Six out of seven facilities suspended routine antenatal and postnatal consultations while two-thirds of CHWs resumed home visits to pregnant women and newborns. CONCLUSIONS: Home isolation was hardly feasible in the rural Amazon context and community isolation was undermined by lack of external supplies and social support. With sustained community transmission, promotion of basic hygiene and mask use becomes essential. To avoid devastating effects on MNH, routine services at facilities need to be urgently re-established alongside COVID-19 preparedness plans. Community-based MNH programmes could offset detrimental indirect effects of the pandemic and provide an opportunity for local COVID-19 prevention and containment.


Assuntos
Controle de Doenças Transmissíveis , Serviços de Saúde Comunitária , Saúde do Lactente , Saúde Materna , Adulto , /prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/normas , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena/tendências , Humanos , Saúde do Lactente/estatística & dados numéricos , Saúde do Lactente/tendências , Recém-Nascido , Masculino , Saúde Materna/estatística & dados numéricos , Saúde Materna/tendências , Peru/epidemiologia , Gravidez , Serviços Preventivos de Saúde/métodos
2.
Artigo em Inglês | MEDLINE | ID: mdl-33352886

RESUMO

This study explored how maternal and infant illness correlated with the risk of postpartum depression in the Chinese Qinba Mountains region. In total, 131 villages comprising 435 families with infants (≤6 months old) were randomly sampled. We collected data on maternal and infant illnesses and maternal health knowledge level. The Depression, Anxiety, and Stress Scale-21 was used to measure the risk of postpartum depression. We used descriptive statistics and multivariate logistic regression for the analysis. Infant overall health status was a risk factor for postpartum depression (odds ratio (OR) = 1.90, 95% Confidence Interval (95% CI) = 1.10~3.28), whereas maternal overall health status was not correlated with postpartum depression (OR = 1.36, 95% CI = 0.55~3.39). For specific illnesses, infants experiencing over two common illnesses in the past two weeks (OR = 1.98, 95% CI = 1.13~3.45) and mothers experiencing over two common pains within two weeks after delivery (OR = 1.77, 95% CI = 1.02~3.08) were risk factors for postpartum depression, whereas infants with mild and severe stunted growth, maternal C-section, and postpartum body mass index (normal or overweight) were not correlated with it (all p > 0.050). Maternal health knowledge was an important moderator of maternal and infant illnesses on the risk of postpartum depression. In conclusion, maternal and infant illness were essential factors for the risk of postpartum depression in a poor rural region in western China, which may be mainly affected by the feeling of uncertainty of illness. Improved maternal and infant health and enhanced maternal health knowledge might alleviate the risk of postpartum depression.


Assuntos
Depressão Pós-Parto , Saúde do Lactente/estatística & dados numéricos , China/epidemiologia , Estudos Transversais , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Lactente , Mães , Período Pós-Parto , Fatores de Risco
3.
Public Health Rep ; 135(5): 658-667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32805192

RESUMO

OBJECTIVES: The health profile of Arab American mothers and infants may differ from that of non-Arab American mothers and infants in the United States as a result of social stigma experienced in the historical and current sociopolitical climate. The objective of our study was to compare maternal health behaviors, maternal health outcomes, and infant health outcomes of Arab American mothers and non-Hispanic white mothers in Massachusetts and to assess the role of nativity as an effect modifier. METHODS: Using data from Massachusetts birth certificates (2012-2016), we conducted adjusted logistic and linear regression models for maternal health behaviors, maternal health outcomes, and infant health outcomes. We used Arab ethnicity as the exposure of interest and nativity as an effect modifier. RESULTS: Arab American mothers had higher odds than non-Hispanic white mothers of initiating breastfeeding (adjusted odds ratio [aOR] = 2.61; 95% CI, 2.39-2.86), giving birth to small-for-gestational-age infants (aOR = 1.28; 95% CI, 1.18-1.39), and having gestational diabetes (aOR = 1.31; 95% CI, 1.20-1.44). Among Arab American mothers, non-US-born mothers had higher odds than US-born mothers of having gestational diabetes (aOR = 1.80; 95% CI, 1.33-2.44) and lower odds of initiating prenatal care in the first trimester (aOR = 0.41; 95% CI, 0.33-0.50). In linear regression models, infants born to non-US-born Arab American mothers weighed 42.1 g (95% CI, -75.8 to -8.4 g) less than infants born to US-born Arab American mothers. CONCLUSION: Although Arab American mothers engage in positive health behaviors, non-US-born mothers had poorer maternal health outcomes and access to prenatal care than US-born mothers, suggesting the need for targeted interventions for non-US-born Arab American mothers.


