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2.
Matern Child Health J ; 24(Suppl 1): 31-38, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31848924

RESUMO

INTRODUCTION: Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal. METHODS: Data were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities. RESULTS: Of the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals. CONCLUSIONS: These findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços Médicos de Emergência/organização & administração , Instalações de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde , Feminino , Acesso aos Serviços de Saúde , Humanos , Saúde do Lactente , Recém-Nascido , Nepal , Gravidez
3.
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
4.
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
5.
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
6.
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
7.
BMC Health Serv Res ; 19(1): 833, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727073

RESUMO

BACKGROUND: Women and families experiencing socioeconomic and psychosocial adversity are the least likely to access health care but most likely to benefit. For health services to effectively meet the needs of individuals experiencing adversity, research involving the health services must be truly representative. However, individuals experiencing adversity are typically excluded from or underrepresented in health services research. This paper reports on the implementation of a quality improvement approach designed to support recruitment and retention of pregnant women experiencing adversity in a longitudinal, health services randomized controlled trial ("right@home"). METHODS: right@home recruited Australian women from 10 public maternity hospitals across the states of Victoria and Tasmania who were experiencing adversity (≥2 risk factors on screening survey). Regular follow-up assessments were conducted by phone or face-to-face to child age 2 years. Research processes were designed taking heed of previous research demonstrating effective strategies for recruiting and retaining minority groups (e.g. piloting the recruitment process; recruiting via the health service providing care to the subgroup; remunerating participants); however, we were concerned that important information was missing. Therefore, once recruitment began, we conducted a continuous evaluation of the research processes, testing and implementing changes to processes or new strategies to maximize recruitment and retention (e.g. using a suite of strategies to maintain contact with families, using flexible data collection methods, obtaining consent for data linkage for future health and education data). RESULTS: right@home enrolled a large cohort of women (N = 722) experiencing high levels of adversity according to socioeconomic status and psychosocial risk factors, and achieved excellent retention (83% completion at 2 years). Most strategies appeared to increase recruitment and retention. All required additional time from the research team to develop and test, and some required extra funding, which ranged from minor (e.g. printing) to substantial (e.g. salaries, remuneration). CONCLUSIONS: By taking a quality improvement approach, supported by sufficient resourcing and flexible research processes, it is possible to recruit and retain a large cohort of women experiencing adversity who are typically missed or lost from longitudinal research.


Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Serviços de Saúde Materna/organização & administração , Gestantes/psicologia , Feminino , Humanos , Estudos Longitudinais , Gravidez , Melhoria de Qualidade , Apoio Social , Populações Vulneráveis
8.
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
9.
Cochrane Database Syst Rev ; 2019(11)2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31686427

