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[PMID]:29474397
[Au] Autor:Cranmer JN; Dettinger J; Calkins K; Kibore M; Gachuno O; Walker D
[Ad] Endereço:Emory University, Atlanta, Georgia, United States of America.
[Ti] Título:Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness.
[So] Source:PLoS One;13(2):e0184252, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. OBJECTIVE-METHOD: We compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial. FINDINGS: Although most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%. SIGNIFICANCE: Comparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade's intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted.
[Mh] Termos MeSH primário: Parto Obstétrico
Serviços de Saúde Materna/organização & administração
[Mh] Termos MeSH secundário: Pré-Escolar
Feminino
Seres Humanos
Lactente
Mortalidade Infantil
Recém-Nascido
Quênia/epidemiologia
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180224
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184252


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[PMID]:29389995
[Au] Autor:Dalinjong PA; Wang AY; Homer CSE
[Ad] Endereço:Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
[Ti] Título:Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana.
[So] Source:PLoS One;13(2):e0184830, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The free maternal health policy was implemented in Ghana in 2008 under the National Health Insurance Scheme (NHIS). The policy sought to eliminate out of pocket (OOP) payments and enhance the utilisation of maternal health services. It is unclear whether the policy had altered OOP payments for services. The study explored views on costs and actual OOP payments during pregnancy. The source of funding for payments was also explored. METHODS: A convergent parallel mixed methods design, involving quantitative and qualitative data collection approaches. The study was set in the Kassena-Nankana municipality, a rural area in Ghana. Women (n = 406) who utilised services during pregnancy were surveyed. Also, 10 focus groups discussions (FGDs) were held with women who used services during pregnancy as well as 28 in-depth interviews (IDIs) with midwives/nurses (n = 25) and insurance managers/directors (n = 3). The survey was analysed using descriptive statistics, focussing on costs from the women's perspective. Qualitative data were audio recorded, transcribed and translated verbatim into English where necessary. The transcripts were read and coded into themes and sub-themes. RESULTS: The NHIS did not cover all expenses in relation to maternal health services. The overall mean for OOP cost during pregnancy was GH¢17.50 (US$8.60). Both FGDs and IDIs showed that women especially paid for drugs and ultrasound scan services. Sixty-five percent of the women used savings, whilst twenty-two percent sold assets to meet the OOP cost. Some women were unable to afford payments due to poverty and had to forgo treatment. Participants called for payments to be eliminated and for the NHIS to absorb the cost of emergency referrals. All participants admitted the benefits of the policy. CONCLUSION: Women needed to make payments despite the policy. Measures should be put in place to eliminate payments to enable all women to receive services and promote universal health coverage.
[Mh] Termos MeSH primário: Pessoal Administrativo/psicologia
Atitude
Financiamento Pessoal
Pessoal de Saúde/psicologia
Serviços de Saúde Materna/economia
Programas Nacionais de Saúde/economia
[Mh] Termos MeSH secundário: Adulto
Antimaláricos/economia
Feminino
Gana
Seres Humanos
Cobertura do Seguro
Gravidez
Inquéritos e Questionários
Ultrassonografia Pré-Natal/economia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antimalarials)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180202
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184830


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[PMID]:29381745
[Au] Autor:Helleringer S; Arhinful D; Abuaku B; Humes M; Wilson E; Marsh A; Clermont A; Black RE; Bryce J; Amouzou A
[Ad] Endereço:Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
[Ti] Título:Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana.
[So] Source:PLoS One;13(1):e0192034, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Reducing neonatal and child mortality is a key component of the health-related sustainable development goal (SDG), but most low and middle income countries lack data to monitor child mortality on an annual basis. We tested a mortality monitoring system based on the continuous recording of pregnancies, births and deaths by trained community-based volunteers (CBV). METHODS AND FINDINGS: This project was implemented in 96 clusters located in three districts of the Northern Region of Ghana. Community-based volunteers (CBVs) were selected from these clusters and were trained in recording all pregnancies, births, and deaths among children under 5 in their catchment areas. Data collection lasted from January 2012 through September 2013. All CBVs transmitted tallies of recorded births and deaths to the Ghana Birth and deaths registry each month, except in one of the study districts (approximately 80% reporting). Some events were reported only several months after they had occurred. We assessed the completeness and accuracy of CBV data by comparing them to retrospective full pregnancy histories (FPH) collected during a census of the same clusters conducted in October-December 2013. We conducted all analyses separately by district, as well as for the combined sample of all districts. During the 21-month implementation period, the CBVs reported a total of 2,819 births and 137 under-five deaths. Among the latter, there were 84 infant deaths (55 neonatal deaths and 29 post-neonatal deaths). Comparison of the CBV data with FPH data suggested that CBVs significantly under-estimated child mortality: the estimated under-5 mortality rate according to CBV data was only 2/3 of the rate estimated from FPH data (95% Confidence Interval for the ratio of the two rates = 51.7 to 81.4). The discrepancies between the CBV and FPH estimates of infant and neonatal mortality were more limited, but varied significantly across districts. CONCLUSIONS: In northern Ghana, a community-based data collection systems relying on volunteers did not yield accurate estimates of child mortality rates. Additional implementation research is needed to improve the timeliness, completeness and accuracy of such systems. Enhancing pregnancy monitoring, in particular, may be an essential step to improve the measurement of neonatal mortality.
[Mh] Termos MeSH primário: Mortalidade da Criança
Serviços de Saúde Materna/organização & administração
[Mh] Termos MeSH secundário: Criança
Gana/epidemiologia
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180131
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0192034


