Implicaciones familiares y sociales de la muerte materna / Family and social implications of maternal death

Introducción: La mortalidad materna es considerada un indicador sensible al desarrollo social, porque muchas de estas muertes ocurren por razones evitables, vinculadas a condiciones de pobreza. Hay datos estadísticos sobre el número de muertes maternas a nivel internacional y local, que resaltan la magnitud del problema, así como el conocimiento científico de las causas de estos fallecimientos; pero escasa información publicada sobre el impacto familiar y el desequilibrio que se produce cuando ocurre una muerte materna, situación que trae consigo desconocimiento sobre la real situación de los hijos huérfanos y la familia. Objetivo: Conocer las implicaciones familiares y sociales de la muerte materna a través de la revisión sistemática de la literatura científica publicada. Materiales y métodos: Se realizó una búsqueda en las bases de datos incluidas en los servicios LILACS, ProQuest, MEDLINE y en la biblioteca virtual de salud SciELO. La muestra final fue de 20 artículos. Resultados: Los estudios mostraron que la pérdida inesperada de la madre genera consecuencias emocionales, económicas y de salud en todos los miembros del hogar. Conclusiones: Los hallazgos indican que esta problemática debe ser abordada de manera integral con el fin de mitigar el impacto que genera la muerte materna.

Introduction: Maternal mortality is considered a sensitive indicator of social development, as many of these deaths occur for preventable reasons, linked to poverty. There is statistical data on the number of internationally and locally maternal deaths, which highlights the magnitude of the problem as well as the scientific knowledge of the causes of these deaths; but there is limited published information on the family impact and imbalance that occurs when a maternal death occurs, which leads to lack of knowledge about the real situation of orphaned children and family. Objective: To know the family and social implications of maternal death through a systematic review of the published scientific literature. Materials and methods: A search in the databases including LILACS, PROQUEST, MEDLINE services and virtual health library SCIELO was conducted. The final sample consisted of 20 articles. Results: The studies showed that the unexpected loss of the mother generates emotional, economic and health consequences for all household members. Conclusions: The findings indicate that this problem must be addressed comprehensively in order to mitigate the impact generated by maternal death.

Comparison of the Quality of Life of Vulnerable Children Resident in Household and Those Resident in Institution in Jos Nigeria.

Background: There are over 143 million orphans globally, however, sub-Saharan Africa/Asian regions account for over 80% of the global burden (143 million orphans), Nigeria inclusive with over 10 million orphans. This has caused a crisis of shelter, as more children drift towards institutional care rather than staying in communities that are laden with a high prevalence of poverty (70% in Nigeria). This development is not the best practice in the care of Orphans and vulnerable children (OVC) based on national policy of OVC care which recommends Household rather than institutional care. Since studies have shown that Institutional care has a negative impact on a child, the place of placement is thus crucial to the outcome of vulnerable children (VC) which can easily be assessed by measuring the Quality of life (QOL). The aim of this study is to compare the QOL of VC living in Household against those living in Institutions. Methods: A cross-sectional comparative study involving 202 VC (aged 6-18 years) was conducted. VC were sampled using the multistage sampling technique across two orphanages and three communities located in suburban areas in Jos East, Jos North and Jos South Local Government Area. Outcome Measure: Quality of Life was determined using the WHOQOL BY (brief for youth) tool after validity and reliability test was done. The total score was transformed into a score of 1-100, with higher score implying higher QOL. Data generated were processed and analyzed using the EPI info version 3.5.1 statistical software. A score < -1 standard deviation (SD) from mean was considered poor, ±1 SD to -1 SD was considered fair and > ±1 SD was considered good. The student t-test was used for comparison of means while chi-square test or fisher exact test was used for comparison of categorical variables. In all statistical tests a p values ≤ 0.05 was considered significant. Results: The QOL score for the study population ranged between 47.2 to 95.2, the mean QOL was 75.2±8.1. The median and mode were both equal (QOL score of 75.2). Comparatively, IVC had higher mean QOL score of 76.9±7.0 compared to HVC 73.3±8.9 (p=0.002). IVC had higher scores compared to HVC in the following domain: psychological (p=0.05), social (p=0.004) and environmental (p=0.002). Conclusion: The QOL of VC in Institution is better than children in suburban Households in Jos Nigeria. IVC are better psychosocially and environmentally. However, a Qualitative study is needed for more depth.

