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1.
Arch Argent Pediatr ; 119(2): 76-82, 2021 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33749192

RESUMO

INTRODUCTION: The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic. METHOD: Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector. RESULTS: In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted. Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment. CONCLUSIONS: All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly.


Assuntos
/prevenção & controle , Recursos em Saúde/provisão & distribução , Cuidado do Lactente/organização & administração , Controle de Infecções/organização & administração , Serviços de Saúde Materna/organização & administração , Argentina/epidemiologia , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Política de Saúde , Humanos , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Masculino , Serviços de Saúde Materna/estatística & dados numéricos , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Guias de Prática Clínica como Assunto , Gravidez
4.
BMC Pregnancy Childbirth ; 21(1): 77, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482762

RESUMO

BACKGROUND: Childbirth is a complex process, and checklists are useful tools to remember steps of such complex processes. The World Health Organization safe childbirth checklist is a tool used to improve the quality of care provided to women giving birth. The checklist was modified by Ministry of Health and was introduced to health centers in Ethiopia by the USAID Transform: Primary Health Care Activity. METHODS: A pre and post intervention study design with prospective data collection was employed. The availability of essential childbirth supplies and adherence of health care providers to essential birth practices were compared for the pre and post intervention periods. RESULTS: The pre and post intervention assessments were conducted in 247 and 187 health centers respectively. A statistically significant improvement from 63.6% pre intervention to 83.5% post intervention was observed in the availability of essential childbirth supplies, t (389.7) = - 7.1, p = 0.000. Improvements in adherence of health care providers to essential birth practices were observed with the highest being at pause point three (26.2%, t (306.3) = - 10.6, p = 0.000) followed by pause point four (21.1%, t (282.5) = - 8.0, p = 0.000), and pause point two (18.2%, t (310.8) = - 9.7, p = 0.000). The least and statistically non-significant improvement was observed at pause point one (3.3%, t (432.0) = - 1.5, p = 0.131). CONCLUSION: Improvement in availability of essential childbirth supplies and adherence of health care providers towards essential birth practices was observed after introduction of a modified World Health Organization safe childbirth checklist. Scale up of the use of the checklist is recommended.


Assuntos
Lista de Checagem/estatística & dados numéricos , Parto Obstétrico/normas , Serviços de Saúde Materna/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Complicações na Gravidez/prevenção & controle , Melhoria de Qualidade/organização & administração , Adulto , Etiópia , Feminino , Morte Fetal/prevenção & controle , Nível de Saúde , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Estudos Prospectivos , Medição de Risco , Organização Mundial da Saúde
5.
Rev Saude Publica ; 54: 100, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33146323

RESUMO

OBJECTIVE: To estimate the adequacy of health care during pregnancy and the postpartum period in puerperal women and newborn users of the Unified Health System and verify the factors associated with greater adequacy. METHODS: We used data obtained in the hospital interview, the prenatal card and the first telephone interview of 12,646 women participating in the study Nascer no Brasil (Birth in Brazil), conducted in 2011 and 2012. In the first stage of the analysis, the sociodemographic and obstetric characteristics of women and the estimation of adequacy of prenatal and postpartum care indicators are described. In the second stage, the cascade of care for actions related to puerperal women and their newborns is presented. Finally, maternal factors associated with the adequacy of the line of care are verified by means of multiple logistic regression. RESULTS: Only two of the four prenatal indicators were considered satisfactory: initiation up to the 16th week of pregnancy and adequate number of appointments. The guidance on which maternity to go for delivery, as well as the guidance to perform the puerperal appointment and the performance of the heel prick test have reached partial level of adequacy. The puerperal appointment, the first routine appointment of the newborn and the obtaining of the heel prick test results presented unsatisfactory adequacy. In the joint analysis of indicators regarding the effective use of services, only 1.5% of mothers and their babies received all recommended health care. Multiparous women living in the North, Northeast and Midwest, with lower schooling, presented the lowest chances of continuity of care. CONCLUSIONS: The indicators evaluated indicate that almost all women and their children presented partial and disjointed care, showing that the coordination of care is still a challenge in the health care of women and children in the puerperal pregnancy period.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde Materna , Período Pós-Parto , Cuidado Pré-Natal , Adolescente , Adulto , Brasil , Criança , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração , Adulto Jovem
7.
Hum Resour Health ; 18(1): 75, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028347

