RESUMEN
BACKGROUND: Rates of maternal mortality and morbidity in Africa remain unacceptably high, as many women deliver at home, without access to skilled birth attendants and life-saving medications. In rural Tanzania, women face significant barriers accessing health care facilities for their deliveries. METHODS: From January 2017 to February 2019 we conducted a multiple baseline (interrupted time series) trial within the four divisions of Rorya District, Tanzania. We collected baseline data, then sequentially introduced a complex intervention in each of the divisions, in randomized order, over 3 month intervals. We allowed for a 6 month transition period to avoid contamination between the pre- and post-intervention periods. The intervention included using community health workers to educate about safe delivery, distribution of birth kits with misoprostol, and a transport subsidy for women living a distance from the health care facility. The primary outcome was the health facility birth rate, while the secondary outcomes were the rates of antenatal and postpartum care and postpartum hemorrhage. Outcomes were analyzed using fixed effects segmented logistic regression, adjusting for age, marital status, education, and parity. Maternal and baby morbidity/mortality were analyzed descriptively. RESULTS: We analyzed data from 9565 pregnant women (2634 before and 6913 after the intervention was implemented). Facility births increased from 1892 (71.8%) before to 5895 (85.1%) after implementation of the intervention. After accounting for the secular trend, the intervention was associated with an immediate increase in the odds of facility births (OR = 1.51, 95% CI 1.14 to 2.01, p = 0.0045) as well as a small gradual effect (OR = 1.03 per month, 95% CI 1.00 to 1.07, p = 0.0633). For the secondary outcomes, there were no statistically significant immediate changes associated with the intervention. Rates of maternal and baby morbidity/mortality were low and similar between the pre- and post-implementation periods. CONCLUSIONS: Access to health care facilities can be improved through implementation of education of the population by community health workers about the importance of a health care facility birth, provision of birth kits with misoprostol to women in late pregnancy, and access to a transport subsidy for delivery for women living at a distance from the health facility. CLINICAL TRIALS REGISTRATION: NCT03024905 19/01/2017.
Asunto(s)
Tasa de Natalidad , Parto Obstétrico , Educación en Salud/métodos , Instituciones de Salud , Accesibilidad a los Servicios de Salud , Adolescente , Adulto , Niño , Agentes Comunitarios de Salud/educación , Femenino , Humanos , Lactante , Persona de Mediana Edad , Atención Posnatal/tendencias , Embarazo , Atención Prenatal/tendencias , Proyectos de Investigación , Población Rural , Determinantes Sociales de la Salud , Tanzanía/epidemiología , Adulto JovenRESUMEN
Importance: Access to postpartum care is restricted for low-income women who are recent or undocumented immigrants enrolled in Emergency Medicaid. Objective: To examine the association of a policy extending postpartum coverage to Emergency Medicaid recipients with attendance at postpartum visits and use of postpartum contraception. Design, Setting, and Participants: This cohort study linked Medicaid claims and birth certificate data from 2010 to 2019 to examine changes in postpartum care coverage on postpartum care and contraception use. A difference-in-difference design was used to compare the rollout of postpartum coverage in Oregon with a comparison state, South Carolina, which did not cover postpartum care. The study used 2 distinct assumptions to conduct the analyses: first, preintervention differences in postpartum visit attendance and contraceptive use would have remained constant if the policy expanding coverage had not been passed (parallel trends assumption), and second, differences in preintervention trends would have continued without the policy change (differential trend assumption). Data analysis was performed from September 2020 to October 2021. Exposures: Medicaid coverage of postpartum care. Main Outcomes and Measures: Attendance at postpartum visits and postpartum contraceptive use, defined as receipt of any contraceptive method within 60 days of delivery. Results: The study population consisted of 27â¯667 live births among 23â¯971 women (mean [SD] age, 29.4 [6.0] years) enrolled in Emergency Medicaid. The majority of all births were to multiparous women (21â¯289 women [76.9%]; standardized mean difference [SMD] = 0.08) and were delivered vaginally (20â¯042 births [72.4%]; SMD = 0.03) and at term (25â¯502 births [92.2%]; SMD = 0.01). Following Oregon's expansion of postpartum coverage to women in Emergency Medicaid, there was a large and significant increase in postpartum care visits and contraceptive use. Assuming parallel trends, postpartum care attendance increased by 40.6 percentage points (95% CI, 34.1-47.1 percentage points; P < .001) following the policy change. Under the differential trends assumption, postpartum visits increased by 47.9 percentage points (95% CI, 41.3-54.6 percentage points; P < .001). Postpartum contraception use increased similarly. Under the parallel trends assumption, postpartum contraception within 60 days increased by 33.2 percentage points (95% CI, 31.1-35.4 percentage points; P < .001). Assuming differential trends, postpartum contraception increased by 28.2 percentage points (95% CI, 25.8-30.6 percentage points; P < .001). Conclusions and Relevance: These findings suggest that expanding Emergency Medicaid benefits to include postpartum care is associated with significant improvements in receipt of postpartum care and contraceptive use.