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[PMID]:28453821
[Au] Autor:Do M; Wang W; Hembling J; Ametepi P
[Ad] Endereço:Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
[Ti] Título:Quality of antenatal care and client satisfaction in Kenya and Namibia.
[So] Source:Int J Qual Health Care;29(2):183-193, 2017 Apr 01.
[Is] ISSN:1464-3677
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: Despite much progress in maternal health service coverage, the quality of care has not seen parallel improvement. This study assessed the quality of antenatal care (ANC), an entry point to the health system for many women. Design: The study used data from recent Service Provision Assessment (SPA) surveys of nationally representative health facilities in Kenya and Namibia. Setting: Kenya and Namibia represent the situation in much of sub-Saharan Africa, where ANC is relatively common but maternal mortality remains high. Participants: The SPA comprised an inventory of health facilities that provided ANC, interviews with ANC providers and clients, and observations of service delivery. Interventions: Not applicable. Main Outcome Measures: Quality was measured in terms of structure and process of service provision, and client satisfaction as the outcome of service provision. Results: Wide variations in structural and process attributes of quality of care existed in both Kenya and Namibia; however, better structural quality did not translate to better service delivery process or greater client satisfaction. Long waiting time was a common problem and was generally more serious in hospitals and health centers than in clinics and smaller facilities; it was consistently associated with lower client satisfaction. The study also indicates that the provider's technical preparedness may not be sufficient to provide good-quality services and to ensure client satisfaction. Conclusions: Findings highlight important program implications, including improving ANC services and promoting their use at health clinics and lower-level facilities, and ensuring that available supplies and equipment are used for service provision.
[Mh] Termos MeSH primário: Satisfação do Paciente/estatística & dados numéricos
Cuidado Pré-Natal/organização & administração
Qualidade da Assistência à Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Feminino
Instalações de Saúde/recursos humanos
Instalações de Saúde/normas
Seres Humanos
Quênia
Serviços de Saúde Materna/organização & administração
Serviços de Saúde Materna/estatística & dados numéricos
Namíbia
Gravidez
Cuidado Pré-Natal/recursos humanos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/intqhc/mzx001


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[PMID]:29384306
[Au] Autor:Houngnihin RA; Sossou AJ
[Ti] Título:[Understanding failure of obstetric referral to the Cotonou University gynaecology and obstetrics clinic].
[Ti] Título:Comprendre le renoncement à la référence obstétricale à la Clinique universitaire de gynécologie et d?obstétrique de Cotonou..
[So] Source:Sante Publique;29(5):719-729, 2017 Dec 05.
[Is] ISSN:0995-3914
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:INTRODUCTION: Since 2000, in the context of the Millennium development goals, Benin has reinforced its obstetric referral system in order to reduce maternal mortality. However, structural, sociocultural and economic problems continue to affect this strategy. The Cotonou University gynaecology and obstetrics clinic (CUGO), at the top of the health pyramid, is emblematic of this situation. This study was designed to elucidate the stakes involved in referral to this hospital based on analysis of the perceptions and experiences of referral personnel. METHODS: Essentially qualitative data collection was conducted by means of in-depth semi-structured interviews from July to December 2015 involving 37 people, including referred women, healthcare personnel and caregivers. RESULTS: The poor quality of information given to women concerning the reasons for referral, the fear of caesarean section, considered to be inevitable, and the difficult relationships with health workers contribute to failure to comply with referral. Rumours concerning reception, waiting times and hospitalization conditions are other factors that must be taken into account. Finally, the distance from the woman's home is a decisive element in acceptance of referral by women and their families. CONCLUSION: Referral is generally perceived as necessary in the case of complications during pregnancy, by both referred women and healthcare personnel. However, differences in points of view are observed when the woman is referred to CUGO.
[Mh] Termos MeSH primário: Serviços de Saúde Materna
Ambulatório Hospitalar
Cooperação do Paciente
Encaminhamento e Consulta
[Mh] Termos MeSH secundário: Adolescente
Adulto
Benin
Comunicação
Feminino
Seres Humanos
Educação de Pacientes como Assunto
Gravidez
Complicações na Gravidez
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.3917/spub.175.0719


