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1.
Lancet Glob Health ; 9(3): e352-e360, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33308422

RESUMO

BACKGROUND: Kyrgyzstan has made considerable progress in reducing child mortality compared with other countries in the region, despite a comparatively low economic standing. However, maternal mortality is still high. Given the availability of an established birth registration system, we aimed to comprehensively assess the trends and determinants of reproductive, maternal, newborn, and child health in Kyrgyzstan. METHODS: For this Countdown to 2030 country case study, we used publicly available data repositories and the national birth registry of Kyrgyzstan to examine trends and inequalities of reproductive, maternal, and newborn health and mortality between 1990 and 2018, at a national and subnational level. Coverage of newborn and maternal health interventions was assessed and disaggregated by equity dimensions. We did Oaxaca-Blinder decomposition to determine the contextual factors associated with the observed decline in newborn mortality rates. We also undertook a comprehensive review of national policies and programmes, as well as a prospective Lives Saved Tool analysis, to highlight interventions that have the potential to avert the most maternal, neonatal, and child deaths. FINDINGS: Over the past two decades, Kyrgyzstan reduced newborn mortality rates by 46% and mortality rates of children younger than 5 years by 69%, whereas maternal mortality rates were reduced by 7% and stillbirth rates by 29%. The leading causes of neonatal deaths were prematurity and asphyxia or hypoxia, and preterm small-for-gestational-age infants were more than 80 times more likely to die in their first month of life compared with those born appropriate-for-gestational age at term. Except for contraceptive use, coverage of essential interventions has increased and is generally high, with limited sociodemographic inequities. With scale-up of a few essential neonatal and maternal interventions, 39% of neonatal deaths, 11% of stillbirths, and 19% of maternal deaths could be prevented by 2030. INTERPRETATION: Kyrgyzstan has reduced newborn mortality rates considerably, with the potential for further reduction. To achieve and exceed the Sustainable Development Goal 3 targets for newborn survival and reducing stillbirths, Kyrgyzstan needs to scale up packages of interventions for the care of small and sick babies, assure quality of care in all health-care facilities with regionalised perinatal care, and create a linked national registry for mothers and neonates with rapid feedback and accountability. FUNDING: US Fund for UNICEF under the Countdown to 2015, UNICEF Kyrgyzstan Office.


Assuntos
Saúde da Criança/tendências , Saúde do Lactente/tendências , Mortalidade Infantil/tendências , Saúde Materna/tendências , Ásia Central/epidemiologia , Pré-Escolar , Feminino , Política de Saúde , Humanos , Lactente , Recém-Nascido , Quirguistão/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos
2.
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
3.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32371428

RESUMO

CONTEXT: The World Health Organization recommends tummy time for infants because of the benefits of improved motor development and reduced likelihood of plagiocephaly. Because of poor uptake of these recommendations, the association of tummy time with other health outcomes requires further investigation. OBJECTIVE: To review existing evidence regarding the association of tummy time with a broad and specific range of infant health outcomes. DATA SOURCES: Electronic databases were searched between June 2018 and April 2019. STUDY SELECTION: Peer-reviewed English-language articles were included if they investigated a population of healthy infants (0 to 12 months), using an observational or experimental study design containing an objective or subjective measure of tummy time which examined the association with a health outcome (adiposity, motor development, psychosocial health, cognitive development, fitness, cardiometabolic health, or risks/harms). DATA EXTRACTION: Two reviewers independently extracted data and assessed their quality. RESULTS: Sixteen articles representing 4237 participants from 8 countries were included. Tummy time was positively associated with gross motor and total development, a reduction in the BMI-z score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling. An indeterminate association was found for social and cognitive domains, plagiocephaly, walking, standing, and sitting. No association was found for fine motor development and communication. LIMITATIONS: Most studies were observational in design and lacked the robustness of a randomized controlled trial. High selection and performance bias were also present. CONCLUSIONS: These findings guide the prioritization of interventions aimed at assisting parents meet the global and national physical activity guidelines.