Asunto(s)
Conducta Anticonceptiva/tendencias , Anticoncepción/economía , Emigrantes e Inmigrantes , Cobertura del Seguro/legislación & jurisprudencia , Medicaid/legislación & jurisprudencia , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Posnatal/economía , Adulto , Anticoncepción/psicología , Anticoncepción/tendencias , Emigrantes e Inmigrantes/psicología , Femenino , Estudios de Seguimiento , Política de Salud/economía , Política de Salud/legislación & jurisprudencia , Humanos , Cobertura del Seguro/tendencias , Medicaid/tendencias , Oregon , Atención Posnatal/legislación & jurisprudencia , Atención Posnatal/tendencias , Estudios Retrospectivos , South Carolina , Estados UnidosRESUMEN
BACKGROUND: Maternal and neonatal mortality and morbidity in the Democratic Republic of Congo (DRC) are among the highest worldwide. As part of a quality improvement programme in a health zone in the DRC aimed at contributing to reduced maternal and neonatal mortality and morbidity, a three-pillar training intervention around childbirth was developed and implemented in collaboration between Swedish and Congolese researchers and healthcare professionals. The aim of this study is to explore contextual factors influencing this intervention. METHODS: A qualitative research design was used, with data collected through focus group discussions (n = 7) with healthcare professionals involved in the intervention before and at the end (n = 9). Transcribed discussions were inductively analysed using content analysis. RESULTS: Three generic categories describe the contextual factors influencing the intervention: i) Incentives motivated participants' efforts to begin a training programme; ii) Involving the local health authorities was important; and (iii) Having physical space, electricity, and equipment in place was crucial. CONCLUSIONS: This study and similar ones highlight that incentives of various types are crucial contextual factors that influence training interventions, and have to be considered already in the planning of such interventions. One such factor is expectations of monetary incentives. To meet this in a small research project like ours would require a reduction of the scale and thus limit the implementation of new evidence-based knowledge into practice aimed at reducing maternal mortality and morbidity.
Asunto(s)
Parto Obstétrico/métodos , Personal de Salud/educación , Atención Posnatal/métodos , Atención a la Salud/tendencias , Parto Obstétrico/tendencias , República Democrática del Congo , Familia , Femenino , Grupos Focales , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Motivación , Parto/fisiología , Atención Posnatal/tendencias , Embarazo , Investigación Cualitativa , Mejoramiento de la CalidadRESUMEN
RESUMEN Introducción: los efectos embriofetales derivados de la exposición a la diabetes mellitus, durante el período prenatal de la vida, se extienden a la etapa posnatal con importantes repercusiones para la salud, incluyendo el efecto transgeneracional de la enfermedad. Objetivo: evaluar la efectividad de una intervención educativa para incrementar el nivel de conocimientos en prevención preconcepcional de efectos embriofetales de la diabetes mellitus en mujeres en edad fértil, pertenecientes al Consultorio 1 del Policlínico Universitario Carlos Verdugo, del municipio Matanzas, entre enero de 2018 y diciembre de 2019. Materiales y métodos: se realizó un estudio de intervención que constó de tres etapas. Un universo de 198 mujeres en edad fértil pertenecientes al Consultorio 1 del Policlínico Universitario Carlos Verdugo, durante el período señalado. Se empleó la encuesta para medir factores de riesgo de diabetes mellitus y conocimientos de las féminas en prevención preconcepcional de los efectos embriofetales de la enfermedad. Resultados: la edad superior a 30 años y la presencia de sobrepeso u obesidad fueron los factores de riesgo más detectados. Resultó calificado de malo el nivel de conocimientos en prevención preconcepcional de efectos embriofetales de la diabetes, previo a la intervención. Conclusiones: después de la implementación del programa educativo, se elevó el conocimiento sobre prevención preconcepcional de efectos embriofetales de la diabetes mellitus en las mujeres en edad fértil del consultorio 1 del Policlínico Universitario Carlos Verdugo, del municipio Matanzas, lo que demostró su efectividad (AU).
