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Esubalew H, Messelu MA, Tarekegn BT, Admasu AT, Abrha NN, Terefe B. Time to full enteral feeding and its predictors among very low birth weight (VLBW) neonates admitted to the neonatal intensive care units (NICU) in comprehensive specialized hospitals in Northwest Ethiopia. BMC Pediatr 2024; 24:366. [PMID: 38807061 PMCID: PMC11131264 DOI: 10.1186/s12887-024-04719-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Time to full enteral feeding is the time when neonates start to receive all of their prescribed nutrition as milk feeds. Delayed to achieve full enteral feeding had resulted in short- and long-term physical and neurological sequelae. However, there are limited studies to assess the time to full enteral feeding and its predictors among very low birth-weight neonates in Ethiopia. Therefore, this study aimed to assess the time to full enteral feeding and its predictors among very low birth-weight neonates admitted to comprehensive specialized hospitals in Northwest Ethiopia. METHODS A multi-center institutional-based retrospective follow-up study was conducted among 409 VLBW neonates from March 1, 2019 to February 30, 2023. A simple random sampling method was used to select study participants. Data were entered into EpiData version 4.2 and then exported into STATA version 16 for analysis. The Kaplan-Meier survival curve together with the log-rank test was fitted to test for the presence of differences among groups. Proportional hazard assumptions were checked using a global test. Variables having a p- value < 0.25 in the bivariable Cox-proportional hazard model were candidates for multivariable analysis. An adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CI) was computed to report the strength of association, and variables having a P-value < 0.05 at the 95% confidence interval were considered statistically significant predictor variables. RESULT The median time to full enteral feeding was 10 (CI: 10-11) days. Very Low Birth-Weight (VLBW) neonates who received a formula feeding (AHR: 0.71, 95% CI: 0.53, 0.96), gestational age of 32-37 weeks (AHR: 1.66, 95% CI: 1.23, 2.23), without Necrotizing Enterocolitis (NEC) (AHR: 2.16, 95% CI: 1.65, 2.84), and single birth outcome (AHR: 1.42, 95% CI: 1.07, 1.88) were statistically significant variables with time to full enteral feeding. CONCLUSION AND RECOMMENDATIONS This study found that the median time to full enteral feeding was high. Type of feeding, Necrotizing Enterocolitis (NEC), Gestational Age (GA) at birth, and birth outcome were predictor variables. Special attention and follow-up are needed for those VLBW neonates with NEC, had a GA of less than 32 weeks, and had multiple birth outcomes.
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Affiliation(s)
- Hilena Esubalew
- Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia.
| | - Mengistu Abebe Messelu
- College of Medicine and Health Sciences, Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
| | - Bethelihem Tigabu Tarekegn
- College of Medicine and Health Sciences, School of Nursing, Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia
| | - Aster Tefera Admasu
- College of Medicine and health Sciences, School of Medicine, Department of Biomedical Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Nigussie Abrha
- College of Medicine and Health Sciences, School of Nursing, Department of Emergency and Critical Care Nursing, Univiersity of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- College of Medicine and Health Sciences, School of Nursing, Department of Community Health Nursing, University of Gondar, Gondar, Ethiopia
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Felipe LL, Albuquerque PC, Lopes JF, Zicker F, Fonseca BDP. [Regional inequalities in access to hospital birth in the state of Rio de Janeiro, Brazil: travel networks, distance, and time (2010-2019)]. CAD SAUDE PUBLICA 2024; 40:e00064423. [PMID: 38775609 PMCID: PMC11111170 DOI: 10.1590/0102-311xpt064423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/26/2023] [Accepted: 12/08/2023] [Indexed: 05/24/2024] Open
Abstract
Difficult access to birth care services is associated with infant and neonatal mortality and maternal morbidity and mortality. In this study, data from the Brazilian Unified National Health System (SUS) were used to map the evolution of geographic accessibility to hospital birth of usual risk in the state of Rio de Janeiro, Brazil, corresponding to 418,243 admissions in 2010-2011 and 2018-2019. Travel flows, distances traveled, and intermunicipal travel time between the pregnant women's municipality and hospital location were estimated. An increase from 15.9% to 21.5% was observed in the number of pregnant women who needed to travel. The distance traveled increased from 24.6 to 26km, and the travel time from 76.4 to 96.1 minutes, with high variation between Health Regions (HR). Pregnant women living in HR Central-South traveled more frequently (37.4-48.9%), and those living in the HRs Baía da Ilha Grande and Northwest traveled the largest distances (90.9-132.1km) and took more time to get to the hospital in 2018-2019 (96-137 minutes). The identification of municipalities that received pregnant women from many other municipalities and municipalities that treated a higher number of pregnant women (hubs and attraction poles, respectively) reflected the unavailability and disparities in access to services. Regional inequalities and reduced accessibility highlight the need to adapt supply to demand and review the distribution of birth care services in the state of Rio de Janeiro. This study contributes to research and planning on access to maternal and child health services and can be used as a reference study for other states in the country.
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Affiliation(s)
| | | | - Juliana Freitas Lopes
- Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Fabio Zicker
- Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Bruna de Paula Fonseca
- Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Torres-Muñoz J, Alberto Cedeño D, Murillo J, Torres-Figueroa S, Torres-Figueroa J. Sociodemographic determinants and mortality of premature newborns in a medium and low-income population in Colombia, 2017-2019. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:385-.95. [PMID: 37871568 PMCID: PMC10624478 DOI: 10.7705/biomedica.6863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/15/2023] [Indexed: 10/25/2023]
Abstract
Introduction The birth of premature babies is a public health problem with a high impact on infant morbidity and mortality. About 40% of mortality in children under five years occurs in the first month of life. Objective To identify the association between maternal sociodemographic factors, premature birth, and mortality in newborns under 37 weeks in Santiago de Cali, 2017-2019. Materials and methods We conducted a descriptive, cross-sectional study. We evaluated the records of Cali's Municipal Public Health Office. We calculated the crude and adjusted odd ratios and confidence intervals (95%) using the logistic regression model, data processing in Stata 16, and georeferencing the cases in the QGIS software. Results From 2017 to 2019, premature babies in Cali corresponded to 11% of births. Poor prenatal care increased 3.13 times the risk of being born before 32 weeks (adjusted OR = 3.13; 95% CI = 2.75 - 3.56) and 1.27 times among mothers from outside the city (adjusted OR = 1.27; 95% CI = 1.15-1.41). Mortality was 4.29 per 1,000 live births. The mortality risk in newborns weighing less than 1,000 g increased 3.42 times (OR = 3.42; 95% CI = 2.85-4.12), delivery by cesarean section in 1.46 (OR = 1.46; CI 95% = 1.14-1.87) and an Apgar score - five minutes after birth- lower than seven in 1.55 times (OR = 1.55; CI 95% = 1.23-1.96). Conclusions We found that less than three prenatal controls, mothers living outside Cali, afro-ethnicity, and cesarean birth were associated with prematurity of less than 32 weeks. We obtained higher mortality in newborns weighing less than 1,000 g.
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Affiliation(s)
- Javier Torres-Muñoz
- INSIDE Research Group, Departmento de Pediatría, Universidad del Valle, Cali, Colombia,.
| | | | - Jennifer Murillo
- INSIDE Research Group, Departmento de Pediatría, Universidad del Valle, Cali, Colombia,.
| | - Sofía Torres-Figueroa
- INSIDE Research Group, Departmento de Pediatría, Universidad del Valle, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad ICESI, Cali, Colombia.
| | - Julián Torres-Figueroa
- INSIDE Research Group, Departmento de Pediatría, Universidad del Valle, Cali, Colombia; Facultad de Ciencias de la Salud, Universidad ICESI, Cali, Colombia.
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Engdaw GT, Tesfaye AH, Feleke M, Negash A, Yeshiwas A, Addis W, Angaw DA, Engidaw MT. Effect of antenatal care on low birth weight: a systematic review and meta-analysis in Africa, 2022. Front Public Health 2023; 11:1158809. [PMID: 37441651 PMCID: PMC10335749 DOI: 10.3389/fpubh.2023.1158809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/25/2023] [Indexed: 07/15/2023] Open
Abstract
Background Risk identification, as well as the prevention and management of diseases associated with pregnancy or other conditions that may occur concurrently, is the essential component of ANC. Method The observational follow-up and cross-sectional studies on the effect of antenatal care on low birth weight in Africa were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five computerized bibliographic databases: Google Scholar, PubMed, Scopus, Cochrane Library, and Hinari Direct were searched for published studies written in English till May 2022. The risk of bias assessment tools developed by the Joanna Briggs Institute for cross-sectional and observational follow-up research was used, and the caliber of each included study was assessed. Seven papers were included, with a total of 66,690 children participating in the study. Results Seven studies met the selection criteria. Prenatal care and low birth weight were linked in four of the seven studies included in the review. The pooled odd ratio for low birth weight in the random-effects model was 0.46 (95% CI: 0.39, 0.53). The pooled odds ratio for low birth weight was 0.21 (95% CI: 0.19, 0.22) and 0.21 (95% CI: 0.19, 0.22), respectively, among pregnant women who had no antenatal care follow-up and those who had antenatal care follow up. Conclusion Women who attended at least one antenatal care appointment were more likely than their counterparts to have a baby of normal weight. Interventions to reduce low birth weight in Africa should focus on providing adequate antenatal care and quality healthcare services to women with low socioeconomic status.
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Affiliation(s)
- Garedew Tadege Engdaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Maru Feleke
- Amhara Regional Health Beauro, Wogera Primary Hospital, Northwest, Ethiopia
| | - Aragaw Negash
- Amhara Regional Health Beauro, Wogera Primary Hospital, Northwest, Ethiopia
| | - Amanuel Yeshiwas
- Amhara Regional Health Beauro, Wogera Primary Hospital, Northwest, Ethiopia
| | - Wabiw Addis
- Amhara Regional Health Beauro, Wogera Primary Hospital, Northwest, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Tadege Engidaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Silveira DM, Santos HGD. [Access to neonatal healthcare services: analysis of displacement networks between municipalities in the State of Paraná, Brazil]. CAD SAUDE PUBLICA 2023; 39:e00244422. [PMID: 37377303 PMCID: PMC10494678 DOI: 10.1590/0102-311xpt244422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/01/2023] [Accepted: 04/26/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to characterize hospitalizations of residents in Paraná State, Brazil, that occurred during the neonatal period in a municipality different from their place of residence from 2008 to 2019, and to describe displacement networks for the first and last biennium of the series, corresponding to periods before and after initiatives to regionalize health services in the state. Admissions of children aged from 0 to 27 days were obtained from the Hospital Information System of the Brazilian National Unified Health System (SIH-SUS) database. For each biennium and health region, the proportion of admissions that occurred outside the municipality of residence, the weighted average distance traveled, and indicators of health and service provision were calculated. Mixed models were fitted to evaluate the biennial trend of the indicators and to investigate factors associated with the neonatal mortality rate (NMR). In total, 76,438 hospitalizations were selected, ranging from 9,030 in 2008-2009 to 17,076 in 2018-2019. The comparison of the networks obtained for 2008-2009 and 2018-2019 revealed an increase in the number of frequent destinations and in the proportion of displacements within the same health region. A decreasing trend was observed for distance, the proportion of live births with 5-minute Apgar ≤ 7, and for NMR. In the adjusted analysis for NMR, besides the biennial effect (-0.64; 95%CI: -0.95; -0.28), only the proportion of live birth with gestational age < 28 weeks showed statistical significance (4.26; 95%CI: 1.29; 7.06). The demand for neonatal hospital care increased over the study period. The displacement networks suggest a positive impact of regionalization, although investment in regions with the potential to become healthcare centers is necessary.