Assuntos
Árabes/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Saúde do Lactente/estatística & dados numéricos , Comportamento Materno/psicologia , Saúde Materna/estatística & dados numéricos , Mães/psicologia , Características de Residência/estatística & dados numéricos , Adulto , Árabes/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Massachusetts , Mães/estatística & dados numéricos
4.
Cochrane Database Syst Rev ; 8: CD013679, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32813276

RESUMO

BACKGROUND: The global burden of poor maternal, neonatal, and child health (MNCH) accounts for more than a quarter of healthy years of life lost worldwide. Targeted client communication (TCC) via mobile devices (MD) (TCCMD) may be a useful strategy to improve MNCH. OBJECTIVES: To assess the effects of TCC via MD on health behaviour, service use, health, and well-being for MNCH. SEARCH METHODS: In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA: We included randomised controlled trials that assessed TCC via MD to improve MNCH behaviour, service use, health, and well-being. Eligible comparators were usual care/no intervention, non-digital TCC, and digital non-targeted client communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. MAIN RESULTS: We included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low-, middle- or high-income countries (LMHIC); pregnant and postpartum women living with HIV (three trials carried out in one lower middle-income country); and parents of children under the age of five years (13 trials conducted in LMHIC). Most interventions (18) were delivered via text messages alone, one was delivered through voice calls only, and the rest were delivered through combinations of different communication channels, such as multimedia messages and voice calls. Pregnant and postpartum women TCCMD versus standard care For behaviours, TCCMD may increase exclusive breastfeeding in settings where rates of exclusive breastfeeding are less common (risk ratio (RR) 1.30, 95% confidence intervals (CI) 1.06 to 1.59; low-certainty evidence), but have little or no effect in settings where almost all women breastfeed (low-certainty evidence). For use of health services, TCCMD may increase antenatal appointment attendance (odds ratio (OR) 1.54, 95% CI 0.80 to 2.96; low-certainty evidence); however, the CI encompasses both benefit and harm. The intervention may increase skilled attendants at birth in settings where a lack of skilled attendants at birth is common (though this differed by urban/rural residence), but may make no difference in settings where almost all women already have a skilled attendant at birth (OR 1.00, 95% CI 0.34 to 2.94; low-certainty evidence). There were uncertain effects on maternal and neonatal mortality and morbidity because the certainty of the evidence was assessed as very low. TCCMD versus non-digital TCC (e.g. pamphlets) TCCMD may have little or no effect on exclusive breastfeeding (RR 0.92, 95% CI 0.79 to 1.07; low-certainty evidence). TCCMD may reduce 'any maternal health problem' (RR 0.19, 95% CI 0.04 to 0.79) and 'any newborn health problem' (RR 0.52, 95% CI 0.25 to 1.06) reported up to 10 days postpartum (low-certainty evidence), though the CI for the latter includes benefit and harm. The effect on health service use is unknown due to a lack of studies. TCCMD versus digital non-targeted communication No studies reported behavioural, health, or well-being outcomes for this comparison. For use of health services, there are uncertain effects for the presence of a skilled attendant at birth due to very low-certainty evidence, and the intervention may make little or no difference to attendance for antenatal influenza vaccination (RR 1.05, 95% CI 0.71 to 1.58), though the CI encompasses both benefit and harm (low-certainty evidence). Pregnant and postpartum women living with HIV TCCMD versus standard care For behaviours, TCCMD may make little or no difference to maternal and infant adherence to antiretroviral (ARV) therapy (low-certainty evidence). For health service use, TCC mobile telephone reminders may increase use of antenatal care slightly (mean difference (MD) 1.5, 95% CI -0.36 to 3.36; low-certainty evidence). The effect on the proportion of births occurring in a health facility is uncertain due to very low-certainty evidence. For health and well-being outcomes, there was an uncertain intervention effect on neonatal death or stillbirth, and infant HIV due to very low-certainty evidence. No studies reported on maternal mortality or morbidity. TCCMD versus non-digital TCC The effect is unknown due to lack of studies reporting this comparison. TCCMD versus digital non-targeted communication TCCMD may increase infant ARV/prevention of mother-to-child transmission treatment adherence (RR 1.26, 95% CI 1.07 to 1.48; low-certainty evidence). The effect on other outcomes is unknown due to lack of studies. Parents of children aged less than five years No studies reported on correct treatment, nutritional, or health outcomes. TCCMD versus standard care Based on 10 trials, TCCMD may modestly increase health service use (vaccinations and HIV care) (RR 1.21, 95% CI 1.08 to 1.34; low-certainty evidence); however, the effect estimates varied widely between studies. TCCMD versus non-digital TCC TCCMD may increase attendance for vaccinations (RR 1.13, 95% CI 1.00 to 1.28; low-certainty evidence), and may make little or no difference to oral hygiene practices (low-certainty evidence). TCCMD versus digital non-targeted communication TCCMD may reduce attendance for vaccinations, but the CI encompasses both benefit and harm (RR 0.63, 95% CI 0.33 to 1.20; low-certainty evidence). No trials in any population reported data on unintended consequences. AUTHORS' CONCLUSIONS: The effect of TCCMD for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. High-quality, adequately powered trials and cost-effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality.


