RESUMO
BACKGROUND: Although it is now widely recognized that reductions in maternal mortality and improvements in women's health cannot be achieved through simple, vertical strategies, few programs have provided successful models for how to integrate services into a comprehensive program for maternal health. We report our experience in rural Lesotho, where Partners In Health (PIH) in partnership with the Ministry of Health and Social Welfare implemented a program that provides comprehensive care of pregnant women from the community to the clinic level. METHODS: Between May and July 2009, PIH trained 100 women, many of whom were former traditional birth attendants, to serve as clinic-affiliated maternal health workers. They received performance-based incentives for accompanying pregnant women during antenatal care (ANC) visits and facility-based delivery. A nurse-midwife provided ANC and delivery care and supervised the maternal health workers. To overcome geographic barriers to delivering at the clinic, women who lived far from the clinic stayed at a maternal lying-in house prior to their expected delivery dates. We analyzed data routinely collected from delivery and ANC registers to compare service utilization before and after implementation of the program. RESULTS: After the establishment of the program, the average number first ANC visits increased from 20 to 31 per month. The clinic recorded 178 deliveries in the first year of the program and 216 in the second year, compared to 46 in the year preceding the program. During the first two years of the program, 49 women with complications were successfully transported to the district hospital, and no maternal deaths occurred among the women served by the program. CONCLUSIONS: Our results demonstrate that it is possible to achieve dramatic improvements in the utilization of maternal health services and facility-based delivery by strengthening human resource capacity, implementing active follow-up in the community, and de-incentivizing home births.
Assuntos
Serviços de Saúde Materna/organização & administração , Bem-Estar Materno , Serviços de Saúde Comunitária , Atenção à Saúde , Parto Obstétrico , Feminino , Humanos , Lesoto , Mortalidade Materna , Tocologia , Enfermeiros Obstétricos , Obstetrícia/educação , Obstetrícia/métodos , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/organização & administração , Desenvolvimento de ProgramasRESUMO
In 2000, all 191 United Nations member states agreed to work toward the achievement of a set of health and development goals by 2015. The achievement of these eight goals, the Millennium Development goals (MDGs) is highly dependent on improving the status of women, who play a key role in health and education in families and communities around the world. Yet structural violence, defined as the systematic exclusion of a group from the resources needed to develop their full human potential, remains a significant barrier against women's development and threatens the achievement of the MDGs. Although sound evidence has long existed for improving women's survival, the will to address women's health concretely and holistically is only recently gaining the advocacy needed to change policy. Concrete examples of the integration of approaches to mitigate structural violence within the delivery of health services do exist and should be incorporated into global advocacy for women's health.
Assuntos
Prioridades em Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Saúde da Mulher , Direitos da Mulher , Defesa do Consumidor , Países em Desenvolvimento , Feminino , Objetivos , Política de Saúde , Promoção da Saúde , Programas Gente Saudável , Humanos , Cooperação Internacional , Mortalidade Materna , Nações UnidasRESUMO
Peripheral neuropathy, or distal sensory polyneuropathy (DSPN), is the most common neurological problem in HIV disease. DSPN also represents a complex symptom that occurs because of peripheral nerve damage related to advanced HIV disease and in association with the use of antiretroviral therapy-particularly in individuals treated with dideoxynucleosides. Although DSPN is a frequent symptom, the specific pathophysiology is not well understood. The HIV-related neuropathies are commonly categorized as distal sensory polyneuropathies, although antiretroviral toxic neuropathies are described in the literature. Recently, mitochondrial toxicity has been identified as a possible etiology of DSPN. As individuals with HIV/AIDS survive longer, often living for decades with the disease, chronic symptoms like DSPN must be addressed. Pharmacologic approaches, complementary therapies, and self-care behaviors that may improve quality of life and limit symptoms of DSPN are important interventions for clinicians and those living with HIV/AIDS to consider in the management of peripheral neuropathy.
Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV , Polineuropatias/etiologia , Polineuropatias/terapia , Algoritmos , Terapia Antirretroviral de Alta Atividade/métodos , Terapia Antirretroviral de Alta Atividade/enfermagem , Biópsia , Causalidade , Doença Crônica , Terapias Complementares , Árvores de Decisões , Monitoramento de Medicamentos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Papel do Profissional de Enfermagem , Avaliação em Enfermagem , Exame Físico , Polineuropatias/diagnóstico , Polineuropatias/epidemiologia , Prevalência , Qualidade de Vida , Medição de Risco , AutocuidadoRESUMO
Multidrug-resistant tuberculosis (MDR-TB) presents an increasing threat to global tuberculosis control. Many crucial management issues in MDR-TB treatment remain unanswered. We reviewed the existing scientific research on MDR-TB treatment, which consists entirely of retrospective cohort studies. Although direct comparisons of these studies are impossible, some insights can be gained: MDR-TB can and should be addressed therapeutically in resource-poor settings; starting of treatment early is crucial; aggressive treatment regimens and high-end dosing are recommended given the lower potency of second-line antituberculosis drugs; and strategies to improve treatment adherence, such as directly observed therapy, should be used. Opportunities to treat MDR-TB in developing countries are now possible through the Global Fund to Fight AIDS, TB, and Malaria, and the Green Light Committee for Access to Second-line Anti-tuberculosis Drugs. As treatment of MDR-TB becomes increasingly available in resource-poor areas, where it is needed most, further clinical and operational research is urgently needed to guide clinicians in the management of this disease.