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Szyhta CC, Silva ZPD, Alencar GP, Almeida MFD. Risk factors for perinatal death in high-risk pregnant women at a tertiary hospital in Curitiba-PR, Brazil: a case-control study. CIENCIA & SAUDE COLETIVA 2023; 28:1043-1058. [PMID: 37042887 DOI: 10.1590/1413-81232023284.16042022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/28/2022] [Indexed: 04/13/2023] Open
Abstract
A case-control study was carried out to estimate risk factors for perinatal mortality in a referral hospital for high-risk pregnancies in Curitiba-PR. Sociodemographic, maternal, pregnancy and concept characteristics data were obtained from the hospital records of 316 cases and 316 controls from 2013 to 2017. A hierarchical multiple logistic regression analysis was performed, remaining in the final model variables with p < 0.05. The results show an increased risk of perinatal death in mothers with blood type B (OR = 2.82; 95%CI: 1.07-7.43), who did not undergo prenatal care (OR = 30.78; 95%CI: 4.23-224.29), fetuses with congenital malformations (OR = 63.90; 95%CI: 27.32-149.48), born under 28 (OR = 24.21; 95%CI: 1, 10-531.81) and between 28-31 weeks of gestation (OR = 6.03; 95%CI: 1.34-27.17) and birth weight below 1,000g (OR = 51.94; 95%CI: 4.31-626.46), between 1,000-1,499g (OR = 11.17; 95%CI: 2.29-54.41) and between 1,500-2,499g (OR = 2.75; 25-6.06). Concepts of pregnancies with premature outcome, low birth weight and the presence of congenital malformations are the main risk factors for perinatal death. On the other hand, adequate prenatal care is an important protective factor.
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Affiliation(s)
- Carla Caroline Szyhta
- Serviço de Epidemiologia, Complexo do Hospital de Clínicas da UFPR, Empresa Brasileira de Serviços Hospitalares. R. Gal. Carneiro 181, Alto da Glória. 80060-900 Curitiba PR Brasil.
| | - Zilda Pereira da Silva
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Gizelton Pereira Alencar
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Marcia Furquim de Almeida
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
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Chafik K, Aslaou F, Barich F, Laamiri FZ, El Ouardighi I, Barkat A. The Prevalence of Neonatal Near Misses in Rabat, Morocco. Cureus 2023; 15:e34486. [PMID: 36874298 PMCID: PMC9982691 DOI: 10.7759/cureus.34486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The concept of near-miss neonatal (NMN) is a potentially useful approach in assessing the quality of newborn care. However, data collected on the status of NMN cases in Morocco is scarce. OBJECTIVE The objective of this study is to determine the prevalence of NMN cases among live births at the University Hospital of Rabat, Morocco. MATERIALS AND METHODS An observational cross-sectional study was conducted on 2676 newborns born at the University Hospital of Rabat, Morocco, and admitted to the National Reference Center of Neonatology and Nutrition (NRCN) from January 1 to December 31, 2021. The main inclusion criteria were the pragmatic and/or management markers of the definition of NMN. Data were extracted using a structured, pre-tested checklist, entered into EpiData, and exported to Statistical Software for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY), and descriptive statistics were performed. RESULTS Among the 2676 selected live births, 2367 were NMN cases (88.5%; 95% CI: 88.3-90.7). More than half of new mothers (57.5%) were referrals, 59.9% of women were multiparous, and 78.5% had under four prenatal care consultations. Obstetric problems affected 373 of the women during pregnancy. A pragmatic criterion was met in 43.6% of NMN situations. Among the management criteria, the use of intravenous antibiotics was the most common factor at 56.0%. CONCLUSIONS This study revealed a high prevalence of NMN. Therefore, concerted efforts are needed to improve maternal health care services, including early identification of complications and appropriate management.
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Affiliation(s)
- Kawtar Chafik
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Fatima Aslaou
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Fatima Barich
- Research, Higher Institute of Nursing Professions and Health Techniques, Rabat, MAR
| | - Fatim Zahra Laamiri
- Laboratory of Health Sciences and Technology, Hassan First University of Settat, Higher Institute of Health Sciences of Settat, Settat, MAR
| | - Ilham El Ouardighi
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Amina Barkat
- Research Team on Health and Nutrition of Mother and Child, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
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Ghirelli EA, Silva FPGD, Oricil AGG, Paula CBVD, Nagashima S, Oldenburg Neto CF, Storti E, Sakiyama FYR, Kayano RM, Sakiyama RR, Moreira VDS, Sotomaior VS, Noronha LD. Role of the NF-kB/parkin/vegfr-1 pathway associated with hypoxic-ischemic insult in germinal matrix samples of newborn infants. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022034. [PMID: 37132761 PMCID: PMC10144076 DOI: 10.1590/1984-0462/2023/41/2022034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/27/2022] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Given the high proliferative activity of germinal matrix and its direct correlation with hypoxemia, it is necessary to investigate the possible molecular regulation pathways, to understand the existing clinical relationship between the hypoxic-ischemic insult and the biomarkers NF-kB, AKT-3, Parkin, TRK-C and VEGFR-1. METHODS A hundred and eighteen germinal matrix samples of the central nervous system of patients who died in the first 28 days of life were submitted to histological and immunohistochemistry analysis to identify the tissue immunoexpression of those biomarkers related to asphyxia, prematurity, and death events within 24h. RESULTS A significantly increased tissue immunoexpression of NF-kB, AKT-3 and Parkin was observed in the germinal matrix of preterm infants. In addition, significantly decreased tissue immunoexpression of VEGFR-1 and NF-kB was observed in patients who experienced asphyxia followed by death within 24 hours. CONCLUSIONS The results suggest a direct involvement between the hypoxic-ischemic insult and NF-kB and VEGFR-1 markers since a decreased immunoexpression of these biomarkers was observed in asphyxiated patients. Furthermore, it is suggested that there was not enough time for VEGFR-1 to be transcribed, translated and expressed on the surface of the plasma membrane. This temporality can be observed in the relationship between NF-kB expression and the survival time of individuals who died within 24 hours, suggesting that this factor is essential for the production of VEGFR-1 and, therefore, to carry out the necessary remodeling effect to neovascularize the affected region.
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Affiliation(s)
| | | | | | | | - Seigo Nagashima
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | - Eduardo Storti
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | | | | | | | | | - Lucia de Noronha
- Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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Risk factors related to preventable infant mortality in Espirito Santo, Brazil. Heliyon 2022; 9:e12227. [PMID: 36685377 PMCID: PMC9852654 DOI: 10.1016/j.heliyon.2022.e12227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/10/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To analyse the factors associated with preventable of infant mortality, in Espirito Santo, Brazil. Methods Data were collected from records of notifiable of infant death of the Mortality Information System. A total of 5,089 infant deaths were classified as preventable and non-preventable according to the International Collaborative Effort on Infant Mortality (ICE) and the State System of Data Analysis Foundation (SEADE) methods. To investigate the factors associated with preventable of deaths, it was applied the logistic regression. Results Approximately, 73% of the deaths were preventable according to the ICE, while 76% were preventable according to the SEADE method. Using to both methods, it was observed that preterm birth, postneonatal death and birth weight between 3000 and above 4,000 g represented higher chances for preventable infant deaths. Furthermore, the medical care was more likely to preventable infant death only for ICE method. Conclusions The factors related to the quality of care offered in the prenatal, prepartum and childbirth periods were more relevant for the occurrence of preventable infant death. Accordingly, it is recommended to strengthen mother-child care to detect risk pregnancies during prenatal care, as well as a hierarchical, regionalized and integrated perinatal network.
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Reis Queiroz M, Ramos Junqueira ME, Roman Lay AA, de Aquino Bonilha E, Furtado Borba M, Castex Aly CM, Moreira RA, Grilo Diniz CS. Neonatal mortality by gestational age in days in infants born at term: A cohort study in Sao Paulo city, Brazil. PLoS One 2022; 17:e0277833. [PMID: 36409732 PMCID: PMC9678289 DOI: 10.1371/journal.pone.0277833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
Birth at term comprises a period with heterogeneous neonatal outcomes that tend to be worse for infants born earlier. However, few studies have analyzed this period, in which each day can make a difference. Therefore, we aim to assess neonatal mortality (NM) according to gestational age (GA) at birth measured in days in term liveborn infants born in 2012-2017 in São Paulo, the largest city in Latin America. This population-based cohort study assessed term liveborn infants followed until the end of the neonatal period. We analyzed 7 models for NM according to GA in days: crude NM adjusted for maternal and prenatal variables, NM additionally adjusted for type of birth and type of hospital, and adjusted NM stratified by type of birth (cesarean and vaginal) and by type of hospital (public and private). We included 440,119 live infants born at 259-293 days of gestation. The median GA at birth was 274 days. In all models, NM was higher for infants born early term, decreasing in infants born full term and rising again in infants born late term. In the unadjusted model, hazard ratios of NM changed daily, decreasing from 3.34 to 1.00 on day 278 and increasing again thereafter. In the stratified analysis according to type of hospital, being born in a public hospital was associated with a reduced risk of NM for infants born at 278-283 days of pregnancy. There was a decrease in GA related to obstetric interventions, especially cesarean sections, which increased NM. The loss of days of pregnancy was larger in private hospitals. Increasing the granularity of GA to days is feasible and has the potential to drive public policies. To the best of our knowledge, this is the first Brazilian study on GA in days using a national live births database.
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Affiliation(s)
- Marcel Reis Queiroz
- Health Department 3, Nove de Julho University, Sao Paulo, São Paulo, Brazil
- Gender and Evidence in Maternal Health (GEMAS), School of Public Health, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Maria Elizangela Ramos Junqueira
- Department of Life Sciences, Public Health Area, State University of Bahia, Salvador, Bahia, Brazil
- Subdepartment of Epidemiological Surveillance, Health Surveillance Board, Salvador Municipal Health Department, Salvador, Bahia, Brazil
| | | | - Eliana de Aquino Bonilha
- Municipal Health Department of Sao Paulo, Sao Paulo, São Paulo, Brazil
- São Camilo University, São Paulo, Brazil
| | - Mariane Furtado Borba
- Department of Epidemiology, Faculty of Public Health, University of Sao Paulo, Sao Paulo, São Paulo, Brazil
| | | | | | - Carmen Simone Grilo Diniz
- Gender and Evidence in Maternal Health (GEMAS), School of Public Health, University of São Paulo, São Paulo, Brazil
- Department of Health, Life Cycles and Society, Faculty of Public Health, University of Sao Paulo, São Paulo, São Paulo, Brazil
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Is there an "acceptable" percentage of using infant formula during hospital stays? J Pediatr (Rio J) 2022; 98:439-441. [PMID: 35644257 PMCID: PMC9510797 DOI: 10.1016/j.jped.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/20/2022] Open
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Woldegeorgis BZ, Obsa MS, Tolu LB, Bogino EA, Boda TI, Alemu HB. Episiotomy Practice and Its Associated Factors in Africa: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:905174. [PMID: 35865171 PMCID: PMC9295659 DOI: 10.3389/fmed.2022.905174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background Episiotomy, a surgical procedure that enlarges the vaginal opening during childbirth, was common practice until the early 2000s. Other sources, including the World Health Organization (WHO), advocate for the selective use of episiotomy. Episiotomy rates, on the other hand, have remained high in developing countries, while declining in developed countries. As a result, the current study sought to determine the overall prevalence of episiotomy in Africa as well as the risk factors associated with its practice. Methods Articles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 14 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. A random-effects meta-analysis model was used to determine the pooled prevalence of episiotomy. A heterogeneity test was conducted using I-Squared (I2) statistics. Egger's test and funnel plots were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through a pooled odds ratio (OR) with a 95% Confidence Interval (CI). Result A total of 21 studies with 40,831 participants were included in the systematic review and meta-analysis. The pooled prevalence of episiotomy practice was 41.7% [95% CI (36.0–47.4), I2 = 99.3%, P < 0.001). Primiparity [OR: 6.796 (95% CI (4.862–9.498)), P < 0.001, I2: 95.1%], medical doctors- assisted delivery [OR: 3.675 (95% CI (2.034–6.640)), P < 0.001, I2: 72.6%], prolonged second stage of labor [OR: 5.539 (95% CI (4.252–7.199)), P < 0.001, I2: 0.0%], using oxytocin [OR: 4.207 (95% CI (3.100–5.709)), P < 0.001, I2: 0.0%], instrument -assisted vaginal delivery [OR: 5.578 (95% CI (4.285–7.260)), P < 0.001, I2: 65.1%], and macrosomia [OR: 5.32 (95% CI (2.738–10.339)), P < 0.001, I2: 95.1%] were factors associated with episiotomy practice. Conclusion In this review, the prevalence of episiotomy among African parturients was high. A selective episiotomy practice should be implemented to reduce the high episiotomy rates. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021293382, identifier: CRD42021293382.
