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2.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047845

RESUMO

Objetivo: este estudo objetivou conhecer as tecnologias de cuidado no alívio da dor no processo de parturição em um hospital de ensino. Método: pesquisa qualitativa e descritiva com 10 puérperas internadas em uma unidade materno-infantil no período de maio a junho de 2017. Os dados foram coletados por meio de entrevistas individuais e analisados conforme a Proposta Operativa de Minayo. Resultados: as puérperas que usaram as tecnologias de alívio da dor no processo de parturição julgaram como excelente e de grande valia os métodos para o alívio da dor. Conclusão: conclui-se que estas tecnologias são importantes para a autonomia e protagonismo da mulher e a vivência positiva do seu processo de parturição, sendo fundamental o investimento em outros métodos de alívio da dor, de modo a qualificar e tornar o parto mais prazeroso e menos traumatizante


Objective: this study aimed to identify the care technologies in pain relief in the birthing process in a teaching hospital. Method: qualitative and descriptive research, in which ten women in labor were hospitalized in a hospital maternal unit, from May to June 2017. Data were collected through individual interviews and analyzed according to Minayo's Operative Proposal. Results: postpartum women who used pain relief technologies in the birthing process considered the methods of pain relief as excellent and of great value. Conclusion: we concluded that these technologies are important for the autonomy and protagonism of women and the positive experience of their process of birthing, recognizing the importance of investing in other methods of pain relief, in order to qualify and make birthing process more pleasurable and less traumatic


Objetivo: este estudio objetivó conocer las tecnologías de cuidado en el alivio del dolor en el proceso de parturición en un hospital de enseñanza. Método: investigación cualitativa y descriptiva, en la que participaron diez puérperas internadas en una unidad materna hospitalaria, en el período de mayo a junio de 2017. Los datos fueron recolectados a través de entrevistas individuales, y analizados conforme a la Propuesta Operativa de Minayo. Resultados: las puérperas que usaron las tecnologías de alivio del dolor en el proceso de parturiado juzgaron como excelente y de gran valor los métodos para el alivio del dolor. Conclusión: se concluye que estas tecnologías son importantes para la autonomía y protagonismo de la mujer y la vivencia positiva de su proceso de parturión, siendo importantes inversiones en otros métodos de alivio del dolor, para calificar y hacer el parto más placentero y menos traumatizante


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Dor do Parto/enfermagem , Manejo da Dor , Parto Normal/enfermagem , Trabalho de Parto , Parto Humanizado , Serviços de Saúde Materna , Enfermagem Obstétrica
4.
Int J Gynaecol Obstet ; 148(1): 27-34, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31544243

RESUMO

OBJECTIVE: Despite the recognized importance of person-centered care, very little information exists on how person-centered maternity care (PCMC) impacts newborn health. METHODS: Baseline and follow-up data were collected from women who delivered in government health facilities in Nairobi and Kiambu counties in Kenya between August 2016 and February 2017. The final analytic sample included 413 respondents who completed the baseline survey and at least one follow-up survey at 2, 6, 8, and/or 10 weeks. Data were analyzed using descriptive, bivariate, and multivariate statistics. Logistic regression was used to assess the relationship between PCMC scores and outcomes of interest. RESULTS: In multivariate analyses, women with high PCMC scores were significantly less likely to report newborn complications than women with low PCMC scores (adjusted odds ratio [aOR] 0.39, 95% confidence interval [CI] 0.16-0.98). Women reporting high PCMC scores also had significantly higher odds of reporting a willingness to return to the facility for their next delivery than women with low PCMC score (aOR 12.72, 95% CI 2.26-71.63). The domains of Respect/Dignity and Supportive Care were associated with fewer newborn complications and willingness to return to a facility. CONCLUSION: PCMC could improve not just the experience of the mother during childbirth, but also the health of her newborn and future health-seeking behavior.