Assuntos
Telefone Celular , Saúde da Criança/normas , Comunicação , Necessidades e Demandas de Serviços de Saúde , Saúde do Lactente/normas , Saúde Materna/normas , Aleitamento Materno/estatística & dados numéricos , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Parto Obstétrico/normas , Feminino , Infecções por HIV/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Saúde Materna/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Período Pós-Parto , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Envio de Mensagens de Texto
5.
PLoS One ; 15(6): e0221670, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32511230

RESUMO

BACKGROUND: Completion along continuum of care for maternal and newborn health (MNH) services like antenatal care, skilled birth attendance and postnatal care services is advantageous over each segment of services. It is one of the currently recommended strategies to reduce both maternal and neonatal mortality and achieve the global target of ending preventable maternal and under-five children's mortality. Although studies on factors affecting each segment of MNH services have been well documented in Ethiopia, there is a dearth of evidence about the level of continuum of care and factors associated with it. This study was intended to fill this gap in evidence in the study area so that interventions could be taken to improve maternal and newborn health. METHODS: A community-basedcross-sectional study was conducted among 432 postnatal women who gave birth in the previous year in Arba Minch Health and Demographic Surveillance System (HDSS) site. Women were selected by computer generated random numbers from a list of women who stayed at least 6 weeks after birth. A pre-tested, structured, and interviewer-administered questionnaire was used for data collection. Data were entered and coded in Epi-data and analyzed using SPSS software version 23. Binary logistic regression model was fitted to identify factors associated with the dependent variable. Bivariate and multivariable analyses were fitted in steps to select candidate variables for multivariable analysis and to control for potential confounding effect respectively. RESULTS: The overall completion along the continuum of care was 42(9.7%). The factors significantly associated with completion of care along the continuumwere timely initiation of antenatalcare (before16weeks) [AOR: 10.7, CI (5.1, 22.7], birth preparedness and complication readiness [AOR: 2.9, CI (1.4, 6.1), pre-pregnancy contraception utilization [AOR: 3.9, CI: 1.4, 11.0], being employed [AOR: 2.6 CI:(1.3, 5.4)], and having a planned pregnancy [AOR:3.5 CI: (1.1, 11.4)]. CONCLUSION AND RECOMMENDATION: Completion along the continuum of care for MNH services was low in the study area. Thus, efforts to improve the completion of care should focus on interventions that enhance early initiation of antenatal care, planned pregnancy, and birth preparedness and complication readiness.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Demografia , Etiópia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Adulto Jovem
6.
PLoS One ; 15(6): e0234573, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525931