RESUMO

BACKGROUND: In low- and middle-income countries (LMICs), health services are under-utilised, and several studies have reported improvements in neonatal outcomes following health education imparted to mothers in homes, at health units, or in hospitals. However, evaluating health educational strategy to deliver newborn care, such as one-to-one counselling or group counselling via peer or support groups, or delivered by health professionals, requires rigorous assessment of methodological design and quality, as well as assessment of cost-effectiveness, affordability, sustainability, and reproducibility in diverse health systems. OBJECTIVES: To compare a community health educational strategy versus no strategy or the existing approach to health education on maternal and newborn care in LMICs, as imparted to mothers or their family members specifically in community settings during the antenatal and/or postnatal period, in terms of effectiveness for improving neonatal health and survival (i.e. neonatal mortality, neonatal morbidity, access to health care, and cost). SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), in the Cochrane Library, MEDLINE via PubMed (1966 to 2 May 2017), Embase (1980 to 2 May 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2 May 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: Community-based randomised controlled, cluster-randomised, or quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted the data. We assessed the quality of evidence using the GRADE method and prepared 'Summary of findings' tables. MAIN RESULTS: We included in this review 33 original trials (reported in 62 separate articles), which were conducted across Africa and Central and South America, with most reported from Asia, specifically India, Pakistan, and Bangladesh. Of the 33 community educational interventions provided, 16 included family members in educational counselling, most frequently the mother-in-law or the expectant father. Most studies (n = 14) required one-to-one counselling between a healthcare worker and a mother, and 12 interventions involved group counselling for mothers and occasionally family members; the remaining seven incorporated components of both counselling methods. Our analyses show that community health educational interventions had a significant impact on reducing overall neonatal mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.78 to 0.96; random-effects model; 26 studies; n = 553,111; I² = 88%; very low-quality evidence), early neonatal mortality (RR 0.74, 95% CI 0.66 to 0.84; random-effects model; 15 studies that included 3 subsets from 3 studies; n = 321,588; I² = 86%; very low-quality evidence), late neonatal mortality (RR 0.54, 95% CI 0.40 to 0.74; random-effects model; 11 studies; n = 186,643; I² = 88%; very low-quality evidence), and perinatal mortality (RR 0.83, 95% CI 0.75 to 0.91; random-effects model; 15 studies; n = 262,613; I² = 81%; very low-quality evidence). Moreover, community health educational interventions increased utilisation of any antenatal care (RR 1.16, 95% CI 1.11 to 1.22; random-effects model; 18 studies; n = 307,528; I² = 96%) and initiation of breastfeeding (RR 1.56, 95% CI 1.37 to 1.77; random-effects model; 19 studies; n = 126,375; I² = 99%). In contrast, community health educational interventions were found to have a non-significant impact on use of modern contraceptives (RR 1.10, 95% CI 0.86 to 1.41; random-effects model; 3 studies; n = 22,237; I² = 80%); presence of skilled birth attendance at birth (RR 1.09, 95% CI 0.94 to 1.25; random-effects model; 10 studies; n = 117,870; I² = 97%); utilisation of clean delivery kits (RR 4.44, 95% CI 0.71 to 27.76; random-effects model; 2 studies; n = 17,087; I² = 98%); and care-seeking (RR 1.11, 95% CI 0.97 to 1.27; random-effects model; 7 studies; n = 46,154; I² = 93%). Cost-effectiveness analysis conducted in seven studies demonstrated that the cost-effectiveness for intervention packages ranged between USD 910 and USD 11,975 for newborn lives saved and newborn deaths averted. For averted disability-adjusted life-year, costs ranged from USD 79 to USD 146, depending on the intervention strategy; for cost per year of lost lives averted, the most effective strategy was peer counsellors, and the cost was USD 33. AUTHORS' CONCLUSIONS: This review offers encouraging evidence on the value of integrating packages of interventions with educational components delivered by a range of community workers in group settings in LMICs, with groups consisting of mothers, and additional education for family members, for improved neonatal survival, especially early and late neonatal survival.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Aconselhamento/métodos , Mortalidade Infantil , Mães/educação , Mortalidade Perinatal , Países em Desenvolvimento , Feminino , Educação em Saúde , Humanos , Lactente , Saúde do Lactente , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
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
11.
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
12.
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
13.
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
14.
PLoS Med ; 16(10): e1002939, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31647821