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Affiliation(s)
- Beshada Zerfu Woldegeorgis
- Department of Internal Medicine, Wolaita Sodo University, Sodo, Ethiopia
- *Correspondence: Beshada Zerfu Woldegeorgis
| | | | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Efa Ambaw Bogino
- Dermatovenereology Department, Wolaita Sodo University, Sodo, Ethiopia
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Marinonio ASS, Costa-Nobre DT, Miyoshi MH, Balda RDCX, Areco KCN, Konstantyner T, Kawakami MD, Sanudo A, Bandiera-Paiva P, de Freitas RMV, Morais LCC, La Porte Teixeira M, Waldvogel BC, de Almeida MFB, Guinsburg R, Kiffer CRV. Clusters of preterm live births and respiratory distress syndrome-associated neonatal deaths: spatial distribution and cooccurrence patterns. BMC Public Health 2022; 22:1226. [PMID: 35725459 PMCID: PMC9210662 DOI: 10.1186/s12889-022-13629-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Prematurity and respiratory distress syndrome (RDS) are strongly associated. RDS continues to be an important contributor to neonatal mortality in low- and middle-income countries. This study aimed to identify clusters of preterm live births and RDS-associated neonatal deaths, and their cooccurrence pattern in São Paulo State, Brazil, between 2004 and 2015. Methods Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥ 400 g, without congenital anomalies from mothers living in São Paulo State, Brazil, during 2004–2015. RDS-associated neonatal mortality was defined as deaths < 28 days with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality and preterm live births rates per municipality were submitted to first- and second-order spatial analysis before and after smoothing using local Bayes estimates. Spearman test was applied to identify the correlation pattern between both rates. Results Six hundred forty-five thousand two hundred seventy-six preterm live births and 11,078 RDS-associated neonatal deaths in São Paulo State, Brazil, during the study period were analyzed. After smoothing, a non-random spatial distribution of preterm live births rate (I = 0.78; p = 0.001) and RDS-associated neonatal mortality rate (I = 0.73; p = 0.001) was identified. LISA maps confirmed clusters for both, with a negative correlation (r = -0.24; p = 0.0000). Clusters of high RDS-associated neonatal mortality rates overlapping with clusters of low preterm live births rates were detected. Conclusions Asymmetric cluster distribution of preterm live births and RDS-associated neonatal deaths may be helpful to indicate areas for perinatal healthcare improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13629-4.
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Affiliation(s)
- Ana Sílvia Scavacini Marinonio
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil.
| | - Daniela Testoni Costa-Nobre
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Milton Harumi Miyoshi
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Rita de Cassia Xavier Balda
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Kelsy Catherina Nema Areco
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Tulio Konstantyner
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Mandira Daripa Kawakami
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Adriana Sanudo
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Paulo Bandiera-Paiva
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Rosa Maria Vieira de Freitas
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Lilian Cristina Correia Morais
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Mônica La Porte Teixeira
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Bernadette Cunha Waldvogel
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Maria Fernanda Branco de Almeida
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Ruth Guinsburg
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Carlos Roberto Veiga Kiffer
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
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Figueiredo KNDRS, Campelo CL, Machado PMA, Silva NBPD, Queiroz RCDS, Silva AAMD, Santos AMD. [Supply of best childbirth practices in maternity units of Rede Cegonha according to Item Response Theory]. CIENCIA & SAUDE COLETIVA 2022; 27:2303-2315. [PMID: 35649018 DOI: 10.1590/1413-81232022276.15962021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to develop an intelligible scale to measure the level of supply of best practices in labor, childbirth and delivery in maternity units in the Rede Cegonha (RC) based on the workers' perception. The scale consisted of seventeen items related to best practices, based on the instrument used in the "Evaluation of care during delivery and birth in maternity hospitals in the RC" research The three-parameter logistic model of Item Response Theory was used to create the scale and analyze the items. The scale consisted of three levels. In the first level, there are maternity hospitals that adequately offered strategies for welcoming and encouraging the pregnant woman to circulate during labor. The second level maternity wards also included the adequate offer of the right to a companion of choice, massage, ball and different birth positions. Finally, the third level maternity hospitals also offered an adequate delivery stool, as well as the items already mentioned. The findings of this study showed the contribution of each item in measuring the level of supply of best practices in care for labor, childbirth and delivery and the construction of an intelligible scale to assess RC maternity hospitals.
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Affiliation(s)
- Kely Nayara Dos Reis Silva Figueiredo
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
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Meier A, Kock KDS. Need for oxygen therapy and ventilatory support in premature infants in a hospital in Southern Brazil. World J Crit Care Med 2022; 11:160-168. [PMID: 36331991 PMCID: PMC9136723 DOI: 10.5492/wjccm.v11.i3.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/19/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prematurity in newborns is a condition that is associated with worse hospital outcomes when compared to birth to term. A preterm infant (PI) is classified when gestational age (GA) < 37 wk.
AIM To analyze prognostic indicators related to the use of oxygen therapy, non-invasive ventilation (continuous positive airway pressure) and mechanical ventilation (MV) in PI.
METHODS This is a retrospective cohort. The sample was composed of PIs from a private hospital in southern Brazil. We included neonates with GA < 37 wk of gestation in the period of January 1, 2018 to December 31, 2018. For data collection, electronic records were used in the Tasy PhilipsTM system, identifying the variables: maternal age, type of birth, prenatal information, GA, Apgar score, birth weight, neonatal morbidities, vital signs in the 1st hour at birth, need for oxygen therapy, continuous positive airway pressure and MV, hospitalization in the neonatal intensive care unit, length of stay and discharge or death.
RESULTS In total, 90 PI records were analyzed. The median (p25-p75) of GA was 34.0 (31.9-35.4) wk, and there were 45 (50%) males. The most common morbidity among PIs was the acute respiratory discomfort syndrome, requiring hospitalization in the neonatal intensive care unit in 76 (84.4%) cases. The utilization rate of oxygen therapy, continuous positive airway pressure and MV was 12 (13.3%), 37 (41.1%) and 13 (14.4%), respectively. The median (p25-p75) length of stay was 12.0 (5.0-22.2) d, with 10 (11.1%) deaths. A statistical association was observed with the use of MV and GA < 28 wk, lower maternal age, low birth weight, Apgar < 8 and neonatal deaths.
CONCLUSION The identification of factors related to the need for MV in prematurity may help in the indication of a qualified team and technologies to promptly meet the unforeseen events that may occur after birth.
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Affiliation(s)
- Amanda Meier
- Department of Physiotherapy, University of South of Santa Catarina, Tubarão 88704-001, SC, Brazil
| | - Kelser de Souza Kock
- Department of Physiotherapy, University of South of Santa Catarina, Tubarão 88704-001, SC, Brazil
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Damasceno AADA, Mosquera PS, Malta MB, Matijasevich A, Cardoso MA. Agreement between information recorded during antenatal care and in the MINA-Brazil study. CIENCIA & SAUDE COLETIVA 2022; 27:1619-1628. [PMID: 35475840 DOI: 10.1590/1413-81232022274.04502021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022] Open
Abstract
This article aims to examine agreement of pre-pregnancy weight, pregnancy weight, height and systolic (SBP) and diastolic (DBP) blood pressure measurements recorded on antenatal record cards with the same information obtained in the MINA-Brazil longitudinal study. 428 pregnant women who participated in the MINA-Brazil study and had an antenatal card at time of childbirth were selected. Concordance analysis of the data used Lin's correlation coefficient and Bland-Altman analysis. There was moderate agreement on self-reported pre-pregnancy weight (0.935) and height (0.913) information, and substantial agreement on the pregnant women's weight in the second (0.993) and third (0.988) trimesters of pregnancy. Little agreement was found on SBP and DBP measured in the second (SBP = 0.447; DBP = 0.409) and third (SBP = 0.436; DBP = 0.332) trimesters of pregnancy. Anthropometric measurements showed strong agreement. There was weak agreement between blood pressure measurements, which may relate both to the variability and the standardisation of these measurements, suggesting the need for continued training of antenatal teams in primary health care.
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Affiliation(s)
| | - Paola Soledad Mosquera
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, 01246-904. São Paulo SP Brasil.
| | - Maíra Barreto Malta
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, 01246-904. São Paulo SP Brasil. .,Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos. Santos SP Brasil
| | | | - Marly Augusto Cardoso
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, 01246-904. São Paulo SP Brasil.
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Rodrigues MAH, Carneiro MM. [Contraception in other countries: The example of Brazil]. Med Sci (Paris) 2022; 38:280-287. [PMID: 35333165 DOI: 10.1051/medsci/2022029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In Brazil, women have free access to contraception through the public health system, the Unified Health System (SUS) which offers the following contraceptive methods: Male and female condoms, diaphragm, spermicide, copper intrauterine device (IUD), combined oral and injectable contraceptive hormones, progestin-only contraceptives and injections of medroxyprogesterone acetate (DMPA), emergency pill, female sterilization and vasectomy. However, difficulties in scheduling appointments, women's lack of information about contraceptive methods, and the limited availability of different methods all contribute to high rates of unintended pregnancies. The rate of contraceptive use by Brazilian women aged 18 to 49 is approximately 62%; poorer parts of the country and low levels of education are among the main factors associated with lower rates of contraceptive method use. There are therefore challenges to be taken up to minimize the rates of unwanted pregnancies, which are still too high, such as better distribution, better offer of different contraceptive methods for all regions of the country and better training of professionals involved in women's health care.
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Affiliation(s)
| | - Marcia Mendonça Carneiro
- Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brésil
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Bernardino FBS, Gonçalves TM, Pereira TID, Xavier JS, Freitas BHBMD, Gaíva MAM. Tendência da mortalidade neonatal no Brasil de 2007 a 2017. CIENCIA & SAUDE COLETIVA 2022; 27:567-578. [DOI: 10.1590/1413-81232022272.41192020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/26/2021] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo deste estudo foi analisar a tendência da mortalidade neonatal no Brasil de 2007 a 2017. Trata-se de um estudo ecológico de série temporal, realizado com dados do Sistema de Informações sobre Mortalidade e do Sistema de Informações sobre Nascidos Vivos, analisados por meio de regressão de Prais-Winsten. Verificou-se uma taxa média de mortalidade neonatal de 9,46/1.000 nascidos vivos no período, com redução de 2,15% ao ano. Houve maior declínio da mortalidade neonatal precoce, comparada com a tardia. Destaca-se tendência crescente dos óbitos neonatais entre neonatos pré-termos, com extremo baixo peso, nascidos de parto cesáreo, filhos de mães com idade superior a 30 anos e escolaridade superior a oito anos de estudo. Em relação às causas de morte, verificou-se tendência crescente dos óbitos por malformações congênitas, doenças infecciosas, doenças endócrinas, nutricionais e metabólicas e causas externas. Constatou-se, ainda, tendência crescente nos óbitos evitáveis por adequada atenção à mulher na gestação e por demais causas não claramente evitáveis. Apesar da redução geral dos óbitos, faz-se necessário intensificar as políticas públicas de assistência adequada à mulher na gestação para garantir melhoria nos demais indicadores analisados.