RESUMO

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidado do Lactente/organização & administração , Serviços de Saúde Materna/organização & administração , Tocologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Betacoronavirus , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Quênia/epidemiologia , Pandemias , Gravidez
9.
Medicine (Baltimore) ; 99(36): e21967, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899033

RESUMO

INTRODUCTION: Medical products transportation has become an important research topic requiring multidisciplinary collaboration among experts in medicine, engineering, and health economics. Current modes of transportation are unable to overcome the limited settings in maternal healthcare, particularly during the event of obstetric emergencies. The drone is a promising medical product aerial transportation (MedART) that holds an enormous potential for delivery of medical supplies in the healthcare system. We conducted a systematic review to examine scientific evidence of positive impact of drone transportation on maternal health. METHODS: The following electronic databases were searched from inception to July 2019: ScienceDirect, PubMed, and EMBASE. The report was made in accordance with the principles of PRISMA guidelines. The search terms used were related to drones including unmanned aerial vehicle (UAV) and unmanned aerial system (UAS), and related to obstetric/maternal including obstetric emergencies and postpartum hemorrhage. Studies were selected if the intervention used were drones, and if any direct or indirect maternal health indicators were reported. Meta-analysis was not done throughout the study in view of the anticipated heterogeneity of each study. RESULTS: Our initial search yielded a total of 244 relevant publications, from which 236 were carried forward for a title and abstract screening. After careful examination, only two were included for systematic synthesis. Among the reasons for exclusion were irrelevance to maternal health purpose, and irrelevance to drone applications in healthcare. An updated search yielded one additional study that was also included. Overall, two studies assessed drones for blood products delivery, and one study used drones to transport blood samples. CONCLUSION: A significant deficiency was found in the number of reported studies analyzing mode of medical products transportation and adaptation of drones in maternal healthcare. Future drone research framework should focus on maternal healthcare-specific drone applications in order to reap benefits in this area.


Assuntos
Aeronaves/instrumentação , Serviços de Saúde Materna/organização & administração , Tecnologia de Sensoriamento Remoto/instrumentação , Emergências , Feminino , Humanos , Serviços de Saúde Materna/tendências , Gravidez , Tecnologia de Sensoriamento Remoto/tendências
10.
Arch Iran Med ; 23(8): 557-560, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32894968

RESUMO

Reducing maternal mortality is one of the Sustainable Development Goals. Although there is no vigorous evidence that pregnant women are in the high-risk groups in response to coronavirus disease 2019 (COVID-19), it is crucial to respond to the pandemic through providing required action plans for confirmed or suspected pregnant women cases while maintaining routine functions. Iran's response and preparedness measures to COVID-19 aimed to meet the essential needs required to protect pregnant women and their families. Establishing a national maternal health network, relying on mechanisms for timely reporting, monitoring, and following-up, preparing guidelines and protocols required for COVID-19 management in pregnant women though a multidisciplinary team working approach, and embedding the precautions of reducing transmission in maternity care were the main measures taken to cope with COVID-19 in pregnancy. Iran's experience in providing maternity care during the COVID-19 can guide other countries affected by COVID-19. However, it should be adapted to local health-care facilities, as well as in response to any further updates on COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Serviços de Saúde Materna/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Gravidez
11.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32913633