RESUMO

BACKGROUND: The coverage of community-based maternal, neonatal, and child health (MNCH) services remains low, especially in hard-to-reach areas. We evaluated the effectiveness of a mobile-phone-and web-based application, Innovative Mobile-phone Technology for Community Health Operations (ImTeCHO), as a job aid to the government's Accredited Social Health Activists (ASHAs) and Primary Health Center (PHC) staff to improve coverage of MNCH services in rural tribal communities of Gujarat, India. METHODS AND FINDINGS: This open cluster-randomized trial was conducted in 22 PHCs in six tribal blocks of Bharuch and Narmada districts in India. The ImTeCHO mobile-phone-and web-based application included various technology-based job aids to facilitate scheduling of home visits, screening for complications, counseling during home visits, and supportive supervision by PHC staff. Primary outcome indicators were a composite index calculated based on coverage of important MNCH services and coverage of at least two home visitations by ASHA within the first week of birth. Primary analysis was intention to treat (ITT). Generalized Estimating Equation (GEE) was used to account for clustering. Eleven PHCs each were randomly allocated to the intervention (280 ASHAs, population: 234,134) and control (281 ASHAs, population: 242,809) arms. The intervention was implemented from February, 2016 to January, 2017. At the end of the implementation, 6,493 mothers were surveyed. Most of the surveyed women were tribal (5,571, 85.8%), and reported having a government-issued certificate for living below poverty line (4,916, 75.7%). The coverage of at least two home visits within first week of birth was 32.4% in the intervention clusters compared to 22.9% in the control clusters (adjusted effect size 10.2 [95% CI: 6.4, 14.0], p < 0.001). Mean number of home visits within first week of birth was 1.11 and 0.80 for intervention and control clusters, respectively (adjusted effect size 0.34 [95% CI: 0.23, 0.45], p < 0.001). The composite coverage index was 43.0% in the intervention clusters compared to 38.5% (adjusted effect size 4.9 [95% CI: 0.2, 9.5], p = 0.03) in the control clusters. There were substantial improvements in coverage home visits by ASHAs during antenatal period (adjusted effect size 15.7 [95% CI: 11.0, 20.4], p < 0.001), postnatal period (adjusted effect size 6.4, [95% CI: 3.2, 9.6], p <0.001), early initiation of breastfeeding (adjusted effect size 7.8 [95% CI: 4.2, 11.4], p < 0.001), and exclusive breastfeeding (adjusted effect size 13.4 [95% CI: 8.9, 17.9], p < 0.001). Number of infant and neonatal deaths was similar in the two arms in the ITT analysis. The limitations of the study include potential risk of inaccuracies in reporting events that occurred during pregnancy by the mothers and the duration of intervention being 12 months, which might be considered short. CONCLUSIONS: In this study, we found that use of ImTeCHO mobile- and web-based application as a job aid by government ASHAs and PHC staff improved coverage and quality of MNCH services in hard-to-reach areas. Supportive supervision, change management, and timely resolution of technology-related issues were critical implementation considerations to ensure adherence to the intervention. TRIAL REGISTRATION: Study was registered at the Clinical Trial Registry of India (www.ctri.nic.in). Trial number: CTRI/2015/06/005847. The trial was registered (prospective) on 3 June, 2015. First enrollment was done on 26 August, 2015.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde Materna/organização & administração , Neonatologia/organização & administração , Telemedicina/métodos , Adulto , Telefone Celular , Análise por Conglomerados , Agentes Comunitários de Saúde , Aconselhamento , Feminino , Serviços de Assistência Domiciliar , Visita Domiciliar , Humanos , Índia/epidemiologia , Recém-Nascido , Internet , Masculino , Gravidez , Desenvolvimento de Programas , Serviços de Saúde Rural/organização & administração , População Rural , Resultado do Tratamento , Adulto Jovem
15.
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
16.
BMC Health Serv Res ; 19(1): 724, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638983

RESUMO

BACKGROUND: Maternal and child morbidity and mortality remains one of the most important public health challenges in developing countries. In rural settings, the promotion of household and community health practices through health extension workers in collaboration with other community members is among the key strategies to improve maternal and child health. Little has been studied on the actual roles and contributions of various individuals and groups to date, especially in the rural areas of Ethiopia. In this study, we explored the role played by different actors in promoting ANC, childbirth and early PNC services, and mainly designed to inform a community based Information, Education & Communication intervention in rural Ethiopia. METHODS: An exploratory qualitative study was conducted on 24 in-depth interviews with health extension workers, religious leaders, women developmental army leaders, and selected community members; and 12 focus group discussions, six with female and six with male community members. Data was captured using voice recorders and field notes and transcribed verbatim in English, and analyzed using Atlas.ti software. Ethical approval for the fieldwork was obtained from Jimma University and the University of Ottawa. RESULTS: Participants described different roles and responsibilities that individuals and groups have in promoting maternal/child health, as well as the perceived roles of family members/husband. Commonly identified roles included promotion of health care services; provision of continuous support during pregnancy, labour and postnatal care; and serving as a link between the community and the health system. Participants also felt unable to fully engage in their identified roles, describing several challenges existing within both the health system and the community. CONCLUSIONS: Involvement of different actors based on their areas of focus could contribute to community members receiving health information from people they trust more, which in turn is likely to increase use of services. Therefore, if our IEC interventions focus on overcoming challenges that limit actors' abilities to engage effectively in promoting use of MCH services, it will be feasible and effective in rural settings, and these actors can become an epicenter in providing community based intervention in using ANC, childbirth and early PNC services.


