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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46724

RESUMO

Folheto da campanha da Semana Mundial do Aleitamento Materno - SMAM 2019, que tem como tema: Empoderar mães e pais, favorecer a amamentação. Hoje e para o futuro!.


Assuntos
Folhetos , Promoção da Saúde , Serviços de Saúde Materno-Infantil , Política de Saúde , Equidade de Gênero , Aleitamento Materno , Leite Humano
2.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46726

RESUMO

A campanha traz como mensagem central a relevância do apoio e do incentivo à família que está amamentando e mostra a importância deste momento para o bebê. Também reforça a necessidade do aleitamento materno até os dois anos ou mais, sendo de forma exclusiva até os 6 meses de vida do bebê. A veiculação da campanha ocorre entre os dias 1º e 15 de agosto.


Assuntos
Leite Humano , Promoção da Saúde , Serviços de Saúde Materno-Infantil , Aleitamento Materno
3.
Rev Saude Publica ; 532019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432932

RESUMO

OBJECTIVE: To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state. METHODS: Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals. RESULTS: Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34-0.71), with high education level (OR = 0.42; 95%CI 0.31-0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41-0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42-0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18-0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66-0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed. CONCLUSIONS: Antepartum peregrination suffers interference from the mother's socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/provisão & distribução , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Equidade em Saúde , Humanos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Gravidez , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
4.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 1032-1048, jul.-set. 2019. tab, graf
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005788

RESUMO

Objetivo: Analisar as internações por condições sensíveis à atenção primária, relacionadas às doenças do pré-natal e do parto no país após a implementação da Rede Cegonha. Metodologia: Estudo descritivo, retrospectivo, realizado a partir da consulta de dados secundários disponibilizados por meio do Departamento de Informática do Sistema Único de Saúde (SUS), durante os anos de 2011 a 2013. Resultados: No período estudado houve um acréscimo de 5.606 casos de internações por condições sensíveis à atenção primária relacionadas às doenças do pré-natal e parto a nível nacional, sendo que a região de maior destaque foi a sudeste com 44.384 hospitalizações. Esta pesquisa apresentou um índice crescente de internações por condições sensíveis à atenção primária por doenças relacionadas ao pré-natal e parto mesmo com a regulamentação da Rede Cegonha. Considerações finais: O aumento das internações demonstra os desafios a serem enfrentados pela atenção primária, visando à redução de adversidades consideradas evitáveis


Objective: To analyze hospitalizations for conditions sensitive to primary care, related to prenatal and childbirth diseases in the country after implementation of the Stork Network. Methodology: a descriptive, retrospective study, carried out based on the consultation of secondary data made available through the Department of Informatics of the Unified Health System, during the years 2011 to 2013. Results: During the study period there were an increase of 5,606 cases of hospitalizations due to conditions sensitive to primary care related to prenatal and childbirth diseases at the national level, and the most prominent region was the Southeast with 44,384 hospitalizations. This research presented an increasing index of hospitalizations for conditions sensitive to primary care due to prenatal and delivery related illnesses even with the regulation of the Stork Network. Final considerations: The increase in hospitalizations demonstrates the challenges to be faced by primary care, aiming to reduce adversities considered avoidable


Objetivo: Analizar las internaciones por condiciones sensibles a la atención primaria, relacionadas a las enfermedades del prenatal y parto en el país después de la implementación de la Red Cigüeña. Metodología: estudio descriptivo, retrospectivo, realizado a partir de la consulta de datos secundarios disponibles a través del Departamento de Informática del Sistema Único de Salud, durante los años de 2011 a 2013. Resultados: En el período estudiado hubo un aumento de 5.606 casos de internaciones por condiciones sensibles a la atención primaria relacionada con las enfermedades del prenatal y parto a nivel nacional, siendo que la región de mayor destaque fue al sureste con 44.384 hospitalizaciones. Esta investigación presentó um índice creciente de internaciones por condiciones sensibles a la atención primaria por enfermedades relacionadas al prenatal y parto incluso con la reglamentación de la Red Cigüeña. Consideraiones finales: El aumento de las internaciones demuestra los desafíos a ser enfrentados por la atención primaria, visando la reducción de adversidades consideradas evitables


Assuntos
Humanos , Feminino , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Avaliação em Saúde/estatística & dados numéricos , Serviços de Saúde da Mulher , Complicações do Trabalho de Parto/epidemiologia
5.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 968-975, jul.-set. 2019. il
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005817

