Magister Curationis - MCur / Background: The neonatal period starts at birth and ends 28 days after birth, and is the most defence less period in the newborn's life. Improving newborn health is a priority for the Ministry of Health and Social Services (MoHSS) in Namibia. The national neonatal mortality rate stood at 21.80 per 1000 live births in the country, and Namibia was unable to attain Millennium Development Goal 4 which focused on reduction of the child mortality rate by two-thirds between 1990 and 2015. Aim: This study investigated the factors contributing to neonatal deaths at a national hospital in the Khomas region of Namibia, with the following objectives: (i) to identify causes of early neonatal deaths; (ii) to identify the causes of late neonatal deaths; and (iii) to identify avoidable and unavoidable factors contributing to neonatal deaths. Methodology: The study used a quantitative research approach with a retrospective descriptive design to investigate factors contributing to neonatal deaths. The primary data were collected from a population of 231 record files of all neonates who died during the period 1 January to 31 December 2013 while admitted to the national hospital before 28 completed days of life. Results: The study identified that of the neonates who died, 67.1% (n=155) were early neonatal deaths (during the first 0–7 days of life), while 32.9% (n=76) died during the late neonatal period (from 8–28 days of life). Of the neonates who died, 50.6% (n=117) were male and 48.48% (n=112) were female. The causes of early and late neonatal deaths were similar, although they happened at different stages. The causes of early neonatal deaths have been identified as respiratory distress syndrome (RDS) – 24.2% (n=56); neonatal sepsis – 12.1% (n=28); birth asphyxia – 11.7 % (n=27); congenital abnormalities – 14.7 % (n=34); hemorrhagic diseases of newborns – 3.9% (n=9); and unknown – 0.6% (n=1). Neonatal sepsis caused the highest number of late neonatal deaths 17.7 %,( n=41); followed by RDS – 7.4% (n=17); congenital abnormalities – 3.9% (n=9); birth asphyxia – 3.1% (n=7); birth trauma – 0.4% (n=1); and unknown factors – 0.4 % (n=1). The study revealed that avoidable factors related to healthcare providers had a severe impact on neonatal deaths, while congenital abnormalities were unavoidable factors. Conclusion: The study concluded that most neonatal deaths are related to actions or inactions of the healthcare providers and could be avoided. Recommendations: Based on the results of the study, further research is required to assess the knowledge, skills, and behaviors of the healthcare providers. Training and education about neonatal resuscitation needs to be carried out on a regular basis.

Made available in DSpace on 2014-06-11T19:35:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-25Bitstream added on 2014-06-13T20:06:50Z : No. of bitstreams: 1 sleutjes_fcm_dr_botfm.pdf: 725660 bytes, checksum: 9a58cee8a9d2137fdcb115679023885d (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Investigar os óbitos neonatais pode ser uma importante estratégia para redução da mortalidade infantil e fetal, pois contribui para melhorar a qualidade da informação sobre esse evento adverso e possibilita a adoção, pelos serviços de saúde, de medidas para a prevenção de óbitos evitáveis. Objetivo Geral: avaliar os óbitos neonatais investigados no Departamento Regional de Saúde VI – Bauru, considerando-se os Colegiados de Gestão Regional, no ano de 2009. Metodologia: estudo descritivo e transversal, que analisou 162 óbitos investigados, a partir das informações digitadas no Sistema de Informações sobre Mortalidade Neonatal (SIM-Neo). Os resultados são apresentados de forma descritiva e a partir de escore síntese que considerou a qualidade da atenção ao pré-natal, ao parto e ao recém-nascido; fatores de risco pré-natal, no parto e com relação ao recém-nascido e situação sociodemográfica materna. Para análise dos escores foi ajustado um modelo para proporções do tipo logístico, considerando Colegiados e categorias como efeitos principais e a interação Colegiados versus categorias. Resultados: passaram por alguma investigação 88,5% dos óbitos ocorridos e 67,3% tiveram investigação completa. A análise dos escores