Knowledge about the contents of mother and child protection card among pregnant women and lactating women of a rural field practice area

Introduction: MCH services are not utilized due to unawareness, poverty and lack of scientific knowledge regarding care during the issue. Though all the details are given in the MCPC to follow positive practices, utilization of the card is being done only for recording of the information. Objective: To assess the knowledge about the contents of mother and child protection card (MCPC) among the pregnant and lactating women of a rural area Methodology: This was a cross sectional study conducted on pregnant women and lactating mothers with child less than a year. Knowledge about the contents of MCPC was collected by interview method. Results: In our study, majority of the mothers had good knowledge about tetanus injection (92.5%), consumption of IFA tablets (72.6%), breastfeeding within an hour (92.5%), exclusive breastfeeding for 6 months (95.6%), cereals to be included in the complementary food (90.6%) and good perception about complete immunization of the baby (100%). Knowledge was found to be poor with respect to ANC checkups and examination, tracking weight of the baby and growth chart; assessing danger signs in newborn and emergency preparation. Conclusion: The study showed good knowledge about TT, IFA, nutrition, danger signs and immunization. There was poor knowledge about ANC checkups, baby growth, danger sings in newborn and emergency preparation.

History of maternal mortality in the city of ribeirão preto, in its regional health department, and in the state of são paulo after the establishment of the maternal committees from 1998 to 2017 / Recorte histórico da mortalidade materna no município de Ribeirão Preto, no seu Departamento Regional de Saúde, e no estado de São Paulo após a instituição dos comitês de mortalidade materna de 1998 a 2017

Abstract Objective To describe the evolution of maternal mortality right after the establishment of maternal death committees in the region of the city of Ribeirão Preto, state of São Paulo, Brazil. Methods The present study describes the spatial and temporal distribution of maternal mortality frequencies and rates, using data from the state of São Paulo, the municipality of Ribeirão Preto, and its Regional Health Department (DRS-XIII) from 1998 to 2017. The present ecological study considered the maternal mortality and live birth frequencies made available by the Computer Science Department of the Brazilian Unified Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS, in the Portuguese acronym)/Ministry of Health, which were grouped by year and political-administrative division (the state of São Paulo, the DRS-XIII, and the city of Ribeirão Preto). The maternal mortality rate (MMR) was calculated and presented through descriptive measures, graphs, and cartograms. Results The overall MMR observed for the city of Ribeirão Preto was of 39.1; for the DRS-XIII, it was of of 40.4; and for the state of São Paulo, it was of 43.8 for every 100 thousand live birhts. During this period, the MMR for the city of Ribeirão Preto ranged from 0% to 80% of the total maternal mortalities, and from 40.7% to 47.2% of live births in the DRS-XIII. The city of Ribeirao Preto had an MMR of 76.5 in 1998and 1999, which decreased progressively to 12.1 until the years of 2012 and 2013, and increased to 54.3 for every 100 thousand live births over the past 4 years. The state of São Paulo State had an MMR of 54.0 in 1998-1999, which varied throughout the study period, with values pregnancy of 48.0 in 2008-2009, and 54.1 for every 100 thousand live births in 2016-2017. Several times before 2015, the city of Ribeirão Preto and the DRS-XIII reached the Millennium Goals. Recently, however, the MMR increased, which can be explained by the improvement in the surveillance of maternal mortality. Conclusion The present study describes a sharp decline in maternal death in the region of Ribeirão Preto by the end of 2012-2013, and a subsequent and distressing increase in recent years that needs to be fully faced.

Resumo Objetivo Descrever a evolução da mortalidade materna após a instituição dos comitês de morte materna na região de Ribeirão Preto. Métodos Este estudo descreveu a distribuição espacial e temporal das frequências e da razão demortalidadematerna, utilizando dados do estado de São Paulo, do Departamento Regional de Saúde de Ribeirão Preto (DRS-XIII), e domunicípio de Ribeirão Preto, no período de 1998 a 2017. O estudo ecológico considerou frequências de mortes maternas e de nascidos vivos disponibilizadas pelo Departamento de Informática do Sistema Único de Saúde (DATASUS)/Ministério da Saúde, que foramagrupadas por ano e pela referida divisão político-administrativa. A taxa de mortalidade materna (TMM) foi calculada e apresentada por medidas descritivas, gráficos e cartogramas. Resultados O total observado para o município de Ribeirão Preto foi uma TMM de 39,1; para o DRS-XIII, TMM de 40,4; e, para o estado de São Paulo, uma TMM de 43,8 por 100 mil habitantes. No período do estudo, a RMM do município de Ribeirão Preto variou de 0% até 80,0% do total de mortes maternas, e de 40,7% a 47,2% dos nascidos vivos no DRS-XIII. O município de Ribeirão Preto apresentou TMM de 76,5 no biênio 1998-1999, que progressivamente diminuiu para 12,1 em 2012-2013, e aumentou para 54,3 por 100mil habitantes nos últimos 4 anos. O estado de São Paulo apresentou TMM de 54,0 em 1998-1999, tendo variado ao longo do período com valores de 48,0 no período 2008-2009, e 54,1 no período 2016-2017. Várias vezes antes de 2015, o município de Ribeirão Preto e o DRS-XIII atingiramas Metas domilênio. Recentemente, porém, a TMM aumentou, o que pode ser explicado pela melhoria da vigilância da mortalidade materna. Conclusão O estudo descreveu um acentuado declínio da morte materna na região de Ribeirão Preto até o final do biênio 2012-2013, e um subsequente e aflitivo aumento em anos recentes, que precisa ser enfrentado.