RESUMO

Objetivo: Descrever o desenvolvimento de estratégias educativas utilizadas em um grupo educativo para gestantes. Métodos: Estudo descritivo, desenvolvido em Acarape/CE, no qual foram realizados oito encontros semanais no período de janeiro a março de 2015. Em cada encontro, foram realizadas dinâmicas de apresentação, exposição do tema proposto em forma de diálogo e atividades para fixação do conhecimento. Resultados: As mulheres foram muito receptivas demonstrando interesse e satisfação com as atividades. Algumas informações já eram de conhecimento das participantes e outras precisaram ser mais detalhadas, no intuito de fornecer subsídios para que elas pudessem se auto cuidar e cuidar de seus filhos com mais propriedade. Conclusão: A atividade oportunizou a reunião de primíparas e multíparas, sendo esta vivência recomendada e considerada muito apropriada ao compartilhamento de experiências, ao aprendizado e à promoção do cuidado na gestação e no puerpério


Objective: The study's purpose has been to describe the development of educational strategies used in an educational group for pregnant women. Methods: It is a descriptive study that was carried out during eight weekly meetings over the period from January to March 2015, in Acarape city, Ceará State. At each meeting, were performed dynamics of presentation; exhibition of the proposed theme in dialogues and activities towards the knowledge capturing process. Results: The women were very receptive showing both interest and satisfaction concerning the activities. The women were already aware of some information, nonetheless, other kinds of information needed to be more detailed in order to provide subsidies, so that women could self-care and care for their children in a better way. Conclusion: The activity provided an opportunity to meeting primiparous and multiparous women, and this experience was considered very appropriate to share experiences, and also to learn and promote the care during pregnancy and postpartum period


Objetivo: Describir el desarrollo de estratégias educativas utilizadas en um grupo educativo para mujeres embarazadas. Métodos: Estudio descriptivo, desarrollo en Acarape-Ce, donde se realizaron ocho reuniones semanales en el período de enero a marzo de 2015. En cada encuentro, se realizaron dinámicas de presentación, exposición del tema propuesto en diálogo y actividades para fijación del conocimiento. Resultados: Las mujeres fueran muy receptivas demonstrando interés y satisfacción con las actividades. Algunas informaciones ya eran conocidas por las mujeres y otras necesitaron ser más detalladas, con el fin de proporcionar subsidios para que las mujeres pudieran autocuidarse y cuidar de sus hijos con más propiedad. Conclusión: La actividad oportunizó la reunión de primíparas y multíparas, siendo esta vivencia recomendada y considerada muy apropriada al compartir experiências, al aprendizaje y la promoción del cuidado durante el embarazo y el puerpério


Assuntos
Humanos , Feminino , Gravidez , Cuidado Pré-Natal/métodos , Educação em Saúde/métodos , Serviços de Saúde Materno-Infantil , Cuidado Pré-Natal/tendências , Grupos de Autoajuda , Educação em Saúde/tendências , Promoção da Saúde
6.
Women Birth ; 32(5): 460-465, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31303540

RESUMO

BACKGROUND: Approaches to health promotion that are collaborative, support strengths inherent in Aboriginal and Torres Strait Islander culture, and demonstrate respect and understanding for individual communities, have achieved the most positive outcomes to date. AIM: To illustrate how the implementation and evaluation of a safe infant sleep health promotion strategy was facilitated by embedding recognised best practice principles for the conduct of research with Aboriginal and Torres Strait Islander peoples and communities. METHODS: The Pepi-Pod® Program was introduced across rural, remote and metropolitan locations in Queensland between 2013 and 2017. This case study discusses the partnership between the Pepi-Pod® Program and one community-controlled maternal and child health service that employed an Aboriginal Health Worker led model of maternal and child health care for remote regions of Queensland. FINDINGS: Best practice principles were embedded within the program design and adaptation, and in the approach to community consultation prior to program implementation. Collaborative partnerships based on trust, which established stakeholder expectations through transparent communication processes, together with effective engagement in achieving program goals, led to the implementation of this evidence-based health promotion initiative as intended. Consideration for locally relevant and culturally competent program delivery was key to success. The integrity of the program was maintained and embedded into ongoing service delivery. CONCLUSIONS: Through adherence to best practice principles for research with Aboriginal and Torres Strait Islander communities, implementation and evaluation of health promotion programs can be conducted in mutually acceptable, feasible and sustainable ways that develop capacity within participating health services.