Assuntos
Desenvolvimento Infantil/fisiologia , Saúde do Lactente/tendências , Decúbito Ventral/fisiologia , Humanos , Lactente , Recém-Nascido , Estudos Observacionais como Assunto/métodos , Plagiocefalia/epidemiologia , Plagiocefalia/prevenção & controle
6.
PLoS One ; 14(12): e0221691, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31887122

RESUMO

BACKGROUND: Globally, low birthweight (LBW) infants (<2.5 kilograms) contribute up to 80% of neonatal mortality. In Bangladesh, approximately 62% of all births occur at home and therefore, weighing newborns immediately after birth is not feasible. Thus, estimates of birthweight in Bangladesh are mostly obtained based on maternal perception of the newborn's birth size. Little is known about how birthweight is perceived in rural communities, and whether families associate birthweight with newborn's health status. Our objective was to explore families' perceptions of newborn's birthweight, and preventive and care practices for a LBW newborn in rural Bangladesh. METHODS: We conducted a qualitative study in two rural settings of Bangladesh, including 32 in-depth interviews (11 with pregnant women, 12 with recently delivered women, 4 with husbands whose wives were pregnant or had a recent birth, 5 with mothers-in-law whose daughters-in-law were pregnant or had a recent birth), 2 focus group discussions with husbands and 4 key-informant interviews with community health workers. We used thematic analysis to analyse the data. RESULTS: Most participants did not consider birthweight a priority for assessing a newborn's health status, although there was a desire for a healthy newborn. Recognition of different categories of birthweight was subjective and often included several physical descriptors including birth size of the newborn. LBW was not considered as a criterion of a newborn's illness unless the newborn appeared unwell. Maternal poor nutrition, inadequate diet in pregnancy, anaemia, illness during pregnancy, short stature, twin births and influence of supernatural spirit were identified as the major causes of LBW. Women's preventive practices for LBW or small newborns were predominantly constrained by a lack of awareness of birthweight and fear of caesarean section. As an effort to avoid caesarean section during birth, several women tended to perform potentially harmful practices in order to give birth to a small size newborn; such as avoiding nutritious food and eating less in pregnancy. Common practices to treat a LBW or small newborn who appeared ill included breastfeeding, feeding animal milk, feeding sugary water, feeding formula, oil massage, keeping the small newborn warm and seeking care from formal and informal care providers including a spiritual leader. Maternal lack of decision-making power, financial constraint, home birth and superstition were the major challenges to caring for a LBW newborn. CONCLUSION: Birthweight was not well-understood in the rural community, which highlighted substantial challenges to the prevention and care practices of LBW newborns. Community-level health education is needed to promote awareness related to the recognition of birthweight in rural settings.


Assuntos
Parto Domiciliar/ética , Saúde do Lactente/etnologia , Saúde do Lactente/tendências , Adulto , Bangladesh/epidemiologia , Peso ao Nascer , Cesárea , Feminino , Parto Domiciliar/tendências , Humanos , Renda , Lactente , Mortalidade Infantil , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Mães/psicologia , Parto , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gravidez , População Rural , Fatores Socioeconômicos
7.
JMIR Mhealth Uhealth ; 7(8): e14540, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31418428

RESUMO

BACKGROUND: While early identification of neonatal illness can impact neonatal mortality rates and reduce the burden of treatment, identifying subtle clinical signs and symptoms of possible severe illness is especially challenging in neonates. The World Health Organization and the United Nations Children's Fund developed the Integrated Management of Neonatal Childhood Illness guidelines, an evidence-based tool highlighting seven danger signs to assess neonatal health. Currently, many mothers in low-resource settings rely on home visits from community health workers (CHWs) to determine if their baby is sick. However, CHWs visit infrequently, and illness is often detected too late to impact survival. Thus, delays in illness identification pose a significant barrier to providing expedient and effective care. Neonatal Monitoring (NeMo), a novel neonatal assessment tool, seeks to increase the frequency of neonatal screening by task-shifting identification of neonatal danger signs from CHWs to mothers. OBJECTIVE: This study aimed to explore the usability and acceptability of the NeMo system among target users and volunteer CHWs by assessing ease of use and learnability. METHODS: Simulated device use and semistructured interviews were conducted with 32 women in the Iganga-Mayuge districts in eastern Uganda to evaluate the usability of the NeMo system, which involves a smartphone app paired with a low cost, wearable band to aid in identification of neonatal illness. Two versions of the app were evaluated using a mixed methods approach, and version II of the app contained modifications based on observations of the first cohort's use of the system. During the posed scenario simulations, participants were offered limited guidance from the study team in order to probe the intuitiveness of the NeMo system. The ability to complete a set of tasks with the system was tested and recorded for each participant and closed- and open-ended questions were used to elicit user feedback. Additionally, focus groups with 12 CHWs were conducted to lend additional context and insight to the usability and feasibility assessment. RESULTS: A total of 13/22 subjects (59%) using app version I and 9/10 subjects (90%) using app version II were able to use the phone and app with no difficulty, despite varying levels of smartphone experience. Following modifications to the app's audio instructions in version II, participants' ability to accurately answer qualitative questions concerning neonatal danger signs improved by at least 200% for each qualitative danger sign. All participants agreed they would trust and use the NeMo system to assess the health of their babies. Furthermore, CHWs emphasized the importance of community sensitization towards the system to encourage its adoption and regular use, as well as the decision to seek care based on its recommendations. CONCLUSIONS: The NeMo system is an intuitive platform for neonatal assessment in a home setting and was found to be acceptable to women in rural Uganda.