Evaluación de competencias específicas de profesionales de enfermería en la atención al neonato crítico / Assessment of Specific Competencies of Nursing Professional in the Care of the Critical Neonate

Introducción: La evaluación de las competencias específicas del profesional de enfermería en la atención al neonato crítico permite diagnosticar su nivel de desarrollo para proponer alternativas que dinamicen la superación profesional en las Unidades de Cuidados Intensivos Neonatales. Objetivo: Evaluar las competencias específicas de los profesionales de enfermería a cargo de la atención al neonato crítico en las Unidades de Cuidados Intensivos Neonatales. Métodos: Estudio descriptivo-observacional, participaron 161 profesionales de enfermería de Unidades de Cuidados Intensivos Neonatales de Santiago de Cuba, de enero 2017 a enero 2018. Las competencias fueron evaluadas a partir de una parametrización para descomponer la variable en dimensiones e indicadores, se aplicaron tres instrumentos evaluativos al universo de profesionales y se realizó una triangulación metodológica a partir de los resultados de las dimisiones obtenidos por los instrumentos. Resultados: Las dimensiones de mayores afectaciones fueron la clínico-quirúrgica y la actualización científica. En la triangulación metodológica se obtuvo 4,17 de media ponderada, significa que la variable se encuentra afectada con un nivel medio de desarrollo. Conclusiones: La evaluación de las competencias permitió declarar que la variable evaluada se encuentra en un nivel medio de desarrollo. Del análisis de los indicadores se obtuvo un inventario de problemas y potencialidades que justifican una propuesta metodológica que dinamice la superación profesional para el desarrollo de las competencias específicas de profesionales de enfermería para la atención al neonato crítico(AU)

Introduction: The assessment of the nursing professional's specific competencies in the care of the critical neonate allows to diagnose their level of development in view of proposing alternatives that boost professional improvement in neonatal intensive care units. Objective: To assess the specific competencies of nursing professionals in charge of critical neonate care in neonatal intensive care units. Methods: Descriptive-observational study, 161 nursing professionals from the Neonatal Intensive Care Units of Santiago de Cuba participated, from January 2017 to January 2018. The competencies were assessed based on a parameterization for decomposing the variable into dimensions and indicators. Three assessment instruments were applied to the study group of professionals and a methodological triangulation was carried out based on the dimensional results obtained by the instruments. Results: The most affected dimensions were the clinical-surgical and scientific update. In the methodological triangulation, 4.17 was obtained as weighted average, which means that the variable is affected with a medium level of development. Conclusions: The assessment of the competences allowed to declare that the assessed variable is in a medium level of development. From the analysis of the indicators, an inventory of problems and potentialities was obtained that justify a methodological proposal that stimulates the professional improvement for the development of the specific competencies of nursing professionals for the care of the critical neonate(AU)

Mortalidade infantil e classificação de sua evitabilidade por cor ou raça em Mato Grosso do Sul / Child mortality and classification of its preventability by skin color or ethnicity in Mato Grosso do Sul, Brazil

Resumo Estudo epidemiológico que objetivou analisar os óbitos infantis em menores de um ano e seus critérios de evitabilidade por cor ou raça, em Mato Grosso do Sul, de 2005 a 2013, a partir dos Sistemas de Informações sobre Mortalidade e sobre Nascidos Vivos. Elaborou-se o coeficiente de mortalidade infantil anual e a descrição dos óbitos por componentes e por grupo de causas evitáveis, mal definidas e não evitáveis para os três triênios. Observou-se declínio do coeficiente de mortalidade infantil para todas as categorias de cor ou raça, com predomínio para as crianças pardas e pretas. O componente Neonatal precoce apresentou maior percentual de óbitos para todas as categorias, com exceção da indígena que registrou predomínio no componente Pós-neonatal. Os óbitos ocorreram, majoritariamente, por causas evitáveis e não foram homogêneos entre as categorias de cor ou raça. Os óbitos por causas mal definidas predominaram entre as crianças indígenas e pardas. A investigação dos óbitos apontou diferenças nos componentes de mortalidade e nas causas evitáveis segundo recorte étnico racial, o que poderá contribuir para o direcionamento de políticas públicas que qualifiquem a rede assistencial materno-infantil, sobretudo para as minorias étnicas.

Abstract The epidemiological study aimed to investigate the mortality of children under one year and the classification of preventability by skin color or ethnicity in Mato Grosso do Sul state in the period 2005-2013 retrieved from the Mortality and Live Births Information Systems. The annual child mortality coefficient and the description of deaths by components and by group of preventable, ill-defined and non-preventable causes for the three triennia were elaborated. The child mortality coefficient declined for all skin color or ethnicity categories, with a predominance of brown and black children. The early neonatal component had higher mortality rates for all categories, except for the indigenous population, which recorded predominance of the post-neonatal component. Deaths were mainly due to preventable causes, and they were not homogeneous among skin color or ethnicity categories. Deaths from ill-defined causes predominated among indigenous and brown children. The investigation of deaths pointed to differences in the components of mortality and preventable causes according to racial and ethnic contour, which could contribute to the direction of public policies that qualify the mother and child care network, especially for ethnic minorities.

Socio-cultural practices related to mother and child health in Mewat, Haryana, India

Background: Mothers and young children bear the burden of high morbidity and high mortality due to various socio-economic and cultural reasons complicated by illiteracy, unawareness, ignorance, and lack of access to health care services. Objective of this study was to discuss the perspectives of women from villages of Mewat, Haryana in India on mother and child health in the context of their socio-cultural norms, practices and assess their information needs related to pregnancy, child birth and child care.Methods: The study design was qualitative and descriptive in nature. FGDs were conducted in four villages in Mewat district of Haryana with approximately 100 community women who were either pregnant or mothers of at least one child in 0-2 years. Through these FGDs, their responses were documented on prevalent socio-cultural norms and practices about antenatal care, institutional delivery, diet during pregnancy and post-partum, breastfeeding, immunization, family planning etc.Results: Majority of women were unaware of the healthy behaviours and desired practices for optimal pregnancy outcomes due to their limited exposure and unavailability of authentic sources of information. They seemed to be unable to follow the right practices because of poor socio-economic status, patriarchal structure with resultant gender dynamics and religious norms, overwork and pre-conceived socio-cultural norms which impede their health seeking behaviour.Conclusions: Knowledge on healthy practices during pregnancy, child birth and child care can promote health seeking behaviour amongst women along with optimal pregnancy outcomes. However, majority of women were unaware about such healthy practices. Hence, it is important to raise awareness amongst women to ensure mother and child health.