Assuntos
Serviços de Saúde Materna/organização & administração , Assistência Centrada no Paciente/métodos , Resultado da Gravidez/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Quênia , Serviços de Saúde Materna/estatística & dados numéricos , Mães/psicologia , Razão de Chances , Assistência Centrada no Paciente/estatística & dados numéricos , Gravidez , Inquéritos e Questionários
5.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 826-832, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874472

RESUMO

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


Assuntos
Doenças Cardiovasculares/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Morte Materna , Mortalidade Materna , Complicações Cardiovasculares na Gravidez/etiologia , Adulto , Causas de Morte , China/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Mortalidade Materna/tendências , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco
6.
Afr J Reprod Health ; 23(3): 30-41, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31782629

RESUMO

Maternal mortality is attracting attention worldwide, but maternal health problems after delivery have received less attention. Most studies focus on prenatal maternal health problems. We aimed to identify factors associated with postpartum health problems among married women of reproductive age in Democratic Republic of the Congo. We employed a cross-sectional study design and randomly enrolled 700 married women of reproductive age in Kenge city. Data collection instrument was developed using the UNICEF Multiple Indicator Cluster Survey. T-test, chi-square test, and binary logistic regression analysis were performed using the SPSS version 24.0. Significant risk factors associated with postpartum health problems were initial postnatal care period; within 24 hours (Odds Ratio [OR]=2.197, 95% confidence interval [CI]: [1.156-4.174], p=.016); within 7 days (OR=1.972, 95% CI: [1.102-3.528, p=.022]; within 14 days (OR=2.124, 95% CI: [1.082-4.172], p=.029) among reproductive health and health service utilization characteristics. Health education by RECO (Relais Cmunataure) was associated with postpartum health problems including PCIME (Prise en Charge Integree des Maladies de l'Enfant; OR=1.845, 95% CI: [1.038- 3.282], p=.037); hand washing (OR=1.897, 95% CI: [1.060-3.396], p=.031); malaria (OR=2.003, 95% CI: [1.192-3.366], p=.009) among Maternal and Child Health intervention characteristics. In conclusion, it is necessary to develop and promote health policies and educational programs focusing on PNC service within 24 hours, PNC services within 7 days, PCIME, hand washing, prevention of malaria.


Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , República Democrática do Congo/epidemiologia , Feminino , Febre/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Malária/epidemiologia , Casamento , Pessoa de Meia-Idade , Hemorragia Pós-Parto/epidemiologia , Período Pós-Parto , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
7.
Afr J Reprod Health ; 23(3): 57-67, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31782632

RESUMO

The health system in many parts of Nigeria has been dysfunctional in several domains including financing, human resources, infrastructure, health management information system and hospital services. In an attempt to scale up Maternal and Child Health (MCH) services and ensure efficiency, Ebonyi State Government in Southeast Nigeria provided funding to mission hospitals across the State as a grant. This study used nonparametric method to assess the effect of this public financing on the efficiency of the mission hospitals. Operational cost and number of hospital beds were used as the input variables, while antenatal registrations, number of immunization doses and hospital deliveries were the output variables. The hospitals were disaggregated into 15 hospital-years. The mean overall technical efficiency of the mission hospitals was 84.05 22.45%. The mean pure technical efficiency was 95.56±6.9% and the scale efficiency was 88.05±22.20%. About 46.67% of all the hospital-years were technically and scale efficient. Although, 55.33% were generally inefficient, only 33.33% of hospital-years exhibited pure technical inefficiency. Low immunization coverage was the major cause of inefficiency. The study showed increased maternal health service output as result of public funding or intervention; however, the mission hospitals could have saved 16% of input resources if they had performed efficiently. It also shows that data envelopment analysis can be used in setting targets/benchmarks for relatively inefficient health facilities, and in monitoring impact of interventions on efficiency of hospitals over-time.


Assuntos
Serviços de Saúde da Criança/organização & administração , Assistência à Saúde/organização & administração , Eficiência Organizacional , Recursos em Saúde/estatística & dados numéricos , Hospitais Religiosos/organização & administração , Serviços de Saúde Materna/organização & administração , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Custos e Análise de Custo , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Feminino , Financiamento Governamental , Hospitais Religiosos/estatística & dados numéricos , Humanos , Masculino , Serviços de Saúde Materna/estatística & dados numéricos , Nigéria , Gravidez , Estudos Retrospectivos
8.
Afr J Reprod Health ; 23(3): 68-78, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31782633

