RESUMEN
BACKGROUND: Per-partum stillbirth continues to represent a public health burden despite the efforts of countries around the world. Prevention of this mortality can only be effective with a better knowledge of factors that are life-threatening to the fetus or newborn. This work aims to determine associated factors with intrapartum and very early neonatal mortality. METHODS: A case-control study was carried out at the maternity of the university hospital in Marrakech, where 290 subjects were selected: 145 cases of intrapartum fetal death or a very early neonatal death, and 145 controls of surviving newborn weighing 2500g or more at birth. Data were collected from obstetric, partogram and death records for the year 2016. The factors that were compared between the two groups were factors before admission to maternity, factors related to the management during labor and to the care of newborn. RESULTS: Statistically significant associations were found between these deaths and several factors including: multiparity versus primiparity adjusted OR=2.27 [1.17-4.42], pregnant women referral from another health facility adjusted OR=2.11 [1.12-3.99], care for women during the transfer adjusted OR=0.21 [0.9-0.49] and prenatal follow-up of pregnancy adjusted OR=0.22 [0.12-0.4]. Were also associated: fetal monitoring during labor adjusted OR=0.22 [0.08-0.62], neonatal respiratory distress adjusted OR=18.48 [7.60-44.98] and Apgar score (⩽7) adjusted OR=6.05 [2.51-14.62]. CONCLUSION: Intrapartum and very early neonatal mortality is closely related to the newborn's condition at birth, fetal monitoring during labor, pregnancy monitoring, and the organization of the referral system.
Asunto(s)
Mortalidad Infantil , Complicaciones del Trabajo de Parto/mortalidad , Mortinato/epidemiología , Adulto , Factores de Edad , Estudios de Casos y Controles , Femenino , Hospitales Universitarios , Humanos , Lactante , Recién Nacido , Servicios de Salud Materna/estadística & datos numéricos , Marruecos/epidemiología , Muerte Perinatal/etiología , Embarazo , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Utilisation of emergency department (ED) for non-urgent problems, usually dealt with in first line health services (FLHS), has an impact both in terms of efficiency (ED care is more expensive than primary health care) and in terms of quality of care (due to ED overcrowding). This study describes the utilisation pattern of the ED at the Children's Hospital of Rabat (CHR) and assesses the appropriateness of ED utilisation. METHODS: During a whole week in September 1991, 24 h/24, information about every child admitted in the ED was collected by outside investigators, using a questionnaire. This questionnaire was divided into two sections. One section, filled out at admission of the child, consisted of the following items: time of arrival, health problem, health seeking pattern and identification of child (name, age, gender and address). The second section was filled out at the medical consultation and consisted primarily of a judgement about the relevance of ED utilisation (urgent/non-urgent condition, need for hospital-based equipment, subjective assessment of delay). RESULTS: During the week under study, 1,544 children were admitted at the ED: 904 at the medical ED and 640 at the surgical ED. At the medical ED, the proportion of urgent cases was 38%; among them, 65% needed hospital-based equipment and among the latter 72% arrived on time. It means that only 18% of the children utilised the ED in an appropriate way. At the surgical ED, the proportion of urgent cases was 56%; among them, 41% needed hospital-based equipment and among the latter 86% arrived on time. It means that only 20% of the children appropriately utilised the surgical ED. Appropriate utilisation is not associated with gender. The proportion of cases judged as urgent was associated neither to hour of admission--at least for the medical ED--nor to distance (less than 15 km). However, the proportion of urgent cases varied according to the day of the week. CONCLUSION: Results confirmed the opinion of the CHR staff: most children admitted to the ED had health problems that should have been cared for at FLHS. Rationalisation of ED utilisation will depend on the health system's ability to supply acceptable and accessible care at FLHS.