Assuntos
Aplicativos Móveis/tendências , Pediatria/instrumentação , Adulto , Feminino , Grupos Focais/métodos , Humanos , Saúde do Lactente/estatística & dados numéricos , Saúde do Lactente/tendências , Recém-Nascido , Masculino , Aplicativos Móveis/estatística & dados numéricos , Triagem Neonatal/métodos , Triagem Neonatal/normas , Pediatria/métodos , Pesquisa Qualitativa , Validação de Programas de Computador , Inquéritos e Questionários , Uganda
8.
Midwifery ; 78: 42-49, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31349183

RESUMO

BACKGROUND: Lack of trained personnel is a major obstacle to providing the full package of emergency obstetric and newborn care (EmONC) services in Ethiopia and other low-income countries. The aim of this study was to evaluate whether a blended learning approach to in-service EmONC training could be as effective as a conventional learning approach while reducing costs. METHODS: A quasi-experimental study design assigned providers in need of EmONC training to blended learning (12 days of offsite training followed by daily SMS and weekly phone calls) or conventional learning (18 days of offsite training followed by a facility visit to mentor participants). A self-administered questionnaire measured provider knowledge before training and three months afterwards. Provider skills were assessed three months post-training with an Objective Structured Clinical Examination (OSCE). Independent sample t-test and multiple linear regression analysis were used to assess differences in mean percentage knowledge and skills scores between learning groups. The direct costs and cost-effectiveness of each learning approach were calculated. RESULT: Knowledge scores were similar for the blended and conventional learning groups before training (58.5% vs 61.5%, p = 0.358) and three months post-training (74.7% vs 75.5% = 0.720), with no significant difference in gains made. Post-training skills scores were significantly higher for conventional than blended learning (85.8% vs 75.3%, p < 0.001). After controlling for other factors in the multiple linear regression analysis, providers with a university degree had significantly higher skills scores than those with a diploma (p < 0.001). Training costs were lower for blended learning than conventional learning (1032 USD vs 1648 USD per trainee). CONCLUSION: Blended learning approach using SMS and phone calls was as effective as conventional one to increase providers' knowledge with substantially lower costs. Further study is warranted to examine the effect of blended learning on providers' skills.


Assuntos
Serviços Médicos de Emergência/métodos , Saúde do Lactente/normas , Obstetrícia/educação , Ensino , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Etiópia , Humanos , Saúde do Lactente/tendências , Obstetrícia/métodos , Obstetrícia/normas
9.
Neoreviews ; 20(5): e258-e271, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31261078

RESUMO

The human microbiota includes the trillions of microorganisms living in the human body whereas the human microbiome includes the genes and gene products of this microbiota. Bacteria were historically largely considered to be pathogens that inevitably led to human disease. However, because of advances in both cultivation-based methods and the advent of metagenomics, bacteria are now recognized to be largely beneficial commensal organisms and thus, key to normal and healthy human development. This relatively new area of medical research has elucidated insights into diseases such as inflammatory bowel disease and obesity, as well as metabolic and atopic disorders. However, much remains unknown about the complexity of microbe-microbe and microbe-host interactions. Future efforts aimed at answering key questions pertaining to the early establishment of the microbiome, alongside what defines its dysbiosis, will likely lead to long-term health and mitigation of disease. Here, we review the relevant literature pertaining to modulations in the perinatal and neonatal microbiome, the impact of environmental and maternal factors in shaping the neonatal microbiome, and future questions and directions in the exciting emerging arena of metagenomic medicine.