  6 / 12056 MEDLINE  
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Texto completo SciELO Saúde Pública
[PMID]:29364356
[Au] Autor:Monguilhott JJDC; Brüggemann OM; Freitas PF; d'Orsi E
[Ad] Endereço:Departamento Acadêmico de Saúde e Serviços, Instituto Federal de Educação, Ciência e Tecnologia de Santa Catarina, Florianópolis, SC, Brasil.
[Ti] Título:Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil.
[So] Source:Rev Saude Publica;52:1, 2018.
[Is] ISSN:1518-8787
[Cp] País de publicação:Brazil
[La] Idioma:por; eng
[Ab] Resumo:OBJECTIVE To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil. METHODS This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%. RESULTS Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49). CONCLUSIONS In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.
[Mh] Termos MeSH primário: Parto Obstétrico/normas
Humanismo
Trabalho de Parto/psicologia
Serviços de Saúde Materna/normas
Guias de Prática Clínica como Assunto
[Mh] Termos MeSH secundário: Adolescente
Adulto
Brasil
Criança
Comparação Transcultural
Estudos Transversais
Parto Obstétrico/psicologia
Família
Feminino
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Direitos do Paciente
Segurança do Paciente/normas
Gravidez
Relações Profissional-Paciente
Fatores Socioeconômicos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE


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[PMID]:28452911
[Au] Autor:Powell AM; DeVita JM; Ogburu-Ogbonnaya A; Peterson A; Lazenby GB
[Ad] Endereço:Department of Obstetrics and Gynecology, The Medical University of South Carolina, Charleston, SC.
[Ti] Título:The Effect of HIV-Centered Obstetric Care on Perinatal Outcomes Among a Cohort of Women Living With HIV.
[So] Source:J Acquir Immune Defic Syndr;75(4):431-438, 2017 08 01.
[Is] ISSN:1944-7884
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Elimination of perinatal transmission is possible but limited by missed care opportunities. Our objective was to investigate the effects of HIV-centered obstetric care (HCC) on missed care opportunities and perinatal HIV transmission in 2 obstetric cohorts at our institution from 2000 to 2014. METHODS: This was a retrospective cohort study of HIV-exposed mother-infant pairs delivering from 2000 to 2014, analyzed according to SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines. Before 2009, women received care in high-risk obstetric care (HRC); subsequently, an HCC service was established. Women who received HRC vs HCC obstetric care were compared to determine differences in maternal and neonatal outcomes. Continuous variables were compared with Student t test and Wilcoxon rank sum tests. Categorical variables were compared using χ test and Fisher exact test. Logistic regression analyses were performed to determine factors associated with outcomes of interest. RESULTS: Over 14 years, 161 women delivered 217 HIV-exposed infants; 78 (36%) women received HCC. Two perinatal HIV transmissions (1.5%) occurred in HRC group compared with none in the HCC group (P = 0.3). Women in HCC were more likely to have HIV RNA viral load <1000 copies per milliliter at delivery (12% vs 26%, P = 0.02), have a contraception plan before delivery (93% vs 60%, P < 0.001), return for postpartum evaluation (80% vs 63%, P = 0.01), and have undetectable HIV viral load postpartum (50 copies per milliliter vs 2067, P < 0.0001). CONCLUSIONS: HCC can potentially reduce the risk of perinatal HIV transmission by improving maternal virologic control during pregnancy and postpartum and increasing postpartum contraceptive use.
[Mh] Termos MeSH primário: Infecções por HIV/tratamento farmacológico
Infecções por HIV/prevenção & controle
Transmissão Vertical de Doença Infecciosa/prevenção & controle
Serviços de Saúde Materna
Assistência Centrada no Paciente/normas
Complicações Infecciosas na Gravidez/tratamento farmacológico
Qualidade da Assistência à Saúde/normas
[Mh] Termos MeSH secundário: Adulto
Fármacos Anti-HIV/uso terapêutico
Contagem de Linfócito CD4
Feminino
Seres Humanos
Recém-Nascido
Saúde Materna
Serviços de Saúde Materna/normas
Período Pós-Parto
Gravidez
Complicações Infecciosas na Gravidez/virologia
RNA Viral
Estudos Retrospectivos
Fatores de Risco
Estados Unidos/epidemiologia
Carga Viral
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents); 0 (RNA, Viral)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1097/QAI.0000000000001432