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Villar VCFL, Rodrigues JLDSDQ, Martins M, Rabello ET. Segurança do paciente na assistência ao parto: o que é debatido nos grupos de Facebook? CAD SAUDE PUBLICA 2022; 38:e00277421. [DOI: 10.1590/0102-311xpt277421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/26/2022] [Indexed: 12/23/2022] Open
Abstract
A segurança do paciente no contexto da assistência ao parto é um tema que vem ocupando as pautas de discussão sobre qualidade do cuidado materno-infantil ao redor do mundo. Discutir os eventos adversos na assistência ao parto e seus fatores contribuintes, na percepção dos pacientes e familiares, reportados em grupos de Facebook. Trata-se de um estudo qualitativo que utilizou a plataforma de mídia digital Facebook como fonte de dados. Foram analisadas 55 postagens relacionadas à assistência ao parto nos meses de setembro e outubro de 2019, quanto ao conteúdo. Os achados foram classificados em duas categorias: (i) eventos adversos incluindo óbitos do recém-nascido, fetal e materno, hemorragias, infecções, lesões neurológicas, problemas relacionados à cirurgia e ao uso de medicamentos; e (ii) fatores contribuintes como atraso no atendimento, diagnóstico ou tratamento, violência obstétrica, erro diagnóstico e identificação do paciente. As plataformas de mídias digitais, podem se constituir espaços legitimados para debates e manifestações acerca de questões relacionadas à saúde incluindo aquelas ligadas à qualidade do cuidado obstétrico. Valorizar a percepção das pacientes, oriundas dessas ou de outras fontes é fundamental, mas requer o envolvimento de lideranças institucionais e profissionais na operacionalização de estratégias que facilitem a identificação precoce de fatores de risco, e possibilitem o diagnóstico e implementação do tratamento adequado oportuno com a participação ativa de pacientes e familiares.
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Souza ÉR, Dumont-Pena É, Patrocino LB. Pandemia do coronavírus (2019-nCoV) e mulheres: efeitos nas condições de trabalho e na saúde. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-11042022e120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O trabalho teve como objetivo discutir os efeitos da pandemia da Covid-19, causada pelo novo coronavírus (2019-nCoV), às condições de trabalho e de saúde das mulheres, com foco nas dinâmicas de gênero. A reflexão proposta partiu da literatura sobre saúde das mulheres e epidemias, valendo-se dos dados sobre a condição das mulheres durante a pandemia da Covid-19, no ano de 2020, sobretudo no Brasil, mas também em demais países com diferentes características socioeconômicas. A análise expôs três aspectos centrais em que a pandemia da Covid-19 afeta a saúde das mulheres, a saber: a exposição das profissionais do cuidado, trabalhadoras da saúde e domésticas; os direitos reprodutivos; e a violência doméstica. O trabalho contribuiu para a compreensão dos modos como epidemias podem expor acentua- damente a saúde das mulheres, seja nas precárias condições de trabalho, na ameaça de suspensão de seus direitos na atenção à saúde ou no aumento da violência no contexto de isolamento social.
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Nicolotti CA, Lacerda JTD. Avaliação da organização e práticas de assistência ao parto e nascimento em três hospitais de Santa Catarina, Brasil. CAD SAUDE PUBLICA 2022; 38:e00052922. [DOI: 10.1590/0102-311xpt052922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
O objetivo foi avaliar a assistência hospitalar ao parto e ao nascimento, analisando aspectos de gestão e assistência desde a admissão das mulheres para o parto até o pós-parto. Foi realizada uma pesquisa avaliativa dos aspectos de gestão e práticas de assistência ao parto e nascimento, desenvolvida no período de novembro de 2019 a fevereiro de 2020, em três hospitais de Santa Catarina, Brasil, com melhor desempenho em uma avaliação nacional de boas práticas de assistência ao parto e ao nascimento. A coleta de dados envolveu análise documental, observação e entrevistas com profissionais da gestão, assistência e puérperas. Foram analisados 30 indicadores, que compuseram uma matriz de análise e julgamento, agrupados nas dimensões Político-Organizacional e Tático-Operacional. O julgamento orientou-se pela comparação entre a pontuação observada e a pontuação máxima esperada em cada um dos componentes da matriz avaliativa. A assistência ao parto e ao nascimento foi parcialmente satisfatória nos hospitais 2 e 3 e insatisfatória no hospital 1. A dimensão Político-Organizacional foi classificada como insatisfatória e a Tático-Operacional parcialmente satisfatória nos três hospitais. Nenhum hospital obteve avaliação satisfatória em mais de 40% dos indicadores. Os hospitais analisados ainda não conseguiram consolidar as mudanças no modelo assistencial na perspectiva do cuidado humanizado, orientado por evidências científicas e direitos.
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22
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Silva MMD, Brito ALDS, Vasconcelos IÁ, Souto REM, Rocha RP, Esteche CMGDCE, Damasceno AKDC, Moraes JLD, Saraiva MRB. Profile of women affected with premature childbirth and neonatal outcomes. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000400002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to describe the profile of women affected with premature childbirth and neonatal outcomes at a referral maternity in the city of Fortaleza-CE, Brazil. Methods: descriptive and retrospective documentary type study, with a quantitative approach, carried out from January to December, 2017, with 253 medical records of women who had premature childbirth in a referral maternity. Results: the average age was 28, with the prevalence of women living in a stable union, graduated from high school and without formal work. The gestational mean average was three pregnancies, gestational age of 34 weeks and three days, and six prenatal consultations, starting in the first trimester. The major intercurrence was pre-eclampsia. In relation to the neonatal data, there was a prevalence of male newborns, with an average of 2.251 kg and a score of seven on the 1-minute Apgar and eight on the 5-minute Apgar. Newborns in going to a hospital accommodation after childbirth and in room air, spending an average of 12.71 days in the hospital. Conclusion: in this case of this research, knowing the woman’s profile and the outcomes in premature newborns is useful to encourage public policies and reduce the sequelae on mother and baby
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Kempton JW, Périssé ARS, Hofer CB, de Vasconcellos ACS, de Sousa Viana PV, de Oliveira Lima M, de Jesus IM, de Souza Hacon S, Basta PC. An Assessment of Health Outcomes and Methylmercury Exposure in Munduruku Indigenous Women of Childbearing Age and Their Children under 2 Years Old. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10091. [PMID: 34639393 PMCID: PMC8508331 DOI: 10.3390/ijerph181910091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from all women of childbearing age (i.e., 12-49) and their infants under two years old in three Munduruku communities (Sawré Muybu, Sawré Aboy, and Poxo Muybu) along the Tapajos River. We explored health outcomes through interviews, vaccine coverage and clinical assessment, and determined baseline hair methylmercury (H-Hg) levels. Hemoglobin, infant growth (Anthropometric Z scores) and neurodevelopment tests results were collected. We found that 62% of women of childbearing age exceeded the reference limit of 6.0 μg/g H-Hg (median = 7.115, IQR = 4.678), with the worst affected community (Sawré Aboy) registering an average H-Hg concentration of 12.67 μg/g. Half of infants aged under 24 months presented with anemia. Three of 16 (18.8%) infants presented H-Hg levels above 6.0 µg/g (median: 3.88; IQR = 3.05). Four of the 16 infants were found to be stunted and 38% of women overweight, evidencing possible nutritional transition. No infant presented with appropriate vaccination coverage for their age. These communities presented with an estimated Infant Mortality Rate (IMR) of 86.7/1000 live births. The highest H-Hg level (19.6 µg/g) was recorded in an 11-month-old girl who was found to have gross motor delay and anemia. This already vulnerable indigenous Munduruku community presents with undernutrition and a high prevalence of chronic methylmercury exposure in women of childbearing age. This dual public health crisis in the context of wider health inequalities has the potential to compromise the development, health and survival of the developing fetus and infant in the first two critical years of life. We encourage culturally sensitive intervention and further research to focus efforts.
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Affiliation(s)
| | - André Reynaldo Santos Périssé
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Cristina Barroso Hofer
- Instituto de Pediatria e Puericultura Martagão Gesteira, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50, Cidade Universitária, Rio de Janeiro 21941-912, Brazil;
| | - Ana Claudia Santiago de Vasconcellos
- Laboratório de Educação Profissional em Vigilância em Saúde, Escola Politécnica de Saúde Joaquim Venân-cio, Fundação Oswaldo Cruz (EPSJV/Fiocruz), Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil;
| | - Paulo Victor de Sousa Viana
- Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (CRPHF/ENSP/Fiocruz), Estrada de Curicica, 2000, Curicica, Rio de Janeiro 22780-195, Brazil;
| | - Marcelo de Oliveira Lima
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Iracina Maura de Jesus
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Sandra de Souza Hacon
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Paulo Cesar Basta
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
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Saloio CÁ, Morais Neto OLD, Gonçalves DA, Bessa HEM, Coelho Júnior JP, Afonso MSM, Carvalho SRD. Magnitude and determinants of neonatal and postneonatal mortality in Goiânia, Goiás, Brazil: a retrospective cohort study, 2012. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 29:e2020132. [PMID: 33206866 DOI: 10.1590/s1679-49742020000500008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/17/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate magnitude and determinants of neonatal and postneonatal mortality rates in Goiânia, Brazil, 2012. METHODS This was a retrospective cohort study based on data linkage of the Live Birth Information System and the Mortality Information System. Logistic regression was used to evaluate factors associated with neonatal and postneonatal death. RESULTS Neonatal mortality (0-27 days of life) was 9.4 deaths per 1,000 live births; while postneonatal mortality (28-364 days of life) was 3.0 deaths per 1,000 live births. Neonatal mortality associated factors were: 0-3 prenatal care visits (OR=13.10 - 95%CI 7.48;22.96), 19-34-week pregnancy (OR=6.25 - 95%CI 2.26;17.29), birth weight <1,500g (OR=62.42 - 95%CI 22.72;171.48) and cesarean delivery (OR=0.54 - 95%CI 0.37;0.79). Postneonatal mortality associated factors were: 0-3 prenatal care visits (OR=4.16 - 95%CI 1.51;11.43) and birth weight <1.500g (OR=18.74 - 95%CI 4.04;87.00). CONCLUSION A low number of prenatal care visits, premature childbirth and low birth weight were the main risk factors for neonatal and postneonatal mortality.
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Affiliation(s)
- Caio Átila Saloio
- Universidade Federal de Goiás, Faculdade de Medicina, Goiânia, GO, Brasil
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25
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Testoni Costa-Nobre D, Kawakami MD, Areco KCN, Sanudo A, Balda RCX, Marinonio ASS, Miyoshi MH, Konstantyner T, Bandiera-Paiva P, Freitas RMV, Morais LCC, Teixeira MLP, Waldvogel B, de Almeida MFB, Guinsburg R, Kiffer CRV. Clusters of cause specific neonatal mortality and its association with per capita gross domestic product: A structured spatial analytical approach. PLoS One 2021; 16:e0255882. [PMID: 34403438 PMCID: PMC8370610 DOI: 10.1371/journal.pone.0255882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Infant mortality rate is a measure of population health and neonatal mortality account for great proportion of these deaths. Underdevelopment might be associated to higher neonatal mortality risk due to assistant related factors. Spatial and temporal distribution of mortality help identifying and developing strategies for interventions. OBJECTIVE To investigate the cluster areas of asphyxia-associated neonatal mortality and to explore its association with per capita gross domestic product (GDP) in São Paulo State (SP), Brazil. METHODS Ecological study including live births residents in SP from 2004-2013. Neonatal deaths (0-27 days) with perinatal asphyxia were defined as intrauterine hypoxia, birth asphyxia or meconium aspiration syndrome written in any line of the Death Certificate. Geoprocessing analytical approach included detection of first order effects through quintiles and spatial moving average maps, followed by second order effects by global and local spatial autocorrelation (Moran and LISA, respectively) before and after smoothing with local Bayesian estimates. Finally, Spearman correlation was applied between asphyxia-associated neonatal mortality and mean per capita GDP rates for the municipalities with significant LISA. RESULTS There were 6,713 asphyxia-associated neonatal deaths among 5,949,267 live births (rate: 1.13/1000) in SP. Spatial moving average maps showed a non-random distribution among municipalities, with presence of clusters (I = 0.048; p = 0.023). LISA map identified clusters of asphyxia-associated neonatal mortality in the south, southeast and northwest. After applying local Bayes estimates, clusters were more pronounced (I = 0.589; p = 0.001). There was a partial overlap of the areas of higher asphyxia-associated neonatal mortality and lower mean per capita GDP. CONCLUSIONS Spatial analysis identified cluster areas of high asphyxia-associated neonatal mortality and low per capita GDP rates, with a significant negative correlation. This optimized, structured, and hierarchical approach to identify high-risk areas of cause-specific neonatal mortality may be helpful for guiding public health efforts to decrease neonatal mortality.