Población infanto-juvenil alojada en hogares de la Ciudad Autónoma de Buenos Aires que transitó por un programa de atención comunitaria durante 2010 / Children and youth population living in institutions in Buenos Aires City and covered by a community care program in 2010

INTRODUCCIÓN: los niños y adolescentes institucionalizados representan un grupo vulnerable. Es importante conocer su situación y necesidades específicas, así como losrecursos requeridos para su adecuada atención. OBJETIVOS: Explorar las características y la trayectoria institucional de los niños y adolescentes institucionalizados en hogares convivenciales, terapéuticos y maternales de la Ciudad Autónoma de Buenos Aires (CABA). Explorar el abordaje que recibieron desde el campode la salud mental, en particular en el Programa de Atención Comunitaria (PAC) durante 2010. MÉTODOS: Se utilizó un diseño descriptivo-exploratorio de tipo cualitativo. Se analizaron variables vinculadas a la trayectoria institucional y al abordaje recibido desde el campo de la salud mental, a partir de la exploración de lashistorias clínicas y de entrevistas semiestructuradas a trabajadores de hogares. RESULTADOS: Se analizaron 29 casos de niños y adolescentes alojados en hogares de CABA. El estudio evidenció prolongados períodos de permanencia, insuficiencia de recursos para la adecuada atención, obstáculos para la inserción social/comunitaria, dificultades en el trabajo de vinculación familiar y en el logro del egreso, situaciones de tensión y conflicto entre las diversas instituciones intervinientes y barreras de accesibilidad a los servicios de salud mental, pero un abordaje eficaz en el PAC. CONCLUSIONES: La restitución de los derechos vulnerados es una cuenta pendiente. Es indispensable adecuar las prácticas a la legislación local y a los postulados de la Convención sobre los Derechos del Niño. También resulta prioritario capacitar al recurso humano que asiste a esta población.

INTRODUCTION: children and adolescents living in institutions represent a vulnerable group. It is important to know their situation and specific needs, as well as theresources required for a proper care. OBJECTIVES: To explore the characteristics and institutional path of children and adolescents living in cohabiting, therapeutic and maternalhomes in Buenos Aires city. To explore the approach they received from the field of mental health particularly in theCommunity Care Program (CCP) in 2010. METHODS: A qualitative, descriptive and exploratory design was used, with an intentional non-probabilistic sample. The institutionaltrajectory and the approach received from the field of mental health were analyzed by exploring medical records and conducting semi-structured interviews to workers homes. RESULTS: A total of 29 cases of children and adolescents living in Buenos Aires Dwelling Homes were analyzed. The study showed long periods of institutionalization, insufficient resources for the proper care, obstacles for social/communityintegration, difficulties regarding family bonds and exit from the institution, tension and conflicts between institutions involved, and barriers to mental health services, but an efficient approach in the CCP. CONCLUSIONS: The restitution of violated rights is still an ongoing issue. Practices should be established according to local law and to the principles set forth by the Convention on the Rights of the Child. Thetraining of human resources devoted to this population is also a priority.

Improving Education Opportunity, Health, and Quality of Life of Orphans and Vulnerable Children: The Sustainable Action against HIV and AIDS in Communities (SAHACOM).

Aims: This study evaluated the impact of the Sustainable Action against HIV and AIDS in Communities (SAHACOM) project in improving education opportunity, health, and quality of life of orphans and vulnerable children (OVC) in Cambodia. Study Design: Operational intervention study. Place and Duration of the Study: Five provinces in Cambodia, from 2010 to 2014. Methodology: A two-stage cluster sampling method was used to select 756 OVC at midterm and 785 OVC at end line for face-to-face interviews. Outcome indicators from end line (2014) were compared to those obtained at midterm (2012). Where possible, the data were also compared with data obtained from baseline documentation (2010). Results: The percentage of OVC receiving external support for child care surged from 30.0% at baseline to 84.0% at midterm but decreased to 76.8% at end line. Compared to children at midterm, children at end line were significantly more likely to report having attended school regularly in the past 12 months, less likely to suspend study in order to work to help feed the family in the past 12 months, less likely to respond that food supports and other basic needs such as clothes and other household materials were the most important needs for their family today, more likely to perceive that supports for child education were the most important for their family today, less likely to report that their family reduced times for daily meals due to the shortage of food in the past 12 months, and more likely to rate their general health and overall quality of life as fair, good, or very good. Conclusion: This study indicates significant impact of the SAHACOM on education, health, and quality of life of OVC in Cambodia. This community-based model should be adapted for future interventions, taking into account the available resources.