RESUMO
OBJECTIVE: In Ecuador, the reported maternal death rate was 45.71 per 100,000 live births in 2013. This may be partly due to a lack of maternal knowledge of obstetric warning signs during pregnancy, delivery and the post-partum period. This study sought to evaluate awareness of obstetric warning signs among pregnant women in relation to individual demographic and area-level socio-economic indicators. STUDY DESIGN: We conducted a cross-sectional analysis of data collected by Ecuador's Ministry of Health at the conclusion of a national maternal health campaign (2014-2015). A nationally representative sample of 3435 pregnant women from the nine administrative zones completed surveys regarding basic demographics and their awareness of obstetric warning signs. METHODS: We defined eight obstetrical warning signs according to the literature and Ecuadorian practice that could occur during pregnancy, delivery and the post-partum period (severe headache, strong abdominal ache, bleeding or presence of malodorous secretion, rupture of the amniotic sac, high fever, abnormal presentation of the baby, decrease in baby's movements and delayed labour). A woman was considered 'aware' if she recognised at least four of the eight warning signs and stated she would seek immediate healthcare at their presentation. For each administrative zone, four socio-economic indicators (poverty, illiteracy, unemployment and subemployment) were obtained from the National Institute of Statistics and Census. Correlates of awareness of the obstetric warning signs were evaluated using hierarchical logistic models clustered by the administrative zone. RESULTS: Nationally, 86.9% of women were 'aware' of obstetric warning signs. After adjustment for age, socio-economic indicators and clustering, indigenous participants were 59% less likely to be aware of obstetric warning signs than mestizos (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.28-0.59). For every 1% increase in area poverty, participants had a 5% decreased likelihood of being aware of obstetric warning signs (OR = 0.95, 95% CI = 0.93-0.96), adjusting for age, ethnicity and other socio-economic indicators. The most effective source of campaign information about obstetric warning signs was personal communication with a healthcare professional, as opposed to mass media advertisements (OR = 1.90, 95% CI = 1.34-2.71). CONCLUSIONS: A majority of Ecuadorian pregnant and post-partum women are aware of obstetric warning signs. Indigenous ethnicity and area-level poverty are associated with a lack of awareness. Personal communication with a healthcare professional was the most effective source of information. These findings have implications for improvement of maternal awareness of warning signs.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Complicações do Trabalho de Parto/psicologia , Adulto , Estudos Transversais , Equador/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Mortalidade Materna , Grupos Populacionais/psicologia , Grupos Populacionais/estatística & dados numéricos , Áreas de Pobreza , Gravidez , Inquéritos e Questionários , Adulto JovemRESUMO
El trauma sigue siendo una causa importante de mortalidad y discapacidad permanente en la población mundial; las consecuencias derivadas del trauma generan cuantiosos gastos al Estado, debido a la pérdida de una población económicamente activa, así como el incremento en el financiamiento de los sistemas de salud. El uso de escalas de evaluación del trauma en el nivel prehospitalario de atención de los sistemas de salud es muy importante para incrementar la sobrevida de los pacientes, ya que este instrumento de evaluación conlleva a determinar el estado de gravedad de los casos y una adecuada derivación a los establecimientos de salud. El objetivo de este estudio fue determinar la eficiencia del triaje prehospitalario en pacientes con trauma a través de la escala Revised Trauma Score (RTS), evaluando las derivaciones a los establecimientos de salud en la ciudad de Quito. Un total de 436 pacientes fue seleccionado de manera aleatoria para caracterizar las variables del trauma; de estos pacientes seleccionados, para el análisis se utilizó el paquete estadístico EPI-INFO. Los resultados muestran valores de derivación inadecuada (subtriaje y sobretriaje) no acorde con la referencia internacional aceptable; sin embargo, estos mostraron ventajas proporcionales en un 64,5 % al usar la escala de evaluación para una derivación adecuada. Estos resultados fueron estadísticamente significativos. Los autores de este estudio recomiendan: tomar acciones para el mejoramiento de las estrategias de atención prehospitalaria de emergencias en el sistema de salud, y fomentar más investigaciones relacionadas al tema.
Trauma continues to be a major cause of mortality and permanent disability in the world population; the consequences of the trauma generate substantial expenditures for the State, due to the loss of an economically active population, as well as an increase in the financing of health systems. The use of scales of evaluation of the trauma in the prehospital level of attention of the health systems are very important to increase the over life of the patients, since this instrument of evaluation entails to determine the state of seriousness of the cases and an adequate Referral to health facilities. The objective of this study was to determine the efficiency of prehospital triage in trauma patients through the Revised Trauma Score (RTS) scale, evaluating the referrals to health facilities in the city of Quito. A total of 436 patients were randomly selected to characterize trauma variables; of these selected patients, only the RTS scale was applied to 203. For the analysis, the statistical package EPI-INFO was used. The results show inadequate derivation values (subtriage and overtriage) not in accordance with the acceptable international reference; However, these showed proportional advantages in 64,5% when using the evaluation scale for a suitable derivation, these results were statistically significant. The authors of this study recommend: taking actions to improve prehospital emergency health care strategies in the health system, and encourage more research related to the topic.