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Affiliation(s)
| | - Mandira Daripa Kawakami
- Escola Paulista de Medicina–Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Adriana Sanudo
- Escola Paulista de Medicina–Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | - Milton Harumi Miyoshi
- Escola Paulista de Medicina–Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina–Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina–Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | | | - Bernadette Waldvogel
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), São Paulo, SP, Brazil
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina–Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Oliveira DMDS, Miranda-Filho DDB, Ximenes RADA, Montarroyos UR, Martelli CMT, Brickley EB, Gouveia MDCL, Ramos RC, Rocha MÂW, Araujo TVBD, Eickmann SH, Rodrigues LC, Bernardes JPDOS, Pinto MHT, Soares KPND, Araújo CMTD, Militão-Albuquerque MDFP, Santos ACOD. Comparison of Oropharyngeal Dysphagia in Brazilian Children with Prenatal Exposure to Zika Virus, With and Without Microcephaly. Dysphagia 2021; 36:583-594. [PMID: 32886254 PMCID: PMC8289769 DOI: 10.1007/s00455-020-10173-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/24/2020] [Indexed: 01/12/2023]
Abstract
Severe brain damage associated with Zika-related microcephaly (ZRM) have been reported to result in oropharyngeal dysphagia (OPD); however, it is unknown if OPD presents in children with prenatal Zika virus (ZIKV) exposure but only mild or undetectable abnormalities. The aims of this study were: to compare the frequency and characteristics of OPD in children with ZRM and in children without microcephaly born to mothers who tested polymerase chain reaction positive (PCR+) for ZIKV during pregnancy; and to investigate the concordance of caregiver reports of OPD with the diagnosis from the clinical swallowing assessment (CSA). Between Mar/2017 and May/2018, we evaluated 116 children (n = 58 with microcephaly, n = 58 children without microcephaly born to ZIKV PCR + mothers) participating in the Microcephaly Epidemic Research Group (MERG) cohort of children born during the 2015-2016 ZIKV epidemic in Pernambuco, Brazil. To assess OPD we used: a CSA; a clinical assessment of the stomatognathic system; and a questionnaire administered to caregivers. The frequency of OPD was markedly higher in children with ZRM (79.3%) than in the exposed but normocephalic group (8.6%). The children with microcephaly also presented more frequently with anatomic and functional abnormalities in the stomatognathic system. There was a high degree of agreement between the caregiver reports of OPD and the CSA (κ = 0.92). In conclusion, our findings confirm that OPD is a feature of Congenital Zika Syndrome that primarily occurs in children with microcephaly and provide support for policies in which children are referred for rehabilitation with an OPD diagnosis based on caregiver report.
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Affiliation(s)
- Danielle Maria da Silva Oliveira
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Demócrito de Barros Miranda-Filho
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Ricardo Arraes de Alencar Ximenes
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
- Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, Pernambuco Brazil
| | - Ulisses Ramos Montarroyos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Celina Maria Turchi Martelli
- Instituto Aggeu Magalhães, Campus da UFPE - Av. Prof. Moraes Rego, S/N - Cidade Universitária, Recife, Pernambuco Brazil
| | - Elizabeth B. Brickley
- London School of Hygiene and Tropical Medicine, London, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | | | - Regina Coeli Ramos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Maria Ângela Wanderley Rocha
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | | | - Sophie Helena Eickmann
- Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, Pernambuco Brazil
| | - Laura Cunha Rodrigues
- London School of Hygiene and Tropical Medicine, London, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Jeyse Polliane de Oliveira Soares Bernardes
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Maria Helena Teixeira Pinto
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | | | | | | | - Ana Célia Oliveira dos Santos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
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Pessa Valente E, Barbone F, de Melo E Lima TR, de Mascena Diniz Maia PFC, Vezzini F, Tamburlini G. Quality of maternal and newborn hospital care in Brazil: a quality improvement cycle using the WHO assessment and quality tool. Int J Qual Health Care 2021; 33:6146808. [PMID: 33619561 DOI: 10.1093/intqhc/mzab028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/09/2021] [Accepted: 02/20/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Increasing efforts toward quality improvement (QI) are necessary in low- and middle-income countries (LMICs) to reduce maternal and perinatal mortality and morbidity and to promote respectful care. In Brazil, perinatal health indicators are below targets in several states despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce. OBJECTIVES We assessed the effects of a 1-year comprehensive QI cycle using a World Health Organization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented QIs obtained after a 1-year comprehensive QI cycle. METHODS Uncontrolled, unblinded, pre-post study carried out in six maternity hospitals in Pernambuco, Brazil, accounting for 29 128 live births in 2014. A standards-based and participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hospital level was used. A national team of assessors supervised by international experts carried out baseline and final assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits. RESULTS At baseline, hospitals presented a variety of quality gaps, the majority common to all participating centers. Gaps in case management of normal and complicated deliveries and in respectful and holistic care were predominant, in both teaching/tertiary and secondary care hospitals. After one year, several improvements were observed, particularly in respectful care during labor and at delivery, in case management of normal labor and delivery and in neonatal care. CONCLUSIONS A systematic participatory approach based on a WHO tool produced important QIs in a relatively short time and should be considered for use for large-scale QI programs in Brazil and other LMICs. Its comprehensive, peer-to-peer and action-oriented nature and its capability to document QI over time and to build a QI culture represent important comparative advantages over other QI interventions.
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Affiliation(s)
- Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, Friuli Venezia Giulia Region 34137, Italy
| | - Fabio Barbone
- Scientific Direction, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, Friuli Venezia Giulia Region 34137, Italy
| | - Tereza Rebecca de Melo E Lima
- Post graduation department, doctorate on integral medicine, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Rua dos Coelhos, 300 - Boa Vista, Recife, Pernambuco 50070-902, Brazil.,Medicine course department, Faculdade Pernambucana de Saúde (FPS), av. Mal. Mascarenhas de Morais, 4861 - Imbiribeira, Recife - Pernambuco 51150-000, Pernambuco, Brazil
| | - Paula Ferdinanda Conceiçîo de Mascena Diniz Maia
- Medicine course department, Faculdade Pernambucana de Saúde (FPS), av. Mal. Mascarenhas de Morais, 4861 - Imbiribeira, Recife - Pernambuco 51150-000, Pernambuco, Brazil.,Pediatric department, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitària, Recife - Pernambuco 50670-901, Brazil
| | - Francesca Vezzini
- Post graduation department, doctorate on integral medicine, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Rua dos Coelhos, 300 - Boa Vista, Recife, Pernambuco 50070-902, Brazil.,Dottorato di Ricerca in Scienze della Riproduzione e dello Sviluppo, Università degli Studi di Trieste, Piazzale Europa, Trieste 34127, Italy
| | - Giorgio Tamburlini
- Dottorato di Ricerca in Scienze della Riproduzione e dello Sviluppo, Università degli Studi di Trieste, Piazzale Europa, Trieste 34127, Italy.,Director, Centro per la Salute del Bambino, Via Nocolò de Rin, 19, Trieste, Friuli Venezia Giulia Region 34143, Italy
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Araujo VMGD, Silva JSD, Silva CLB, Costa MDSDO, Costa EC, Frias PG, Barros MVGD, Correia Junior MADV. Factors associated with neonatal death among adolescent mothers. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to analyze factors associated with neonatal death among adolescent mothers. Methods: randomized hospital-based cross-sectional study in a tertiary institution,, data from the Sistema de Informação sobre Nascidos Vivos (Sinasc), (Live Birth Information System), Sistema de Informação sobre Mortalidade (SIM) (Mortality Information System), and medical records. The study population was comprised of 1,341 adolescents aged 10-19 who had assisted childbirth at the institution between 2012 to 2016. The independent variables were sociodemographic characteristics, care, prenatal, childbirth, birth, and newborn’s hospitalization, as well as the baby’s characteristics. Logistic regression analysis was carried out to assess the association between neonatal death and explanatory variables. Results: the factors associated with death were from the countryside or other States (OR=2.68; CI95% =1.24-5.81), Apgar scores lower than 7 in the 1st (OR= 9.52; CI95% = 4.15-21.81) and the 5th (OR=4.17; CI95%=1.53-11.34) minutes of life; and birth weight less than 999g (OR=13.37; CI95% =3, 64-49.04) and between 1,500 to 2,499g (OR=3.43; CI95%=1.37-8.58). Conclusions: apgar and low birth weight were associated with the neonatal death among adolescent mothers, as well as the fact they come from the countryside and other States. These findings show, in addition to classic risks, potential difficulties for adolescents in having access to healthcare services in their hometown. To reduce the risks, there is a need for restructuring the maternal and child healthcare network and ensure a social protection network for these girls.
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França KEXD, Vilela MBR, Frias PGD, Chaves MA, Sarinho SW. [Neonatal near miss in referral hospitals for high-risk pregnancy and childbirth: a cross-sectional study]. CAD SAUDE PUBLICA 2021; 37:e00196220. [PMID: 34105622 DOI: 10.1590/0102-311x00196220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
The article aimed to describe and compare indicators of neonatal near miss in referral hospitals for high-risk pregnancy and childbirth. This exploratory study was performed in two general hospitals in Recife, Pernambuco, Brazil. The study included cases of neonatal near miss in the year 2016 with gestational age < 33 weeks, birthweight < 1,750g, 5-minute Apgar < 7, or admission to the neonatal intensive care unit (ICU) and that remained alive at 7 days of life. Data were extracted from the Brazilian Information System on Live Births, Mortality Information System, Hospital Information System, and National Registry of Healthcare Establishments to characterize all live births at the institutions, cases of near miss, and availability of technology. Neonatal near miss and early neonatal mortality rates were calculated. The Pernambuco Maternal-Child Institute (IMIP) received the most serious cases and had the highest neonatal near miss rate (119.21 per thousand live births; p = 0.009) and early neonatal mortality rate (35.22 per thousand live births; p < 0.001). The University Hospital had the highest proportion of neonatal ICU admissions (76% of the near miss cases; p < 0.001). Neonatal near miss rates differed between the hospitals and are useful for surveillance of neonatal care in healthcare institutions, but they require attention to the local profile and context when the objective is to perform evaluations with classification. The findings reflect the complexity of assessing different health services.
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Diniz CSG, Franzon ACA, Fioretti-Foschi B, Niy DY, Pedrilio LS, Amaro E, Sato JR. Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25016. [PMID: 33945496 PMCID: PMC8143871 DOI: 10.2196/25016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/27/2021] [Accepted: 02/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. OBJECTIVE This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. METHODS A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. RESULTS The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. CONCLUSIONS This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. TRIAL REGISTRATION The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/25016.
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Affiliation(s)
- Carmen Simone Grilo Diniz
- School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
- Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Ana Carolina Arruda Franzon
- Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Gender and Evidence on Maternity and Health Study Group, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Beatriz Fioretti-Foschi
- Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Gender and Evidence on Maternity and Health Study Group, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Denise Yoshie Niy
- Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Gender and Evidence on Maternity and Health Study Group, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Edson Amaro
- Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Big Data, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - João Ricardo Sato
- Big Data, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Sao Bernardo do Campo, Brazil
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da Matta Machado Fernandes L, Lansky S, Reis Passos H, T. Bozlak C, A. Shaw B. Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study. PLoS One 2021; 16:e0248740. [PMID: 33861756 PMCID: PMC8051805 DOI: 10.1371/journal.pone.0248740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 03/04/2021] [Indexed: 01/02/2023] Open
Abstract
Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women’s experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women’s needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.