RESUMO

BACKGROUND: Globally, the under-10 years of age mortality has not been comprehensively studied. We applied the life-course perspective in the analysis and interpretation of the event history demographic and verbal autopsy data to examine when and why children die before their 10th birthday. METHODS: We analysed a decade (2005-2015) of event histories data on 22385 and 1815 verbal autopsies data collected by Iganga-Mayuge HDSS in eastern Uganda. We used the lifetable for mortality estimates and patterns, and Royston-Parmar survival analysis approach for mortality risk factors' assessment. RESULTS: The under-10 and 5-9 years of age mortality probabilities were 129 (95% Confidence Interval [CI] = 123-370) per 1000 live births and 11 (95% CI = 7-26) per 1000 children aged 5-9 years, respectively. The top four causes of new-born mortality and stillbirth were antepartum maternal complications (31%), intrapartum-related causes including birth injury, asphyxia and obstructed labour (25%), Low Birth Weight (LBW) and prematurity (20%), and other unidentified perinatal mortality causes (18%). Malaria, protein deficiency including anaemia, diarrhoea or gastrointestinal, and acute respiratory infections were the major causes of mortality among those aged 0-9 years-contributing 88%, 88% and 46% of all causes of mortality for the post-neonatal, child and 5-9 years of age respectively. 33% of all causes of mortality among those aged 5-9 years was a share of Injuries (22%) and gastrointestinal (11%). Regarding the deterministic pattern, nearly 30% of the new-borns and sick children died without access to formal care. Access to the treatment for the top five morbidities was after 4 days of symptoms' recognition. The childhood mortality risk factors were LBW, multiple births, having no partner, adolescence age, rural residence, low education level and belonging to a poor household, but their association was stronger among infants. CONCLUSIONS: We have identified the vulnerable groups at risk of mortality as LBW children, multiple births, rural dwellers, those whose mother are of low socio-economic position, adolescents and unmarried. The differences in causes of mortalities between children aged 0-5 and 5-9 years were noted. These findings suggest for a strong life-course approach in the design and implementation of child health interventions that target pregnant women and children of all ages.


Assuntos
Causas de Morte , Mortalidade da Criança , Mortalidade Infantil , Adolescente , Adulto , Criança , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Masculino , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Anamnese/estatística & dados numéricos , Fatores Socioeconômicos , Uganda
7.
PLoS One ; 15(6): e0233985, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32492055

RESUMO

INTRODUCTION: In sub-Saharan Mozambique, high adolescent fertility rates are a significant public health problem. Understanding the consequences of teenage pregnancies facilitates effective strategies for improving the quality of care of both mother and the newborn. AIMS: To identify the factors associated with adolescent motherhood in Tete (Mozambique). METHODS: This was a cross-sectional study including 821 pregnant women (255 teenagers) admitted to the general maternity ward of the Provincial Hospital between March and October 2016. The survey included clinical data of the mother and newborn. RESULTS: The overall prevalence of adolescent deliveries was 31.8% (95% CI 27.9% - 34.2%). Multivariate analysis showed that independent factors associated with teenage motherhood were: number of pregnancies (OR 0.066; 95% CI 0.040-0.110), pregnancy follow-up (OR 0.29; CI 0.173-0.488) and previous abortions (OR 4.419; 95% CI 1.931-10.112). When the age of the mother was analysed as a continuous variable, positively associated factors were body mass index, arterial hypertension, HIV infection, previous abortions, pregnancy follow-up, and the weight of the newborn. Negatively associated factors were episiotomy and respiratory distress in the newborn. CONCLUSION: Teenage motherhood is a serious public health problem in Mozambique. Intensive sexual and reproductive health planning for adolescents is needed.


Assuntos
Saúde do Adolescente/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Gravidez na Adolescência/estatística & dados numéricos , Aborto Induzido/estatística & dados numéricos , Adolescente , Serviços de Saúde do Adolescente/organização & administração , Estudos Transversais , Feminino , Número de Gestações , Planejamento em Saúde/organização & administração , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Moçambique/epidemiologia , Gravidez , Gravidez na Adolescência/prevenção & controle , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
8.
Ann Hum Biol ; 47(2): 132-141, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32429760

