ABSTRACT
Abstract Objectives: to evaluate the structure and adequacy of maternal healthcare facilities in Piauí. Methods: cross-sectional study in 26 hospitals with more than 200 births/year between 2018-2019. The structure was assessed by direct observation and interview with manager, in four domains: physical aspects, human resources, equipment, and drugs. Fisher's chi-square/exact tests were used to assess differences in adequacy of structure. Results: only 46.2% of the maternal healthcare facilities had pre-delivery, parturition and immediate post-partum room. Pediatricians (73.1%) and anesthesiologists (61.5%) were the least present professionals on-duty regime. Regarding drugs, magnesium sulfate and oxytocin were observed in 76.9% of hospitals. Overall adequacy was 23.1%, being higher in maternal healthcare facilities in the capital (p=0.034) and in private ones (p=0.031). Conclusions: Data show inequalities in the structure of maternity hospitals of the state. The absence of health professionals, essential drugs, and appropriate physical structure can expose women and newborns to unnecessary and avoidable risks.
Resumo Objetivos: avaliar a estrutura e adequação das maternidades do Piauí. Métodos: estudo transversal em 26 hospitais com mais de 200 partos/ano entre 2018 e 2019. A estrutura foi avaliada por observação direta e entrevista com gestor, em quatro domínios: aspectos físicos, recursos humanos, equipamentos e medicamentos. Foram empregados os testes do quiquadrado/exato de Fisher para avaliar diferenças na adequação da estrutura. Resultados: apenas 46,2% das maternidades tinham quarto pré-parto, parto e puerpério. Pediatras (73,1%) e anestesistas (61,5%) foram os profissionais menos presentes em regime de plantão. Dos medicamentes, sulfato de magnésio e ocitocina foram observados em 76,9% dos hospitais. A adequação global foi de 23,1%, sendo maior em maternidades da capital (p=0,034) e privadas (p=0,031) Conclusões: os dados exibem desigualdades na estrutura das maternidades do estado. A ausência de profissionais de saúde, medicamentos essenciais e estrutura física apropriada pode expor mulheres e recém-nascidos a riscos desnecessários e evitáveis.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Quality of Health Care , Structure of Services , Maternal-Child Health Services/organization & administration , Hospitals, Maternity/organization & administration , Midwifery/organization & administration , Ancillary Services, Hospital , Brazil , Chi-Square Distribution , Cross-Sectional StudiesABSTRACT
Abstract This article explores reproduction as a broad phenomenon that is integrated to social life and marked by power relations, in an analysis of the processes and structures that integrate subjects' lives and bind them with the State. Reproductive processes, which are more than physiological, connect subjects, health services and other sectors that represent the State. This ethnographic study, carried out between 2011 and 2015, focused on reproduction as a biosocial process among mostly black, low-income shellfish gatherers and fishermen living in Riachão - a village located on an island in the 'baixo sul' region of Bahia. Through ethnographic analysis, we explore the experiences of the reproductive process of the 18 women we followed during the research to conclude that the State plays a central role in the network of relationalities that constitute reproduction, establishing an oscillating and ambiguous relationship of care and violence with women at each stage: a fragile and discontinued care relationship during pregnancy; an intense, exclusive relationship marked by violence during childbirth; and a lack of care for the health of women in the puerperium, combined with high surveillance in the care of babies.
Resumo Este artigo explora a reprodução como fenômeno amplo, integrado à vida social e marcado por relações de poder, analisando os processos e estruturas que integram a vida dos sujeitos e destes com o Estado. Os processos reprodutivos, para além do fisiológico, conectam sujeitos, serviços de saúde e outros setores representantes do Estado. Trata-se de um estudo etnográfico realizado entre 2011 e 2015, sobre reprodução enquanto processo biossocial, com marisqueiras e pescadores, majoritariamente negros e de baixa renda, moradores de Riachão - uma vila, localizada em uma ilha, no baixo-sul da Bahia. A partir de uma análise etnográfica, demonstramos as formas de vivência do processo reprodutivo das 18 mulheres que acompanhamos ao longo da pesquisa e concluímos que o Estado exerce papel central na rede de relacionalidades que constituem a reprodução, estabelecendo uma relação oscilante e ambígua de cuidado e violência com as mulheres a cada fase: uma relação de cuidado, frágil e descontinuada, na gestação; uma relação intensa, exclusiva e marcada por violências no parto; e a ausência de cuidado para com a saúde das mulheres no puerpério, conjugada à alta vigilância nos cuidados dos bebês.
Subject(s)
Humans , Female , Pregnancy , Reproduction , Socioeconomic Factors , Parenting , State , Brazil , Maternal and Child Health , Delivery of Health Care , Obstetric ViolenceABSTRACT
A decreased mortality rate among infants and children has been a health target for most health facilities. South Africa’s free maternal healthcare services are not adequately utilized due to the tradition of new mothers following their parents’ footsteps. The use of medicinal plant species in maternal healthcare has been perceived to be effective and reliable in preventing illness among communities. For this study, ethnobotanical data were collected by means of interviews using semi-structured questions responded to by the elderly, community adults, and youth who had been selected on the basis of referrals. Infants within the communities have been treated with traditional medicine for ailments, such as colic, nail biting, sunken, and bulging fontanelles. Hypoxis hemerocallidea Fisch., C. A. Mey. & Ave-Lall, Lippia javanica (Burm.f.) Spreng., Vachellia karroo (Hayne) Banfi & Glasso, and Annona senegalensis Pers. subsp. senegalensis were among plant species which were frequently reported as being used medicinally. The decoction was mostly prepared from the roots (79%) followed by bulbs (8%) and most of the decoction was taken orally. The study identified 13 plant species used successfully for the treatment of bulging and sunken fontanelles.