Assuntos
Saúde do Lactente/tendências , Metagenoma/fisiologia , Metagenômica/tendências , Microbiota/fisiologia , Feminino , Previsões , Humanos , Recém-Nascido , Metagenômica/métodos , Gravidez
10.
J Perinatol ; 39(8): 1031-1041, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31182774

RESUMO

Advancements in neonatal care globally highlight ongoing disparities in neonatal outcomes between low-income countries (LICs) and high-income countries (HICs). Drivers of this gap are primarily prematurity, infection, and intrapartum-related events. Significant success is being achieved; however, for neonatal outcomes in LIC to approximate those of HICs within a generation, acceleration of the current trajectory of progress is needed. This requires a renewed focus on newborn-specific and newborn-sensitive strategies. Newborn-specific strategies are those directly affecting the well-being of the neonate. Newborn-sensitive strategies address the broader macro-environmental drivers that affect underlying neonatal outcomes such as decreased poverty, improved sanitation, and increased maternal empowerment and health. To create such an enabling macro-environment requires significant political will, financing, advocacy, and policy generation. This manuscript highlights recent advances in newborn research, programming, policy, and funding, and highlights key opportunities to bend the curve on advancing neonatal health globally.


Assuntos
Saúde do Lactente/tendências , Mortalidade Infantil/tendências , Causas de Morte , Serviços de Saúde da Criança , Países em Desenvolvimento , Feminino , Saúde Global , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/terapia , Serviços de Saúde Materna , Gravidez
12.
Drug Saf ; 42(1): 1-12, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30246225

RESUMO

Information on the safety of medication use during pregnancy and breastfeeding is scarce, yet use of medication among pregnant and breastfeeding women is widespread. The pREGnant, the Dutch Pregnancy Drug Register, was set up to obtain insight into medication use among pregnant and breastfeeding women and potential effects on maternal and fetal/infant health. The systematically documented, good quality data on medication use during pregnancy and lactation in pREGnant will be used in signal detection, epidemiologic studies and counseling of healthcare providers and patients. The register has a prospective cohort design. The population is derived from pregnant women throughout the Netherlands. Data collection started in April 2014 and enrollment of women is continuous and is characterized by a relative high proportion of women born in the Netherlands with a high education compared with the general Dutch pregnant population. Data on current pregnancy, obstetric history, maternal lifestyle, health and medication use, delivery, and infant health are collected through web-based questionnaires completed by the participating women (three times during pregnancy and three times during the infant's first year of life). If permission is given, the self-reported data can be complemented with information retrieved from Perined, the perinatal registry of the Netherlands, and from obstetric and medical records, and/or pharmacy records. Here, we provide detailed information on the design of the pREGnant, the Dutch Pregnancy Drug Register, as well as descriptive information on characteristics of the participants so far. Currently, steps are being taken to implement the register on a large scale in the Netherlands.


Assuntos
Saúde do Lactente/tendências , Saúde Materna/tendências , Resultado da Gravidez/epidemiologia , Sistema de Registros , Inquéritos e Questionários , Adolescente , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Países Baixos/epidemiologia , Gravidez , Estudos Prospectivos , Adulto Jovem
13.
Cien Saude Colet ; 23(6): 1915-1928, 2018 Jun.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29972499

RESUMO

This study presents an overview of public sector interventions and progress made on the women's and child health front in Brazil between 1990 and 2015. We analyzed indicators of antenatal and labor and delivery care and maternal and infant health status using data from the Live Birth Information System and Mortality Information System, national surveys, published articles, and other sources. We also outline the main women's and child health policies and intersectoral poverty reduction programs. There was a sharp fall in fertility rates; the country achieved universal access to antenatal and labor and delivery care services; access to contraception and breastfeeding improved significantly; there was a reduction in hospital admissions due to abortion and in malnutrition. The rates of congenital syphilis, caesarean sections and preterm births remain excessive. Under-five mortality decreased by more than two-thirds, but less pronounced for the neonatal component. The maternal mortality ratio decreased from 143.2 to 59.7 per 100 000 live births. Despite worsening scores or levelling off across certain health indicators, the large majority improved markedly.