relativos à qualidade da atenção pré-natal evidenciou diferença quando se consideraram os piores resultados (escore menores que cinco), sendo o Colegiado Vale do Jurumirim diferente e melhor que o de Bauru e o de Lins. Com relação à qualidade da assistência ao parto, houve diferença quando se compararam os Colegiados Vale do Jurumirim, Bauru e Cuesta Botucatu com Lins, sendo pior a situação de Lins. Para a qualidade da atenção ao neonato, os Colegiados de Bauru e Jaú diferiram e foram melhores que o Vale do Jurumirim. Quanto ao risco do neonato, o Colegiado Vale do Jurumirim... / Introduction: Investigating neonatal deaths can be an important strategy to reduce child and fetal mortality as it contributes to improve the quality of information on such adverse event and allows for the adoption of measures for prevention of evitable deaths by health care services. Objective: To evaluate neonatal deaths investigated at the Regional Health Department VI (DRS VI) – Bauru by taking into account the Regional Management Collegiates in 2009. Methodology: This is a descriptive crosssectional study that analyzed 162 deaths investigated from the information entered on the Neonatal Mortality Information System (SIM-Neo). Results are presented in a descriptive fashion and based on a synthesis score which considered the quality of prenatal care, the care to delivery and the care to newborns; prenatal risk factors, delivery risks and those related to newborns as well as maternal sociodemographic conditions. For score analysis, a logistic model was fitted for proportions by taking into account Collegiates and categories as main effects and the Collegiate-versuscategory interaction. Results: 88.5% of the occurring deaths underwent some investigation, and 67.3% were completely investigated. The analysis of the scores related to the quality of prenatal care showed difference when the worse scores (scores lower than five) were considered, and Vale do Jurumirim Collegiate was different and better than those in Bauru and Lins. As regards the quality of care to delivery, difference was found when comparing the Collegiates in Vale do Jurumirim, Bauru and Cuesta Botucatu with that in Lins, and Lins showed the worst situation. As for the quality of care to neonates, the Collegiates in Bauru and Jau differed and were better than that in Vale do Jurumirim. Concerning risk to neonates, the Collegiate... (Complete abstract click electronic access below)

Orientador: Cristina Maria Garcia de Lima Parada / Banca: Maria Antonieta de Barros Leite Carvalhaes / Banca: Luana Carandina / Banca: Marilisa Barros / Banca: Maria José Clapis / Resumo: Investigar os óbitos neonatais pode ser uma importante estratégia para redução da mortalidade infantil e fetal, pois contribui para melhorar a qualidade da informação sobre esse evento adverso e possibilita a adoção, pelos serviços de saúde, de medidas para a prevenção de óbitos evitáveis. Objetivo Geral: avaliar os óbitos neonatais investigados no Departamento Regional de Saúde VI - Bauru, considerando-se os Colegiados de Gestão Regional, no ano de 2009. Metodologia: estudo descritivo e transversal, que analisou 162 óbitos investigados, a partir das informações digitadas no Sistema de Informações sobre Mortalidade Neonatal (SIM-Neo). Os resultados são apresentados de forma descritiva e a partir de escore síntese que considerou a qualidade da atenção ao pré-natal, ao parto e ao recém-nascido; fatores de risco pré-natal, no parto e com relação ao recém-nascido e situação sociodemográfica materna. Para análise dos escores foi ajustado um modelo para proporções do tipo logístico, considerando Colegiados e categorias como efeitos principais e a interação Colegiados versus categorias. Resultados: passaram por alguma investigação 88,5% dos óbitos ocorridos e 67,3% tiveram investigação completa. A análise dos escores relativos à qualidade da atenção pré-natal evidenciou diferença quando se consideraram os piores resultados (escore menores que cinco), sendo o Colegiado Vale do Jurumirim diferente e melhor que o de Bauru e o de Lins. Com relação à qualidade da assistência ao parto, houve diferença quando se compararam os Colegiados Vale do Jurumirim, Bauru e Cuesta Botucatu com Lins, sendo pior a situação de Lins. Para a qualidade da atenção ao neonato, os Colegiados de Bauru e Jaú diferiram e foram melhores que o Vale do Jurumirim. Quanto ao risco do neonato, o Colegiado Vale do Jurumirim... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Investigating neonatal deaths can be an important strategy to reduce child and fetal mortality as it contributes to improve the quality of information on such adverse event and allows for the adoption of measures for prevention of evitable deaths by health care services. Objective: To evaluate neonatal deaths investigated at the Regional Health Department VI (DRS VI) - Bauru by taking into account the Regional Management Collegiates in 2009. Methodology: This is a descriptive crosssectional study that analyzed 162 deaths investigated from the information entered on the Neonatal Mortality Information System (SIM-Neo). Results are presented in a descriptive fashion and based on a synthesis score which considered the quality of prenatal care, the care to delivery and the care to newborns; prenatal risk factors, delivery risks and those related to newborns as well as maternal sociodemographic conditions. For score analysis, a logistic model was fitted for proportions by taking into account Collegiates and categories as main effects and the Collegiate-versuscategory interaction. Results: 88.5% of the occurring deaths underwent some investigation, and 67.3% were completely investigated. The analysis of the scores related to the quality of prenatal care showed difference when the worse scores (scores lower than five) were considered, and Vale do Jurumirim Collegiate was different and better than those in Bauru and Lins. As regards the quality of care to delivery, difference was found when comparing the Collegiates in Vale do Jurumirim, Bauru and Cuesta Botucatu with that in Lins, and Lins showed the worst situation. As for the quality of care to neonates, the Collegiates in Bauru and Jau differed and were better than that in Vale do Jurumirim. Concerning risk to neonates, the Collegiate... (Complete abstract click electronic access below) / Doutor

Magister Public Health - MPH / Background: Every year, about 20 million infants are born with low birth weight globally, putting a heavy burden on health care and social systems, especially in developing countries as they are often understaffed and/or lack optimally functional equipment. In 1978, Dr E. Rey proposed the Kangaroo Mother Care (KMC) programme which was further developed by coworkers at one of the largest obstetric facilities in Santa Fe de Bogotá, Colombia. KMC was introduced as an alternative to the expensive and seldom used traditional methods to care for low birth weight infants. KMC is currently not practised at Tsumeb district hospital despite many infants born with low weight in the district. Aim: The aim of the study was to explore perceptions regarding the implementation of Kangaroo Mother Care in the maternity ward of Tsumeb district hospital. Study design: This was a qualitative exploratory study. Study population and sampling: The study population are doctors and nurses working in Tsumeb district, the Chief Medical Officer (CMO) as well as the health programme administrators in the family health division of the Ministry of Health and Social Services (MOHSS), Oshikoto region. Purposive sampling was used to select participants. Results: Perceptions were grouped into three main themes namely the parent-related, health worker-related and baby-related. Parent-related perceptions include self-trust, increased competency, less frustration, and active involvement of parents in baby care, which are similar to the literature and regarded as benefits of KMC. Health worker-related perceptions included both reduced workload and an increased workload. Baby-related perceptions are reduced morbidity, increased bonding and improved care. The study also revealed the barriers to KMC implementation as well as factors that can make KMC implementation a success. Conclusions: Three broad themes emerged from the study, parent-related, health worker-related and baby-related. Most of the health workers’ perceptions are similar to the benefits of KMC found in the literature but, some health workers have negative perceptions regarding KMC.