RESUMO

The best way to ensure that preterm infants benefit from relevant neonatal expertise as soon as they are born is to transfer the mother and baby to an appropriately specialised neonatal facility before birth (" in utero"). This review explores the evidence surrounding the importance of being born in the right unit, the advantages of in utero transfers compared to ex utero transfers, and how to accurately assess which women are at most risk of delivering early and the challenges of in utero transfers. Accurate identification of the women most at risk of preterm birth is key to prioritising who to transfer antenatally, but the administrative burden and pathway variation of in utero transfer in the UK are likely to compromise optimal clinical care. Women reported the impact that in utero transfers have on them, including the emotional and financial burdens of being transferred and the anxiety surrounding domestic and logistical concerns related to being away from home. The final section of the review explores new approaches to reforming the in utero transfer process, including learning from outside the UK and changing policy and guidelines. Examples of collaborative regional guidance include the recent Pan-London guidance on in utero transfers. Reforming the transfer process can also be aided through technology, such as utilising the CotFinder app. In utero transfer is an unavoidable aspect of maternity and neonatal care, and the burden will increase if preterm birth rates continue to rise in association with increased rates of multiple pregnancy, advancing maternal age, assisted reproductive technologies, and obstetric interventions. As funding and capacity pressures on health services increase because of the COVID-19 pandemic, better prioritisation and sustained multi-disciplinary commitment are essential to maximise better outcomes for babies born too soon.


Assuntos
Serviços de Saúde da Criança , Recém-Nascido Prematuro , Serviços de Saúde Materna/organização & administração , Transferência de Pacientes , Infecções por Coronavirus , Feminino , Humanos , Lactente , Recém-Nascido , Pandemias , Pneumonia Viral , Gravidez , Gravidez Múltipla , Reino Unido
12.
PLoS One ; 15(8): e0237656, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866167

RESUMO

OBJECTIVE: Preterm birth is the primary driver of neonatal mortality worldwide, but it is defined by gestational age (GA) which is challenging to accurately assess in low-resource settings. In a commitment to reducing preterm birth while reinforcing and strengthening facility data sources, the East Africa Preterm Birth Initiative (PTBi-EA) chose eligibility criteria that combined GA and birth weight. This analysis evaluated the quality of the GA data as recorded in maternity registers in PTBi-EA study facilities and the strength of the PTBi-EA eligibility criteria. METHODS: We conducted a retrospective analysis of maternity register data from March-September 2016. GA data from 23 study facilities in Migori, Kenya and the Busoga Region of Uganda were evaluated for completeness (variable present), consistency (recorded versus calculated GA), and plausibility (falling within the 3rd and 97th birth weight percentiles for GA of the INTERGROWTH-21st Newborn Birth Weight Standards). Preterm birth rates were calculated using: 1) recorded GA <37 weeks, 2) recorded GA <37 weeks, excluding implausible GAs, 3) birth weight <2500g, and 4) PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks. RESULTS: In both countries, GA was the least recorded variable in the maternity register (77.6%). Recorded and calculated GA (Kenya only) were consistent in 29.5% of births. Implausible GAs accounted for 11.7% of births. The four preterm birth rates were 1) 14.5%, 2) 10.6%, 3) 9.6%, 4) 13.4%. CONCLUSIONS: Maternity register GA data presented quality concerns in PTBi-EA study sites. The PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks accommodated these concerns by using both birth weight and GA, balancing issues of accuracy and completeness with practical applicability.


Assuntos
Coleta de Dados/normas , Idade Gestacional , Serviços de Saúde Materna/organização & administração , Nascimento Prematuro/epidemiologia , Sistema de Registros/estatística & dados numéricos , Peso ao Nascer , Coleta de Dados/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Quênia/epidemiologia , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Nascimento Prematuro/prevenção & controle , Melhoria de Qualidade , Sistema de Registros/normas , Reprodutibilidade dos Testes , Estudos Retrospectivos , Uganda/epidemiologia
13.
Br J Clin Psychol ; 59(4): 480-502, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32808684