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Affiliation(s)
| | - Sônia Lansky
- Department of Health, Belo Horizonte, Minas Gerais, Brazil
| | | | - Christine T. Bozlak
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, United States of America
| | - Benjamin A. Shaw
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, United States of America
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Vieira VC, Lima RCG, Queiroz DB, Medeiros DSD. Vertically transmitted infections and extrauterine growth restriction in preterm neonates: a new risk factor. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to investigate the association between Vertically Transmitted Infections (VTI) and Extrauterine Growth Restriction (EUGR) among premature infants in Neonatal Intensive Care Units (NICU). Methods: part of a large non-concurrent cohort study with medical records analysis. We evaluated EUGR in premature infants at a gestational age at birth of > 32 weeks and <36 weeks and presented a corrected gestational age of 36 completed weeks during a 27-day birth follow-up. Premature infants with major congenital anomalies were excluded. We analyzed associations among EUGR, VTI and covariables related to maternal disease, birth characteristics, perinatal morbidities and clinical practices. Results: out of the 91 premature infants, 59.3% (CI95%=48.9-69.0%) developed EUGR. VTI were observed in 4.4%o of the population; all premature infants affected by VTI had EUGR. The VTI found were syphilis, cytomegalovirus disease and toxoplasmosis. The final analysis has showed a positive association between VTI and EUGR (RR=1.57; CI95%o=1.07-2.30); the female covariables (RR=1.50; CI95%=1.11-2.02), moderate premature classification (RR=1.41; CI95%=1.06-1.87) and small for gestational age (RR=2.69; CI95% 1.853.90) have also influenced this outcome. Conclusion: this study revealed VTI as an important morbidity factor, with impact on the increased risk of EUGR between premature infants affected by these diseases.
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Kawakami MD, Sanudo A, Teixeira MLP, Andreoni S, de Castro JQX, Waldvogel B, Guinsburg R, de Almeida MF. Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country. BMC Pregnancy Childbirth 2021; 21:169. [PMID: 33639885 PMCID: PMC7913394 DOI: 10.1186/s12884-021-03652-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/18/2021] [Indexed: 01/21/2023] Open
Abstract
Background It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths. Methods Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors. Results Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32–41 weeks, in 2009 for 28–31 weeks, and in 2011 for 22–27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0–3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28–36 weeks. Conclusions There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care.
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Affiliation(s)
- Mandira D Kawakami
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | | | - Solange Andreoni
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | - Josiane Q X de Castro
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | - Maria Fernanda de Almeida
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil.
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Fonseca JM, Silva AAM, Rocha PRH, Batista RLF, Thomaz EBAF, Lamy-Filho F, Barbieri MA, Bettiol H. Racial inequality in perinatal outcomes in two Brazilian birth cohorts. ACTA ACUST UNITED AC 2021; 54:e10120. [PMID: 33503156 PMCID: PMC7822460 DOI: 10.1590/1414-431x202010120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to estimate and compare racial inequality in low birth weight (LBW), preterm birth (PTB), and intrauterine growth restriction (IUGR) in two Brazilian birth cohorts. This was a cross-sectional study nested within two birth cohorts in Ribeirão Preto (RP) and São Luís (SL), whose mothers were interviewed from January to December 2010. In all, 7430 (RP) and 4995 (SL) mothers were interviewed. The maternal skin color was the exposure variable. Associations were adjusted for socioeconomic and biological covariates: maternal education, per capita family income, family economic classification, household head occupation, maternal age, parity, marital status, prenatal care, type of delivery, maternal pre-pregnancy BMI, hypertension, hypertension during pregnancy, and smoking during pregnancy collected from questionnaires applied at birth. Statistical analysis was done with the chi-squared test and logistic regression. In RP, newborns from mothers with black skin color had a higher risk of LBW and IUGR, even after adjusting for socioeconomic and biological variables (P<0.001). In SL, skin color was not a risk factor for LBW (P=0.859), PTB (P=0.220), and IUGR (P=0.062), before or after adjustment for socioeconomic and biological variables. The detection of racial inequality in these perinatal outcomes only in the RP cohort after adjustment for socioeconomic and biological factors may be reflecting the existence of racial discrimination in the RP society. In contrast, the greater miscegenation present in São Luís may be reflecting less racial discrimination of black and brown women in this city.
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Affiliation(s)
- J M Fonseca
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - A A M Silva
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - P R H Rocha
- Departamento de Pediatria e Puericultura, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R L F Batista
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - E B A F Thomaz
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - F Lamy-Filho
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - M A Barbieri
- Departamento de Pediatria e Puericultura, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - H Bettiol
- Departamento de Pediatria e Puericultura, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Souza JP, Méio MDBB, de Andrade LM, Figueiredo MR, Gomes Junior SC, Pereira Junior JP, Brickley E, Lopes Moreira ME. Adverse fetal and neonatal outcomes in pregnancies with confirmed Zika Virus infection in Rio de Janeiro, Brazil: A cohort study. PLoS Negl Trop Dis 2021; 15:e0008893. [PMID: 33395421 PMCID: PMC7781387 DOI: 10.1371/journal.pntd.0008893] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/16/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To analyze adverse fetal and neonatal outcomes of Zika virus infection by the timing of infection during pregnancy. Method: Cohort study of 190 pregnancies with 193 offspring with a positive RT-PCR test for Zika virus (March/2016 to April/2017). RESULTS Death or defects related to congenital Zika virus infection were identified in 37.3% of fetuses and newborns, and microcephaly in 21.4% of the newborns. The proportion of small for gestational age newborns was 21.9%. Maternal symptoms in the first trimester were significantly associated with the birth of newborns with microcephaly/cerebral atrophy, small for gestational age and with the deaths (one abortion, one stillbirth and the two neonatal deaths). Maternal infection during the second trimester was further associated with asymptomatic newborns at birth. The study showed that 58.5% of the offspring with microcephaly and / or cortical atrophy were small for gestational age, with an evident decrease in symptomatic offspring without microcephaly, 24.1%, and with only 9.1% in the asymptomatic group. CONCLUSION This study showed that the earlier the symptoms appear during gestation, the more severe the endpoints. We found a higher percentage of small for gestational age newborns exposed to Zika virus early in gestation. We also found a group of apparently asymptomatic newborns with proven Zika infection, which highlights the importance of follow up studies in this population.
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Affiliation(s)
- Juliana P. Souza
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Dalva B. B. Méio
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura Medeiros de Andrade
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mirza R. Figueiredo
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Saint Clair Gomes Junior
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jose Paulo Pereira Junior
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elizabeth Brickley
- Assistant Professor of Infectious Disease Epidemiology, Faculty of Epidemiology and Population, London School Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
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Fontenele MMFT, Silva CF, Leite ÁJM, Castro ECM, Carvalho FHC, Silva AVSE. SNAPPE II: ANALYSIS OF ACCURACY AND DETERMINATION OF THE CUTOFF POINT AS A DEATH PREDICTOR IN A BRAZILIAN NEONATAL INTENSIVE CARE UNIT. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2020; 38:e2019029. [PMID: 33331559 PMCID: PMC7747781 DOI: 10.1590/1984-0462/2020/38/2019029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the accuracy of the Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II) as a death predictor, to determine the cutoff point for mortality, and to analyze the association of independent variables with death. METHODS Prospective, longitudinal, hospital-based study on newborns admitted to the Neonatal Intensive Care Unit (NICU) for the first time from November 1, 2016 to April 30, 2017. Newborns with less than 12 hours of length of stay at the NICU, out-of-hospital births, major congenital malformations, and inter-hospital transfer were excluded. Variables were grouped according to hierarchical framework, related to maternal characteristics (distal level), prenatal and childbirth care (intermediate level), and birth conditions (proximal level). Descriptive analyses of SNAPPE II score ranges, Receiver Operating Characteristics Curve (ROC curve) to define the cutoff point for mortality, and bivariate analysis by the Wald test and multiple logistic regression were conducted. RESULTS After selection, the sample consisted of 247 newborns. In this study, the SNAPPE II cutoff point for mortality was 27, with sensitivity of 84.1% and specificity of 82.4%. 61% of those with a score ≥27 died. Multiple logistic regression showed an association between death and proximal-level variables: sepsis (Odds Ratio [OR] 10.68; 95% confidence interval [95%CI] 2.82-40.48; p<0.001); SNAPPE II ≥27 (OR 5.85; 95%CI 1.90-18.05; p=0.002); birth weight 750-999 g (OR 4.15; 95%CI 1.06-16.14; p=0.040); and nonuse of surfactant (OR 0.159; 95%CI 0.04-0.53; p=0.003). CONCLUSIONS Neonatal mortality was directly proportional to increase in SNAPPE II. Score≥27 increased the odds of dying by six times compared with neonates with lower scores. The proximal variables related to health conditions and neonatal care were associated with death.
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Barreto CTG, Tavares FG, Theme-Filha M, Farias YN, Pantoja LDN, Cardoso AM. Baixo peso ao nascer, prematuridade e restrição de crescimento intra-uterino: resultados dos dados de base da primeira coorte de nascimentos indígenas no Brasil (coorte de nascimentos Guarani). BMC Pregnancy Childbirth 2020; 20:748. [PMID: 33267830 PMCID: PMC7709282 DOI: 10.1186/s12884-020-03396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
ABSTRATO FUNDO: O baixo peso ao nascer (BPN) continua sendo um importante problema de saúde global, associado a uma série de resultados adversos de saúde ao longo da vida. As evidências sugerem que o BPN é um determinante relevante de morbidade e mortalidade em grupos indígenas, que geralmente têm acesso limitado às políticas públicas de saúde e nutrição. O conhecimento da prevalência de BPN e de suas causas subjacentes pode contribuir com etapas essenciais para a prevenção de seus efeitos sobre a saúde. O estudo teve como objetivo estimar as prevalências de BPN, prematuridade e restrição de crescimento intra-uterino (RCIU) e investigar seus determinantes na primeira coorte de nascimentos indígenas no Brasil. MéTODOS: Este estudo transversal utilizou dados de linha de base coletados da primeira coorte de nascimentos indígenas no Brasil, a Coorte de Nascimentos Guarani. O Brasil é um dos países com maior diversidade étnica do mundo, com 305 povos indígenas e 274 línguas nativas. Os Guarani são uma das cinco maiores etnias, com aldeias localizadas principalmente na região sul. Todos os nascimentos únicos de 1º de junho de 2014 a 31 de maio de 2016 foram selecionados em 63 aldeias indígenas Guarani nas regiões Sul e Sudeste. Foi realizada regressão logística múltipla hierárquica. RESULTADOS As taxas de prevalência de BPN, prematuridade e RCIU foram 15,5, 15,6 e 5,7%, respectivamente. As chances de BPN foram menores em recém-nascidos de mães que vivem em casas de tijolo e argamassa (OR: 0,25; IC 95%: 0,07-0,84) e foram maiores em filhos de mães ≤20 anos de idade (OR: 2,4; IC 95%: 1,29-4,44) e com anemia crônica antes da gravidez (OR: 6,41; IC 95%: 1,70-24,16). A prematuridade foi estatisticamente associada ao tipo de fonte de energia para cozinhar (fogão a lenha - OR: 3,87; IC 95%: 1,71-8,78 e fogueiras - OR: 2,57; IC 95%: 1,31-5,01). RCIU foi associado à primiparidade (OR: 4,66; IC 95%: 1,68-12,95) e anemia materna crônica antes da gravidez (OR: 7,21; IC 95%: 1,29-40,38). CONCLUSõES: Idade materna, estado nutricional e paridade, condições de moradia e exposição à poluição interna foram associados com resultados perinatais na população indígena Guarani. Esses resultados indicam a necessidade de investir no acesso e melhoria da assistência pré-natal; também no fortalecimento do Subsistema de Saúde Indígena, e em ações intersetoriais para o desenvolvimento de políticas habitacionais e de saneamento e melhorias ambientais ajustadas às necessidades e conhecimentos dos povos indígenas.