RESUMO

The Saving Mothers Project was conducted from September 2015 to March 2017 in Bunda and Tarime Districts, Mara Region, Tanzania. The purpose of this project was to train community health workers (CHWs) to use mobile phones applications to register and educate pregnant women about safe deliveries and encourage them to access skilled health care providers for antenatal care and delivery, and to provide nurses and CHWs with clean birth kits with misoprostol to distribute to women. The birth kits were for use in case women could not access the health facility, or if the health facility was lacking supplies at the time of delivery. The overall goal of the study was to reduce the maternal mortality rate by increasing women's access to health services where possible, and to clean supplies when a non-facility birth was unavoidable. This paper reports on a mixed methods evaluation of the project including a survey of over two thousand four hundred women, and focus groups with women, community health workers, and nurses participating in the project. The results of the survey and focus groups demonstrate a high degree of satisfaction with the birth kits and misoprostol and an increase in facility birth rates where the project was implemented. Differences between the two districts illustrate that policy maker support is key to successful implementation.


Assuntos
Agentes Comunitários de Saúde/educação , Acesso aos Serviços de Saúde , Serviços de Saúde Materna/organização & administração , Mortalidade Materna , Tocologia/educação , Misoprostol/provisão & distribução , Ocitócicos/provisão & distribução , Hemorragia Pós-Parto/prevenção & controle , Adulto , Telefone Celular , Feminino , Humanos , Misoprostol/administração & dosagem , Aplicativos Móveis , Ocitócicos/administração & dosagem , Guias de Prática Clínica como Assunto , Gravidez , Resultado da Gravidez , Gestantes , Cuidado Pré-Natal , População Rural , Tanzânia , Adulto Jovem
9.
Afr J Reprod Health ; 23(3): 149-160, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31782639

RESUMO

Task shifting of Caesarean-sections to non-physician clinicians (NPCs) has raised concerns over NPCs' competences and rationale of using them in facilities where medical doctors (MDs) are scarce to provide mentorship. We conducted a scoping review to provide an update on NPCs' contribution to C-sections including barriers and enablers to task shifting. Using the PRISMA Flow Diagram, we identified 15 eligible articles from Google Scholar, PubMed and Africa Index Medicus using specific search terms and a pre-established inclusion criterion. All 15 studies characterised NPCs: their names, training, challenges and enablers to task shifting. NPCs performed 50%-94% C-sections. Outcomes of such C-sections were comparable to those performed by MDs. Enablers included supportive policies, pre-existing human resources for health shortage, well- resourced health facilities and supervision of NPCs. Weak health systems were major barriers. While NPCs make a significant contribution to accessing C-sections services, there is need to address challenges to fully realize benefits.


Assuntos
Cesárea , Delegação Vertical de Responsabilidades Profissionais , Mão de Obra em Saúde , Serviços de Saúde Materna , Feminino , Acesso aos Serviços de Saúde , Humanos , Gravidez
10.
BMC Public Health ; 19(1): 1448, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684905

RESUMO

BACKGROUND: Very few postpartum women want to become pregnant within the next 2 years, but approximately 60% of postpartum women in low- and middle-income countries are not using contraceptive methods. The World Health Organization recommends that women receive postpartum family planning (PPFP) counseling during antenatal, immediate postpartum, and postnatal services. Our objective was to establish whether PPFP counseling is being provided in antenatal and postnatal care services in SNNPR, Ethiopia and whether receipt of PPFP counseling improved uptake of postpartum family planning use by 6 months postpartum. METHODS: Longitudinal data from the Performance Monitoring for Accountability 2020 - Maternal and Newborn Health study were used. At screening, 329 women were identified as six or more months pregnant; 307 completed the survey at 6 months postpartum. We used weighted parametric survival analysis with Weibull distribution to assess the effect of receipt of postpartum counseling in antenatal and/or postnatal care by 6 weeks postpartum on contraceptive uptake, after adjusting for intention to use family planning, wantedness of the index pregnancy, delivery location, amenorrhea, exclusive breastfeeding, residence, parity, and education. RESULTS: Coverage of PPFP counseling is low; by six-weeks postpartum only 20% of women had received counseling. Women who received counseling in postnatal care only and postnatal care and antenatal care took up contraception at significantly higher rates than women who did not receive any counseling (HR: 3.4, p < .01 and HR: 2.5, p = .01, respectively). There was no difference between women who received PPFP counseling only in ANC and women who did not receive counseling at all. Women who did not want the child at all took up contraception at significantly lower rates than women who wanted the child at that time (HR: 0.3, p = .04). Women who had four or more children took up contraception at significantly lower rates than woman with 1-3 children (HR: 0.3, p = .01). There were no significant differences by delivery location, exclusive breastfeeding, residence, or education. CONCLUSION: Integration of postpartum family planning counseling into postnatal care services is an effective means to increase postpartum contraceptive uptake, but significant gaps in coverage, particularly in the delivery and postnatal period, remain.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde , Serviços de Planejamento Familiar/organização & administração , Serviços de Saúde Materna/organização & administração , Período Pós-Parto/psicologia , Adolescente , Adulto , Etiópia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
11.
BMC Public Health ; 19(1): 1493, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703734