RESUMO

OBJECTIVES: To investigate whether levels of perfectionism, organization, and intolerance of uncertainty predispose women to more negative birth experiences and post-partum post-traumatic stress symptoms (PTSS). Birth experience was also examined as a potential moderator of the relationship between levels of the personality traits and post-natal PTSS. DESIGN: Prospective survey. METHOD: First-time expectant mothers (N = 10,000) were contacted via Emma's Diary during the perinatal period. At 32-42 weeks' gestation, participants completed measures examining the three personality traits and prenatal mood. At 6-12 weeks' post-partum, instruments assessing childbirth experience, birth trauma, PTSS, and post-natal mood were completed. Data from 418 women were analysed. RESULTS: Higher perfectionism and intolerance of uncertainty were associated with more negative birth appraisals and PTSS. Organization was unrelated to birth experience or PTSS. In a regression, higher intolerance of uncertainty and perfectionism statistically predicted more negative birth appraisals. Only perfectionism predicted PTSS. Birth experience did not moderate the relationship between perfectionism or intolerance of uncertainty and PTSS. CONCLUSIONS: Personality risk factors for negative birth experiences and post-natal PTSS are identifiable prenatally. Maternity care providers could educate women about the unique roles of high perfectionism and intolerance of uncertainty during antenatal birth preparation. PRACTITIONER POINTS: Women who expect themselves to be more perfect or who find it more difficult to cope with uncertainty had more negative experiences of childbirth. Women with higher levels of perfectionism were more likely to experience more symptoms of post-traumatic stress during the early post-natal period. Being more perfectionistic continued to have a more negative effect on women's well-being after birth, regardless of whether they had a positive or negative experience of birth. Integrating these findings into antenatal discussion around birth preferences would increase women's awareness of predisposing and obstetric risk factors that partially explain experiences of unsatisfactory births and post-partum post-traumatic stress.


Assuntos
Ansiedade/psicologia , Parto Obstétrico/psicologia , Serviços de Saúde Materna/organização & administração , Parto/psicologia , Personalidade , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estresse Psicológico/complicações , Incerteza , Adulto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/normas , Depressão/psicologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/psicologia , Inquéritos e Questionários
14.
Women Birth ; 33(6): 540-543, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32798066

RESUMO

BACKGROUND: Rapid changes to how maternity health care is delivered has occurred in many countries across the globe in response to the COVID-19 pandemic. Maternity care provisions have been challenged attempting to balance the needs and safety of pregnant women and their care providers. Women experiencing a pregnancy after loss (PAL) during these times face particularly difficult circumstances. AIM: In this paper we highlight the situation in three high income countries (Australia, Ireland and USA) and point to the need to remember the unique and challenging circumstances of these PAL families. We suggest new practices may be deviating from established evidence-based guidelines and outline the potential ramifications of these changes. FINDINGS: Recommendations for health care providers are suggested to bridge the gap between the necessary safety requirements due to the pandemic, the role of the health care provider, and the needs of families experiencing a pregnancy after loss. DISCUSSION: Changes to practices i.e. limiting the number of antenatal appointments and access to a support person may have detrimental effects on both mother, baby, and their family. However, new guidelines in maternity care practices developed to account for the pandemic have not necessarily considered women experiencing pregnancy after loss. CONCLUSION: Bereaved mothers and their families experiencing a pregnancy after loss should continue to be supported during the COVID-19 pandemic to limit unintended consequences.


Assuntos
Luto , Infecções por Coronavirus/prevenção & controle , Serviços de Saúde Materna/organização & administração , Mães/psicologia , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Gestantes/psicologia , Natimorto/psicologia , Aborto Espontâneo , Austrália , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Irlanda , Pandemias , Morte Perinatal , Pneumonia Viral/epidemiologia , Gravidez , Estados Unidos
16.
Malawi Med J ; 32(1): 13-18, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32733654