Assuntos
Pesquisa Participativa Baseada na Comunidade/métodos , Assistência à Saúde Culturalmente Competente , Medicina Baseada em Evidências , Promoção da Saúde/métodos , Serviços de Saúde Materno-Infantil , Grupo com Ancestrais Oceânicos , Austrália , Pesquisa Participativa Baseada na Comunidade/ética , Feminino , Serviços de Saúde do Indígena , Humanos , Lactente , Queensland
7.
J Glob Health ; 9(1): 010808, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31275568

RESUMO

Background: Home visits by community health workers (CHWs) during pregnancy and soon after delivery are recommended to improve newborn survival. However, as the roles of CHWs expand, there are concerns regarding the capacity of community health systems to deliver high effective coverage of home visits. The WHO's Rapid Access Expansion (RAcE) program supported the Malawi Ministry of Health to align their Community-Based Maternal and Newborn Care (CBMNC) package with the latest WHO guidelines and to implement and evaluate the feasibility and coverage of home visits in Ntcheu district. Methods: A population-based survey of 150 households in Ntcheu district was conducted in July-August 2016 after approximately 10 months of CBMNC implementation. Thirty clusters were selected proportional-to-size using the most recent census. In selected clusters, five households with mothers of children under six months of age were randomly selected for interview. The Health Surveillance Assistants (HSAs) providing community-based services to the same clusters were purposively selected for a structured interview and register review. Results: Less than one third of pregnant women (30.7%; 95% confidence interval CI = 21.7%-41.5%) received a home visit during pregnancy and only 20.7% (95% CI = 13.0%-29.4%) received the recommended two visits. Coverage of postnatal visits was even lower: 11.4% (95%CI = 6.8%-18.5%) of mothers and newborns received a visit within three days of delivery and 20.7% (95%CI = 12.7%-32.0%) received a visit within the first eight days. Reaching newborns soon after delivery requires timely participation of the family and/or health facility staff to notify the HSA - yet only 42.9% (95% CI = 33.4%-52.9%) of mothers reported that the HSA was informed of the delivery. Coverage of postnatal home visits among those who informed the HSA was significantly higher than among those in which the HSA was not informed (46.7% compared to 1.3%; P = 0.00). Most HSAs had the necessary equipment and supplies and were active in CBMNC: 83.9% (95% CI = 70.2%-97.6%) of HSAs had pregnancy home visits and 77.4% (95% CI = 61.8%-93.0%) had postnatal home visits documented in their registers for the previous three months. Conclusions: We found low coverage of home visits during pregnancy and soon after delivery in a well-supported program delivery environment. Most HSAs were conducting home visits, but not at the level needed to reach high coverage. These findings were similar to previous studies, calling into question the feasibility of the current visitation schedule. It is time to re-align the CBMNC package with what the existing platform can deliver and identify strategies to better support HSAs to implement home visits to those who would benefit most.


Assuntos
Agentes Comunitários de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Serviços de Saúde Materna , Serviços de Saúde Materno-Infantil , Estudos de Viabilidade , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Recém-Nascido , Malaui , Gravidez , Organização Mundial da Saúde
8.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(2): 447-458, Apr.-June 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1013137

RESUMO

Abstract Objectives: to evaluate prenatal care in Primary Care by identifying the aspects that influence structural and operational adequacy. Methods: evaluation research with analysis of 4,059 municipalities that joined the 2nd cycle of the Program for Improving Access and Quality in Primary Care in 2013-2014. The evaluative model composed of 19 indicators grouped in structural aspects and operational aspects dimensions was validated in a consensus conference. Data analysis was descriptive, with the issuance of value judgment. Results: in structural aspects, 32.6% of the municipalities presented adequacy, whilst in operational ones, only 24.1%. In the general prenatal evaluation, less than a quarter (24.6%) of the municipalities was adequate, those with up to 10 thousand inhabitants had a higher percentage of adequacy (41.6%). The South region presented adequacy of 33.8%, considering all sizes. Conclusions: most municipalities presented low adequacy in prenatal care, with better performance of structural aspects. Smaller municipalities presented better results in all analyzed items. Structural aspects and general evaluation of prenatal care are highlighted in the South region. Adequate attention to prenatal care needs to be comprehensive and equitable, with the strengthening of regional networks geared towards social inclusion.