RESUMO

BACKGROUND: Antenatal care (ANC) services are critical for maternal health but Nigeria performs poorly in ANC utilisation compared to other countries in sub-Saharan Africa. This study aimed to assess socioeconomic inequalities in ANC utilisation and the determinants of these inequalities in Nigeria. METHODS: The 2013 Nigeria Demographic and Health Survey data with 18,559 women was used for analysis. The paper used concentration curves and indices for different measures of ANC utilisation (no ANC visit, 1-3 ANC visits, at least four ANC visits, and the number of ANC visits). A positive (or negative) concentration index means that the measure of ANC utilisation was concentrated on the richer (poorer) population compared to their poorer (richer) counterparts. The concentration indices were also decomposed using standard methodologies to examine the significant determinants of the socioeconomic inequalities in no ANC visit, at least four ANC visits, and the number of ANC visits. RESULTS: No ANC visit was disproportionately concentrated among the poor (concentration index (CI) = - 0.573), whereas at least four ANC visits (CI = 0.582) and a higher number of ANC visits (CI = 0.357) were disproportionately concentrated among the rich. While these results were consistent across all the geopolitical zones and rural and urban areas, the inequalities were more prevalent in the northern zones (which also have the highest incidence of poverty in the country) and the rural areas. The significant contributors to inequalities in ANC utilisation were the zone of residence, wealth, women's education (especially secondary) and employment, urban-rural residence, ethnicity, spousal education, and problems with obtaining permission to seek health care and distance to the clinic. CONCLUSIONS: Addressing wealth inequalities, enhancing literacy, employment and mitigating spatial impediments to health care use will reduce socioeconomic inequalities in ANC utilisation in Nigeria. These factors are the social determinants of health inequalities. Thus, a social determinants of health approach is needed to address socioeconomic inequalities in ANC coverage in Nigeria.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Adulto , Grupos Étnicos , Feminino , Inquéritos Epidemiológicos , Humanos , Alfabetização , Nigéria , Gravidez , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto Jovem
12.
Medicine (Baltimore) ; 98(45): e17709, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702622

RESUMO

BACKGROUND: The rising maternal and child healthcare costs and the lack of training and educational resources for healthcare workers have reduced service quality in primary health centers of China. We sought to compare strategies promoting healthcare service utilization in rural western China. METHOD: A randomized community trial was carried out in Zhen'an country between 2007 and 2009. Two cross-sectional surveys were conducted to compare the outcomes of financial subsidy for pregnant women seeking antenatal care and clinical training provided to healthcare workers by difference-in-difference estimation. RESULTS: In all, 1113 women completed the questionnaires. The proportion of postnatal visits increased three times in the training group, reaching 35.7%. The number of women who received advice from their doctors regarding nutrition and warning signs necessitating immediate medical attention also improved significantly (5.8% and 8.2%, respectively). Furthermore, the percentage of women who underwent blood tests increased significantly to 19.5% in the training group. Compared to the financial group, the training group had more women who breastfed for longer than 4 months (15.8%) and provided timely complementary feeding (8.9%). CONCLUSION: The training intervention appeared to have improved prenatal care utilization. Essential obstetric training helped enhance knowledge and self-efficacy among healthcare workers.