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Affiliation(s)
- Carla Tatiana Garcia Barreto
- Universidade do Estado do Rio de Janeiro (UERJ), Av. Marechal Rondon, 381. São Francisco Xavier, Rio de Janeiro, RJ, CEP: 20950-000, Brazil.
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Felipe Guimarães Tavares
- Escola de Enfermagem Aurora de Afonso Costa. Faculdade de Enfermagem, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Mariza Theme-Filha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil. PLoS One 2020; 15:e0240631. [PMID: 33057414 PMCID: PMC7561084 DOI: 10.1371/journal.pone.0240631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. Objective To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. Method We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). Results The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10th and 25th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10th and 25th quantiles, but a negative association in the upper tail (75th and 90th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. Conclusion PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of antenatal or child consultations benefited the most by participating in PMAQ, which suggests that PMAQ might motivate worse performing health providers to catch up.
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Oliva-Costa S, Nahass S, Dourado A, Lopes S. Morbidity and mortality due to surgical congenital malformations from the perspective of surgical neonatal ICU outside a maternity service: a retrospective cohort study. ACTA ACUST UNITED AC 2020; 66:1252-1257. [PMID: 33027454 DOI: 10.1590/1806-9282.66.9.1252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/26/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the characteristics of patients treated at a level III surgical Neonatal Intensive Care Unit outside of a maternity service and analyze possible risk factors for mortality in this population. METHODS A retrospective cohort study evaluating patients admitted to a level III surgical Neonatal Intensive Care Unit from June/2015 to November/2017. Univariate analysis was performed by the Chi-square test and T-student test or Mann-Whitney test. Multivariate analysis by logistic regression was performed including in the model the variables with a P-value <0.2 in univariate analysis. Kaplan-Meier curve and Log-Rank test were performed using the variables that were statistically associated with death in the multivariate analysis. A significance level of a=5% and an error B=80% were adopted. RESULTS During this period, 246 patients were admitted to this service. 58 (23.8%) patients died, with a mean time until death of 18 days. Half of the patients had a clinical diagnosis of sepsis (50.6%), blood culture was positive in 25.2%, and gram-positive bacteria (48.4%) were the main pathogens isolated. The variables that remained in the final model after multivariate analysis were diagnosis of congenital heart disease (OR = 4.5; p = 0.016), clinical diagnosis of sepsis (OR = 8.1; p = 0.000), and isolation of gram-positive bacteria in blood culture (OR = 3.9; p = 0.006). CONCLUSION The level III surgical Neonatal Intensive Care Unit outside of a maternity service has a different profile of morbidity and mortality, and death was associated with the diagnosis of congenital heart disease, the clinical diagnosis of sepsis, and the isolation of gram-positive bacteria in the blood culture.
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Affiliation(s)
- Sofia Oliva-Costa
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Samir Nahass
- Coordenador médico UTIN cirúrgica HMG; Hospital Martagão Gesteira (HMG), Salvador, BA, Brasil
| | - Andréa Dourado
- Enfermeria líder UTIN cirúrgica HMG; Hospital Martagão Gesteira (HMG), Salvador, BA, Brasil
| | - Selma Lopes
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil.,Médica da UTIN cirúrgica; Hospital Martagão Gesteira (HMG), Salvador, BA, Brasil
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Silva RID, Santos LHBD, Strauch JCM, Cavalcanti MDLT, Kale PL. [Intermunicipal healthcare flows and perinatal births and deaths in Greater Metropolitan Rio de Janeiro, Brazil, in 2011 and 2014]. CAD SAUDE PUBLICA 2020; 36:e00163419. [PMID: 33027429 DOI: 10.1590/0102-311x00163419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/17/2020] [Indexed: 11/21/2022] Open
Abstract
The regionalization of perinatal care should consider existing healthcare structures for facilitating access. This spatial-temporal ecological study identified intermunicipal flows of perinatal births and deaths in Greater Metropolitan Rio de Janeiro, Brazil, in 2011 and 2014, defined parameters, and systematized proposals for organizing the regionalization of perinatal care. The data sources were the Brazilian Information System on Live Births, Mortality Information System, National Registry of Healthcare Establishments, and 2010 Population Census. The study identified existing relations between the mothers' municipalities of residence and the occurrence of perinatal births and deaths. Each municipality was analyzed singly and pairwise (residence/occurrence) according to the vital event, healthcare resources, and pragmatic criteria of life-threatening conditions at birth. We conducted descriptive analyses of dominant flows, exploratory principal components analysis, and cluster analysis. The existing healthcare networks were identified, and 47 variables were summarized in three factors (analytical dimensions) - availability of beds, risk of life-threatening conditions, and socioeconomic status - accounting for 60%/80%, 20%/30%, 13%/22%, respectively, of the variance pertaining to each year analyzed. The factors were used to form clusters, classified in 3 to 5 strata. Three proposals were drafted for perinatal health regions. The study's principal contribution was having presented parameters for monitoring the regionalization and systematic reevaluation of this process based on administrative records.
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Affiliation(s)
- Rosanna Iozzi Da Silva
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brasil.,Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Julia Célia Mercedes Strauch
- Escola Nacional de Ciências Estatísticas, Instituto Brasileiro de Geografia e Estatística, Rio de Janeiro, Brasil
| | | | - Pauline Lorena Kale
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Inequalities in infant mortality in Brazil at subnational levels in Brazil, 1990 to 2015. Popul Health Metr 2020; 18:4. [PMID: 32993802 PMCID: PMC7526088 DOI: 10.1186/s12963-020-00208-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/19/2020] [Indexed: 01/13/2023] Open
Abstract
Background In this study, infant mortality rate (IMR) inequalities are analyzed from 1990 to 2015 in different geographic scales. Methods The Ministry of Health (MoH) IMR estimates by Federative Units (FU) were compared to those obtained by the Global Burden of Disease (GBD) group. In order to measure the inequalities of the IMR by FU, the ratios from highest to lowest from 1990 to 2015 were calculated. Maps were elaborated in 2000, 2010, and 2015 at the municipality level. To analyze the effect of income, IMR inequalities by GDP per capita were analyzed, comparing Brazil and the FU to other same-income level countries in 2015, and the IMR municipal estimates were analyzed by income deciles, in 2000 and 2010. Results IMR decreased from 47.1 to 13.4 per 1000 live births (LB) from 1990 to 2015, with an annual decrease rate of 4.9%. The decline was less pronounced for the early neonatal annual rate (3.5%). The Northeast region showed the most significant annual decline (6.2%). The IMR estimates carried out by the GBD were about 20% higher than those obtained by the MoH, but in terms of their inequalities, the ratio from the highest to the lowest IMR among the 27 FU decreased from 4 to 2, for both methods. The percentage of municipalities with IMR higher than 40 per 1000 LB decreased from 23% to 2%, between 2000 and 2015. Comparing the IMR distribution by income deciles, all inequality measures of the IMR decreased markedly from 2000 to 2010. Conclusion The results showed a marked decrease in the IMR inequalities in Brazil, regardless of the geographic breakdown and the calculation method. Despite clear signs of progress in curbing infant mortality, there are still challenges in reducing its level, such as the concentration of deaths in the early neonatal period, and the specific increases of post neonatal mortality in 2016, after the recent cuts in social investments.
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França KEXD, Vilela MBR, Frias PGD, Sarinho SW. EARLY NEONATAL NEAR MISS IN A UNIVERSITY HOSPITAL: COMPARATIVE CROSS-SECTIONAL STUDY. ACTA ACUST UNITED AC 2020; 39:e2019317. [PMID: 32996995 PMCID: PMC7518722 DOI: 10.1590/1984-0462/2021/39/2019317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare 2012 and 2016 data on early neonatal near miss indicators from Health Information Systems at a university hospital. METHODS This is a cross-sectional study conducted in 2012 and 2016. We considered early neonatal near misses the live births that presented one of the following risk conditions at birth: gestational age <33 weeks, birth weight <1,750g or 5-minute Apgar score <7, or Neonatal Intensive Care Unit (NICU) admission, and were alive until the 7th day of life. Data were collected from the Live Birth Information System, Hospital Information System, and Mortality Information System. We calculated the early neonatal mortality rate, neonatal near miss rate, severe neonatal outcome rate, early neonatal survival index, and early neonatal mortality index, compared by year of birth. RESULTS In 2012, 304 early neonatal near misses were registered, with a higher proportion of cases with very low birth weight and mothers who had zero to three prenatal visits. In 2016, the number of cases was 243, with a predominance of more NICU admissions. The incidence of early neonatal deaths and early neonatal near misses was higher in 2012 than in 2016. CONCLUSIONS Neonatal near miss indicators identified difference between years. The cases were more severe in 2012 and there were more NICU admissions in 2016.
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Miranda ECS, Rodrigues CB, Machado LG, Gomes MADSM, Augusto LCR, Simões VMF, Magluta C, Lamy-Filho F. Neonatal bed status in Brazilian maternity hospitals: an exploratory analysis. CIENCIA & SAUDE COLETIVA 2020; 26:909-918. [PMID: 33729346 DOI: 10.1590/1413-81232021263.21652020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Neonatal units should be organized as a progressive care line, with intermediate and intensive care beds (conventional and kangaroo). The aim of this study was to evaluate the status and adequacy of neonatal beds in maternity hospitals linked to the 'Stork Network' ("Rede Cegonha"). A descriptive study was conducted in 606 maternity hospitals in all regions of Brazil. The databases used belonged to the Stork Network Evaluation Survey and the National Live Birth System. To assess the distribution of neonatal beds by typology, the parameters proposed in Ordinance N. 930/2012 of the Ministry of Health were used. Most neonatal units are not organized as a progressive care line with the three types of bed planned. Kangaroo intermediate care beds comprise the minority of implanted beds. There is a concentration of intensive and intermediate beds in the Southeast and South regions, which show a kangaroo intermediate care bed deficit. Analyzing the adequacy of beds by the number of live births, one can observe an inadequacy of Kangaroo care beds in all regions of Brazil, as well as intensive bed deficit in the North and Northeast regions, and adequacy of conventional intermediate care beds in all regions.
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Affiliation(s)
- Elaine Cristina Silva Miranda
- Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
| | - Camila Brito Rodrigues
- Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
| | | | | | | | - Vanda Maria Ferreira Simões
- Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
| | - Cynthia Magluta
- Instituto Fernando Figueira, Fiocruz. Rio de Janeiro RJ Brasil
| | - Fernando Lamy-Filho
- Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
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Silva LBRADA, Angulo-Tuesta A, Massari MTR, Augusto LCR, Gonçalves LLM, Silva CKRTD, Minoia NP. Evaluation of the Rede Cegonha: feedback of results for Brazilian maternity hospitals. CIENCIA & SAUDE COLETIVA 2020; 26:931-940. [PMID: 33729348 DOI: 10.1590/1413-81232021263.25782020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/05/2020] [Indexed: 11/22/2022] Open
Abstract
This paper describes and analyzes the process of providing feedback on the results of the second evaluation cycle of good practices of delivery and birth care in maternity hospitals linked to the Rede Cegonha, a Ministry of Health strategy implemented in 2011 to improve obstetric and neonatal healthcare and management. This is a qualitative study based on the documentary analysis of 27 reports from the states and the Federal District referring to the feedback workshops with 1.641 participants, 40% of whom were professionals and managers of the maternity hospitals evaluated, 25% of state representatives, 20% of municipal health secretariats and 15% of federal representatives. Around 46% of maternity hospitals' action plans in 11 states were received from January to August 2019. The results show the challenge of incorporating the monitoring and evaluation processes in these maternity hospitals' daily lives due to structural issues in institutional culture. This situation interferes with the local systematic analysis of information and the implementation of national evaluation cycles with the swift and continuous feedback of the results since access to secondary national data is non-existent in good delivery care practices.