Assuntos
Saúde da Criança/tendências , Saúde do Lactente/tendências , Saúde Materna/tendências , Saúde Reprodutiva/tendências , Adolescente , Adulto , Brasil , Criança , Pré-Escolar , Assistência à Saúde/tendências , Feminino , Acesso aos Serviços de Saúde/tendências , Indicadores Básicos de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Mortalidade Materna/tendências , Pessoa de Meia-Idade , Programas Nacionais de Saúde/organização & administração , Pobreza , Gravidez , Adulto Jovem
14.
Health Econ ; 27(8): 1319-1324, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29766619

RESUMO

Three recent studies have documented short- and long-run benefits of early-infancy health interventions in Norway, Sweden, and Denmark: Universal nurse home visiting (NHV) and well-baby center care decreased infant mortality and positively impacted long-run survival (DK, S), morbidity (DK, N), and educational and labor market outcomes (N). Using Danish conscription data, this paper examines intermediate outcomes to assess both potential mechanisms and the importance of selective survival for the long-run health effects of NHV. We do not find strong effects of NHV for young adult's height or obesity status, but we find that NHV increases treated individuals' probability of emigration. As emigrants in our sample are positively selected and as they are not part of the samples used in long-run analyses, this finding suggests that the established long-run health benefits of NHV may be lower bounds.


Assuntos
Visita Domiciliar , Saúde do Lactente/tendências , Mortalidade Infantil/tendências , Adulto , Dinamarca , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Econômicos , Noruega , Enfermeiros de Saúde Comunitária , Obesidade , Fatores de Risco , Suécia , Adulto Jovem
15.
BMC Pregnancy Childbirth ; 18(1): 171, 2018 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-29769063

RESUMO

BACKGROUND: Early initiation of breastfeeding (EIBF) lowers the risk for all-cause mortality in babies, including those with low birth weight. However, rates of neonatal mortality and delayed initiation of breastfeeding remain high in most low- and middle-income countries. This study aimed to assess the trends and factors associated with EIBF in Namibia from 2000 to 2013. METHODS: An analysis of EIBF trends was conducted using data from three Namibia Demographic Health Surveys. The present sample included singleton children younger than 2-years from 2000 (n = 1655), 2006-2007 (n = 2152) and 2013 (n = 2062) surveys. Descriptive statistics were used to analyse respondents' demographic, socioeconomic and obstetric characteristics. Factors associated with EIBF were assessed using univariate analysis and further evaluated using multivariable logistic regression analysis. RESULTS: EIBF significantly decreased from 82.5% (confidence interval [CI]: 79.5-85.0) in 2000 to 74.9% (72.5-77.2) in 2013. Factors associated with EIBF in 2000 were urban residence (adjusted odds ratio 0.58, 95% CI: 0.36-0.93), poorer household wealth index (1.82, 1.05-3.17), lack of antenatal care (0.14, 0.03-0.81), small birth size (0.38, 0.24-0.63) and large birth size (0.51, 0.37-0.79). In 2013, factors associated with EIBF were maternal age of 15-19 years (2.28, 1.22-4.24), vaginal delivery (2.74, 1.90-3.93), married mothers (1.57, 1.16-2.14), delivery assistance from health professionals (3.67, 1.23-10.9) and birth order of fourth or above (1.52, 1.03-2.26). CONCLUSIONS: Namibia has experienced a declining trend in EIBF rates from 2000 to 2013. Factors associated with EIBF differed between 2000 and 2013. The present findings highlight the importance of continued commitment to addressing neonatal health challenges and strengthening implementation of interventions to increase EIBF in Namibia.


Assuntos
Aleitamento Materno/tendências , Saúde do Lactente/tendências , Mães/estatística & dados numéricos , Fatores de Tempo , Parto Obstétrico/estatística & dados numéricos , Demografia , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Modelos Logísticos , Namíbia , Razão de Chances , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos
16.
Aust J Gen Pract ; 47(4): 193-198, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29621858

RESUMO

BACKGROUND: Newborn babies are very vulnerable in their first weeks of life. Timely and appropriate management of neonatal conditions is paramount for health and developmental outcomes. OBJECTIVE: The aim of this article is to provide an overview of common neonatal presentations to general practice, and highlight significant conditions that may require referral to the emergency department and/or other specialist. DISCUSSION: Clinical history and examination are the most important tools in neonatal assessment. Babies often present with non-specific symptoms, but a thorough clinical assessment can identify the ‘unwell baby’ who requires immediate transfer to hospital. This includes babies with sepsis, moderate­to­severe dehydration or who are in acute cardiorespiratory compromise. A comprehensive neonatal assessment will also help to differentiate babies with significant conditions that may warrant further specialist input from those with normal neonatal development where parental support and reassurance may be sufficient.