RESUMO

Background: This paper reports on part of a larger study, the aim of which was to develop an intervention to collaboratively develop innovative strategies to promote effective collaborative practices among midwives and medical professionals working in intrapartum care unit. Collaborative practice is a critical marker for success in improving quality of maternity care. To date, there has been limited exploration of collaborative practices between midwives and medical professionals working in intrapartum care from the African perspective. Aim: This paper reports findings of the discovery phase of appreciative inquiry (AI) set out to understand the perspectives of midwives and medical professionals on collaborative practices at Queen Elizabeth Central Hospital labour and delivery ward in Malawi. Methods: The study used an exploratory qualitative approach framed in an Appreciative Inquiry theoretical perspective. Appreciative Inquiry consists of four phases :(discovery, dream, design and destiny).The discovery phase consisted of 16 in-depth interviews and 2 focus group discussions among purposively selected midwives (4 nurse midwives, 2 midwifery unit matrons) and medical professionals (2 obstetricians, 4 registrars, 2 intern doctors, 2 clinical officers) working in the labour ward. All interviews and discussions were audiotaped and transcribed verbatim. Data were analysed using thematic analysis. Results: Five dominant themes emerged: collaborative breakdown, benefits of collaboration, the importance of positive and respectful attitude, barriers to effective collaborative practices and strategies to improve collaborative practice. Conclusion/Recommendations: Aligning the perspectives of the members of the two disciplines is significant to effective implementation of collaborative intrapartum care. Participants demonstrated that there is increased parallel working of midwives and doctors at QECH. This is not professionally healthy. Therefore, putting together the viewpoints of the professions to create a mutually agreeable professional framework of collaborative intrapartum practice is significant. Additionally, there is an obvious need to address the professional concerns of both disciplines.


Assuntos
Comportamento Cooperativo , Relações Interprofissionais , Serviços de Saúde Materna/organização & administração , Tocologia , Enfermeiras Obstétricas/psicologia , Médicos/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Hospitais Universitários , Humanos , Entrevistas como Assunto , Trabalho de Parto , Malaui , Unidade Hospitalar de Ginecologia e Obstetrícia , Gravidez , Pesquisa Qualitativa
17.
Aust N Z J Obstet Gynaecol ; 60(4): 628-632, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32648254

RESUMO

COVID-19 has posed major challenges for health care. Hospitals around the world have needed to rapidly prepare for the emerging pandemic. Translational simulation - simulation that is integrated and focused on emerging clinical priorities - offers numerous opportunities to aid in pandemic preparation. We describe our approach to preparing our institution's maternity services for the COVID-19 pandemic using translational simulation. We suggest lessons for providers of maternity services, and for those who support them through simulation activities.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Serviços de Saúde Materna/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Treinamento por Simulação
18.
BMC Public Health ; 20(1): 1093, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32652971

RESUMO

BACKGROUND: The Chinese government has been strengthening the primary care system since the launch of the New Healthcare System Reform in 2009. Among all endeavors, the most obvious and significant improvement lays in maternal and child health. This study was designed to explore the association of primary care physician supply with maternal and child health outcomes in China, and provide policy suggestions to the law makers. METHODS: Six-year panel dataset of 31 provinces in China from 2012 to 2017 was used to conduct the longitudinal ecological study. Linear fixed effects regression model was applied to explore the association of primary care physician supply with the metrics of maternal and child health outcomes while controlling for specialty care physician supply and socio-economic covariates. Stratified analysis was used to test whether this association varies across different regions in China. RESULTS: The number of primary care physicians per 10,000 population increased from 15.56 (95% CI: 13.66 to 17.47) to 16.08 (95% CI: 13.86 to 18.29) from 2012 to 2017. The increase of one primary care physician per 10,000 population was associated with 5.26 reduction in maternal mortality per 100,000 live births (95% CI: - 6.745 to - 3.774), 0.106% (95% CI: - 0.189 to - 0.023) decrease in low birth weight, and 0.419 decline (95% CI: - 0.564 to - 0.273) in perinatal mortality per 1000 live births while other variables were held constant. The association was particularly prominent in the less-developed western China compared to the developed eastern and central China. CONCLUSION: The sufficient supply of primary care physician was associated with improved maternal and child health outcomes in China, especially in the less-developed western region. Policies on effective and proportional allocation of resources should be made and conducted to strengthen primary care system and eliminate geographical disparities.


Assuntos
Saúde da Criança/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Médicos de Atenção Primária/organização & administração , Atenção Primária à Saúde/organização & administração , Adulto , Criança , Serviços de Saúde da Criança/organização & administração , China/epidemiologia , Feminino , Reforma dos Serviços de Saúde , Humanos , Recém-Nascido , Mortalidade Materna/tendências , Gravidez
19.
Midwifery ; 88: 102779, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32600862
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