Teste do pezinho: condições materno-fetais que podem interferir no exame em recém-nascidos atendidos na unidade de terapia intensiva / Heel prick test: maternal-fetal conditions that may have an effect on the test results in newborns admitted to the intensive care unit

RESUMO Objetivo: Descrever as características do teste do pezinho dos neonatos atendidos na unidade de terapia intensiva de um hospital universitário, bem como verificar se existiam condições maternas e fetais que pudessem interferir no resultado desse exame. Métodos: Estudo retrospectivo longitudinal de abordagem quantitativa que avaliou 240 prontuários médicos. Os dados coletados foram submetidos à análise estatística descritiva. Resultados: Houve predomínio de gestantes com idades entre 20 a 34 anos, com Ensino Médio completo e que realizaram mais de seis consultas pré-natais. As intercorrências ou patologias maternas ocorreram em 60% das mães, e a maioria (67,5%) não apresentou nenhuma condição que pudesse interferir no resultado do teste do pezinho. A maioria dos neonatos era prematura e exibiu baixo peso ao nascimento. Cerca de 90% dos neonatos exibiram condições que poderiam influenciar no exame, principalmente prematuridade, nutrição parenteral e transfusão sanguínea. Dos 240 neonatos, 25% apresentaram resultado alterado no teste do pezinho, sobretudo para fibrose cística e hiperplasia adrenal congênita. Conclusão: Existem condições maternas e neonatais que podem interferir no teste do pezinho e, nesse sentido, sua investigação é imprescindível, visando direcionar ações que promovam a saúde materno-infantil e consolidem a triagem neonatal nessa população.

ABSTRACT Objective: To describe the characteristics of the heel prick test in newborns admitted to the intensive care unit of a university hospital as well as to determine whether maternal and fetal conditions could have affected the results of this test. Methods: Retrospective longitudinal study with a quantitative approach that evaluated 240 medical records. The data collected were analyzed by descriptive statistical analysis. Results: There was a predominance of pregnant women aged 20 to 34 years who had a complete secondary education and who had more than six prenatal care visits. Maternal complications or pathologies occurred in 60% of the mothers, and most (67.5%) did not present any condition that could have affected the heel prick test results. Most newborns were premature and exhibited low birth weight. Approximately 90% of newborns exhibited conditions that could have influenced the test, especially prematurity, parenteral nutrition and blood transfusion. Of the 240 newborns, 25% had abnormal heel prick test results, especially for cystic fibrosis and congenital adrenal hyperplasia. Conclusion: There are maternal and neonatal conditions that can affect heel prick test results, and therefore, their investigation is essential, aiming to guide measures that promote mother and child health and consolidate neonatal screening in this population.

Atravessamentos de Gênero na implementação da Estratégia Rede Cegonha na Região Metropolitana II do Rio de Janeiro / Gender crossings in "Rede Cegonha" Strategy Implementation at IIth metropolitan district of Rio de Janeiro state

O artigo apresenta resultados de uma pesquisa qualitativa exploratória que envolveu profissionais de saúde que atuam na implementação da Estratégia Rede Cegonha na Região Metropolitana II do estado do Rio de Janeiro. A pesquisa ocorreu pari passu à Ação Extensão "Rede Cegonha: uma proposta interinstitucional de Educação Permanente", realizada por docentes e técnicos da Universidade Federal Fluminense, com fins de qualificação da assistência materno-infantil nessa região. A metodologia incluiu análise documental da Estratégia, observação participante das atividades da Ação de Extensão, e aplicação de entrevista com os Coordenadores Municipais de Educação Permanente, visando identificar concepções dos profissionais de saúde sobre gênero e refletir sobre seus impactos nas ações de assistência realizadas no âmbito da Rede Cegonha. Os resultados indicaram que a assistência é guiada exclusivamente por concepções e subjetividades individuais prévias dos profissionais, apontando a necessidade de ações de Educação Permanente em Saúde que propiciem a re-elaboração coletiva de conceitos e práticas, com fins de reduzir as iniquidades e garantir o acesso a boas práticas de cuidado materno-infantil.

The paper features the results of an exploratory qualitative research with health workers in Rede Cegonha Strategy implementation at IIth metropolitan district of Rio de Janeiro state. The research was developed pari passu to an Extension Action named "Rede Cegonha: uma proposta inter institucional de Educação Permanente", performed by technicians and professors from Universidade Federal Fluminense, wich aimed to qualify mother and child health assistance in that region. The methodology included documental analysis, participant observation and interview whit the Permanent Education Coordinators, for purposes of identifying professionals' conceptions about gender and its impacts in health assistance. The results showed that the assistance was guided only by previous conceptions and subjectivities of these professionals, pointing out the necessity of health permanent education actions to support a collective re-elaboration of concepts and practices, to reduce inequities and ensure the access to good practices of mother and child care.

