RESUMEN
OBJECTIVE: To determine if the Expanding Maternal and Neonatal Survival (EMAS) program was associated with improved effectiveness of the referral system in Indonesia to facilitate timely and effective management of complications experienced by women and newborns. METHODS: Poisson regression using longitudinal monitoring data was used to assess the impact of the EMAS program on stabilization practices prior to referral. Data from a nonrandomized quasi-experimental pre-post evaluation study were used to assess the impact of the EMAS program along the referral pathway using χ2 analysis. RESULTS: Monitoring data demonstrated improvements in intervention areas for stabilization of pre-eclampsia/eclampsia (24% vs 61%, incidence rate ratio [IRR] 2.4; 95% confidence interval [CI], 2.3-2.6) and treatment of newborns with suspected severe infection (30% vs 54%, IRR 2.0; 95% CI, 1.6-2.4) prior to referral. The EMAS program was associated with significantly higher levels of communication, advanced notification, back referral, and hospital emergency readiness and staff preparedness compared with the comparison arm. CONCLUSION: The EMAS program contributed to improvements in the management of obstetric and newborn complications, including communication, transportation, and preparation of pregnant mothers in need of referral and hospital emergency readiness and staff preparedness.
Asunto(s)
Servicios de Salud Materno-Infantil/normas , Evaluación de Programas y Proyectos de Salud , Derivación y Consulta/normas , Adulto , Femenino , Humanos , Indonesia/epidemiología , Lactante , Mortalidad Infantil , Recién Nacido , Enfermedades del Recién Nacido/prevención & control , Enfermedades del Recién Nacido/terapia , Mortalidad Materna , Ensayos Clínicos Controlados no Aleatorios como Asunto , Complicaciones del Trabajo de Parto/terapia , Distribución de Poisson , Embarazo , Mejoramiento de la CalidadRESUMEN
OBJECTIVE: To assess whether the Expanding Maternal and Neonatal Survival (EMAS) program was associated with improved care provided during hospital-based childbirth. METHODS: A quasi-experimental study with two rounds of data collection examined whether EMAS interventions improved facility-based labor and childbirth care. Direct clinical observations were conducted for 1208 deliveries across 13 hospitals in 12 districts. Primary outcome measures included implementation of standard practices to reduce the risk of complications during labor and childbirth for both women and newborns. RESULTS: Adjusted difference-in-difference analysis compared the mean difference in quality scores between EMAS intervention hospitals and comparison sites and consistently found significantly better performance in EMAS sites: 14 points higher for labor monitoring (ß-coefficient 14.1; 95% confidence interval [CI], 7.1-21.0); 38 points higher for newborn resuscitation readiness (ß-coefficient 38.1; 95% CI, 31.1-45.2); and 33 points higher for infection prevention practices (ß-coefficient 32.6; 95% CI, 28.5-36.8). CONCLUSION: EMAS approaches emphasizing facility readiness and adherence to performance standards significantly improved labor monitoring and complication prevention practices during childbirth.
Asunto(s)
Parto Obstétrico/normas , Trabajo de Parto , Servicios de Salud Materno-Infantil/normas , Evaluación de Programas y Proyectos de Salud , Adulto , Parto Obstétrico/estadística & datos numéricos , Femenino , Hospitales/estadística & datos numéricos , Humanos , Indonesia/epidemiología , Lactante , Mortalidad Infantil , Recién Nacido , Mortalidad Materna , Servicios de Salud Materno-Infantil/estadística & datos numéricos , Ensayos Clínicos Controlados no Aleatorios como Asunto , Embarazo , Mejoramiento de la CalidadRESUMEN
Using remote sensing of sea surface temperature (SST), sea surface height anomaly (SSHA) and chlorophyll-a (Chl-a) together with catch data, we investigated the detection and persistence of important pelagic habitat hotspots for skipjack tuna in the Gulf of Bone-Flores Sea, Indonesia. We analyzed the data for the period between the northwest and southeast monsoon 2007-2011. A pelagic hotspot index was constructed from a model of multi-spectrum satellite-based oceanographic data in relation to skipjack fishing performance. Results showed that skipjack catch per unit efforts (CPUEs) increased significantly in areas of highest pelagic hotspot indices. The distribution and dynamics of habitat hotspots were detected by the synoptic measurements of SST, SSHA and Chl-a ranging from 29.5° to 31.5°C, from 2.5 to 12.5 cm and from 0.15 to 0.35 mg m-3, respectively. Total area of hotspots consistently peaked in May. Validation of skipjack CPUE predicted by our model against observed data from 2012 was highly significant. The key pelagic habitat corresponded with the Chl-a front, which could be related to the areas of relatively high prey abundance (enhanced feeding opportunity) for skipjack. We found that the area and persistence of the potential skipjack habitat hotspots for the 5 years were clearly identified by the 0.2 mg m-3 Chl-a isopleth, suggesting that the Chl-a front provides a key oceanographic indicator for global understanding on skipjack tuna habitat hotspots in the western tropical Pacific Ocean, especially within Coral Triangle tuna.