RESUMO

Background: Completion of the full series of childhood vaccines on-time is crucial to ensuring greater protection against vaccine-preventable diseases.Aim: To examine determinants of complete and on-time vaccination and evaluate the relationship between vaccination patterns and severe morbidity outcomes.Subjects and methods: Vaccination information from infants in Nairobi Urban Health and Demographic Surveillance System was used to evaluate full and on-time vaccination coverage of routine immunisation. Logistic regression was used to identify determinants of full and on-time vaccination coverage. Cox regression model was used to evaluate the relationship between vaccination status and subsequent severe morbidity. A shared frailty cox model was fitted to account for the heterogeneity in hospitalisation episodes.Results: Maternal age, post-natal care, parity, ethnicity, and residence place were identified as determinants of vaccination completion. Institutional deliveries and residence place were identified as the determinants of on-time vaccination. A significant 58% (confidence interval [CI]: 15-79%) (p = .017) lower mortality was observed among fully immunised children compared with not fully immunised. Lower mortality was observed among on-time immunised children, 64% (CI: 20-84%) compared to those with delays.Conclusions: Improving vaccination timeliness and completion schedule is critical for protection against vaccine preventable diseases and may potentially provide protection beyond these targets.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Morbidade , Vacinação/estatística & dados numéricos , Humanos , Lactente , Quênia/epidemiologia , Características de Residência , Classe Social
9.
Infant Ment Health J ; 41(2): 206-219, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32242965

RESUMO

Implementation research suggests that fidelity to a therapeutic model is important for enhancing outcomes, yet can be difficult to achieve in community practice settings. Furthermore, few published studies have reported on characteristics of treatment fidelity. The present study examined fidelity to the Infant Mental Health Home Visiting (IMH-HV) model among 51 therapists with a range of experience practicing in community settings across the state of Michigan. IMH therapists completed fidelity checklists after every session with participating families to track use of 15 treatment strategies central to the IMH-HV model across the 12-month study period. Results indicated that the most commonly endorsed components utilized in home visits were developmental guidance and infant-parent psychotherapy, followed by the provision of emotional support. Use of IMH-HV components did not vary over time for the entire sample; however, patterns of strategies used showed somewhat more variability among more experienced therapists and when serving higher risk families. Findings demonstrate that IMH-HV therapists report a range of adherence to the model in community settings, with greatest fidelity to several model core components. Ongoing training in the flexible use of all core strategies may further enhance fidelity and contribute to positive outcomes for caregivers and their children receiving IMH-HV services.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Adulto , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Michigan , Cuidado Pós-Natal , Psicoterapia
10.
PLoS One ; 15(4): e0230852, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32243445

RESUMO

BACKGROUND: Because of a lack of preference-based health-related quality of life (HRQoL) instruments suitable for infants aged 0-12 months, we previously developed the Infant QoL Instrument (IQI). The present study aimed to generate an algorithm to estimate utilities for the IQI. METHODS: Via an online survey, respondents from the general population and primary caregivers from China-Hong Kong, the UK, and the USA were presented 10 discrete choice scenarios based on the IQI classification system. An additional sample of respondents from the general population were also asked if they considered the examined health states to be worse than death. Coefficients for the IQI item levels were obtained with a conditional logit model based on the responses of the primary caregivers for IQI states only. These coefficients were then normalized using the rank-ordered logit model based on the responses from the general population who assessed "death" as a choice option. In this way, the values were rescaled from full health (1.0) to death (0.0), and consequently, they became suitable for the computation of quality-adjusted life years. RESULTS: The total sample consisted of 1409 members of the general population and 1229 primary caregivers. Results indicated that, out of the 7 IQI items ("sleeping," "feeding," "breathing," "stooling/poo," "mood," "skin," and "interaction"), "breathing" had the highest impact on the HRQoL of infants. Moreover, except for "stooling," all item levels were statistically significant. The general population sample considered none of the health states as worse than death. The utility value for the worst health state was 0.015 (State 4444444). CONCLUSIONS: The IQI is the first generic instrument to assess overall HRQoL in 0-1-year-old infants by providing values and utilities. Using discrete choice experiments, we demonstrated that it is possible to derive utilities of infant health states. The next step will be to collect IQI values in a clinical population of infants and to compare these values with those of other instruments.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Qualidade de Vida , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Inquéritos e Questionários
11.
Artigo em Inglês | MEDLINE | ID: mdl-32121288