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Affiliation(s)
| | - Antonia Angulo-Tuesta
- Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Faculdade de Ceilândia. Brasília DF Brasil
| | - Maria Teresa Rossetti Massari
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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45
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Genovesi FF, Canario MADSS, Godoy CBD, Maciel SM, Cardelli AAM, Ferrari RAP. Maternal and child health care: adequacy index in public health services. Rev Bras Enferm 2020; 73 Suppl 4:e20170757. [PMID: 32756749 DOI: 10.1590/0034-7167-2017-0757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/23/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to analyze the adequacy of maternal and child-care in prenatal care, childbirth and the puerperal period, in the public health service. METHODS longitudinal study carried out in a city in Paraná with 357 puerperal women in a public maternity ward, outpatient clinic for immediate puerperal return and home visit 42 days postpartum. Four care domains were grouped (1 - Prenatal, 2 - Maternity, 3 - Immediate puerperal return, 4 - Late puerperal return). Mean, median, standard deviation and coefficient of variance were calculated considering adequate assistance when ≥ 70%; and inadequate, inferior. RESULTS lowest suitability average in Domain 3 (39.37%) and highest for Domain 4 (74.82%); median of 50.00% at 3 and 76.90% at 4. The largest standard deviation, in Domain 3 (25.18%); and high coefficient of variance for 1 and 3. CONCLUSIONS in maternal and child follow-up, rates close to adequate in maternity care and higher in late puerperal return, meanwhile prenatal and immediate puerperal return were below the recommended in the health care network.
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46
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Carvalho OMC, Junior ABV, Augusto MCC, Leite ÁJM, Nobre RA, Bessa OAAC, de Castro ECM, Lopes FNB, Carvalho FHC. Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study. BMC Pregnancy Childbirth 2020; 20:437. [PMID: 32727418 PMCID: PMC7391531 DOI: 10.1186/s12884-020-03128-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center. Methods This case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true “controls”), “near-miss,” and “neonatal death.” Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson’s chi-square and Fisher’s exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression. Results Comparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8–5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3–108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6–7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1–5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0–5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2–2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7–4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2–91.8). Conclusions The delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.
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Affiliation(s)
| | | | | | - Álvaro Jorge Madeiro Leite
- Departamento de Saúde Comunitária / Universidade Federal do Ceará. Fortaleza, Fortaleza, CE, Brazil.,Departamento de Saúde da Mulher, da Criança e do Adolescente UFC, Fortaleza, Brazil
| | - Rivianny Arrais Nobre
- Universidade de Fortaleza/ UNIFOR, Fortaleza, CE, Brazil.,Departamento de Saúde da Mulher, da Criança e do Adolescente UFC, Fortaleza, Brazil
| | | | | | | | - Francisco Herlânio Costa Carvalho
- Departamento de Saúde Comunitária / Universidade Federal do Ceará. Fortaleza, Fortaleza, CE, Brazil.,Departamento de Saúde da Mulher, da Criança e do Adolescente UFC, Fortaleza, Brazil.,Maternidade Escola Assis Chateaubriand, Fortaleza, CE, Brazil
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47
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Bittencourt SDDA, Vilela MEDA, Marques MCDO, Santos AMD, Silva CKRTD, Domingues RMSM, Reis AC, Santos GLD. Labor and childbirth care in maternities participating in the "Rede Cegonha/Brazil": an evaluation of the degree of implementation of the activities. CIENCIA & SAUDE COLETIVA 2020; 26:801-821. [PMID: 33729338 DOI: 10.1590/1413-81232021263.08102020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022] Open
Abstract
Using a judgment framework, this article analyzes the degree of implementation of the best practices in labor and childbirth care contained in the guidelines of the Rede Cegonha (RC) across Brazil. The study eligibility criteria were public and mixed hospitals located in a health region with a RC action plan in place in 2015, resulting in a total of 606 facilities distributed across the country. Three different data collection methods were used: face-to-face interviews with managers, health professionals and puerperal women; document analysis; and on-site observation. The framework was built around the five guidelines of the Labor and Childbirth component of the RC. Degree of implantation was rated as follows: adequate; partially adequate and inadequate. The performance of maternity facilities was rated as partially adequate for all guidelines except for hospital environment, which was rated as inadequate. A huge variation in degree of implementation was observed across regions, with the South and Southeast being the best-performing regions in most items. The results reinforce the need for an ongoing evaluation of the actions developed by the RC to inform policy-making and the regulation of labor and childbirth care.
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Affiliation(s)
| | | | | | | | | | - Rosa Maria Soares Madeira Domingues
- Laboratório de Pesquisa Clínica em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Ana Cristina Reis
- Escola Politécnica Joaquim Venâncio, Fiocruz. Rio de Janeiro RJ Brasil
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Gedefaw G, Alemnew B, Demis A. Adverse fetal outcomes and its associated factors in Ethiopia: a systematic review and meta-analysis. BMC Pediatr 2020; 20:269. [PMID: 32493464 PMCID: PMC7268488 DOI: 10.1186/s12887-020-02176-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite the reduction of neonatal morbidity and mortality, is one of the third Sustainable Development Goal to end the death of children, the burden of the problem still the major challenge in Ethiopia. Globally, the most common causes of neonatal morbidity and mortality are adverse fetal outcomes (low birth weight, stillbirth, prematurity, congenital defect). Therefore this systematic review and meta-analysis aimed to estimate the pooled prevalence of adverse fetal outcomes and its associated factors in Ethiopia. METHOD International databases (PubMed, Google scholar, web of science and science direct) were searched. Seventeen articles were included, among these, fourteen were cross-sectional and three of them were case-control studies. Publication bias was employed using a funnel plot and eggers test. The I2 statistic was computed to check the heterogeneity of studies. Subgroup analysis was performed for the evidence of heterogeneity. RESULT A total of 11,280 study participants were used to estimate the pooled prevalence of adverse fetal outcomes. The overall pooled prevalence of adverse fetal outcomes in Ethiopia was 26.88% (95% CI; 20.73-33.04). Low birth weight 10.06% (95% CI; 7.21-12.91) and prematurity 8.76% (95% CI; 5.4-12.11) were the most common adverse birth outcome at the national level. Rural in residency (AOR = 2.31; 95% CI: 1.64-3.24), lack of antenatal care follow up (AOR = 3.84; 95% CI: 2.76-5.35), pregnancy-induced hypertension (AOR = 7.27; 95% CI: 3.95-13.39), advanced maternal age ≥ 35(AOR = 2.72; 95% CI: 1.62-4.58, and having current complication of pregnancy (AOR = 4.98; 95% CI: 2.24-11.07) were the factors associated with adverse birth outcome. CONCLUSION The pooled prevalence of adverse fetal outcomes in Ethiopia was high. Rural in residency, lack of antenatal care follow up, pregnancy-induced hypertension, advanced maternal age ≥ 35, and having current complications of pregnancy were the factors associated with adverse fetal outcomes. PROSPERO PROTOCOL REGISTRATION CRD42020149163.
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Affiliation(s)
- Getnet Gedefaw
- Department of Midwifery, College of health sciences, Woldia University, Woldia, Ethiopia.
| | - Birhan Alemnew
- Department of Medical laboratory science, College of health sciences, Woldia University, Woldia, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of health sciences, Woldia University, Woldia, Ethiopia
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49
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Lima RG, Vieira VC, Medeiros DSD. Determinants of preterm infants’ deaths at the Neonatal Intensive Care Units in the Northeast Countryside in Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000200012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to assess preterm infants’ characteristics, health conditions and neonatal care effect on their death at the neonatal ICU. Methods: this was a non-concurrent cohort study, including preterm infants from three neonatal ICUs from January 1st to December 31st, 2016, followed during the neonatal period and deaths registered during the entire hospitalization. Multivariate analysis was performed using Poisson regression. Results: of the 181 preterm infants, 18.8% died during hospitalization. Associated with the outcome: a gestational age between 28 and 32 weeks (RR= 5.66; CI95%= 2.08-15.40), and less than 28 weeks (RR=9.24; CI95%=3.27-26.12), Apgar score of 5th minutes less than 7 (RR: 1.82; CI95%=1.08-3.08), use of invasive mechanical ventilation up to 3 days (RR= 4.44; CI95%= 1.66-11.87) and 4 days and more (RR=6.87; CI95%=2.58-18.27). Besides the late sepsis (RR: 3.72, CI95%=1.77-7.83), acute respiratory distress syndrome (RR=2.86, CI95%=1.49-5.46), pulmonary hemorrhage (RR=1.97; CI95%=1.40-2.77), and necrotizing enterocolitis (RR= 3.41; CI95%=1.70-6.83). Conclusions: the results suggest the importance of using strategies to improve care during childbirth, conditions for extremely premature infants, early weaning from a mechanical ventilation and prevention on nosocomial infection.
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Souza RT, Costa ML, Mayrink J, Feitosa FE, Rocha Filho EA, Leite DF, Vettorazzi J, Calderon IM, Sousa MH, Passini R, Baker PN, Kenny L, Cecatti JG. Perinatal outcomes from preterm and early term births in a multicenter cohort of low risk nulliparous women. Sci Rep 2020; 10:8508. [PMID: 32444773 PMCID: PMC7244568 DOI: 10.1038/s41598-020-65022-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/17/2020] [Indexed: 11/08/2022] Open
Abstract
Preterm birth is the major contributor for neonatal and under-five years mortality rates and also accounts for a short- and long-term adverse consequences up to adulthood. Perinatal outcomes may vary according to lots of factors as preterm subtype, late prematurity, which account for the vast majority of cases, country and population characteristics. An under-recognition of the perinatal outcomes and its associated factors might have underpowered strategies to provide adequate care and prevent its occurrence. We aim to estimate the frequency of maternal and perinatal outcomes in women with different categories of preterm and term births, factors associated with poorer perinatal outcomes and related management interventions. A multicentre prospective cohort in five maternities in Brazil between 2015 and 2018. Nulliparous low-risk women with singletons were included. Comprehensive data were collected during three antenatal visits (at 19-21weeks, 27-29 weeks and 37-39 weeks). Maternal and perinatal outcomes were also collected according to maternal and neonatal medical records. Women who had spontaneous (sPTB) and provider-initiated (pi-PTB) preterm birth were compared to those who had term birth. Also, late preterm birth (after 34 weeks), and early term (37-38 weeks) were compared to full term birth (39-40 weeks). Bivariate analysis estimated risk ratios for maternal and adverse outcomes. Finally, a multivariate analysis was conducted to address factors independently associated with any adverse perinatal outcome (APO). In total, 1,165 women had outcome data available, from which 6.7% had sPTB, 4.0% had pi-PTB and 89.3% had a term birth. sPTB and pi-PTb were associated with poorer perinatal outcomes, as well as late sPTB, late pi-PTB and early term neonates. pi-PTB (RRadj 8.12, 95% CI [2.54-25.93], p-value 0.007), maternal weight gain between 20 and 27 weeks
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Affiliation(s)
- Renato T Souza
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Maria L Costa
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Jussara Mayrink
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Francisco E Feitosa
- MEAC - School Maternity of the Federal University of Ceará, in Fortaleza, CE, Brazil
| | - Edilberto A Rocha Filho
- Department of Maternal and Child Health, Maternity of Clinic Hospital, Federal University of Pernambuco, in Recife, PE, Brazil
| | - Débora F Leite
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
- Department of Maternal and Child Health, Maternity of Clinic Hospital, Federal University of Pernambuco, in Recife, PE, Brazil
| | - Janete Vettorazzi
- Department of Obstetrics and Gynaecology, Maternity of the Clinic Hospital, Federal University of RS, Porto Alegre, RS, Brazil
| | - Iracema M Calderon
- Department of Obstetrics and Gynaecology, Botucatu Medical School, Unesp, Botucatu, SP, Brazil
| | - Maria H Sousa
- Statistics Unit, Jundiai School of Medicine, Jundiaí, SP, Brazil
| | - Renato Passini
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil
| | - Philip N Baker
- College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Louise Kenny
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Jose G Cecatti
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) School of Medical Sciences, Campinas, SP, Brazil.
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