Serviços de Saúde Materna como estratégia biopolítica de disciplinamento dos corpos em Cuba / Maternal health services in Cuba - a biopolitical strategy for disciplining pregnant women' bodies / Servicios de Salud Maternal como estrategia biopolítica de disciplinamiento de los cuerpos en Cuba

A saúde materno-infantil se apresenta como uma das áreas prioritárias na atenção à saúde em Cuba. O presente artigo tem como objetivo analisar os serviços de saúde materna (chamados em Cuba de Hogares Maternos) - onde as mulheres são internadas para receberem cuidados médicos pelo tempo necessário nas situações de risco ou complicações na gestação - enquanto uma estratégia biopolítica. Nesse sentido, buscamos problematizar a utilização dessa estratégia de docilização e disciplinamento das gestantes, ao mesmo tempo em que reconhecemos ser esta uma potente estratégia de governo para preservação da vida em Cuba.(AU)

Maternal and child health is a healthcare priority in Cuba. This article analyzes the provision of maternal health services in Cuba's Hogares Maternos (maternity homes), where mothers are admitted in cases of high-risk pregnancy or complications. We problematize the docilization and disciplining of pregnant women, while at the same time recognizing that this process as a powerful strategy for preserving life in Cuba.(AU)

La salud materno-infantil se presenta como una de las áreas prioritarias en la atención de la salud en Cuba. El objetivo del presente artículo es analizar los servicios de salud maternal (que en Cuba se denominan Hogares Maternos) - en donde las mujeres son ingresadas para recibir cuidados médicos durante el tiempo que sea necesario en las situaciones de riesgo o de complicaciones durante el embarazo - como estrategia biopolítica. En ese sentido, buscamos problematizar la utilización de esa estrategia de docilización y disciplinamiento de las embarazadas, al mismo tiempo en que reconocemos que esta es una potente estrategia de gobierno para la preservación de la vida en Cuba.(AU)

Renovation of Maternal-child Healthcare Centers and the National Maternal-child Medical Center Based on the Mother and Child Act

The Mother and Child Act is the most important law set up to maintain and improve maternal-child healthcare. This act was established in 1973 and was revised to improve maternal-child healthcare. This act includes the establishment and management of a maternal-child healthcare center in the district, a maternal-child regional healthcare center in the province, and a national maternal-child medical center. In the baby boom era, maternal-child healthcare centers provided maternity care and delivery services as well as emergency obstetrical management, but those centers stopped providing maternity care in the low birth-rate era. The last revised act included the establishment of a national maternal-child medical center to care for the increase in the number of high-risk pregnancies. This review briefly evaluates the goals and roles of a maternal-child healthcare center and a national maternal-child medical center according to the Mother and Child Act, and integrates high risk pregnancies with a neonatal care center to renovate the maternity healthcare system.

Assessment of health management information system for monitoring of maternal health in Jaleswar Block of Balasore District, Odisha, India

Background: In 2005, the Government of India implemented the National Rural Health Mission for reduction of maternal mortality. One of the major impediments in improving maternal health since then has been a poor management of the Health Management Information System (HMIS) at grass-roots level which could integrate data collection, processing, reporting, and use of information for necessary improvement of health services. Objective: The paper identifies the challenges in generating information for HMIS and its utilization for improvement of maternal health program in the tribal-dominated Jaleswar block in Odisha, India. It also aims to understand the nature and orientation of the HMIS data generated by the government for the year 2013–2014. Methods: The study is a cross-sectional type which used observation and interview methods. Primary data were gathered from health professionals to understand the challenges in generating information for HMIS and its utilization. Next, to understand the nature and orientation of HMIS, data pertaining to tribal block were analyzed. Results: The findings show that there are challenges in generation of quality data, capacity building of workforce, and monitoring of vulnerable tribal population. The discrepancies between HMIS data and field reality display the gap in formulation of policy and its implementation. Conclusion: The study unearths the existing politics of knowledge generation. This shows highly standardized procedures and information gathering by use of dominant biomedical concepts of maternal health with limited inclusion of local birthing conceptions and needs of vulnerable tribal pregnant women.

Risco gestacional e fatores associados em mulheres atendidas pela rede pública de saúde / Riesgo gestacional y factores asociados en mujeres atendidas por la red pública de salud / Gestational risk and associated factors in women cared by the public health network

RESUMO Objetivou-se classificar e estimar os fatores associados ao risco gestacional em mulheres atendidas para o parto pelo Sistema Único de Saúde (SUS). Estudo transversal com entrevista e consulta ao cartão da gestante e ao prontuário hospitalar de 607 puérperas residentes em município do Estado do Paraná, Brasil. O risco gestacional foi classificado segundo critérios do programa Rede Mãe Paranaense - RMP e a associação com características maternas foi realizada por meio de análise de regressão logística. Das puérperas, 50,9% tiveram gravidez classificada como de risco habitual, 5,8% risco intermediário e 43,3% alto risco. Para classificação do risco, o tabagismo (12,7%), a raça negra (11,4%), os distúrbios hipertensivos (9,6%) e a infecção do trato urinário de repetição (8,4%) foram as condições mais frequentes. A reação paterna negativa à gestação (ORaj=1,71), o IMC pré-gestacional elevado (ORaj=1,67) e ter tido duas ou mais gestações anteriores (ORaj=1,85) foram independentemente associados ao alto risco gestacional. Para prevenir complicações na gestação, a equipe de saúde deve considerar os fatores modificáveis, como o tabagismo, hipertensão, infecção de trato urinário e também não modificáveis, como raça/cor negra, história de IMC pré-gestacional elevado e reação negativa do pai da criança à gestação.