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols / Health Studies / M.A. (Health Studies)

Introdução - O estudo de eventos de saúde deve levar em conta que as características dos indivíduos de uma determinada localidade não constituem simples somatórios das medidas de cada um dos sujeitos e há que se considerar um modelo explicativo baseado em níveis de organização e na estrutura de dependência entre o nível individual e o nível de contexto onde esses sujeitos estão inseridos. Assim, a análise dos nascimentos e da mortalidade neonatal e fetal pode incorporar diferentes variáveis associadas ao contexto onde se expressam considerando a complexidade e as particularidades dessas ocorrências numa população e num espaço tão diverso. Metodologia - Foi realizado estudo transversal dos nascimentos, óbitos neonatais (<28 dias de vida) e óbitos fetais de mães residentes e ocorridos no município de São Paulo. Os endereços de residência materna foram geocodificados e foi calculada a distância entre as residências e o hospital de ocorrência. Além disso, cada indivíduo foi caracterizado com informações socioeconômicas do Censo Demográfico de 2010, segundo área de Ponderação. Os setores censitários de residência foram classificados segundo Índice Paulista de Vulnerabilidade Social IPVS. Os hospitais foram classificados em SUS e não SUS e para os Nascidos Vivos (e óbitos neonatais) também foram classificados segundo referência para atendimento de risco gestacional. Foram obtidos aglomerados de Nascidos Vivos (NV) através da técnica de varredura espacial. Através de análise multinível foi verificado o efeito do contexto socioeconômico na mortalidade neonatal e fetal. Resultados - Verificou-se que os aglomerados tanto SUS como não SUS não são homogêneos entres si, com diferenças em relação à idade das mães, escolaridade, número de consultas pré-natal e prematuridade. A distância média teórica percorrida pelas mães até o hospital foi 51,8% menor nos aglomerados SUS que nos não SUS. A menor distância nos nascimentos SUS indica a regionalização da assistência ao parto no município de São Paulo. Os resultados mostraram que há um aumento da taxa de mortalidade neonatal com o aumento da vulnerabilidade social. Houve um efeito contextual da vulnerabilidade social e observa-se que apenas as variáveis individuais que representam as características da gestação, recém-nascido e assistência pré-natal mostraram-se associadas à mortalidade neonatal. O efeito contextual da vulnerabilidade social nas variáveis individuais que representam as características da gestação, feto e escolaridade materna mostrou-se associadas à mortalidade fetal. Na modelagem multinível não foi observada variabilidade importante da mortalidade fetal entre os níveis. Conclusões - A detecção de aglomerados e sua caracterização socioeconômica das áreas contribuem para o entendimento do padrão de nascimentos e nas intervenções de saúde pública, proporcionando melhoria no atendimento das necessidades de acesso ao pré-natal e parto de forma mais eficiente. Os resultados em relação à mortalidade neonatal e fetal revelam que as desigualdades sociais estão presentes na cadeia causal desses dois desfechos e o que contribui com a compreensão dos fatores de risco para a mortalidade neonatal e fetal, principalmente no que diz respeito à participação da vulnerabilidade social na mortalidade e explicita a distância entre a residência materna e o hospital como um indicador socioeconômico / Introduction - The study of health events should take into account that the characteristics of the individuals of a given locality are not simple sums of the measures of each one of the subjects and it is necessary to consider an explanatory model based on levels of organization and the structure of dependence between the Individual level and the context level where these subjects are inserted. Thus, the analysis of neonatal and fetal births and mortality can incorporate different variables associated to the context considering the complexity and the peculiarities of these occurrences in a population and in such a diverse space. Methodology - A cross-sectional study of births, neonatal deaths (<28 days of life) and fetal deaths of resident mothers occurred in the city of. The maternal residence addresses were geocoded to calculate the distance between the residences and the hospital. In addition, each individual was characterized with socioeconomic information from the Demographic Census of 2010, according to the weighting areas. The census tracts of residence were classified according to Index of Social Vulnerability - IPVS. Hospitals were classified in SUS and non-SUS and for live births (and neonatal deaths) were also classified according to reference for gestational risk care. The clusters of live births (LB) were obtained