ABSTRACT Introduction: the embryo-fetal effects derived of the exposition to diabetes mellitus during the prenatal period of the life, extend to the postnatal stage, with important repercussions for health, including the disease's transgenerational effect. Objective: to assess the effectiveness of an educational intervention for increasing knowledge on pre-conceptional prevention of embryo-fetal effects of diabetes mellitus in fertile-aged women belonging to Family Doctor's office 1, of the University Policlinic Carlos Verdugo, municipality of Matanzas, from January 2018 to December 2019. Materials and methods: an interventional study was carried out, divided into three stages. The universe were 198 fertile-aged women belonging to Family Doctor's office 1, of the University Policlinic Carlos Verdugo, during the stated period. A survey was used to measure diabetes mellitus risk factors and women's knowledge on pre-conceptional preventing the disease's embryo-fetal effects. Results: age over 30 and being overweight or obese were the most frequently found risk factors. The knowledge level on pre-conceptional preventing diabetes mellitus embryo-fetal effects was poor before the intervention. Conclusions: after implementing the educational program, knowledge on pre-conceptional prevention of diabetes mellitus embryo-fetal effects increased among fertile-aged women of the Family Doctor's 1, of the policlinic Carlos Verdugo, of the municipality of Matanzas, demonstrating its effectiveness (AU).
Asunto(s)
Humanos , Femenino , Atención Prenatal/métodos , Diabetes Mellitus/prevención & control , Desarrollo Embrionario y Fetal , Atención Posnatal/tendencias , Asunción de Riesgos , Educación en Salud/métodos , Relaciones Materno-Fetales , Enfermedades Fetales/prevención & controlAsunto(s)
COVID-19/epidemiología , Anticoncepción Postcoital/tendencias , Servicios de Planificación Familiar/tendencias , Atención Dirigida al Paciente/tendencias , Periodo Posparto , Femenino , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Atención Posnatal/tendencias , Embarazo , Reino UnidoAsunto(s)
COVID-19 , Control de Enfermedades Transmisibles/métodos , Atención Posnatal , Atención Primaria de Salud , Salud de la Mujer/normas , COVID-19/epidemiología , COVID-19/prevención & control , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Recién Nacido , Masculino , Innovación Organizacional , Distanciamiento Físico , Atención Posnatal/métodos , Atención Posnatal/organización & administración , Atención Posnatal/normas , Atención Posnatal/tendencias , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , SARS-CoV-2 , Medicina Estatal/normas , Telemedicina , Reino UnidoAsunto(s)
Lactancia Materna , Infecciones por Coronavirus , Control de Infecciones/métodos , Leche Humana , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Sistemas de Apoyo Psicosocial , Betacoronavirus/inmunología , Betacoronavirus/aislamiento & purificación , Lactancia Materna/métodos , Lactancia Materna/psicología , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Masculino , Leche Humana/inmunología , Leche Humana/virología , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Atención Posnatal/métodos , Atención Posnatal/tendencias , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , SARS-CoV-2 , Estados UnidosRESUMEN
Background Preeclampsia and gestational hypertension are hypertensive disorders of pregnancy (HDP) that identify an increased risk of developing chronic hypertension and cardiovascular disease later in life. Postpartum follow-up may facilitate early screening and treatment of cardiovascular risk factors. Our objective is to describe patterns of postpartum visits with primary care and women's health providers (eg, family medicine and obstetrics) among women with and without HDP in a nationally representative sample of commercially insured women. Methods and Results We conducted a retrospective cohort study using insurance claims from a US health insurance database to describe patterns in office visits in the 6 months after delivery. We identified 566 059 women with completed pregnancies between 2005 and 2014. At 6 months, 13% of women with normotensive pregnancies, 18% with HDP, and 23% with chronic hypertension had primary care visits (P<0.0001 for comparing HDP and chronic hypertension groups with control participants). Only 58% of women with HDP had 6-month follow-up with any continuity provider compared with 47% of women without hypertension (P<0.0001). In multivariable analysis, women with severe preeclampsia were 16% more likely to have postpartum continuity follow-up (adjusted odds ratio, 1.16; 95% CI, 1.2-1.21). Factors associated with a lower likelihood of any follow-up included age ≥30 years, Black race, Hispanic ethnicity, and having multiple gestations. Conclusions Rates of continuity care follow-up after a pregnancy complicated by hypertension were low. This represents a substantial missed opportunity to provide cardiovascular risk screening and management to women at increased risk of future cardiovascular disease.
Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/prevención & control , Hipertensión Inducida en el Embarazo/diagnóstico , Atención Posnatal/tendencias , Adulto , Cuidados Posteriores , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/epidemiología , Femenino , Humanos , Hipertensión Inducida en el Embarazo/epidemiología , Hipertensión Inducida en el Embarazo/etnología , Seguro de Salud/estadística & datos numéricos , Tamizaje Masivo/métodos , Preeclampsia/diagnóstico , Preeclampsia/epidemiología , Embarazo , Atención Primaria de Salud/normas , Estudios Retrospectivos , Factores de Riesgo , Servicios de Salud para Mujeres/normasRESUMEN
CONTEXT: Postnatal length of hospital stay has reduced internationally but evidence-based policies to support earlier discharge are lacking. OBJECTIVE: To determine the effects of early postnatal discharge on infant outcomes. DATA SOURCES: CENTRAL (Cochrane Central Register of Controlled Trials), Medline, Embase, Cumulative Index to Nursing and Allied Health Literature , and SCI (Science Citation Index) were searched through to January 15, 2018. STUDY SELECTION: Studies reporting infant outcomes with early postnatal discharge versus standard discharge were included if they met Effective Practice and Organisation of Care study design criteria. DATA EXTRACTION: Two authors independently assessed eligibility and extracted data, resolving disagreements by consensus. Data from interrupted time series (ITS) studies were extracted and reanalyzed in meta-analyses. Meta-analyses of randomized controlled trials (RCTs) used random effects models. RESULTS: Of 9298 studies, 15 met the inclusion criteria. RCT meta-analyses revealed that infants discharged <48 hours after vaginal birth and <96 hours after cesarean birth were more likely to be readmitted to the hospital within 28 days compared to standard discharge (risk ratio: 1.70; 95% confidence interval [CI] 1.34 to 2.15). ITS meta-analyses revealed a reduction in the proportion of infants readmitted within 28 days after minimum postnatal stay policies and legislation were introduced (change in slope: -0.62; 95% CI -1.83 to 0.60), with increasing impact in the first and second years (effect estimate: -4.27 [95% CI -7.91 to -0.63] and -6.23 [95% CI -10.15 to -2.32]). LIMITATIONS: Withdrawals and crossover limited the value of RCTs in this context but not ITS evidence. CONCLUSIONS: Infants discharged early after birth were more likely to be admitted within 28 days. The introduction of postnatal minimum length of stay policies was associated with a long-term reduction in neonatal hospital readmission rates.
Asunto(s)
Tiempo de Internación/tendencias , Alta del Paciente/tendencias , Readmisión del Paciente/tendencias , Atención Posnatal/tendencias , Ensayos Clínicos Controlados Aleatorios como Asunto , Lactancia Materna/tendencias , Femenino , Humanos , Lactante , Atención Posnatal/métodos , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Factores de TiempoAsunto(s)
Infecciones por Coronavirus , Enfermería Basada en la Evidencia , Enfermería Neonatal , Pandemias , Neumonía Viral , Atención Posnatal , American Nurses' Association , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Enfermería Basada en la Evidencia/métodos , Enfermería Basada en la Evidencia/tendencias , Femenino , Humanos , Recién Nacido , Control de Infecciones/organización & administración , Enfermería Neonatal/organización & administración , Enfermería Neonatal/normas , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Atención Posnatal/métodos , Atención Posnatal/organización & administración , Atención Posnatal/tendencias , SARS-CoV-2 , Estados UnidosRESUMEN
BACKGROUND: Very early discharge from hospital is an element of Ontario midwifery care. Our aim in the present study was to describe the frequency of very early hospital discharge for newborns in Ontario midwifery care over time. METHODS: We conducted a retrospective population-based cohort study, including all midwife-attended singleton term cephalic newborns delivered by spontaneous vaginal birth at Ontario hospitals between April 2003 and February 2017. Our primary outcome was very early hospital discharge (< 6 h after birth) for newborns. Secondary outcomes were pediatric consultation before hospital discharge, phototherapy before hospital discharge and readmission for treatment of jaundice. We used generalized linear mixed models to estimate the relation between maternal, neonatal and hospital factors and very early discharge, while accounting for clustering by hospital. RESULTS: The study cohort included 101 852 newborns born at 89 hospitals. Between 2003/04 and 2016/17, the unadjusted rate of very early discharge decreased from 34.3% to 30.7%. This trend was not significant after adjustment for covariates (odds ratio 1.0, 95% confidence interval 0.99-1.0). Unadjusted rates of pediatric consultation, phototherapy and readmission for jaundice all rose slightly over the study period. Hospital-specific risk-adjusted frequencies of very early discharge ranged from 5% (n = 1479) to 83% (n = 3459) across the 75 Ontario hospitals with at least 100 newborns included in the study cohort. INTERPRETATION: Hospital-level factors contributed to the observed decrease in crude rates of very early discharge for midwifery clients. Wide variation in these rates across Ontario hospitals points to room for improvement to make more efficient use of health care resources by promoting optimal levels of very early discharge.
