ABSTRACT
Introducción: los vínculos que establecemos se configuran en redes sociales. El análisis de estas redes nos permite comprender su influencia en la salud materna, asunto poco estudiado. Objetivo: caracterizar las redes sociales de gestantes con y sin diagnóstico de morbilidad materna extrema. Metodología: se realizó un análisis de las redes de seiscientas mujeres: 150 maternas diagnosticadas con morbilidad materna extrema y 450 gestantes sanas, configurándose así un estudio de casos y controles. Las maternas estuvieron hospitalizadas en hospitales de Medellín durante el 2011 y el 2012, donde respondieron una encuesta de caracterización de las relaciones sociales durante el embarazo. Resultados: las maternas reportaron relaciones extensas, densas y cercanas y se mostraron satisfechas con el soporte social recibido. La morbilidad materna extrema se asoció con la exposición a alguna forma de agresión, contar con un mayor número de contactos y mayor satisfacción con la red. Este último puede ser un sesgo del diseño utilizado.
Introduction: The boundaries that we establish configure social networks. Analyze these networks allow us to understand their influence in maternal health. Objective: to characterize social networks of pregnant women with and without extreme maternal morbidity. Methodology: a case-control study through a social network analysis of six hundred pregnant women: 150 with extreme maternal morbidities diagnosis and 450 who went to maternal services for different reasons. Women were hospitalized between 2011 and 2012 and they responded a social network characterization survey. Findings: in general, women reported satisfactory, strong and long relationships. For cases, antecedents of aggression, a wider social network and more satisfaction were statistically associated. This could be a bias due the type of the study. It's necessary a deeply knowledge of this relation.
Introdução: as ligações são configurados estabelecer redes sociais. A análise dessas redes nos permite compreender sua influência na saúde materna, um assunto pouco estudado. Objetivo: Caracterizar as redes sociais de mulheres grávidas com e sem diagnóstico de morbidade materna extremo. Metodologia: 150 materna diagnosticado com morbidade materna extrema e 450 mulheres grávidas saudáveis, constituindo, assim, um estudo de casos e controles: uma análise das redes de seiscentas mulheres ocorreu. Materna foram internadas em hospitais em Medellín em 2011 e 2012, onde eles responderam a um inquérito caracterização das relações sociais durante a gravidez. Resultados: maternos relataram relações grandes, densos e íntimos e expressaram satisfação com o suporte social recebido. morbidade materna extrema associada à exposição a qualquer forma de agressão, ter mais contato e maior satisfação com a rede; este último, pode ser utilizado um desenho de polarização.
ABSTRACT
OBJETIVO: El objetivo de este estudio es establecer si la morbilidad materna extrema (MME) se asocia con algunas características del acceso y la utilización de los servicios obstétricos de las gestantes participantes. MÉTODOS: Se realizó un estudio de casos y controles con 600 pacientes en embarazo, en parto o el puerperio atendidas entre 2011 y 2012 en servicios de obstetricia de Medellín (Colombia). Se consideraron casos (n = 150) las pacientes obstétricas que durante el ingreso cumplían los criterios de MME establecidos por el sistema de vigilancia que se aplica en la ciudad. Los controles (n = 450) se obtuvieron aleatoriamente de las mismas instituciones que los casos. La información se recabó mediante entrevista personalizada, revisión de la historia clínica y calificación del cuidado médico, realizada por el personal del programa de vigilancia. El análisis se realizó sobre la base del modelo Camino para la supervivencia a la muerte materna de la OPS/OMS, CDC, FNUAP-LAC y Mother Care. RESULTADOS: El porcentaje de embarazo no planificado en las mujeres estudiadas fue 57,6% y el retraso en la decisión de buscar atención, 32,0%. La etnia (OR = 1,8; IC95%: 1,0-2,9) y el retraso por deficiencias en la calidad de la atención prestada (OR = 8,3; IC95%: 5,0-13,7) fueron las variables que se encontraron asociadas con la MME. CONCLUSIONES: Los hallazgos sugieren que mejorar la efectividad y calidad de los programas de planificación familiar, control prenatal y atención obstétrica hospitalaria pudiera contribuir a reducir los casos evitables de MME.
OBJECTIVE: The objective of this study was to determine whether there is an association between severe maternal mortality (SMM) and the characteristics of access to and use of obstetric services by the participating women. METHODS: A study of cases and controls was conducted in a group of 600 women who were attended during pregnancy or the puerperium between 2011 and 2012 by obstetric services located in Medellín, Colombia. The study considered cases (n = 150) in obstetric patients who met the criteria for SMM established by the surveillance system being used in Medellín at the time of their admission. The controls (n = 450) were randomly selected in the same institutions where the patients were being treated. The information was obtained through an in-person interview, review of the patient’s clinical history, and rating of the medical care provided by surveillance program personnel. The analysis was based on the model Road Map for Preventing Maternal Death developed jointly by Pan American Health Organization/World Health Organization, Centers for Disease Control, United Nations Population Fund for Latin America and the Caribbean, and Mothercare UK. RESULTS: The proportion of unplanned pregnancies in the women studied was 57.6%, while the proportion of delay in the decision to seek care was 32.0%. Two variables were found to be associated with SMM: ethnicity (OR = 1.79) and delays due to deficiencies in the quality of care provided (OR = 8.54). CONCLUSIONS: The findings suggest that improving the effectiveness and quality of family planning, prenatal check-up, and hospital obstetric care programs could help to reduce avoidable cases of SMM.