RESUMO

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


Assuntos
Instalações de Saúde/estatística & dados numéricos , Promoção da Saúde/métodos , Visita Domiciliar/estatística & dados numéricos , Cuidado do Lactente/métodos , Saúde do Lactente/estatística & dados numéricos , Mães/educação , População Rural/estatística & dados numéricos , Adolescente , Adulto , Camboja , Área Programática de Saúde/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Adulto Jovem
12.
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
13.
Matern Child Health J ; 24(Suppl 1): 5-14, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31773465

RESUMO

INTRODUCTION: Nepal has made considerable progress on improving child survival during the Millennium Development Goal period, however, further progress will require accelerated reduction in neonatal mortality. Neonatal survival is one of the priorities for Sustainable Development Goals 2030. This paper examines the trends, equity gaps and factors associated with neonatal mortality between 2001 and 2016 to assess the likelihood of Every Newborn Action Plan (ENAP) target being reached in Nepal by 2030. METHODS: This study used data from the 2001, 2006, 2011 and 2016 Nepal Demographic and Health Surveys. We examined neonatal mortality rate (NMR) across the socioeconomic strata and the annual rate of reduction (ARR) between 2001 and 2016. We assessed association of socio-demographic, maternal, obstetric and neonatal factors associated with neonatal mortality. Based on the ARR among the wealth quintile between 2001 and 2016, we made projection of NMR to achieve the ENAP target. Using the Lorenz curve, we calculated the inequity distribution among the wealth quintiles between 2001 and 2016. RESULTS: In NDHS of 2001, 2006, 2011 and 2016, a total of 8400, 8600, 13,485 and 13,089 women were interviewed respectively. There were significant disparities between wealth quintiles that widened over the 15 years. The ARR for NMR declined with an average of 4.0% between 2001 and 2016. Multivariate analysis of the 2016 data showed that women who had not been vaccinated against tetanus had the highest risk of neonatal mortality (adjusted odds ratio [AOR] 3.38; 95% confidence interval [CI] 1.20-9.55), followed by women who had no education (AOR 1.87; 95% CI 1.62-2.16). Further factors significantly associated with neonatal mortality were the mother giving birth before the age of 20 (AOR 1.76; CI 95% 1.17-2.59), household air pollution (AOR 1.37; CI 95% 1.59-1.62), belonging to a poorest quintile (AOR 1.37; CI 95% 1.21-1.54), residing in a rural area (AOR 1.28; CI 95% 1.13-1.44), and having no toilet at home (AOR 1.21; CI 95% 1.06-1.40). If the trend of neonatal mortality rate of 2016 continues, it is projected that the poorest family will reach the ENAP target in 2067. CONCLUSIONS: Although neonatal mortality is declining in Nepal, if the current trend continues it will take another 50 years for families in the poorest group to attain the 2030 ENAP target. There are different factors associated with neonatal mortality, reducing the disparities for maternal and neonatal care will reduce mortality among the poorest families.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Mortalidade Infantil/tendências , Morte Perinatal , Desenvolvimento Sustentável , Adolescente , Adulto , Intervalo entre Nascimentos , Estudos Transversais , Prestação Integrada de Cuidados de Saúde , Demografia , Feminino , Objetivos , Disparidades nos Níveis de Saúde , Humanos , Lactente , Idade Materna , Pessoa de Meia-Idade , Mães , Nepal/epidemiologia , Pobreza , Gravidez , Características de Residência , Adulto Jovem
14.
Arch Environ Occup Health ; 75(1): 18-26, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30595111

RESUMO

The association between early daycare attendance and risk of allergic diseases remains inconclusive. Therefore, we examined the association among Japanese children on a long-term basis using a nationwide longitudinal survey data. We estimated the association between daycare attendance at age 6 or 18 months and allergy development using information on outpatient visits for atopic dermatitis (AD), food allergy (FA), and asthma and admission for asthma up to 12 years of age as a proxy for developing these diseases, with multilevel logistic regression. Early daycare attendance was associated with increased odds of AD at ages 2.5-3.5 years: the adjusted odds ratio (OR) was 1.34 [95% CI: 1.21, 1.47]. The association with FA was equivocal. The odds of asthma was increased before age 3.5 years and afterwards decreased: the adjusted ORs were 1.60 [1.44, 1.77] for ages 1.5-2.5 years and 0.77 [0.69, 0.87] for ages 5.5-7 years. The effect of early daycare attendance depends on the type of allergies.