ABSTRACT
Background: An insurance scheme called Jaminan Kesehatan Aceh (JKA) was established by the local government to achieve universal coverage for Aceh's population who were not registered under the national insurance scheme for the poor (Jamkesmas). Objective: This study was conducted to compare women's satisfaction before and after the implementation of JKA and across different insurance schemes. Methods: The study was conducted from July 2011 to July 2012 on satisfaction of maternal health services among 1197, 15-49 years aged old women living in eight districts of Aceh Province, Indonesia, and a cluster sampling technique was applied. Analysis of variance was used to assess the effects of different insurance schemes, period, and type of services on satisfaction with maternal health services. Results: Women were mostly satisfied with birth delivery services (mean score: 2.69) followed by postnatal care (mean score: 2.62) and antenatal care services (mean score: 2.37). Conclusion: Over the changing period, the average level of satisfaction in the JKA group increased significantly.
ABSTRACT
Este trabajo aborda las principales características del surgimiento y primeros diez años de funcionamiento de los Centros de Higiene Infantil, establecimientos dependientes del Departamento de Salubridad Pública desde 1922 en la Ciudad de México y que tuvieron como objetivo atender a las madres, desde el periodo de gestación, y a los niños, desde el nacimiento hasta los dos años de edad. Revisa las acciones que dieron origen a este proyecto y su consolidación. Analiza la estructura de estos Centros, las características de las madres y los niños que atendieron, así como las funciones que realizaron médicos y enfermeras enfatizando la noción de prevención de las enfermedades infantiles, para finalmente mostrar un primer balance acerca de los alcances y limitaciones que tuvieron.
This article deals with the main features of the emergence and first ten years of the Centros de Higiene Infantil, facilities run by the Departamento de Salubridad Pública from 1922 on in Mexico City with the goal of providing care for mothers from pregnancy onwards and children from birth to two years of age. It reviews the actions that gave rise to this project and how it became established. It analyzes the structure of these centers, the characteristics of the mothers and children seen there and the functions performed by doctors and nurses, stressing the notion of preventing childhood illnesses, and ends with a first assessment of the effects and limitations of these centers.
Subject(s)
Humans , Chlorides/chemistry , Gold Compounds/chemistry , Gold/chemistry , Metal Nanoparticles/chemistry , Oxidation-Reduction , Particle Size , PhaeophyceaeABSTRACT
It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidenceinformed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or communitylevel; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality.
ABSTRACT
Pregnant women infected with Trichomonas vaginalis are often untreated and evidence from the biology and epidemiology of the organism suggests that it may play an important role in causing adverse pregnancy outcomes. Using high vaginal swab from consenting pregnant women, a follow-up hospital based survey of T. vaginalis infection and its effect on pregnancy outcome among pregnant women attending antenatal clinics was conducted. Pregnancy outcome was determined on the basis of delivery before 37 weeks of gestation (according to general standards), low birth weight infants and neonatal conjunctivitis. The presence of T. vaginalis was re-examined at the point of delivery to exclude treated cases of infection during gestation period. Of the 688 pregnant women who gave birth within the study period, 89(12.9%) were positive for T. vaginalis with 31(19.38%) of the positive patients having pre-term delivery. Also, of the total of 89 infants from the infected mothers, 21(24.14%) had low birth weight of below 2.5 Kg, while 31(18.8%) had conjunctivitis. The result shows that the infection of T. vaginalis during pregnancy is significantly associated with adverse pregnancy outcomes. In view of the public health importance of this common sexually transmitted disease (STD), we advocate routine surveillance of trichomoniasis among pregnant women and prompt treatment of infected individuals and their sexual partners.
ABSTRACT
Objective To establish the healthcare management mode for pregnant women adapting to the characteristics of transient population which can safeguard the maternal and infant health or reduce the maternal mortality rate and prenatal mortality rate. Methods Five suburban communities of Chaoyang District, Haidian District and Fengtai District of Beijing were chosen as intervention group, which received systemic healthcare management of pregnant women in transient population, another five suburban communities were selected as control group. Results Both maternal mortality rate and prenatal mortality rate in intervention group were lower than those in control group. To evaluate the effect of systemic healthcare for pregnant women, an average of four antenatal clinic visits were completed in intervention group and eight visits in control group. There was no statistical difference in occurrence of maternal complications, newborn weight and occurrence rate of neonatal asphyxia between two groups. The expense of hospital vaginal delivery was no more than 1000 yuan in intervention group and more than 1000 yuan in control group, while the outcomes of mothers and neonates in two groups had no significant difference. Conclusion The systemic healthcare and community management mode for pregnant women in transient population can safeguard the maternal and infant health with scientific, practical, and replica-ble significances.