Resumo Objetivos: avaliar a atenção ao pré-natal na Atenção Básica identificando os aspectos que influenciam a adequação estrutural e operacional. Métodos: pesquisa avaliativa com análise de 4.059 municípios que aderiram ao 2° ciclo do Programa de Melhoria do Acesso e da Qualidade na Atenção Básica em 2013-2014. O modelo avaliativo composto por 19 indicadores agrupados nas dimensões aspectos estruturais e aspectos operacionais foi validado em conferência de consenso. A análise de dados foi descritiva, com emissão de juízo de valor. Resultados: nos aspectos estruturais 32,6% dos municípios apresentaram adequação e nos operacionais, apenas 24,1%. Na avaliação geral do pré-natal menos de um quarto (24,6%) dos municípios ficaram adequados, àqueles com até 10 mil habitantes apresentaram maior percentual de adequação (41,6%). A região Sul apresentou adequação de 33,8%, considerando todos os portes. Conclusões: a maior parte dos municípios apresentou baixa adequação na atenção ao pré-natal, com melhor desempenho dos aspectos estruturais. Municípios de menor porte apresentaram melhores resultados em todos os itens analisados. Destaque para a região Sul nos aspectos estruturais e na avaliação geral do pré-natal. Uma adequada atenção ao pré-natal precisa ser integral e equânime, com fortalecimento das redes regionais voltadas para a inclusão social.


Assuntos
Humanos , Feminino , Gravidez , Cuidado Pré-Natal , Atenção Primária à Saúde , Garantia da Qualidade dos Cuidados de Saúde , Avaliação em Saúde , Administração Municipal , Qualidade da Assistência à Saúde , Brasil , Indicadores de Morbimortalidade , Educação em Saúde , Saúde da Mulher , Serviços de Saúde Materno-Infantil
9.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(2): 335-341, Apr.-June 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1013140

RESUMO

Abstract Objectives: ididentify the scores on the pregnant women's knowledge on the signs of alert and labor and correlate the scores with the maternal age, number of children and the guidance they received during pregnancy. Methods: this is a descriptive, cross-sectional study with a quantitative approach on pregnant women's previous knowledge of the signs of alert and labor performed with 100 pregnant women on their 30th week of gestation at the Hospital de Clínicas da UFTM (Clinical Hospital). The data collection was carried out from April to June 2016, using a semi-structured instrument tested as a pilot study. Results: only 21% of the pregnant women reported taking part in the pregnant women's group; 61% of them referred to not receiving any information on the signs of alert and labor. A statistically significant association was verified between the number of correct answers and the guidance they received during prenatal consultations. However, there was no correlation between the correct scores on maternal age and the number of children. Conclusions: the pregnant women who did not receive any kind of guidance, they had lower scores on the correct answers, which shows the importance of guiding them about Health Education during their prenatal consultations.


Resumo Objetivos: identificar escores de conhecimento de gestantes sobre os sinais de alerta e de trabalho de parto e correlacionar escores de acerto com a idade materna, o número de filhos e o recebimento de orientações durante a gestação. Métodos: trata-se de um estudo de abordagem quantitativa, transversal, sobre o conhecimento prévio acerca dos sinais de alerta e de trabalho de parto realizado com 100 gestantes, a partir da 30ª semana gestacional, no Hospital de Clínicas da UFTM. A coleta de dados foi realizada no período de abril a junho de 2016 por meio de instrumento semiestruturado, testado mediante estudo piloto. Resultados: apenas 21% das gestantes relataram a participação em grupo de gestantes e 61% referiram não ter recebido nenhum tipo de informação sobre os sinais de alerta e de trabalho de parto. Verificou-se uma associação estatisticamente significante entre o número de acertos e as orientações recebidas durante o pré-natal. Entretanto, não houve correlação entre escores de acerto e a idade materna e o número de filhos. Conclusões: gestantes que não receberam orientações tiveram escores de acertos mais baixos o que demonstra a importância da Educação em Saúde durante o pré-natal.


Assuntos
Humanos , Feminino , Gravidez , Cuidado Pré-Natal , Trabalho de Parto , Serviços de Saúde Materno-Infantil , Tocologia/educação , Gravidez , Educação em Saúde , Idade Materna , Dor do Parto
10.
Sante Publique ; Vol. 31(1): 165-175, 2019 January February.
Artigo em Francês | MEDLINE | ID: mdl-31210511

RESUMO

OBJECTIVE: Community Health Workers (CHWs) were promoted in Benin to improve maternal and child health care (MCH). To improve community health workers' performance, a Quality Improvement Team (QIT) was set up to reinforce CHW capacities. The objective of this work is to present an assessment of QIT's contribution to CHW's performance and MCH coverage in the municipality of Savè. METHODOLOGY: The design of the study includes a pre- and post- analysis. Data were extracted from CHWs' activity reports and routine health information systems from 2011 to 2014 in 22 health facilities. Individual in-depth interviews were also performed with some key informants. The performance of CHW and the MCH indicators were determined according to the National Community Health Policy. RESULTS: The QIT improved Community Health Workers' performance and maternal and child health indicators in Savè. Educational sessions, skilled delivery care coverage, percentage of newborn seen over twice a week, percentage of children treated according national standards, percentage of children fully immunized, percentage of women using family planning methods were increased. CONCLUSION: The establishment of QIT improved CHW's performance and the use of maternal and child health services in Savè. This strategy could be useful for community-based surveillance.