Assuntos
Pessoal de Saúde/educação , Serviços de Saúde Materna/economia , Serviços de Saúde Rural/economia , Estudos Transversais , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Autoeficácia , Inquéritos e Questionários
13.
Int J Equity Health ; 18(1): 155, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615516

RESUMO

BACKGROUND: Various factors influence health service utilization at the community level. Research on the barriers to uptake of local health services is essential to reduce maternal and child mortality and morbidity. The Amazon region of Peru has some of the poorest health indicators in the country. The current study set out to better understand the health-seeking behavior and perspectives of mothers in Amazonian communities, exploring individual- and contextual-level barriers for seeking care at local health facilities for common maternal and child health issues. METHODS: The study employed a mixed-methods design by conducting 50 structured interviews with mothers of children under the age of 4. The study took place in 5 communities in Loreto, Peru. The quantitative data was analyzed with descriptive statistics to identify participants' socio-demographic characteristics and reported utilization of health services. The qualitative data was analyzed in three rounds: inductive codebook development, application of the codebook, and thematic synthesis to contextualize the quantitative results and better understand the perspectives of the mothers regarding maternal and child health issues and the local health services. RESULTS: Overall, reported health service utilization among study participants was relatively high. However, the mothers identified several individual- and contextual-level factors that may affect their experiences and the health-seeking behaviors of other mothers in their communities: (i) embarrassment, fear, and trust, (ii) insufficient number and poor attitudes of health personnel, (iii) limited supply of basic medicines and materials in the health facility, and (iv) low demand for family planning services and limited awareness of adolescent-specific services. CONCLUSION: Several findings in the current study reflect the reduced conditions of health services, while others display that many mothers maintain a positive outlook on the health services available to them and are proactive in the care of their child. The study provides valuable insight into the use of local health services and the common perspectives that are hindering further uptake at the community level in the Amazon of Peru, with important implications for health policy.


Assuntos
Serviços de Saúde da Criança/organização & administração , Comportamentos Relacionados com a Saúde , Acesso aos Serviços de Saúde/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Criança , Serviços de Planejamento Familiar/organização & administração , Feminino , Política de Saúde , Humanos , Masculino , Peru , Características de Residência , Fatores Socioeconômicos
14.
Int J Equity Health ; 18(1): 154, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615526

RESUMO

INTRODUCTION: In Africa, a majority of women bring their infant to health services for immunization, but few are checked in the postpartum (PP) period. The Missed opportunities for maternal and infant health (MOMI) EU-funded project has implemented a package of interventions at community and facility levels to uptake maternal and infant postpartum care (PPC). One of these interventions is the integration of maternal PPC in child clinics and infant immunization services, which proved to be successful for improving maternal and infant PPC. AIM: Taking stock of the progress achieved in terms of PPC with the implementation of the interventions, this paper assesses the economic cost of maternal PPC services, for health services and households, before and after the project start in Kaya health district (Burkina Faso). METHODS: PPC costs to health services are estimated using secondary data on personnel and infrastructure and primary data on time allocation. Data from two household surveys collected before and after one year intervention among mothers within one year PP are used to estimate the household cost of maternal PPC visits. We also compare PPC costs for households and health services with or without integration. We focus on the costs of the PPC intervention at days 6-10 that was most successful. RESULTS: The average unit cost of health services for days 6-10 maternal PPC decreased from 4.6 USD before the intervention in 2013 (Jan-June) to 3.5 USD after the intervention implementation in 2014. Maternal PPC utilization increased with the implementation of the interventions but so did days 6-10 household mean costs. Similarly, the household costs increased with the integration of maternal PPC to BCG immunization. CONCLUSION: In the context of growing reproductive health expenditures from many funding sources in Burkina Faso, the uptake of maternal PPC led to a cost reduction, as shown for days 6-10, at health services level. Further research should determine whether the increase in costs for households would be deterrent to the use of integrated maternal and infant PPC.