Assuntos
Saúde do Lactente/tendências , Atenção Primária à Saúde/métodos , Comportamento Alimentar , Febre/diagnóstico , Febre/etiologia , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Humanos , Recém-Nascido , Anamnese/métodos , Atenção Primária à Saúde/tendências , Fenômenos Fisiológicos Respiratórios
17.
BMJ Open ; 8(3): e020578, 2018 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-29500215

RESUMO

OBJECTIVE: Instrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma. DESIGN: A retrospective observational study. SETTINGS AND PARTICIPANTS: All hospital singleton live births in Washington State, USA, 2004-2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI. RESULTS: Overall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00). CONCLUSION: While the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery.


Assuntos
Parto Obstétrico/efeitos adversos , Saúde do Lactente/tendências , Saúde Materna/tendências , Complicações do Trabalho de Parto/epidemiologia , Ferimentos e Lesões/etiologia , Adolescente , Adulto , Traumatismos do Nascimento/epidemiologia , Cesárea , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Feminino , Humanos , Recém-Nascido , Lacerações , Modelos Logísticos , Forceps Obstétrico , Períneo/lesões , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Vagina , Washington/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
18.
BMC Pediatr ; 18(1): 32, 2018 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-29415674

RESUMO

BACKGROUND: Rapid economic and cultural transition in the United Arab Emirates has been accompanied by a rise in chronic disease. Early childhood is known to affect health outcomes in adulthood. This prospective longitudinal study examined the general health of Emirati infants born in a government maternity hospital in the Emirate of Abu Dhabi in October 2002. METHODS: One hundred twenty-five women, who had recently given birth, were interviewed as part of a larger study encompassing a wide range of cultural, social, and behavioural aspects of health. They were then re-interviewed at three (n = 94), six (n = 59) and 15 months postpartum (n = 52). Data are presented using univariate statistics. RESULTS: In this study seven infants (6%) were born prematurely and four infants (3%) were classified as small for gestational age, while 11 (9%) of the infants weighed less than 2500 g. Low birth weight infants (LBW) were significantly more likely to require treatment in the neonatal intensive care unit (OR = 30.83, p = 0.00). Iron supplementation during pregnancy was associated with fewer underweight infants (OR = 3.92, p = 0.042). No associations were found between infant birth weight and maternal age, age at marriage, consanguinity, education level, current maternal employment, parity, pre-existing anaemia or anaemia in pregnancy, diabetes, folic acid intake, multivitamin intake or infant gender. Maternally-reported infant health issues, vaccination, medication, breast-feeding and infant nutrition, and use of secure car seats are also reported. CONCLUSIONS: The health of infants at birth in this UAE sample showed improvements compared to previous studies. The proportion of LBW infants is decreasing and continuing improvements in health care in the UAE are having a positive impact on infant health.


Assuntos
Saúde do Lactente/tendências , Adolescente , Adulto , Países em Desenvolvimento , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Prospectivos , Mudança Social , Emirados Árabes Unidos , Adulto Jovem
19.
Lancet ; 391(10129): 1538-1548, 2018 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-29395268

RESUMO

Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH.


Assuntos
Saúde Global/tendências , Cobertura Universal do Seguro de Saúde/tendências , Saúde da Criança/estatística & dados numéricos , Saúde da Criança/tendências , Conservação dos Recursos Naturais/tendências , Saúde Global/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Equidade em Saúde/tendências , Humanos , Saúde do Lactente/estatística & dados numéricos , Saúde do Lactente/tendências , Saúde Materna/estatística & dados numéricos , Saúde Materna/tendências , Mortalidade/tendências , Estado Nutricional , Saúde Reprodutiva/estatística & dados numéricos , Saúde Reprodutiva/tendências , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
20.
Lancet ; 391(10129): 1493-1512, 2018 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-29395272