Assuntos
Agentes Comunitários de Saúde/organização & administração , Serviços de Saúde Materno-Infantil/organização & administração , Melhoria de Qualidade/organização & administração , Benin , Criança , Saúde da Criança , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/normas , Agentes Comunitários de Saúde/normas , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materno-Infantil/normas
11.
Manchester; The National Institute for Health and Care Excellence (NICE); June 2019. 54 p.
Monografia em Inglês | BIGG | ID: biblio-1014955

RESUMO

This guideline covers diagnosing and managing hypertension (high blood pressure), including preeclampsia, during pregnancy, labour and birth. It also includes advice for women with hypertension who wish to conceive and women who have had a pregnancy complicated by hypertension. It aims to improve care during pregnancy, labour and birth for women and their babies.


Assuntos
Humanos , Gravidez , Pré-Eclâmpsia/prevenção & controle , Hipertensão/diagnóstico , Complicações do Trabalho de Parto/prevenção & controle , Saúde Materno-Infantil , Serviços de Saúde Materno-Infantil/organização & administração
12.
BMC Public Health ; 19(1): 791, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226977

RESUMO

BACKGROUND: Ghana is among African countries not likely to achieve the Sustainable Development Goal (SDG) three (3) target of reducing maternal mortality to 70 per 100,000 live births by the year 2030 if maternal and child health services utilization are not improved. Community engagement in health is therefore advocated to help address this challenge. This study evaluated the impact of a community engagement intervention on maternal and child health services utilization in Ghana. METHODS: This study was a cluster randomised trial among primary healthcare facilities (n = 64) in the Greater Accra and Western regions in Ghana. Multivariate multiple regression analysis and paired-ttest were used to determine impact of the community engagement intervention on maternal and child health indicators at baseline and follow-up. RESULTS: Intervention health facilities recorded significant improvements over control facilities in terms of average spontaneous vaginal deliveries per month per health facility (baseline mean = 15, follow-up mean = 30, p = 0.0013); child immunizations (baseline mean = 270, follow-up mean = 455, p = 0.0642) and female condoms distribution (baseline mean = 0, follow-up mean = 2, p = 0.0628). Other improved indicators in intervention facilities were average number of Human Immunodeficiency Virus (HIV) tests for non-pregnant women (baseline mean = 55, follow-up 104, p = 0.0213); HIV tests for pregnant women (baseline mean = 40, follow-up mean = 119, p = 0.0067) and malaria tests (baseline mean = 43, follow-up mean = 380, p = 0.0174). Control facilities however performed better than intervention facilities in terms of general laboratory tests, voluntary counselling and testing, treatment of sexually transmitted infections, male child circumcisions and other minor surgical procedures. CONCLUSION: Community engagement in health has the potential of improving utilization of maternal and child health services. There is the need for multi-stakeholder dialogues on complementing existing quality improvement interventions with community engagement strategies.


Assuntos
Participação da Comunidade , Promoção da Saúde/organização & administração , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Seguimentos , Gana , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Avaliação de Programas e Projetos de Saúde
13.
Global Health ; 15(1): 38, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196193

RESUMO

In Uganda, more than 336 out of every 100,000 women die annually during childbirth. Pregnant women, particularly in rural areas, often lack the financial resources and means to access health facilities in a timely manner for quality antenatal, delivery, and post-natal services. For nearly the past decade, the Makerere University School of Public Health researchers, through various projects, have been spearheading innovative interventions, embedded in implementation research, to reduce barriers to access to care. In this paper, we describe two of projects that were initially conceived to tackle the financial barriers to access to care - through a voucher program in the community - on the demand side - and a series of health systems strengthening activities at the district and facility level - on the supply side. Over time, the projects diverged in the content of the intervention and the modality in which they were implemented, providing an opportunity for reflection on innovation and scaling up. In this short report, we used an adaptation of Greenhalgh's Model of Diffusion to reflect on these projects' approaches to implementing innovative interventions, with the ultimate goal of reducing maternal and neonatal mortality in rural Uganda. We found that the adapted model of diffusion of innovations facilitated the emergence of insights on barriers and facilitators to the implementation of health systems interventions. Health systems research projects would benefit from analyses beyond the implementation period, in order to better understand how adoption and diffusion happen, or not, over time, after the external catalyst departs.


