ABSTRACT
We used a mixed design study to analyze the inequalities and inequities in Maternal Mortality (MM) for Chocó (Colombia) between 2010-2018. The quantitative component consisted of an analytical ecological design, where proportions, ratios, measures of central tendency and rates ratios, rate difference, Gini and concentration indices were calculated to measure inequalities. The qualitative component had a phenomenological and interpretive approach. One hundred thirty-one women died in Choco between 2010-2018. The Maternal Mortality Ratio was 224/100.000 live births. The Gini coefficient was 0.35, indicating inequality in the distribution of the number of MM with respect to live births. The health service offers have been concentrated in the private sector in urban areas (77%). The exercise of midwifery has played an important role in maternal and perinatal care processes, especially in territories where the State has been absent. Nevertheless, it occurs in complex circumstances such as the armed conflict, lack of transportation routes, and income deficits, affecting the timelines and care quality for these vulnerable groups. MM in Chocó has been a consequence of deficiencies in the health system and weaknesses in its infrastructure (absence of a high level of maternal-perinatal care). This is in addition to the territory's geographical characteristics, which increase vulnerability and health risks for women and their newborns. In Colombia, as well as in other countries, many maternal and newborn deaths are preventable because their causes are due to social injustices.
Subject(s)
Maternal Health Services , Midwifery , Pregnancy , Humans , Infant, Newborn , Female , Maternal Mortality , Colombia/epidemiology , Income , Socioeconomic FactorsABSTRACT
Comparar el nivel de implementación del Modelo de Vigilancia de la Morbilidad Materna Extrema (MVMME) y las principales barreras y facilitadores respecto de la implementación en dos grupos de instituciones prestadoras de servicios de salud (IPS) de Colombia.Materiales y métodos: estudio mixto, que emplea técnicas de información cuantitativa (instrumento semiestructurado) y cualitativa (entrevista a profundidad). Las IPS en las que se inició el modelo IPS piloto (IPSP) fueron comparadas con otro grupo de IPS que no participó en la inserción inicial del mismo, las que se denominarán IPS control (IPSC). Ambas fueron seleccionadas por conveniencia en conjunto con el Ministerio de Salud. El nivel de implementación se presenta como proporción por institución. La información se trianguló para complementar la información de los diferentes componentes de la implementación del MVMME.Resultados: hubo diferencias en la implementación según el grupo de IPS, en IPSP hubo mayor difusión de protocolos, detección, notificación, flujo de la información, análisis y toma de decisiones. En IPSC hubo más dificultades con la asignación de la causa principal, definir criterios de evitabilidad e identificar demoras. El volumen de profesionales, las horas promedio mes y los perfiles eran mayores en IPSP que en IPSC. El rango del nivel de implementación entre las IPSP varió entre el 73 y el 94 %; en el grupo de IPSC el rango estuvo entre 41 y 90 %. En las IPSP había mayor claridad sobre el papel del MVMME como herramienta para mejorar la calidad en la atención de las gestantes. En IPSC, si bien consideraban que el modelo ayudaba a mejorar la calidad, era interpretado como una sobrecarga de trabajo.Conclusiones: el mayor desarrollo en IPSP podría estar asociado a un mayor acompañamiento por parte del MS-UNFPA, y una mayor voluntad política e institucional para su implementación...
To compare the level of implementation of the Extreme Maternal Morbidity Surveillance Model (EMMSM). and the main barriers and facilitators to the implementation in two groups of Healthcare Service Providers (HSP) in Colombia.Materials and methods: Mixed study using quantitative (semi-structured tool) and qualitative (In-depth interview) information techniques. The healthcare service providers in which the pilot model was implemented (pHSP) were compared with another group of healthcare institutions that did not participate in the initial implementation, hereinafter called control HSP (cHSP). They were are all selected jointly with the Ministry of Health (MoH) based on convenience. The level of implementation is presented in terms of proportions for each healthcare institution. The information was crossed-referenced in order to supplement the data of the various components of the EMMSM implementation.Results: Differences in implementation were found for each IPS group. In the IPSP there was greater dissemination of the protocols, detection, notification, information flows and decision-making.In the IPSC group there were more difficulties in determining main causes, defining avoidability criteria, and identifying delays. The numbers of professional staff, mean monthly hours and profiles were higher among the IPSP when compared with the IPSC...