through the spatial sweep technique. The effect of the socioeconomic context on neonatal and fetal mortality was verified by multilevel analysis. Results - It was verified that the clusters both SUS and non-SUS are not homogeneous between them, with differences in relation to the mothers\' age, schooling, number of prenatal consultations and prematurity. The mean theoretical distance traveled by the mothers to the hospital was 51.8% lower in the SUS clusters than in the non-SUS. The shorter distance in SUS births indicates the regionalization of childbirth care in the city of São Paulo. The results showed that there is an increase in the neonatal mortality rate with increased social vulnerability. There was a contextual effect of social vulnerability and it was observed that only the individual variables that represent the characteristics of gestation, newborn and prenatal care were shown to be associated with neonatal mortality. The contextual effect of social vulnerability on the individual variables that represent the characteristics of gestation, fetus and maternal schooling has been shown to be associated with fetal mortality. In the multilevel modeling whose context was the level of vulnerability of the place of maternal residence, no significant variability of fetal mortality between the levels was observed. Conclusion - The detection of clusters and their socioeconomic characterization of the areas contribute to the understanding of the birth pattern and the public health interventions, providing an improvement in the attendance of prenatal access and delivery needs in a more efficient way. The results in relation to neonatal and fetal mortality reveal that social inequalities are present in the causal chain of these two outcomes and that contributes to the understanding of the risk factors for neonatal and fetal mortality, especially with regard to the participation of social vulnerability In mortality and explicit the distance between the maternal residence and the hospital as a socioeconomic indicator

The purpose of the research was to determine the underlying contributory factors in an obstetric unit at the district hospital in Mpumalanga province, South Africa, regarding neonatal deaths and to propose strategies for midwifery practice. Quantitative, nonexperimental, descriptive, exploratory and retrospective (ex-post facto) design was used to explore and describe the factors contributing to neonatal deaths. Data collection was done using an audit tool. The conclusions drawn from this study supported the assumptions that there are factors related to antenatal, intrapartum, postnatal and neonatal care that contribute to neonatal deaths, thus emphasizing the urgency of improving the care of pregnant mothers and their babies through effective implementation of programmes and protocols / Health Studies / M.A. (Health Studies)

Introdução - O estudo de eventos de saúde deve levar em conta que as características dos indivíduos de uma determinada localidade não constituem simples somatórios das medidas de cada um dos sujeitos e há que se considerar um modelo explicativo baseado em níveis de organização e na estrutura de dependência entre o nível individual e o nível de contexto onde esses sujeitos estão inseridos. Assim, a análise dos nascimentos e da mortalidade neonatal e fetal pode incorporar diferentes variáveis associadas ao contexto onde se expressam considerando a complexidade e as particularidades dessas ocorrências numa população e num espaço tão diverso. Metodologia - Foi realizado estudo transversal dos nascimentos, óbitos neonatais (<28 dias de vida) e óbitos fetais de mães residentes e ocorridos no município de São Paulo. Os endereços de residência materna foram geocodificados e foi calculada a distância entre as residências e o hospital de ocorrência. Além disso, cada indivíduo foi caracterizado com informações socioeconômicas do Censo Demográfico de 2010, segundo área de Ponderação. Os setores censitários de residência foram classificados segundo Índice Paulista de Vulnerabilidade Social IPVS. Os hospitais foram classificados em SUS e não SUS e para os Nascidos Vivos (e óbitos neonatais) também foram classificados segundo referência para atendimento de risco gestacional. Foram obtidos aglomerados de Nascidos Vivos (NV) através da técnica de varredura espacial. Através de análise multinível foi verificado o efeito do contexto socioeconômico na mortalidade neonatal e fetal. Resultados - Verificou-se que os aglomerados tanto SUS como não SUS não são homogêneos entres si, com diferenças em relação à idade das mães, escolaridade, número de consultas pré-natal e prematuridade. A distância média teórica percorrida pelas mães até o hospital foi 51,8% menor nos aglomerados SUS que nos não SUS. A menor distância nos nascimentos SUS