Assuntos
Difusão de Inovações , Serviços de Saúde Materno-Infantil/organização & administração , Modelos Organizacionais , Serviços de Saúde Rural/organização & administração , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Recém-Nascido , Gravidez , Uganda
14.
BMC Public Health ; 19(1): 766, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208383

RESUMO

BACKGROUND: No studies have examined distribution, retention and use of maternal and child health (MCH) home-based records (HBRs) in the poorest women in low income countries. Our primary objective was to compare distribution of the new Afghanistan MCH HBR (the MCH handbook) to the poorest women (quintiles 1-2) with the least poor women (quintiles 3-5). Secondary objectives were to assess distribution, retention and use of the handbook across wealth, education, age and parity strata. METHODS: This was a population based cross sectional study set in Kama and Mirbachakot districts of Afghanistan from August 2017 to April 2018. Women were eligible to be part of the study if they had a child born in the last 6 months. Multivariable logistic regression models were constructed to adjust for clustering by district and potential confounders decided a priori (maternal education, maternal age, parity, age of child, sex of child) and to calculate adjusted odds ratios (aOR), 95% confidence intervals (95% CI) and corresponding p values. Principal components analysis was used to create the wealth quintiles using standard methods. Wealth categories were 'poorest' (quintiles 1,2) and 'least poor' (quintiles 3,4,5). RESULTS: 1728/1943 (88.5%) mothers received a handbook. The poorest women (633, 88.8%) had similar odds of receiving a handbook compared to the least poor (990, 91.7%) (aOR 1.26, 95%CI [0.91-1.77], p value 0.165). Education status (aOR 1.03, 95%CI [0.63-1.68], p value 0.903) and age (aOR 1.39, 95%CI [0.68-2.84], p value 0.369) had little effect. Multiparous women (1371, 91.5%) had a higher odds than primiparous women (252, 85.7%) (aOR 1.83, 95%CI [1.16-2.87], p value 0.009). Use of the handbook by health providers and mothers was similar across quintiles. Ten (0.5%) women reported that they received a book but then lost it. CONCLUSIONS: We were able to achieve almost universal coverage of our new MCH HBR in our study area in Afghanistan. The handbook will be scaled up over the next three years across all of Afghanistan and will include close monitoring and assessment of coverage and use by all families.


Assuntos
Registros de Saúde Pessoal , Serviços de Assistência Domiciliar/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Mães/estatística & dados numéricos , Pobreza , Adolescente , Adulto , Afeganistão , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
15.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46575

RESUMO

O documento denominado Carta Brasil 2018, foi entregue ao Ministro da Saúde, Henrique Mandetta, pela Nisia Trindade, a presidente da Fundação Oswaldo Cruz. - Firmando o Compromisso da Rede Brasileira de Bancos de Leite Humano com a excelência do SUS. Esse documento reúne os compromissos assumidos pela Rede Brasileira de Bancos de Leite Humano durante o I Congresso em Rede realizado no dia 13 de dezembro de 2018 e foi assinado por todos os bancos de leite humano em funcionamento nos estados brasileiros. Link para acesso ao documento: https://rblh.fiocruz.br/sites/rblh.fiocruz.br/files/usuario/80/cartabrasil2018fim_modificado_8.pdf


Assuntos
Bancos de Leite , Leite Humano , Serviços de Saúde Materno-Infantil , Saúde Materno-Infantil , Promoção da Saúde
16.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46576

RESUMO

Realizado no Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, o Lançamento da Campanha Nacional de Doação de Leite Materno 2019.


Assuntos
Bancos de Leite , Promoção da Saúde , Saúde Materno-Infantil , Serviços de Saúde Materno-Infantil , Leite Humano
17.
Niger J Clin Pract ; 22(5): 682-691, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31089024

RESUMO

Background: Studies on the application of complex adaptive systems (CAS) framework to describe variations in free healthcare policies during implementation are limited. This study uses a CAS framework to explore interactions among actors and to explain how specific characteristics of CAS framework change in institutional designs of a Free Maternal and Child Healthcare Program (FMCHP) in Nigeria. Materials and Methods: A qualitative, case study approach was used to collect data on variations in features of FMCHP from policymakers (n = 16) and providers (n = 16) selected by purposeful sampling from the Ministry of Health and two health districts in Enugu State based on their posts in FMCHP, using semi-structured interview. Additional qualitative data were collected through document review. Main actors, their roles, incentives, and power were identified. Data were analyzed using thematic analysis guided by a CAS framework. Results: Six core features of FMCHP changed during implementation, namely, revenue collection, the role of Ministry of Health, the role of the state teaching hospital, introduction of evidence of tax payment, provider payment process, and establishment of a Financial Monitoring Committee. Formal rules alone did not guarantee consistency and stability of policies. Power imbalances, coordination, and cooperation among actors affected fidelity of policy implementation. The CAS phenomena associated with these changes include path dependence, feedback, lever points, emergent behaviors, and phase transition. Conclusion: Managing changes in free healthcare policies requires recognizing the power shifts, nonlinearity of outcomes, unpredictable consequences and feedbacks, and addressing the context, adaptive behavior, and network of actors.