RESUMO

BACKGROUND: The Millennium Development Goal (MDG) period saw dramatic gains in health goals MDG 4 and MDG 5 for improving child and maternal health. However, many Muslim countries in the south Asian, Middle Eastern, and African regions lagged behind. In this study, we aimed to evaluate the status of, progress in, and key determinants of reproductive, maternal, newborn, child, and adolescent health in Muslim majority countries (MMCs). The specific objectives were to understand the current status and progress in reproductive, maternal, newborn, child, and adolescent health in MMCs, and the determinants of child survival among the least developed countries among the MMCs; to explore differences in outcomes and the key contextual determinants of health between MMCs and non-MMCs; and to understand the health service coverage and contextual determinants that differ between best and poor or moderate performing MMCs. METHODS: In this country-level ecological study, we examined data from between 1990 and 2015 from multiple publicly available data repositories. We examined 47 MMCs, of which 26 were among the 75 high-burden Countdown to 2015 countries. These 26 MMCs were compared with 48 non-Muslim Countdown countries. We also examined characteristics of the eight best performing MMCs that had accelerated improvement in child survival (ie, that reached their MDG 4 targets). We estimated adolescent, maternal, under-5, and newborn mortality, and stillbirths, and the causes of death, essential interventions coverage, and contextual determinants for all MMCs and comparative groups using standardised methods. We also did a hierarchical multivariable analysis of determinants of under-5 mortality and newborn mortality in low-income and middle-income MMCs. FINDINGS: Despite notable reductions between 1990 and 2015, MMCs compared with a global esimate of all countries including MMCs had higher mortality rates, and MMCs relative to non-MMCs within Countdown countries also performed worse. Coverage of essential interventions across the continuum of care was on average lower among MMCs, especially for indicators of reproductive health, prenatal care, delivery, and labour, and childhood vaccines. Outcomes within MMCs for mortality and many reproductive, maternal, newborn, child, and adolescent health indicators varied considerably. Structural and contextual factors, especially state governance, conflict, and women and girl's empowerment indicators, were significantly worse in MMCs compared with non-MMCs within the high-burden Countdown countries, and were shown to be strongly associated with child and newborn mortality within low-income and middle-income MMCs. In adjusted hierarchical models, among other factors, under-5 mortality in MMCs increased with more refugees originating from a country (ß=23·67, p=0·0116), and decreased with better political stability or absence of terrorism (ß=-0·99, p=0·0285), greater political rights or government effectiveness (ß=-1·17, p<0·0001), improvements in log gross national income per capita (ß=-4·44, p<0·0001), higher total adult literacy (ß=-1·69, p<0·0001), higher female adult literacy (ß=-0·97, p<0·0001), and greater female to male enrolment in secondary school (ß=-16·1, p<0·0001). The best performing MMCs were Azerbaijan, Bangladesh, Egypt, Indonesia, Kyrgyzstan, Morocco, Niger, and Senegal, which had higher coverage of family planning interventions and newborn or child vaccinations, and excelled in many of the above contextual determinants when compared with moderate or poorly performing MMCs. INTERPRETATION: The status and progress in reproductive, maternal, newborn, child, and adolescent health is heterogeneous among MMCs, with little indication that religion and its practice affects outcomes systemically. Some Islamic countries such as Niger and Bangladesh have made great progress, despite poverty. Key findings from this study have policy and programmatic implications that could be prioritised by national heads of state and policy makers, development partners, funders, and the Organization of the Islamic Cooperation to scale up and improve these health outcomes in Muslim countries in the post-2015 era. FUNDING: US Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn, and Child Survival, the Centre for Global Child Health, Hospital for Sick Children, and the Aga Khan University.


Assuntos
Saúde do Adolescente/tendências , Saúde da Criança/tendências , Saúde do Lactente/tendências , Islamismo , Saúde Materna/tendências , Religião e Medicina , Adolescente , Saúde do Adolescente/estatística & dados numéricos , Adulto , Criança , Saúde da Criança/estatística & dados numéricos , Mortalidade da Criança/tendências , Assistência à Saúde/normas , Assistência à Saúde/tendências , Feminino , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/tendências , Mortalidade Materna/tendências , Indicadores de Qualidade em Assistência à Saúde , Fatores Socioeconômicos
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