RESUMEN El objetivo fue clasificar y estimar los factores asociados al riesgo gestacional en mujeres atendidas para el parto por el Sistema Único de Salud (SUS). Estudio transversal con entrevista y consulta al registro de la gestante y al registro hospitalario de 607 puérperas residentes en un municipio del estado de Paraná, Brasil. El riesgo gestacional fue clasificado según criterios del programa Rede Mãe Paranaense (RMP), y la asociación con características maternas fue realizada por medio de análisis de regresión logística. De las puérperas, 50,9% tuvieron embarazo clasificado como de riesgo habitual, 5,8% riesgo intermediario y 43,3% alto riesgo. Para clasificación del riesgo, el consumo de tabaco (12,7%), la raza negra (11,4%), los trastornos hipertensivos (9,6%) y la infección urinaria de repetición (8,4%) fueron las condiciones más frecuentes. La reacción paterna negativa al embarazo (ORaj=1,71), el IMC pregestacional elevado (ORaj=1,67) y haber tenido dos o más embarazos anteriores (ORaj=1,85) fueron independientemente asociados al embarazo de alto riesgo. El equipo de salud debe considerar los factores modificables, como el consumo de tabaco, hipertensión, infección urinaria, y también no modificables, como raza negra, historia de IMC pregestacional elevado y reacción negativa del padre del niño al embarazo, para prevenir complicaciones en la gestación.

ABSTRACT This study aimed to classify and estimate the factors associated with gestational risk in women cared for delivery by the Unified Health System (SUS). A cross-sectional study with interviews and consultation to the card of the pregnant woman and the hospital records of 607 puerperal women resident in the municipality of the state of Paraná, Brazil. The gestational risk was classified according to the criteria of the program Parent Network Paranaense - RMP and the association with maternal characteristics was performed by means of logistic regression analysis. The puerperal women, 50.9% had risk pregnancy classified as usual, 5.8% intermediate risk and 43.3% high risk. For the classification of risk, smoking (12.7%), black race (11.4%), hypertensive disorders (9.6%) and urinary tract infection (8.4%) were the most frequent conditions. The paternal reaction in the negative pregnancy (ORaj=1.71), the pre-gestational BMI high (ORaj=1.67) and having had two or more previous pregnancies (ORaj=1.85) were independently associated with a high risk pregnancy. To prevent complications in pregnancy, the health care team should consider the modifiable factors such as smoking, hypertension, urinary tract infection and also non-modifiable, such as race/color black, history of pre-gestational BMI high and negative reaction of the father of the child to the pregnancy.

Experiencias de la "Misión Niño Jesús" durante el cumplimiento de misión Internacionalista en Venezuela / Experience of the "Mission Niño Jesus" during the fulfillment of the internationalist mission in Venezuela

Introducción: la colaboración internacional en el área de la salud ha constituido para Cuba un principio. La enfermera tiene la misión de brindar servicios con respeto a la dignidad humana, amor, dedicación, sacrificio y entrega, con ética, respeto y equidad al tratar a pacientes, familiares y comunidad. Objetivo: exponer experiencias de la "Misión Niño Jesús" en Venezuela. Métodos: estudio descriptivo de corte transversal en el Centro Diagnóstico Integral "San José de la Sierrita", Municipio Mara, Región Guajira del Estado Zulia, desde junio de 2011 hasta agosto de 2013. El universo de estudio quedó constituido por 269 embarazadas atendidas en el centro. Se utilizó el método observacional documental de carnets obstétricos, las variables estudiadas fueron año de ocurrencia, asistencia y tipo de Parto. Se analizó la información con distribuciones de frecuencias absolutas y porcentajes, se calculó el coeficiente de correlación de Pearson para demostrar incremento o no de los partos, se prefijó un intervalo de confianza del 95 por ciento. Resultados: el 34,57 por ciento las mujeres atendidas en el Centro Diagnóstico Integral parieron en el mismo y tuvieron resultados satisfactorios durante el parto, alumbramiento y puerperio al igual que sus bebés. Se comprobó que de manera creciente las embarazadas se realizaron el control prenatal en los módulos de misión médica cubana. Conclusiones: la experiencia de la "Misión Niño Jesús" durante el cumplimiento de la misión Internacionalista en la República Bolivariana de Venezuela logró resultados positivos en el cumplimiento de los indicadores materno-infantiles de la comunidad atendida(AU)

Introduction: International health collaboration has constituted a principle for Cuba. The nurse has the mission of providing services with respect to human dignity, love, dedication, sacrifice and self-giving, with ethics, respect and equity in dealing with patients, families and the community. Objective: To present experiences of the "Mission Niño Jesús" in Venezuela. Methods: A cross-sectional descriptive study at San José de la Sierrita Comprehensive Diagnostic Center, Mara Municipality, Guajira Region of Zulia State, from June 2011 to August 2013. The study universe consisted of 269 pregnant women treated in the Center. The observational documentary method of obstetrical cards was used, the variables studied were year of occurrence, attendance and delivery type. Data were analyzed with absolute frequency distributions and percentages, the Pearson correlation coefficient was calculated to show whether or not births were increased, a 95 percent confidence interval was set. Results: 34.57 percent of the women attended at the Comprehensive Diagnostic Center gave birth and had satisfactory results during labor, delivery and puerperium, as did their babies. It was verified that the pregnant women increasingly received prenatal control in the modules of Cuban medical mission. Conclusions: The experience of the "Mission Niño Jesús" during the fulfillment of the Internationalist mission in the Bolivarian Republic of Venezuela attained positive results in the fulfillment of maternal and child indicators of the served community(AU)

Computer Tablet‑based Health Technology for Strengthening Maternal and Child Tracking in Bihar.