Assuntos
Assistência à Saúde/organização & administração , Política de Saúde , Serviços de Saúde Materno-Infantil/organização & administração , Formulação de Políticas , Assistência à Saúde/economia , Humanos , Serviços de Saúde Materno-Infantil/economia , Nigéria , Estudos de Casos Organizacionais , Desenvolvimento de Programas , Pesquisa Qualitativa , Análise de Sistemas
18.
BMC Public Health ; 19(1): 434, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023306

RESUMO

BACKGROUND: Detection of the premalignant forms cervical cancer through screening in the target age group is one of the effective strategies in the prevention of the disease. Nevertheless, the cervical cancer screening service use remains considerably low in Ethiopia. Indeed; promoting screening behaviors requires understanding the factors influencing women's motivation towards the service. Our study has explored the psycho-graphic factors associated to intention to use cervical cancer screening among women visiting maternal and child health services in Southern Ethiopia, 2017. METHODS: Institution based cross-sectional study was used employing 422 women's age between 30 and 49 years old. A structured questionnaire was used to collect data on interviewer-administered basis. All assumptions of theory of planned behavior (TPB) were considered to measure intention, attitude, perceived social pressure and perceived ability to control circumstances against cervical cancer screening. Data were analyzed using statistical package for social sciences version 21.0. Multiple linear regression models were conducted to identify factors associated to intention to use cervical cancer screening. P-value less than 5% was considered to indicate significant association. RESULT: Four hundred and two (95%) of the respondents completed the interview. Knowledge of the disease signs, symptoms, risk factors and prevention methods was 162(41.4%). Knowledge about the disease and past screening experience were positively associated with intention to use cervical cancer screening (ß = 0.145, 95% CI = [0.047, 0.170]) and (ß = 0.098, 95% CI = [0.093, 1.001]) respectively. Further; standardized regression coefficient showed that all dimensions of TPB were positively associated to intention to use the services with perceived behavioral control (ß = 0.297, 95% CI = [0.172, 0.343]), perceived social pressure (ß = 0.248, 95% CI = [0.131, 0.301]) and attitude towards screening (ß = 0.110, CI = [0.018, 0.158]). CONCLUSION: Overall; the intention to use cervical cancer screening was a function of attitude, perceived social pressure and perceived behavioral control confirming the hypothesis of the study. None of the socio-demographic variables were associated to intention. Health behavior change interventions should focus on increasing knowledge and empowering women that enable them to evaluate their control beliefs and develop ability against social norms and circumstances that compete with the use of cervical cancer screening services.


Assuntos
Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Intenção , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Estudos Transversais , Etiópia , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Análise Multivariada , Teoria Psicológica , Inquéritos e Questionários , Neoplasias do Colo do Útero/psicologia
19.
BJOG ; 126(8): 1043-1051, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30957402

RESUMO

OBJECTIVE: To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. DESIGN: Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care). SETTING: Fifteen maternity units in three European countries - Germany (five), Ireland (five), and Italy (five) - with relatively low VBAC rates. POPULATION: Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control. METHODS: A cost-utility analysis from both societal and health-services perspectives, using a decision tree. MAIN OUTCOME MEASURES: Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3 months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost-utility ratios were calculated per country. RESULTS: The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95% CI €258-268) and 0.008 QALYs (95% CI 0.008-0.009 QALYs) for Germany, €456 (95% CI €448-464) and 0.052 QALYs (95% CI 0.051-0.053 QALYs) for Ireland, and €1174 (95% CI €1170-1178) and 0.006 QALYs (95% CI 0.005-0.007 QALYs) for Italy. The incremental cost-utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy. CONCLUSION: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. TWEETABLE ABSTRACT: The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland.