Asunto(s)
Tiempo de Internación , Alta del Paciente , Atención Posnatal/estadística & datos numéricos , Atención Posnatal/tendencias , Adolescente , Adulto , Estudios de Cohortes , Femenino , Edad Gestacional , Historia del Siglo XXI , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Paridad , Atención Posnatal/historia , Vigilancia en Salud Pública , Estudios Retrospectivos , Adulto JovenAsunto(s)
Control de Enfermedades Transmisibles , Infecciones por Coronavirus , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Servicios de Salud Materna/organización & administración , Pandemias , Neumonía Viral , Atención Posnatal , Complicaciones Infecciosas del Embarazo , Betacoronavirus/aislamiento & purificación , COVID-19 , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Atención Posnatal/métodos , Atención Posnatal/organización & administración , Atención Posnatal/tendencias , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Medición de Riesgo , SARS-CoV-2 , Salud de la MujerRESUMEN
OBJECTIVE: To explore care workers' experiences with a flexible planning of home-based postpartum care as an innovative instrument to facilitate more client-centred care. DESIGN: A mixed-methods design with a primarily qualitative approach followed by a quantitative follow-up, according to the Priority-Sequence model. SETTING: This study is part of a larger research project researching the health effects of a flexible planning in postpartum care. The new planning enables clients and care workers to spread and/or pause the care over 14 days postpartum instead of the standard planning of eight to ten consecutive days. PARTICIPANTS: Maternity home care workers who provide care according the flexible planning. Eight care workers were interviewed, another eight care workers participated in the focus group discussion, and 59 care workers filled in the survey. FINDINGS: Two main unintended consequences of the flexible planning were found: 1. care workers experienced an undesirable 'shift in their tasks' along the course of the postpartum period and 2. were heavily worried about 'making enough contracted hours'. Consequently, care workers unwillingly performed much more domiciliary activities compared to the standard planning, especially during the final days of care. KEY CONCLUSIONS: The predominant nursing tasks and responsibilities of care workers appeared insufficient to respond to clients' altering needs. In addition, shorter working days and on-call duties caused an undesired excessive high-level of flexibility among care workers. Consequently, care was paradoxically determined by organisational structures rather than clients' individual needs. IMPLICATIONS FOR PRACTICE: Our study elucidated that co-creation together with health professionals is a prerequisite for successfully implementing innovations as their way of working and personal lives are profoundly affected.