Background: UNICEF along with the State Government of Bihar launched a computer tablet‑based Mother and Child Tracking System (MCTS) in 2014, to capture real‑time data online and to minimize the challenges faced with the conventional MCTS. Objective: The article reports the process of implementation of tablet‑based MCTS in Bihar. Methods: In‑depth interviews with medical officers, program managers, data managers, auxiliary nurse midwives (ANMs), and a monitoring and evaluation specialist were conducted in October 2015 to understand the process of implementation, challenges and possibility for sustainability, and scale‑up of the innovation. Results: MCTS innovation was introduced initially in one Primary Health Centre each in Gaya and Purnia districts. The device, supported with Android MCTS software and connected to a dummy server, was given to ANMs. ANMs were trained in its application. The innovation allows real‑time data entry, instant uploading, and generation of day‑to‑day work plans for easy tracking of beneficiaries for providing in‑time health‑care services. The nonlinking of the dummy server to the national MCTS portal has not lessened the burden of data entry operators, who continue to enter data into the national portal as before. Conclusion: The innovation has been successfully implemented to meet its objective of tracking the beneficiaries. The national database should be linked to the dummy server or visible impact. The model is sustainable if the challenges can be met. Mobile technology offers a tremendous opportunity to strengthen the capacity of frontline workers and clinicians and increase the quality, completeness, and timeliness of delivery of critical health services.

Use of mother and child healthcare services according to social and demographic characteristics in a city in Paraíba, Brazil / Utilizaςão de serviς os de saúde materno-infantil segundo características sociodemográficas em cidade do interior do estado da Paraíba, Brasil / Utilización de servicios de salud materno-infantil según características sociodemográficas en una ciudad del interior del estado de Paraíba, Brasil

Objective: To analyse the type of service used (public or private) for antenatal care and during delivery and post-partum according to maternal social and demographic characteristics in the city of Campina Grande, Paraiba, Brazil. Materials and methods: Cross-sectional analytical study of 633 mothers with children under one year of age who were surveyed in order to gather social, demographic, antenatal, partum and post- partum data, including the type of service used. The association between maternal social and demographic characteristics and the type of service used was analysed. Results: The usage of public services was 77% for antenatal care and 80.1% for delivery/puerperium. A systematic difference was found in the use of public services among women with a lower level of schooling (PR = 1.31 95% CI: 1.14-1.43) and families covered by the social programme (PR = 1.28 95 % CI: 1.14-1.33). Conclusion: Findings highlight inequalities in the use of antenatal and partum/post-partum healthcare services.

Objetivo: Analisar o tipo de serviςo utilizado (se público ou privado) na assistência pré-natal e ao parto/puerpério segundo características sociodemográficas maternas na cidade de Campina Grande, Paraíba, Brasil. Materiais e métodos: Estudo transversal analítico no qual entrevistaram-se 633 mães de filhos menores de um ano, obtendo-se informaςões sociodemográficas e da atenςão ao pré-natal, ao parto e ao puerpério, inclusive sobre o tipo de serviςo utilizado. Analisou-se a associaςão das caraterísticas sociodemográficas maternas com o tipo de serviςo utilizado. Resultados: A utilizaςão do serviςo público foi de 77,0% na assistência pré-natal e de 80,1% no caso do parto/puerpério. Verificou-se vantagem sistemática na utilizaςão de serviςos públicos de saúde durante o pré-natal e o parto/puerpério nas mulheres de menor escolaridade (PR=1.31 95%CI: 1.14-1.43) e nas de famílias beneficiadas pelo Programa Bolsa Família (PR= 1.28 95%CI: 1.14-1.33). Conclusões: Os achados destacam desigualdades no uso de serviςos de saúde do pré-natal e parto/ puerpério.

Objetivo: analizar el tipo de servicio utilizado (público o privado) en la asistencia prenatal y el parto/ posparto según características sociodemográficas maternas en la ciudad de Campina Grande, Paraíba (Brasil). Materiales y métodos: estudio transversal analítico, en el cual se entrevistaron 633 madres de hijos menores de un año, obteniéndose información sociodemográfica del prenatal, parto y puerperio, incluido el tipo de servicio utilizado. Se analizó la asociación de las características sociodemográficas maternas con dicho servicio. Resultados: la utilización del servicio público fue de 77,0 % en la asistencia prenatal y de 80,1 % en el parto/puerperio. Se encontró una diferencia sistemática en la utilización de servicios públicos en las mujeres de menor escolaridad (PR = 1,31; IC 95 %: 1,14-1,43) y en familias beneficiadas por programa social (PR = 1,28 IC 95 %: 1,14-1,33). Conclusión: los hallazgos destacan desigualdades en la utilización de los servicios de salud prenatal y parto/posparto.

Is mother and child tracking system (MCTS) on the right track? An experience from a northern state of India.

Background: Effective monitoring and supervision of health care programs depend on complete, accurate, and timely flow of data. Mother and Child Tracking System (MCTS) is a centralized information technology (IT)-based application launched in 2009 for improving the delivery of maternal and child health care services through name-based tracking. There is minimal evidence in the literature evaluating the operational aspects of such a name-based tracking system even after 5 years of its implementation. Objective: The present study was thus conducted to understand the opportunities and challenges in the operationalization of MCTS strategy in a district in Haryana and to understand the stakeholder's perspectives. Materials and Methods: Performance of Routine Information System Management (PRISM) framework was used. This cross-sectional study was conducted in Shahzadpur block of Ambala district, Haryana, India involving in-depth interviews of health care providers and clients in 12 subcenters (SCs) and two primary health centers (PHCs). Results: Lack of appropriate training, overburdened data entry operator (DEO) and auxiliary nurse midwife (ANM), poor Internet connectivity, slow server speed, and frequent power failures were revealed as major limitations for the effective implementation of MCTS. Nearly 18% of the clients reported receiving short message service (SMS) and only 6% could understand the SMS. Conclusion: MCTS has led to accountability and improved supervision of health workers, apart from empowering the community.