indica a regionalização da assistência ao parto no município de São Paulo. Os resultados mostraram que há um aumento da taxa de mortalidade neonatal com o aumento da vulnerabilidade social. Houve um efeito contextual da vulnerabilidade social e observa-se que apenas as variáveis individuais que representam as características da gestação, recém-nascido e assistência pré-natal mostraram-se associadas à mortalidade neonatal. O efeito contextual da vulnerabilidade social nas variáveis individuais que representam as características da gestação, feto e escolaridade materna mostrou-se associadas à mortalidade fetal. Na modelagem multinível não foi observada variabilidade importante da mortalidade fetal entre os níveis. Conclusões - A detecção de aglomerados e sua caracterização socioeconômica das áreas contribuem para o entendimento do padrão de nascimentos e nas intervenções de saúde pública, proporcionando melhoria no atendimento das necessidades de acesso ao pré-natal e parto de forma mais eficiente. Os resultados em relação à mortalidade neonatal e fetal revelam que as desigualdades sociais estão presentes na cadeia causal desses dois desfechos e o que contribui com a compreensão dos fatores de risco para a mortalidade neonatal e fetal, principalmente no que diz respeito à participação da vulnerabilidade social na mortalidade e explicita a distância entre a residência materna e o hospital como um indicador socioeconômico / Introduction - The study of health events should take into account that the characteristics of the individuals of a given locality are not simple sums of the measures of each one of the subjects and it is necessary to consider an explanatory model based on levels of organization and the structure of dependence between the Individual level and the context level where these subjects are inserted. Thus, the analysis of neonatal and fetal births and mortality can incorporate different variables associated to the context considering the complexity and the peculiarities of these occurrences in a population and in such a diverse space. Methodology - A cross-sectional study of births, neonatal deaths (<28 days of life) and fetal deaths of resident mothers occurred in the city of. The maternal residence addresses were geocoded to calculate the distance between the residences and the hospital. In addition, each individual was characterized with socioeconomic information from the Demographic Census of 2010, according to the weighting areas. The census tracts of residence were classified according to Index of Social Vulnerability - IPVS. Hospitals were classified in SUS and non-SUS and for live births (and neonatal deaths) were also classified according to reference for gestational risk care. The clusters of live births (LB) were obtained through the spatial sweep technique. The effect of the socioeconomic context on neonatal and fetal mortality was verified by multilevel analysis. Results - It was verified that the clusters both SUS and non-SUS are not homogeneous between them, with differences in relation to the mothers\' age, schooling, number of prenatal consultations and prematurity. The mean theoretical distance traveled by the mothers to the hospital was 51.8% lower in the SUS clusters than in the non-SUS. The shorter distance in SUS births indicates the regionalization of childbirth care in the city of São Paulo. The results showed that there is an increase in the neonatal mortality rate with increased social vulnerability. There was a contextual effect of social vulnerability and it was observed that only the individual variables that represent the characteristics of gestation, newborn and prenatal care were shown to be associated with neonatal mortality. The contextual effect of social vulnerability on the individual variables that represent the characteristics of gestation, fetus and maternal schooling has been shown to be associated with fetal mortality. In the multilevel modeling whose context was the level of vulnerability of the place of maternal residence, no significant variability of fetal mortality between the levels was observed. Conclusion - The detection of clusters and their socioeconomic characterization of the areas contribute to the understanding of the birth pattern and the public health interventions, providing an improvement in the attendance of prenatal access and delivery needs in a more efficient way. The results in relation to neonatal and fetal mortality reveal that social inequalities are present in the causal chain of these two outcomes and that contributes to the understanding of the risk factors for neonatal and fetal mortality, especially with regard to the participation of social vulnerability In mortality and explicit the distance between the maternal residence and the hospital as a socioeconomic indicator