Assuntos
Serviços de Saúde Comunitária/economia , Redução de Custos/economia , Acesso aos Serviços de Saúde/economia , Serviços de Saúde Materna/economia , Adulto , Burkina Faso , Assistência à Saúde/economia , Eficiência Organizacional , Feminino , Humanos , Imunização/economia , Lactente , Cuidado Pós-Natal/economia , Período Pós-Parto , Gravidez
15.
Afr Health Sci ; 19(2): 1833-1840, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656465

RESUMO

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


Assuntos
Parto Obstétrico/estatística & dados numéricos , Mortalidade Materna/tendências , Complicações do Trabalho de Parto/mortalidade , Complicações na Gravidez/mortalidade , Adulto , Parto Obstétrico/métodos , Feminino , Hospitais , Humanos , Estudos Longitudinais , Serviços de Saúde Materna/organização & administração , Complicações do Trabalho de Parto/etnologia , Gravidez , Gestantes , Encaminhamento e Consulta , Estudos Retrospectivos
16.
Bull Hist Med ; 93(3): 335-364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31631070

RESUMO

Over the past decade historians have explored the rise of the mid-twentieth-century population/family planning movement on both the international and the local levels. This article bridges the gap between these studies by exploring the work diaries of Dr. Adaline Pendleton ("Penny") Satterthwaite, a midlevel technical advisor who traveled to over two dozen countries for the Population Council from 1965 to 1974. Penny's diaries draw our attention to a diverse network of advocates who mediated between international population activists, state actors, and local communities while also acting as conduits for the transnational spread of strategies and resources. Her experiences also provide evidence of the coercive practices, gendered tensions, and political conflicts shaping the movement while illustrating the resistance and engagement of local actors, the existence of health- and women-centered approaches even during the high period of population control, and the many structural and social barriers shaping family planning projects in practice.


Assuntos
Serviços de Planejamento Familiar/história , Serviços de Saúde Materna/história , Controle da População/história , Consultores/história , Serviços de Planejamento Familiar/organização & administração , Feminino , História do Século XX , Humanos , Serviços de Saúde Materna/organização & administração , México , Controle da População/métodos , Gravidez
17.
Health Care Women Int ; 40(12): 1302-1335, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31600118

RESUMO

First Nations women who live on rural and remote reserves in Canada leave their communities between 36 and 38 weeks gestational age to receive labor and birthing services in large urban centers. The process and administrative details of this process are undocumented despite decades of relocation as a routine component of maternity care. Using data from 32 semistructured interviews and information from peer-reviewed literature, grey literature, and public documents, I constructed a descriptive map and a visual representation of the policy. I present new and detailed information about Canada's health policy as well as recommendations to address the health care gaps identified.


Assuntos
Política de Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Índios Norte-Americanos , Tocologia/métodos , Parto/etnologia , Gestantes/psicologia , Canadá , Feminino , Humanos , Entrevistas como Assunto , Manitoba , Serviços de Saúde Materna/organização & administração , Área Carente de Assistência Médica , Gravidez , Gestantes/etnologia , Pesquisa Qualitativa , População Rural
18.
BMC Med ; 17(1): 184, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570106

RESUMO

BACKGROUND: The healthcare system can be understood as the dynamic result of the interaction of hospitals, patients, providers, and government configuring a complex network of reciprocal influences. In order to better understand such a complex system, the analysis must include characteristics that are feasible to be studied in order to redesign its functioning. The analysis of the emergent patterns of pregnant women flows crossing municipal borders for birth-related hospitalizations in a region of São Paulo, Brazil, allowed to examine the functionality of the regional division in the state using a complex systems approach and to propose answers to the dilemma of concentration vs. distribution of maternal care regional services in the context of the Brazilian Unified Health System (SUS). METHODS: Cross-sectional research of the areas of influence of hospitals using spatial interaction methods, recording the points of origin and destination of the patients and exploring the emergent patterns of displacement. RESULTS: The resulting functional region is broader than the limits established in the legal provisions, verifying that 85% of patients move to hospitals with high technology to perform normal deliveries and cesarean sections. The region has high independence rates and behaves as a "service exporter." Patients going to centrally located hospitals travel twice as long as patients who receive care in other municipalities even when the patients' conditions do not demand technologically sophisticated services. The effects of regulation and the agents' preferences reinforce the tendency to refer patients to centrally located hospitals. CONCLUSIONS: Displacement of patients during delivery may affect indicators of maternal and perinatal health. The emergent pattern of movements allowed examining the contradiction between wider deployments of services versus concentration of highly specialized resources in a few places. The study shows the potential of this type of analysis applied to other type of patients' flows, such as cancer or specialized surgery, as tools to guide the regionalization of the Brazilian Health System.