Assuntos
Agentes Comunitários de Saúde , Promoção da Saúde , Serviços de Saúde Materna/organização & administração , Papel Profissional , Adulto , Atitude do Pessoal de Saúde , Etiópia , Feminino , Humanos , Gravidez , Saúde Pública , População Rural
17.
BMC Res Notes ; 12(1): 619, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547839

RESUMO

OBJECTIVE: To assess labor pain control and associated factors among women who give birth at Leku primary hospital, southern Ethiopia, 2018/19. A systematic random sampling technique was used to select 404 mothers who gave birth at Leku hospital during the data collection period. Data were collected by two first degree midwives immediately after delivery using Labor Agentry Scale (LAS). RESULTS: In this study, 404 mothers were participated making the response rate of 100%. Among the participants, 104 (25.7%) of mothers reported Mild control of labor pain. Maternal age of 19 to 24 year AOR = 5.85 (95% CI 2.14, 15.98), being farmer AOR = 2.5 (1.14, 5.57), primi-para AOR = 0.13 (0.06, 0.3), good family support AOR = 2.8 (1.49, 5.3), short duration of labor (< 12 h) AOR = 3.2 (1.65, 6.23) and history of pregnancy loss AOR = 0.06 (0.03, 0.14) were significantly associated with greater control of labor pain. In general, compared to other studies, the level of labor pain control is good in this study area. Enhancing factors of labor pain control have to be strengthened to increase greater control of labor pain. Qualitative research is highly recommended to identify cultural factors related to labor pain control and management.


Assuntos
Parto Obstétrico/psicologia , Dor do Parto/diagnóstico , Trabalho de Parto/psicologia , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Hospitais , Humanos , Dor do Parto/fisiopatologia , Dor do Parto/psicologia , Serviços de Saúde Materna/organização & administração , Tocologia , Gravidez
18.
BMC Pregnancy Childbirth ; 19(1): 331, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500580

RESUMO

BACKGROUND: In the United Kingdom, midwives will engage in discussions with the multidisciplinary team as to whether they can provide Obstetric High Dependency Care (OHDC) on the Delivery Suite or whether a woman's care should be escalated to the critical care team. This study aimed to explore the question: What factors influence midwives to provide OHDC or request care be escalated away from the obstetric unit in hospitals remote from tertiary referral centres? METHODS: Focus groups were undertaken with midwives (n = 34) across three obstetric units in England, with annual birth rates ranging from 1500 to 5000 per annum, in District General Hospitals. Three scenarios in the form of video vignettes of handover were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission of woman with chest pain receiving facial oxygen and requiring continuous electrocardiogram (ECG) monitoring. Two focus groups were conducted in each of the obstetric units with experienced midwives. Data were analysed using a qualitative framework approach. RESULTS: Factors influencing midwives' care escalation decisions included the care environment, a woman's diagnosis and fetal or neonatal factors. The overall plan of care including the need for ECG and invasive monitoring were also influential factors. Midwives in the smallest obstetric unit did not have access to the facilities for OHDC provision. Midwives in the larger obstetric units provided OHDC but identified varying degrees of skill and sometimes used 'workarounds' to facilitate care provision. Midwifery staffing levels, skill mix and workload were also influential. Some differences of opinion were evident between midwives working in the same obstetric units as to whether OHDC could be provided and the support they would enlist to help them provide it. Reliance on clinical guidelines appeared variable. CONCLUSIONS: Findings indicate that there may be inequitable OHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable OHDC care including skills development for midwives and precise escalation guidelines to minimise workarounds. Training for midwives must include strategies that prevent skills fade.