Assuntos
Asma/epidemiologia , Creches/estatística & dados numéricos , Dermatite Atópica/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Hospitalização/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Asma/etiologia , Dermatite Atópica/etiologia , Hipersensibilidade Alimentar/etiologia , Humanos , Hipersensibilidade , Incidência , Lactente , Japão/epidemiologia , Estudos Longitudinais
15.
Am J Hum Biol ; 32(1): e23357, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31868269

RESUMO

OBJECTIVES: Infant feeding plays a critical role in child health and development. Few studies to date have examined the link between household water insecurity and infant feeding, and none in a cross-cultural context. Therefore, we examined the perceived impact of household water insecurity in four domains: breastfeeding, non-breastmilk feeding, caregiver capabilities, and infant health. Our research was conducted as part of the Household Water Insecurity Experiences (HWISE) study. METHODS: We interviewed respondents from 19 sites in 16 low- and middle-income countries (N = 3303) about the link between water insecurity and infant feeding. We then thematically analyzed their open-ended textual responses. In each of the four domains (breastfeeding, non-breastmilk feeding, caregiver capabilities, infant health), we inductively identified cross-cultural metathemes. We analyzed the distribution of themes across sites quantitatively and qualitatively. RESULTS: Water was perceived to directly affect breastfeeding and non-breastmilk feeding via numerous pathways, including timing and frequency of feeding, unclean foods, and reduced dietary diversity. Water was perceived to indirectly affect infant feeding through caregiver capabilities by increasing time demands, exacerbating disease, undernutrition, and mortality, and requiring greater efficacy of caregivers. Respondents made connections between water challenges and infant health, for example, increased risk of infectious diseases, undernutrition, and mortality. CONCLUSIONS: These findings suggest that water presents many, and sometimes unexpected, challenges to infant feeding. By systematically investigating biocultural pathways by which water impacts infant and young child feeding, it will be possible to understand if, and how, water security can be leveraged to improve child nutrition and health.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Cuidadores/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Água , Países em Desenvolvimento , Comportamento Alimentar , Humanos , Lactente , Recém-Nascido
17.
PLoS One ; 14(11): e0225412, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31765400

RESUMO

Women in South Africa experience high levels of Intimate Partner Violence (IPV). There are numerous health consequences experienced by victims. However, children of IPV victims often experience negative emotional and developmental outcomes as well. In South Africa, infant and child health outcomes are not optimal and IPV is high, and thus there is a need to determine whether a relationship between them exists. This study used the 2016 South African Demographic and Health Survey. Mothers aged 15 to 49 and who were included in the Domestic Violence module formed the study population. Frequency tables and graphs were done, and unadjusted and adjusted logistic regressions were performed with each of the three reported child health outcomes (birth weight, duration of breastfeeding and diarrhoea incidence), IPV and other socio-demographic factors. Thirteen percent of women have experienced IPV. Five percent of their children were low birth weight, 10% had experienced diarrhoea; but 87% had been breastfed for 6+ months. Mothers in the rich wealth category were 37% more likely to have a child born at low birth weight but those aged 20 to 39 had around a 60% less likelihood of breastfeeding for 6+ months than 15 to 19-year olds. Women who had experienced IPV had around 77% higher odds of having a child experience diarrhoea in the last 2 weeks. Wealthier mothers often have unhealthier lifestyle practices and behaviours, due to more disposable income which could account for lower birth weight children. Mothers in tertiary education and starting their professional careers are normally around 20 to 39 years and should be provided supportive structures to be allowed to breastfeed their children. The long-term emotional and developmental consequences to children of IPV victims are known, but we now know that there are also very immediate consequences to the health of these children as well.


