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1.
Int Health ; 10(3): 163-171, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29618017

RESUMO

Background: Helping Babies Breathe (HBB), a basic neonatal resuscitation curriculum, improves early neonatal mortality in low-resource settings. Our goal was to determine retention of resuscitation skills by different cadres of providers using the approved HBB Spanish translation in a rural clinic and community hospital in Honduras. Methods: Twelve clinic and 37 hospital providers were trained in 1 d HBB workshops and followed from July 2012 to February 2014. Resuscitation skills were evaluated by objective structured clinical evaluations (OSCEs) at regular intervals. Clinic providers practiced monthly, whereas hospital providers were randomized to monthly practice for 6 months vs three consecutive practices at 3, 5 and 6 months. Results: In the rural clinic, follow-up OSCE assessment showed rapid loss of skills by 1 month after HBB training. For all providers, repeated monthly testing resulted in improvements and maintenance of OSCE performance. In the community hospital, over all time points, the group with monthly OSCEs had 2.9 greater odds of passing compared with the group who practiced less frequently. Physicians were found to have 4.3 times greater odds of passing compared with nurses. Conclusions: Rapid loss of resuscitation skills occurs after an initial training. Repeated practice leads to retention of skills in all types of providers. Further investigation is warranted to determine the clinical correlation of neonatal outcomes after HBB training.


Assuntos
Asfixia Neonatal/terapia , Competência Clínica , Pessoal de Saúde/educação , Ressuscitação/educação , Currículo , Feminino , Pessoal de Saúde/estatística & dados numéricos , Honduras , Hospitais Comunitários , Humanos , Recém-Nascido , Masculino , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural
2.
BJOG ; 125(2): 119-129, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27704677

RESUMO

OBJECTIVE: Stillbirths are among the most common adverse pregnancy outcomes, with 98% occurring in low-income countries. More than one-third occur in sub-Saharan Africa (SSA). However, the medical conditions causing stillbirths and interventions to reduce stillbirths from these conditions are not well documented. We estimated the reductions in stillbirths possible with combinations of interventions. DESIGN: We developed a computerised model to estimate the impact of various interventions on stillbirths caused by the most common conditions. The model considered the location of obstetric care (home, clinic or hospital) and each intervention's efficacy, penetration and utilisation. Maternal transfers were also considered. SETTING AND POPULATION: Pregnancies in SSA in 2012. METHODS: For each condition, we created a series of scenarios involving different combinations of interventions and modelled their impact on stillbirth rates. MAIN OUTCOME MEASURES: Stillbirths associated with various maternal and fetal conditions and the percentage reduction with various interventions. RESULTS: Eight to ten maternal and fetal conditions were responsible for most stillbirths, but none for more than 15%. The most common conditions causing stillbirths in SSA include obstructed labour and uterine rupture, fetal distress and umbilical cord complications, fetal growth restriction, pre-eclampsia/eclampsia, and placental abruption/placenta praevia. Syphilis and malaria contribute smaller numbers. Reducing stillbirths requires appropriate diagnosis and management of each condition, usually including hospital care for monitoring and delivery, often by caesarean section. Maternal syphilis and malaria were the only conditions for which outpatient management alone reduced stillbirth. CONCLUSIONS: Most stillbirths in low-income countries occur at term and during labour and therefore are preventable by appropriate obstetric care. Management focused on the maternal and fetal conditions that cause stillbirths is necessary to achieve stillbirth rates approaching those found in high-income countries. TWEETABLE ABSTRACT: Reducing stillbirth incidence requires appropriate management of each causative condition and often caesarean delivery.


Assuntos
Serviços de Saúde Materna , Modelos Teóricos , Avaliação de Resultados em Cuidados de Saúde , Cuidado Pré-Natal , Natimorto/epidemiologia , África Subsaariana/epidemiologia , Feminino , Humanos , Complicações do Trabalho de Parto/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Resultado da Gravidez
3.
J Perinatol ; 37(10): 1153-1160, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28726790

RESUMO

BACKGROUND: To evaluate changes in neonatal resuscitation and postnatal care following Helping Babies Breathe (HBB) training at a community hospital in rural Honduras. We hypothesized that HBB training would improve resuscitation and essential newborn care interventions. METHODS: Direct observation and video recording of delivery room care spanned before and after an initial HBB workshop held in August 2013. Rates of essential newborn care interventions were compared in resuscitations performed by individuals who had and had not received HBB training, and run charts recording performance of newborn care practices over time were developed. RESULTS: Ten percent of deliveries (N=250) were observed over the study period, with 156 newborn resuscitations performed by individuals without HBB training, compared to 94 resuscitations performed by HBB trainees. After HBB training, significant improvements were seen in skin-to-skin care, breastfeeding within 60 min of age, and delayed cord clamping after 1 min (all P<0.01). More babies cared for by HBB trainees received basic neonatal resuscitation such as drying and stimulation. Run charts tracking these practices over time showed significant improvements after HBB training that were sustained during the study period, but remained below ideal goals. With improvement in drying/stimulation practices, fewer babies required bag/mask ventilation. CONCLUSION: In a rural Honduran community hospital, improvements in basic neonatal resuscitation and postnatal essential newborn care practices can be seen after HBB training. Further improvements in newborn care practices may require focused quality improvement initiatives for hospitals to sustain high quality care.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Capacitação em Serviço/métodos , Melhoria de Qualidade , Ressuscitação/educação , Estudos de Casos e Controles , Competência Clínica , Feminino , Honduras , Hospitais Comunitários , Humanos , Recém-Nascido , Masculino , Assistência Perinatal/métodos , Gravidez , População Rural , Fatores de Tempo
4.
J Perinatol ; 35(8): 547-52, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25927274

RESUMO

OBJECTIVE: Leptin is an adipokine that regulates energy homeostasis. The objective of this study was to establish a gestational age-specific standard for amniotic fluid leptin (AFL) levels and examine the relationship between AFL, maternal overweight and fetal growth restriction. STUDY DESIGN: Amniotic fluid was obtained at mid-gestation from singleton gravidas, and leptin was quantified using enzyme-linked immunosorbent assay. Amniotic fluid samples from 321 term pregnancies were analyzed. Clinical data, including fetal ultrasound measurements and maternal and infant characteristics, were available for a subset of patients (n=45). RESULTS: The median interquartile range AFL level was significantly higher at 14 weeks' gestation (2133 pg ml(-1) (1703 to 4347)) than after 33 weeks' gestation (519 pg ml(-1) (380 to 761), P trend<0.0001), an average difference of 102 pg ml(-1) per week. AFL levels were positively correlated with maternal pre-pregnancy body mass index (BMI) (r=0.36, P=0.03) adjusting for gestational age at measurement, but were not associated with fetal growth. CONCLUSIONS: AFL levels are higher at mid-gestation than at late gestation, and are associated with maternal pre-pregnancy BMI.


Assuntos
Líquido Amniótico/metabolismo , Retardo do Crescimento Fetal/metabolismo , Leptina/análise , Leptina/normas , Sobrepeso/metabolismo , Peso ao Nascer , Índice de Massa Corporal , Ensaio de Imunoadsorção Enzimática , Feminino , Desenvolvimento Fetal , Idade Gestacional , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Placenta/patologia , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez
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