Assuntos
Competência Clínica , Parto Obstétrico , Serviços de Saúde Materna/organização & administração , Tocologia , Complicações do Trabalho de Parto , Carga de Trabalho/psicologia , Adulto , Atitude do Pessoal de Saúde , Salas de Parto/normas , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Feminino , Grupos Focais , Humanos , Tocologia/métodos , Tocologia/organização & administração , Tocologia/normas , Determinação de Necessidades de Cuidados de Saúde , Complicações do Trabalho de Parto/classificação , Complicações do Trabalho de Parto/terapia , Transferência de Pacientes/métodos , Gravidez , Encaminhamento e Consulta , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/normas , Reino Unido
19.
BMC Pregnancy Childbirth ; 19(1): 332, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500582

RESUMO

BACKGROUND: The North Eastern region in Kenya experiences challenges in the utilization of maternal and newborn health services. In this region, culture and religion play a major role in influencing healthcare seeking behaviour of the community. This study was conducted to (i) understand key inherent barriers to health facility delivery in the Somali community of North Eastern Kenya and (ii) inform interventions on specific needs of this community. METHODS: The study was conducted among community members of Garissa sub-County as part of a baseline assessment before the implementation of an intervention package aimed at creating demand and increasing utilization of maternal and newborn services. Focus group discussions and key informant interviews were conducted with clan leaders, Imams, health managers, member of the county assembly, and service users (women and men) in three locations of Garissa sub-County. Data were analysed through content analysis, by coding recurrent themes and pre-established themes. RESULTS: Using health facility for delivery was widely acceptable and most respondents acknowledged the advantages and benefits of skilled birth delivery. However, a commonly cited barrier in using health facility delivery was the issue of male nurses and doctors attending to women in labour. According to participants, it is against their culture and thus a key disincentive to using maternity services. Living far from the health facility and lack of a proper and reliable means of transportation was also highlighted as a reason for home delivery. At the health facility level, respondents complained about the poor attitude of health care providers, especially female nurses being disrespectful; and the limited availability of healthcare workers, equipment and supplies. Lack of awareness and information on the importance of skilled birth attendance was also noted. CONCLUSION: To increase health facility delivery, interventions need to offer services that take into consideration the sociocultural aspect of the recipients. Culturally acceptable and sensitive services, and awareness on the benefits of skilled birth attendance among the community members are likely to attract more women to use maternity services and thus reduce adverse maternal and newborn health outcomes.


Assuntos
Cultura , Parto Obstétrico , Serviços de Saúde Materna , Enfermeiros/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Gestantes/psicologia , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Parto Obstétrico/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Quênia , Masculino , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/organização & administração , Tocologia/normas , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , Fatores Sexuais , Percepção Social , Recusa do Paciente ao Tratamento/psicologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos
20.
BMC Health Serv Res ; 19(1): 655, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500636

RESUMO

BACKGROUND: Uganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda's skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care. METHODS: This is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis. RESULTS: The skilled birth attendance policy was an important priority on Uganda's maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional. CONCLUSION: Uganda's skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.


Assuntos
Política de Saúde , Acesso aos Serviços de Saúde/normas , Serviços de Saúde Materna/organização & administração , Tocologia/organização & administração , Enfermeiras Obstétricas/provisão & distribução , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Instalações de Saúde/normas , Acesso aos Serviços de Saúde/organização & administração , Humanos , Serviços de Saúde Materna/normas , Mortalidade Materna , Tocologia/normas , Tocologia/estatística & dados numéricos , Enfermeiras Obstétricas/organização & administração , Enfermeiras Obstétricas/normas , Obstetrícia/normas , Formulação de Políticas , Gravidez , Qualidade da Assistência à Saúde , Uganda
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