Assuntos
Saúde da Criança/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Violência por Parceiro Íntimo/estatística & dados numéricos , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Fatores Socioeconômicos , África do Sul
18.
Sci Rep ; 9(1): 17867, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31780760

RESUMO

Epidemiological knowledge of pediatric diseases may improve professionals' understanding of the pathophysiology of and risk factors for diseases and is also crucial for decision making related to workforce and resource planning in pediatric departments. In this study, a pediatric disease epidemiology knowledgebase called PedMap (http://pedmap.nbscn.org) was constructed from the clinical data from 5 447 202 outpatient visits of 2 189 868 unique patients at a children's hospital (Hangzhou, China) from 2013 to 2016. The top 100 most-reported pediatric diseases were identified and visualized. These common pediatric diseases were clustered into 4 age groups and 4 seasons. The prevalence, age distribution and co-occurrence diseases for each disease were also visualized. Furthermore, an online prediction tool based on Gaussian regression models was developed to predict pediatric disease incidence based on weather information. PedMap is the first comprehensive epidemiological resource to show the full view of age-related, seasonal, climate-related variations in and co-occurrence patterns of pediatric diseases.


Assuntos
Saúde da Criança/estatística & dados numéricos , Meio Ambiente , Hospitais Pediátricos/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Adolescente , Fatores Etários , Big Data , Criança , Pré-Escolar , China , Humanos , Lactente , Recém-Nascido , Análise Espaço-Temporal
19.
Artigo em Inglês | MEDLINE | ID: mdl-31652714

RESUMO

Background: Adverse birth outcomes are related to unfavorable fetal growth conditions. A latent variable, named Favorable Fetal Growth Condition (FFGC), has been defined by Bollen et al., in 2013; he showed that this FFGC latent variable mediates the effects of maternal characteristics on several birth outcomes. Objectives: The objectives of the present study were to replicate Bollen's approach in a population of newborns in Paris and to investigate the potential differential effect of the FFGC latent variable according to the neighborhood socioeconomic level. Methods: Newborn health data were available from the first birth certificate registered by the Maternal and Child Care department of the City of Paris. All newborns (2008-2011) were geocoded at the mother residential census block. Each census block was assigned a socioeconomic deprivation level. Several mothers' characteristics were collected from the birth certificates: age, parity, education and occupational status and the occupational status of the father. Three birth outcomes were considered: birth weight (BW), birth length (BL) and gestational age (GA). Results: Using a series of structural equation models, we confirm that the undirected model (that includes the FFGC latent variable) provided a better fit for the data compared with the model where parental characteristics directly affected BW, BL, and/or GA. However, the strength, the direction and statistical significance of the associations between the exogenous variables and the FFGC were different according to the neighborhood deprivation level. Conclusion: Future research should be designed to assess the how robust the FFGC latent variable is across populations and should take into account neighborhood characteristics to identify the most vulnerable group and create better design prevention policies.


Assuntos
Peso ao Nascer , Estatura , Retardo do Crescimento Fetal/etiologia , Idade Gestacional , Áreas de Pobreza , Características de Residência , Saúde da População Urbana/estatística & dados numéricos , Adulto , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/epidemiologia , Humanos , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Masculino , Paris/epidemiologia , Gravidez , Fatores de Risco
20.
East Mediterr Health J ; 25(7): 503-513, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31612982

RESUMO

Background: Understanding the impact of delivery mode on neonatal morbidity becomes essential in the context of rising Caesarian delivery rates. Aims: We aimed to compare the selected outcomes in neonates born by low-risk planned Caesarian delivery versus planned normal vaginal delivery (NVD). Methods: This prospective cohort study examined early, and late neonatal complications among 1071 neonates born through low-risk planned Caesarian delivery and 1367 neonates born through planned NVD, in Fars, Islamic Republic of Iran, during 2012-2014. Results: Gestational age of neonates born through Caesarian delivery was significantly lower than their counterparts in NVD group. Accordingly, babies' birth weights were 3166 (±442.4) grams in Caesarian delivery group and 3213 (±454.8) grams in NVD group. Normal skin colour at birth was more prevalent in the Caesarian delivery group compared to the NVD group (85% vs. 81.3%, P = 0.04). No significant differences were detected between the two groups regarding birth trauma, birth height and head circumference, and developing infection, icterus and convulsion during neonatal period. Also, height and weight at two years of age did not significantly differ in both groups. Conclusion: The results of this study show that neonates born by Caesarian delivery and NVD had the same early and late outcomes.


Assuntos
Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Saúde do Lactente/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Peso ao Nascer , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Irã (Geográfico) , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Fatores Socioeconômicos
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