Current Status and Future Challenges for Maternal and Child Health in North Korea

The Government of North Korea with WHO proposed the improvement of healthcare for mothers and children as the second-highest priority for North Korea in 2009. The maternal mortality ratio in North Korea was 76 per 100,000 live birth in 2012, almost seven times higher than that of South Korea. The leading cause of maternal death was postpartum hemorrhage, which accounted for 33 percent of all mothers' deaths. Postpartum hemorrhage is indeed a life-threatening crisis that requires a well-established emergency obstetric care (EmOC) system including safe blood. The rate of children under the age of five with chronic malnutrition stood at 27.9 percent in 2012. Infant malnutrition was more prevalent after the first six months of life, with the rate reaching a peak of 36.8 percent at 24 months of age. The proportion of chronic malnutrition was lowest in Pyongyang, at 19.6 percent, and second-lowest in South Phyongan, at 25.8 percent. On the other hand, the proportion was the highest in the three provinces of Ryanggang, Jagang and South Hamgyong at 39.6 percent, 33.4 percent, and 32.9 percent, respectively. Lack of food security has led to a high prevalence of malnutrition. The mortality rate of children under the age of five was 25 per 1,000 live birth in 2014. Of the North Korean children who die under the age of five, 51 percent died within first four weeks of their birth in 2010. Of these, 40 percent was born low birth weight (less than 2,500 grams at birth), indicating the severity of malnutrition in mothers. Therefore this paper suggests strategies approach to improve the quality of the population for the next generation unified the Korean peninsula for future initiatives. First, we need to develop of strategies and actions for reducing geographical disparity in access to maternal and child health services in North Korea. Second, we have to introduce a 'Mother and Child 1,000-Day Project' to reduce undernutrition among mothers and children in the first 1,000 days of a child's life, from conception to two years old. Third, it is desirable to adopt a policy on access to primary health care to build local governance.

Estratégias de integração das práticas assistenciais de saúde e de vigilância sanitária no contexto de implementação da Rede Cegonha / Strategies for integration of health care practices and sanitary surveillance in the context of the implementation of Rede Cegonha - a Brazilian mother and infant health care network

As mortalidades maternas e infantis têm sido objeto de análise ao longo da história da saúde coletiva no Brasil e diversas têm sido as estratégias de enfrentamento propostas. O Ministério da Saúde tem trabalhado nesse sentido, sendo a estratégia da Rede Cegonha a mais recente política nesse contexto. Tendo em vista o princípio da integralidade e a conformação do Sistema Único de Saúde (SUS) em redes de atenção, faz-se necessária efetiva integração das práticas em saúde desenvolvidas, dentre as quais estão as ações de Vigilância Sanitária (Visa). Considerando que a integração de práticas assistenciais e de Visa pode contribuir para melhorias nas taxas de mortalidade citadas, este artigo é decorrente de uma pesquisa qualitativa que analisou a integração destas ações em quatro municípios do Estado de São Paulo: Campinas, Indaiatuba, Jaguariúna e Santa Bárbara D'Oeste. A pesquisa foi realizada através de entrevistas com gestores de Visa e de saúde da mulher, e os dados foram analisados através da técnica de análise temática. Os resultados convergem com outros estudos, identificando o isolamento das práticas assistenciais e de Visa. A inserção da Visa nos espaços coletivos de gestão mostra-se estratégia em potencial para o planejamento e execução das ações de saúde no contexto estudado.

Mother and infant mortality has been the scope of analysis throughout the history of public health in Brazil and various strategies to tackle the issue have been proposed to date. The Ministry of Health has been working on this and the Rede Cegonha strategy is the most recent policy in this context. Given the principle of comprehensive health care and the structure of the Unified Health System in care networks, it is necessary to ensure the integration of health care practices, among which are the sanitary surveillance actions (SSA). Considering that the integration of health care practices and SSA can contribute to reduce mother and infant mortality rates, this article is a result of qualitative research that analyzed the integration of these actions in four cities in the State of São Paulo/Brazil: Campinas, Indaiatuba, Jaguariúna and Santa Bárbara D'Oeste. The research was conducted through interviews with SSA and maternal health managers, and the data were evaluated using thematic analysis. The results converge with other studies, identifying the isolation of health care practices and SSA. The insertion of SSA in collectively-managed areas appears to be a potential strategy for health planning and implementation of actions in the context under scrutiny.

The Early Emergence of Temporal Reference in Mother-Child Multimodal Communication / Emergencia temprana de la referencia temporal en la comunicación multimodal entre madre-niño

The study longitudinally explores the early emergence of temporal reference to objects/events that are either present or absent in time while mothers and children use and combine pointing and verbal references. Over one year of observations and in five separate sessions, eight Spanish mothers and their one- and two-year-old babies were observed while performing daily routines at home. The results indicated that overall mothers and children used more verbs referring to the present frame than to the past and future frames. As compared with the production of utterances accompanied by pointing, children were more likely to produce present references in the young group and displaced references (mostly near past and near future) in the older group when utterances were produced without pointing. Mothers closely preceded or accompanied the children's verbal and gestural referential production to either immediate or displaced referents across ages, indicating that they systematically engage their children in talking about the present and especially about the future.

El estudio explora de forma longitudinal la aparición temprana de la referencia temporal de los objetos/eventos que están presentes o ausentes en el tiempo, mientras que las madres y los niños usan y combinan señales y referencias verbales. Más de un año de observaciones y en cinco sesiones separadas, ocho madres españolas y sus bebés de uno y dos años de edad se observaron en el desempeño de las rutinas diarias en el hogar. Los resultados indicaron que las madres en general y los niños utilizan más verbos que se refieren al marco actual que a las situaciones pasadas y futuras. En comparación con la producción de los enunciados acompañados de señalar, los niños eran más propensos a producir referencias presentes en el grupo de jóvenes y referencias desplazadas (en su mayoría cerca de pasado y futuro cercano) en el grupo de mayor edad cuando se produjeron declaraciones sin apuntar. Las madres más facilmente precedian o acompañaban de forma verbal y gestual la producción referencial de los niños ya sea a los referentes inmediatos o desplazadas en todas las edades, lo que indica que se dedican sistemáticamente a sus hijos en hablar sobre el presente y especialmente sobre el futuro.