Asunto(s)
Planificación en Salud Comunitaria/métodos , Personal de Salud/psicología , Servicios de Atención de Salud a Domicilio/normas , Atención Posnatal/normas , Adulto , Femenino , Grupos Focales/métodos , Personal de Salud/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/tendencias , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Atención Dirigida al Paciente/tendencias , Atención Posnatal/métodos , Atención Posnatal/tendencias , Investigación Cualitativa , Horario de Trabajo por Turnos/psicología , Horario de Trabajo por Turnos/normas , Horario de Trabajo por Turnos/estadística & datos numéricos , Encuestas y CuestionariosAsunto(s)
Profilaxis Posexposición/tendencias , Atención Posnatal/tendencias , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/prevención & control , Adolescente , Adulto , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Profilaxis Posexposición/métodos , Atención Posnatal/métodos , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Adulto JovenRESUMEN
INTRODUCTION: Sepsis is one of the most common causes of mortality in postnatal women globally and many other women who develop sepsis are left with severe morbidity. Women's knowledge of postnatal sepsis and how it can be prevented by simple changes to behaviour is lacking. METHODS: This paper describes the co-development and feasibility testing of a digital animation intervention called DAISI (digital animation in service improvement). This DAISI is designed to enhance postnatal women's awareness of sepsis and how to reduce their risk of developing the condition. We co-designed the digital animation over a six-month period underpinned by theory, best evidence and key stakeholders, translated it into Urdu then assessed its use, firstly in a focus group with women from different Black, Asian and Minority Ethnic (BAME) groups and secondly with 15 clinical midwives and 15 women (including BAME women). Following exposure to the intervention, midwives completed a questionnaire developed from the COM-B behaviour change model and women participated in individual and focus group interviews using similar questions. RESULTS: The animation was considered acceptable, culturally sensitive and simple to implement and follow. DISCUSSION: DAISI appears to be an innovative solution for use in maternity care to address difficulties with the postnatal hospital discharge process. We could find no evidence of digital animation being used in this context and recommend a study to test it in practice prior to adopting its use more widely. If effective, the DAISI principle could be used in other maternity contexts and other areas of the NHS to communicate health promotion information.
Asunto(s)
Servicios de Salud Materna/normas , Educación del Paciente como Asunto/normas , Conducta de Reducción del Riesgo , Sepsis/diagnóstico , Adulto , Estudios de Factibilidad , Femenino , Grupos Focales/métodos , Humanos , Servicios de Salud Materna/tendencias , Educación del Paciente como Asunto/métodos , Educación del Paciente como Asunto/tendencias , Atención Posnatal/métodos , Atención Posnatal/tendencias , Embarazo , Investigación Cualitativa , Grupos Raciales/estadística & datos numéricos , Medicina Estatal/normas , Medicina Estatal/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
PURPOSE: Coronavirus Disease-2019 (COVID-19) is a rapidly evolving pandemic. It is well-known that pregnant women are more susceptible to viral infection due to immune and anatomic factors. Therefore, the viral pandemic might affect the reproductive health and maternity services especially in low-resource countries. MATERIALS AND METHODS: In this article, we tried to highlight the impact of COVID-19 on reproductive health and maternity health services in low resource countries with emphasis on adapting some of the published best practice recommendations to suit a struggling environment. CONCLUSION: Pregnant women residing in low resource countries represent a uniquely vulnerable group in epidemics due to several factors. Maternity services in low resource countries are adapting to provide antenatal and postnatal care amidst a rapidly shifting health system environment due to the COVID-19 pandemic.
Asunto(s)
Infecciones por Coronavirus , Servicios de Salud Materna , Pandemias , Atención Perinatal , Neumonía Viral , Atención Posnatal , Complicaciones Infecciosas del Embarazo , Salud Reproductiva/normas , Betacoronavirus , COVID-19 , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Países en Desarrollo , Egipto/epidemiología , Femenino , Humanos , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/normas , Servicios de Salud Materna/provisión & distribución , Evaluación de Necesidades , Innovación Organizacional , Pandemias/prevención & control , Atención Perinatal/métodos , Atención Perinatal/tendencias , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Atención Posnatal/métodos , Atención Posnatal/tendencias , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , SARS-CoV-2RESUMEN
BACKGROUND: Egypt has achieved important reductions in maternal and neonatal mortality and experienced increases in the proportion of births attended by skilled professionals. However, substandard care has been highlighted as one of the avoidable causes behind persisting maternal deaths. This paper describes changes over time in the use of childbirth care in Egypt, focusing on location and sector of provision (public versus private) and the content of immediate postpartum care. METHODS: We used five Demographic and Health Surveys conducted in Egypt between 1995 and 2014 to explore national and regional trends in childbirth care. To assess content of care in 2014, we calculated the caesarean section rate and the percentage of women delivering in a facility who reported receiving four components of immediate postpartum care for themselves and their newborn. RESULTS: Between 1995 and 2014, the percentage of women delivering in health facilities increased from 35 to 87% and women delivering with a skilled birth attendant from 49 to 92%. The percentage of women delivering in a private facility nearly quadrupled from 16 to 63%. In 2010-2014, fewer than 2% of women delivering in public or private facilities received all four immediate postpartum care components measured. CONCLUSIONS: Egypt achieved large increases in the percentage of women delivering in facilities and with skilled birth attendants. However, most women and newborns did not receive essential elements of high quality immediate postpartum care. The large shift to private facilities may highlight failures of public providers to meet women's expectations. Additionally, the content (quality) of childbirth care needs to improve in both sectors. Immediate action is required to understand and address the drivers of poor quality, including insufficient resources, perverse incentives, poor compliance and enforcement of existing standards, and providers' behaviours moving between private and public sectors. Otherwise, Egypt risks undermining the benefits of high coverage because of substandard quality childbirth care.