Assuntos
Análise Custo-Benefício , Serviços de Saúde Materno-Infantil/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Nascimento Vaginal Após Cesárea/economia , Adulto , Análise por Conglomerados , Feminino , Alemanha , Humanos , Irlanda , Itália , Gravidez , Anos de Vida Ajustados por Qualidade de Vida
20.
Arch. Health Invest ; 8(4): 217-223, abr. 2019.
Artigo em Português | BBO - Odontologia | ID: biblio-1007086

RESUMO

O parto pré-termo, é aquele que ocorre antes da 37ª semana de gestação, e é o problema perinatal atual mais importante, pois está associado à morbidade e mortalidade significativas no início da vida. O objetivo do estudo foi caracterizar o nascimento de pré-termos entre mulheres residentes no Estado do Piauí, no período entre 2011 a 2015. Trata-se de estudo descritivo utilizando os dados do Sistema de Informações sobre Nascidos Vivos (SINASC) coletados do banco de dados do Departamento de Informática do Sistema Único de Saúde (DATASUS). A população foi constituída por 23.754 nascidos vivos, sendo 26.182 pré-termos. Houve aumento percentual do número de recém-nascidos pré-termos entre os anos estudados. Observou-se que idade materna variou entre 20 e 34 anos, a maioria das mães eram casadas, com escolaridade de 8 a 11 anos, de gravidez única, com 7 consultas pré-natal ou mais, recém-nascido de raça/cor parda relacionaram-se com o nascimento pré-termo. Partos vaginais, recém-nascidos do sexo masculino, também se relacionaram à prematuridade, assim como, a influência da situação socioeconômica. Os recém-nascidos pré-termos caracterizaram-se principalmente por serem de 32 a 36 semanas, sexo masculino, pardos e peso normal ao nascer. Assim, os dados obtidos permitem concluir que o conhecimento e a avaliação do perfil das mães e o número e a situação do nascimento dessas crianças é importante no planejamento de estratégias de saúde eficazes na atenção materno-infantil, objetivando aprimorar políticas públicas para a sobrevivência do recém-nascido e a consequente redução da ocorrência da prematuridade(AU)


Preterm birth is one that occurs before the 37th week of gestation, and is the most important current perinatal problem, since it is associated with significant morbidity and mortality in early life. The objective of the study was to characterize preterm birth among women residing in the State of Piauí, in the period between 2011 and 2015. This is a descriptive study using data from the Information System on Live Births (SINASC) collected from the database of the Department of Information Technology of the National Health System (DATASUS). The population consisted of 23,754 live births, with 26,182 preterms. There was a percentage increase in the number of preterm newborns between the years studied. It was observed that maternal age varied between 20 and 34 years, most of the mothers were married, with education from 8 to 11 years of single pregnancy, with 7 prenatal consultations or more, newborn of race / brown color related with preterm birth. Vaginal births, newborn males, were also related to prematurity, as well as the influence of socioeconomic status. The preterm newborns were mainly characterized as being from 32 to 36 weeks, male, brown and normal birth weight. Thus, the data obtained allow us to conclude that the knowledge and evaluation of the mothers' profile and the number and situation of the birth of these children is important in the planning of effective health strategies in maternal and child care, aiming at improving public policies for the survival of the child. newborn and consequent reduction in the occurrence of prematurity(AU)


El parto pre-término, es el que ocurre antes de la 37ª semana de gestación, y es el problema perinatal actual más importante, pues está asociado a la morbilidad y mortalidad significativas al inicio de la vida. El objetivo del estudio fue caracterizar el nacimiento de pre-términos entre mujeres residentes en el Estado de Piauí, en el período entre 2011 a 2015. Se trata de un estudio descriptivo utilizando los datos del Sistema de Información sobre Nacidos vivos (SINASC) recogidos de la base de datos del Departamento de Informática del Sistema Único de Salud (DATASUS). La población fue constituida por 23.754 nacidos vivos, siendo 26.182 pre-términos. Se observó un aumento porcentual del número de recién nacidos pre-términos entre los años estudiados. Se observó que la edad materna varía entre 20 y 34 años, la mayoría de las madres estaban casadas, con escolaridad de 8 a 11 años, de embarazo único, con 7 consultas prenatales o más, recién nacido de raza / color parda relacionadas con el nacimiento pre-término. Partos vaginales, recién nacidos del sexo masculino, también se relacionaron con la prematuridad, así como la influencia de la situación socioeconómica. Los recién nacidos pre-términos se caracterizaron principalmente por ser de 32 a 36 semanas, sexo masculino, pardos y peso normal al nacer. Así, los datos obtenidos permiten concluir que el conocimiento y la evaluación del perfil de las madres y el número y la situación del nacimiento de estos niños es importante en la planificación de estrategias de salud eficaces en la atención materno-infantil, con el objetivo de mejorar políticas públicas para la supervivencia del niño, el recién nacido y la consiguiente reducción de la ocurrencia de la prematuridade(AU)


Assuntos
Recém-Nascido Prematuro , Serviços de Saúde Materno-Infantil , Sistemas de Saúde , Políticas Públicas de Saúde
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