Perfil sociodemográfico e de saúde de mulheres soropositivas em um pré-natal de alto risco / Socio-demographic and health profile of seropositive women in high-risk pre-natal care / Perfil sociodemográfico y de salud de mujeres seropositivas en un prenatal de alto riesgo

Estudo transversal, descritivo e documental, o qual descreve o perfil sociodemográfico e de saúde das 47 gestantes soropositivas para o vírus da imunodeficiência humana em um pré-natal de alto risco, com corte temporal de 2008 a 2012. O perfil caracterizou-se por gestantes com idade média de 27 anos, não brancas, com escolaridade entre o Ensino Fundamental e Médio, em união estável, donas de casa, residindo no interior do Estado, primigestas ou secundigestas e primíparas, com média de cinco consultas pré-natais, iniciado com 14 semanas de gestação ou mais, em uso de Biovir® e Kaletra®, e negaram uso de drogas e diagnóstico para o vírus anterior à gestação atual. Concluiu-se ser necessário conhecer o perfil da gestante soropositiva visando planejar ações que favoreçam a assistência; padronizar os registros e readequar o pré-natal de alto risco segundo as diretrizes do Ministério da Saúde do Brasil.

This transversal, descriptive and documental study describes the socio-demographic and health profile of 47 pregnant women, seropositive for the Human Immunodeficiency Virus in high-risk prenatal care, between 2008 - 2012. The profile is characterized by pregnant women with a mean age of 27 years old, non-whites, with an educational level of Junior and Senior High School, in stable relationships, housewives, living in non-metropolitan parts of the state, primigravidas or secundigravidas and primiparous, with a mean of five prenatal consultations, initiated at the 14th week of pregnancy or later, using Biovir® and Kaletra®, and who denied taking drugs and being diagnosed for the virus prior to the current pregnancy. It is concluded that it is necessary to know the profile of the seropositive pregnant woman with a view to: planning actions promoting care; standardizing the records, and; re-adjusting high-risk prenatal care in accordance with Brazilian Ministry of Health guidelines.

Estudio transversal, descriptivo y documental, lo cual describe el perfil sociodemográfico y de salud de 47 gestantes seropositivas para el virus de la inmunodeficiencia humana en un prenatal de alto riesgo, con corte temporal de 2008 a 2012. El perfil se caracterizó por contener gestantes con edad media de 27 años, no blancas, con escolaridad entre la Enseñanza Fundamental y Medio, en unión estable, amas de casa, que vivían en interior del Estado, de primera o segunda gestación y primíparas, con media de cinco consultas prenatales, iniciadas con 14 semanas de gestación o más, en uso de Biovir® y Kaletra®. Las mujeres negaron usar drogas, así como el hecho del diagnóstico para el virus ser anterior a la gestación actual. Se concluye que es necesario conocer el perfil de la gestante seropositiva con fines de planear acciones que ayuden en la asistencia; estandarizar los registros y readecuar el prenatal de alto riesgo de acuerdo a las directrices del Ministerio de la Salud de Brasil.

Aleitamento materno e cuidado: uma proposta winnicotiana / Breastfeeding and care: winnicott?s purpose / Lactancia materna y cuidado: una propuesta winnicitiana

As campanhas de incentivo ao aleitamento materno há décadas vem alertando para os benefícios de tal prática, tanto do ponto de vista fisiológico quanto emocional. Porém, para que esses benefícios estejam presentes, é preciso que a mãe apresente uma disponibilidade afetiva para a amamentação e a atuação dos profissionais da saúde pode interferir consideravelmente nesta prática. Considerando a relevância deste tema nos tempos atuais e o fato de Winnicott ter se dedicado à orientação aos profissionais da saúde, o presente estudo almeja apresentar uma reflexão teórica acerca do aleitamento materno, a partir da teoria winnicottiana, e as implicações da mesma para o cuidado em saúde materno-infantil. Dentre as conclusões obtidas, destacamos que cabe aos profissionais facilitar a manifestação dos cuidados maternos, processo que pertence à mãe. O respeito ao tempo, ritmo e desejo da mãe por amamentar é um dos principais ensinamentos winnicottianos às equipes de saúde.

Campaigns to encourage breastfeeding have been informing people for decades about the benefits of this practice, both physiologically and emotionally. However, for this to happen it is necessary the mother to show an affective availability in breastfeeding, and health professionals may considerably affect this practice. Considering the current relevance of this topic and the fact that Winnicott is dedicated to guiding health professionals, this study aims to present a theoretical reflection on breastfeeding from the Winnicottian theory and its implications in mother-child health care. Among the conclusions, we highlight that the professionals should facilitate the manifestation of mothering care, a process which belongs to the mother. Respecting the mother?s time and her breastfeeding rhythm and wishes is one of the main Winnicottian teachings to the health team.

Las campañas de incentivo a la lactancia materna desde hace décadas ha estado advirtiendo para los beneficios de tal práctica, tanto del punto de vista fisiológico cuanto emocional. Pero, para que dichos beneficios estén presentes, es necesario que la madre presente una disponibilidad afectiva para la amamantar y la actuación de los profesionales de la salud puede interferir considerablemente en esta práctica. Considerando la relevancia de este tema en los tiempos actuales y el hecho de Winnicott haberse dedicado a la orientación de los profesionales de la salud, el presente estudio almeja presentar una reflexión teórica sobre la lactancia materna, a partir de la teoría Winnicottiana, y las implicaciones de la misma para el cuidado con la salud materno-infantil. Entre las conclusiones obtenidas, destacamos que cabe a los profesionales facilitar la manifestación de los cuidados maternos, proceso que pertenece a la madre. Respetar el tiempo, ritmo y deseo de la madre de amamantar es una de las principales enseñanzas winnicottianas a los equipos de salud.