Asunto(s)
Entorno del Parto/tendencias , Cesárea/tendencias , Atención Posnatal/tendencias , Sector Privado/tendencias , Sector Público/tendencias , Adolescente , Adulto , Peso al Nacer , Lactancia Materna/tendencias , Estudios Transversales , Egipto , Femenino , Humanos , Recién Nacido , Tiempo de Internación/tendencias , Persona de Mediana Edad , Partería/tendencias , Parto , Atención Perinatal/tendencias , Embarazo , Calidad de la Atención de Salud , Encuestas y Cuestionarios , Adulto JovenAsunto(s)
Conducta Anticonceptiva/psicología , Aceptación de la Atención de Salud/psicología , Habitaciones de Pacientes/normas , Atención Posnatal/normas , Adulto , Conducta Anticonceptiva/estadística & datos numéricos , Femenino , Humanos , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Habitaciones de Pacientes/organización & administración , Habitaciones de Pacientes/estadística & datos numéricos , Proyectos Piloto , Atención Posnatal/métodos , Atención Posnatal/tendencias , Reino UnidoRESUMEN
OBJECTIVE: There is ongoing poor evaluation of post-birth care and an urgent need to improve women's satisfaction. To develop and evaluate an acceptable and useable post-birth care plan template through collaboration with women and community midwives. DESIGN: Qualitative methodology using an action research design. SETTING AND PARTICIPANTS: North East Scotland. 10 pregnant women and 6 community midwives. FINDINGS: Seven themes emerged from thematic analysis that informed the format of the PBCP template: being prepared for transitions, physical needs, psychosocial needs, cultural, religious and spiritual needs, organisation of care information, knowledge transfer, financial information and guidance. KEY CONCLUSIONS: Women and midwives recognised the benefit of using a PBCP to ensure all information is covered and that care is individualised and organised according to cultural, social and physical needs, especially when there is fragmentation of services. The open conversational style of the PBCP provides opportunity to explore post-birth needs and how they develop over time. IMPLICATIONS FOR PRACTICE: PBCPs provide an opportunity for women to explore their post-birth needs with their midwife, enabling them to have meaningful, respectful conversations with their midwives during the antenatal and post-birth period. This has the potential to increase women's satisfaction with their care and is particularly pertinent in regions where fragmentary systems of care are prevalent.
Asunto(s)
Atención Posnatal/métodos , Adulto , Femenino , Grupos Focales/métodos , Investigación sobre Servicios de Salud , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Atención Posnatal/tendencias , Investigación Cualitativa , EscociaRESUMEN
BACKGROUND: Prenatal care providers play a central role in breastfeeding outcomes. A survey on obstetricians' support of breastfeeding was conducted in 1993 in Monroe County, NY. Since the landscape of prenatal care and breastfeeding support has changed significantly in the past 2 decades, we repeated and extended this survey in 2015. RESEARCH AIM: To determine changes in breastfeeding support by prenatal care providers over a 20 year period. METHODS: We sent a 46-item on-line or paper questionnaire to all categories of prenatal care providers identified by an online search. A breastfeeding support score was created based on the prior survey, with a maximum score of 3. One point was awarded for: (1) personally discussing breastfeeding; (2) generally suggesting breastfeeding; and (3) commonly receiving questions from patients. Data were analyzed using Chi-square. RESULTS: We had 164 participants (response rate 80%). More current participants, compared to 1993, reported discussing (97% vs. 86%, p < .001) and recommending (93% vs. 80%, p = .001) breastfeeding. Only 10% of 2015 participants gave infant formula samples, compared with 34% in 1993 (p < .0001). Improvement in the support score was seen, with 98% of current participants having high scores compared to 87% in 1993 (p < .001). Similar numbers reported receiving breastfeeding education, though more reported that the education was inadequate (54% vs. 19%, p < .0001). CONCLUSION: Breastfeeding support improved significantly over time, even though breastfeeding education has not improved in quality or quantity. Improving education of prenatal care providers may help future providers be more prepared to support breastfeeding.