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[PMID]:29360311
[Au] Autor:Raduege TJ; Thomson Reuters Accelus..
[Ti] Título:Benefits and Services.
[So] Source:Issue Brief Health Policy Track Serv;2017:1-59, 2017 Dec 26.
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Benefícios do Seguro
Medicaid/organização & administração
[Mh] Termos MeSH secundário: Orçamentos
Administração de Caso
Criança
Serviços de Saúde da Criança
Serviços de Saúde Comunitária
Serviços de Saúde Bucal
Serviços de Planejamento Familiar
Governo Federal
Infecções por HIV
Serviços de Assistência Domiciliar
Seres Humanos
Cobertura do Seguro
Seguro de Serviços Farmacêuticos
Assistência de Longa Duração
Serviços de Saúde Materna
Serviços de Saúde Mental
Terapia Ocupacional
Patient Protection and Affordable Care Act
Modalidades de Fisioterapia
Governo Estadual
Telemedicina
Abandono do Uso de Tabaco
Transporte de Pacientes
Estados Unidos
Transtornos da Visão/terapia
Serviços de Saúde da Mulher
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE


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[PMID]:29337995
[Au] Autor:Jacobs C; Michelo C; Chola M; Oliphant N; Halwiindi H; Maswenyeho S; Baboo KS; Moshabela M
[Ad] Endereço:School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
[Ti] Título:Evaluation of a community-based intervention to improve maternal and neonatal health service coverage in the most rural and remote districts of Zambia.
[So] Source:PLoS One;13(1):e0190145, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A community-based intervention comprising both men and women, known as Safe Motherhood Action Groups (SMAGs), was implemented in four of Zambia's poorest and most remote districts to improve coverage of selected maternal and neonatal health interventions. This paper reports on outcomes in the coverage of maternal and neonatal care interventions, including antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) in the study areas. METHODOLOGY: Three serial cross-sectional surveys were conducted between 2012 and 2015 among 1,652 mothers of children 0-5 months of age using a 'before-and-after' evaluation design with multi-stage sampling, combining probability proportional to size and simple random sampling. Logistic regression and chi-square test for trend were used to assess effect size and changes in measures of coverage for ANC, SBA and PNC during the intervention. RESULTS: Mothers' mean age and educational status were non-differentially comparable at all the three-time points. The odds of attending ANC at least four times (aOR 1.63; 95% CI 1.38-1.99) and SBA (aOR 1.72; 95% CI 1.38-1.99) were at least 60% higher at endline than baseline surveillance. A two-fold and four-fold increase in the odds of mothers receiving PNC from an appropriate skilled provider (aOR 2.13; 95% CI 1.62-2.79) and a SMAG (aOR 4.87; 95% CI 3.14-7.54), respectively, were observed at endline. Receiving birth preparedness messages from a SMAG during pregnancy (aOR 1.76; 95% CI, 1.20-2.19) and receiving ANC from a skilled provider (aOR 4.01; 95% CI, 2.88-5.75) were significant predictors for SBA at delivery and PNC. CONCLUSIONS: Strengthening community-based action groups in poor and remote districts through the support of mothers by SMAGs was associated with increased coverage of maternal and newborn health interventions, measured through ANC, SBA and PNC. In remote and marginalised settings, where the need is greatest, context-specific and innovative task-sharing strategies using community health volunteers can be effective in improving coverage of maternal and neonatal services and hold promise for better maternal and child survival in poorly-resourced parts of sub-Saharan Africa.
[Mh] Termos MeSH primário: Serviços de Saúde da Criança/normas
Serviços de Saúde Materna/normas
População Rural
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Recém-Nascido
Gravidez
Adulto Jovem
Zâmbia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180210
[Lr] Data última revisão:
180210
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180117
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190145


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[PMID]:29236699
[Au] Autor:Solnes Miltenburg A; van der Eem L; Nyanza EC; van Pelt S; Ndaki P; Basinda N; Sundby J
[Ad] Endereço:Institute of Health and Society, Section for International Health, Faculty of Medicine, University of Oslo, Oslo, Norway.
[Ti] Título:Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study.
[So] Source:PLoS One;12(12):e0188279, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client's wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for response-based services, which should be assessed based on locally determined criteria.
[Mh] Termos MeSH primário: Serviços de Saúde da Criança/normas
Serviços de Saúde Materna/normas
Melhoria de Qualidade
Serviços de Saúde Rural/normas
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Lactente
Recém-Nascido
Gravidez
Tanzânia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188279



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