Assuntos
Procedimentos Clínicos/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Cesárea/estatística & dados numéricos , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Estudos Transversais , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Parto Obstétrico/métodos , Parto Obstétrico/normas , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/normas , Transferência de Pacientes/organização & administração , Gravidez , Indicadores de Qualidade em Assistência à Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Análise de Sistemas , Transporte de Pacientes/estatística & dados numéricos
19.
Lakartidningen ; 1162019 Oct 07.
Artigo em Sueco | MEDLINE | ID: mdl-31593289

RESUMO

The medical and nursing care of preterm infants has improved over the last decades, including the involvement of parents in the daily care. Previously parents could only visit a few scheduled hours per day but today most neonatal units in Sweden strive to let the parents be the primary caregivers, with the right to stay at the unit during the entire hospitalization period. Despite this development, there is still need for a number of improvements, not only in the neonatal care but also during the complicated pregnancy.


Assuntos
Terapia Intensiva Neonatal/organização & administração , Poder Familiar , Nascimento Prematuro , Papel (figurativo) , Aleitamento Materno , Continuidade da Assistência ao Paciente , Pai , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Serviços de Saúde Materna/organização & administração , Mães , Alta do Paciente , Educação de Pacientes como Assunto , Gravidez , Apoio Social , Suécia
20.
Nursing (Säo Paulo) ; 22(257): 3193-3198, out.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1026064

RESUMO

O processo de parturição é um evento fisiológico, que ocasiona contrações uterinas e dilatação cervical, o feto exerce pressão sobre as estruturas do assoalho pélvico materno aumentando a intensidade da dor. Este estudo buscou evidenciar o conhecimento e aplicabilidade dos métodos não farmacológicos utilizados pelos enfermeiros obstetras para alívio da dor na parturição. Trata-se de uma pesquisa de campo, com abordagem qualitativa, onde foram entrevistados 20 enfermeiros obstetras numa maternidade de referência Materno Infantil no Estado do Pará no período de outubro a novembro de 2016. Evidenciou-se o conhecimento dos enfermeiros obstetras sobre os métodos não farmacológicos, entretanto, somente uma pequena parcela dos profissionais utilizam os métodos em benefício da parturiente, devido a carga de trabalho ou falta de estrutura. Mesmo com as dificuldades encontradas nas práxis do cuidado os enfermeiros buscam vencer os obstáculos que aparecem no exercício profissional.(AU)


The process of parturition is a physiological event, which causes uterine contractions and cervical dilatation, the fetus exerts pressure on the structures of the maternal pelvic floor, increasing the intensity of the pain. This study aimed to demonstrate the knowledge and applicability of nonpharmacological methods used by obstetrical nurses to relieve parturition pain. This is a field research with a qualitative approach, where 20 obstetrician nurses were interviewed in a Maternal Infant Reference Maternity Hospital in the State of Pará from October to November 2016. The obstetrical nurses' knowledge about methods However, only a small proportion of these professionals use these methods for the benefit of the parturient, due to work load or lack of structure. Even with the difficulties found in the practice of care nurses seek to overcome the obstacles that appear in the professional practice.(AU)


El proceso de parturión es un evento fisiológico, que ocasiona contracciones uterinas y dilatación cervical, el feto ejerce presión sobre las estructuras del suelo pélvico materno aumentando la intensidad del dolor. Este estudio buscó evidenciar el conocimiento y aplicabilidad de los métodos no farmacológicos utilizados por los enfermeros obstetras para alivio del dolor en la parturición. Se trata de una investigación de campo, con abordaje cualitativo, donde fueron entrevistados 20 enfermeros obstetras en una maternidad de referencia Materno Infantil en el Estado de Pará en el período de octubre a noviembre de 2016. Se evidenció el conocimiento de los enfermeros obstetras acerca de métodos no farmacológicos, sin embargo, sólo una pequeña parte de estos profesionales utilizan tales métodos en beneficio de la parturienta, debido a la carga de trabajo o falta de estructura. Incluso con las dificultades encontradas en las práxis del cuidado los enfermeros buscan vencer los obstáculos que aparecen en el ejercicio profesional.(AU)


Assuntos
Humanos , Feminino , Gravidez , Trabalho de Parto , Saúde Materno-Infantil , Dor do Parto , Manejo da Dor , Enfermagem Obstétrica , Parto , Serviços de Saúde Materna
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