Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references. Available also from UMI Company.

Background: The initiation of antenatal care (“booking”) is universally recommended in the first trimester. While working in the Michael Mapongwana antenatal clinic (ANC) in Khayelitsha, the researcher noticed that late booking was prevalent, with consequent impaired antenatal care and increased potential for adverse outcomes. The objective of this qualitative study was to understand why women book late at this specific ANC. Methods: Twenty-three in-depth, open-ended interviews were conducted with 23 late bookers (i.e. who booked after 18 weeks) who attended the ANC between June and October in 2009. The interviews were recorded, transcribed, and analysed according to the “Framework” model. Results: The mean gestational age at booking was 26,4 weeks (range: 20 to 34 weeks). The majority were multigravid, unmarried and unemployed. A high incidence of previous or current obstetric problems was noted. Important personal barriers included ignorance of purpose of antenatal care, ignorance of ideal booking time, and denial or late recognition of an unplanned pregnancy. Provider barriers appeared to be significant, especially the cumbersome booking system, absence of an ultrasound service, and perceived poor quality of care. Conclusion: A combination of personal and provider barriers contributed to late booking at this clinic - it seems that the perceived effort of attending this antenatal service outweighed the perceived value thereof. Provider barriers should be addressed by accommodating patients’ needs, optimising nurse-patient interaction, provision of an ultrasound service and improvement of the booking system. Public awareness of early booking and the holistic value of antenatal care should also be enhanced.

No description available.

Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 223-241).

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.

Trata o presente estudo de uma avaliação da assistência pré-natal oferecida pelo serviço municipal de saúde a gestantes adolescentes, residentes no município de Franca, estado de São Paulo, para saber se esta cumpre os protocolos estabelecidos pela Portaria GM/MS nº 569 de 1º de junho de 2000, do Ministério da Saúde, para o atendimento da gestante em todo ciclo gravídico-puerperal. É um estudo com referencial teórico da avaliação de serviços de saúde, utilizando o indicador de processo para descrever como a assistência está sendo prestada às gestantes adolescentes inscritas no SISPRENATAL no município de Franca (SP), nos anos de 2006 e 2007. Foram usados como ferramentas essenciais os dados estatísticos alimentados no sistema de informação, utilizando como critérios os indicadores apontados pelo Ministério da Saúde. Os resultados, nos itens priorizados para a avaliação, indicam precariedade no serviço prestado. A análise sugere que a assistência oferecida à gestante é de baixa qualidade, em particular à adolescente grávida. Nos resultados destaca-se: 81,7% das gestantes adolescentes iniciaram o acompanhamento de PN antes de 120 dias de gestação, contudo realizam-se em média 4,4 consultas durante o PN, e apenas para 32,8% delas foi cumprido o protocolo de realização de no mínimo seis consultas de PN. Quanto à distribuição da realização dos exames laboratoriais durante o PN, foi verificado que em média 77% das gestantes adolescentes tiveram exames realizados na primeira consulta e que somente 28,8% tiveram seus exames repetidos dentre a 28ª e 30ª semana de gestação. Observou-se que uma pequena parcela (6,7%) de gestante realizou a consulta puerperal antes de completarem 42 dias de pós parto e que a maioria (84,9%) se concentra na consulta puerperal após 42 dias de pós parto. Em relação à imunização contra o Tétano, foi verificado que apenas 51,9% encontrava-se imunizada ou que já havia recebido a dose de reforço da vacina Dupla adulto. A discussão em torno dessas diferenças possibilitou ao término do estudo, concernir que o município de Franca (SP), enquanto fornecedor de dados ao sistema SISPRENATAL, nos anos considerados não teve êxito. Portanto, é pertinente que se realize a avaliação do processo nos anos subsequentes bem como as ações necessárias para a melhoria deste quadro. / The present study deals with a detailed evaluation of the prenatal attendance offered by the service municipal of health, to pregnant adolescents, who live in Franca, state of São Paulo. This evaluation was conducted to know if the protocols estabilished by the Portaria GM/MS n° 569, of June 1, 2000, of the Ministry of Health for the pregnant womans service in the whole pregnancy-puerperal cycle was being fullfilled. It is a study which has a theoretical referencial of the evaluation of the health service , using the process indicator in a way so as to describe how the attendance to the pregnant adolescent enrolled in the SISPRENATAL , in Franca (SP), in the years 2006 and 2007, is being rendered. Statistic data which was fed in the system, the indicators pointed out by the municipality, where the results in the prioritized items for the evaluation are shown, were used. They indicated the precariousness of the rendered service. However, those data needed to be confronted with the reality of the town, and for that, not only information on the background and the profile of the pregnant adolescent was gotten, but also, the conditions in which the collection of data was processed, were observed. Flaws in the whole process were found. While the infant mortality indicator approached the positive goal, proposed by the municipality, showing an effectiveness in the procedures that precede the childbirth - Pregnant women attendance, available hospital service - , the SISPRENATAL data fed in the system suggested that there was no attendance to pregnant women, in particular, to pregnant adolescents, being offered. At the end of the study, the discussion around those differences made it possible to reach a possible conclusion: Franca (SP), as a data supplier to the SISPRENATAL system in the considered years , was not successful. Nevertheless, constant changes in the practiced actions are developing favorably in all aspects. Those changes include: The preparation of the internal teams for the valorization and the understanding of the real data transformed into information by the system to the Ministry of Health, participation in the community through partnership with the for continuing secretary of the education awareness work (which is especially aimed at the school population in the age group that goes from childhood to adolescence and refers to a wide variety of themes, but mainly adolescence pregnancy), availability of safety contraceptive methods in all UBS´s, besides the decentralization of the Family Planning for the units in order to protect the women reproductive rights, providing them with an easier access to the services.

Trata o presente estudo de uma avaliação da assistência pré-natal oferecida pelo serviço municipal de saúde a gestantes adolescentes, residentes no município de Franca, estado de São Paulo, para saber se esta cumpre os protocolos estabelecidos pela Portaria GM/MS nº 569 de 1º de junho de 2000, do Ministério da Saúde, para o atendimento da gestante em todo ciclo gravídico-puerperal. É um estudo com referencial teórico da avaliação de serviços de saúde, utilizando o indicador de processo para descrever como a assistência está sendo prestada às gestantes adolescentes inscritas no SISPRENATAL no município de Franca (SP), nos anos de 2006 e 2007. Foram usados como ferramentas essenciais os dados estatísticos alimentados no sistema de informação, utilizando como critérios os indicadores apontados pelo Ministério da Saúde. Os resultados, nos itens priorizados para a avaliação, indicam precariedade no serviço prestado. A análise sugere que a assistência oferecida à gestante é de baixa qualidade, em particular à adolescente grávida. Nos resultados destaca-se: 81,7% das gestantes adolescentes iniciaram o acompanhamento de PN antes de 120 dias de gestação, contudo realizam-se em média 4,4 consultas durante o PN, e apenas para 32,8% delas foi cumprido o protocolo de realização de no mínimo seis consultas de PN. Quanto à distribuição da realização dos exames laboratoriais durante o PN, foi verificado que em média 77% das gestantes adolescentes tiveram exames realizados na primeira consulta e que somente 28,8% tiveram seus exames repetidos dentre a 28ª e 30ª semana de gestação. Observou-se que uma pequena parcela (6,7%) de gestante realizou a consulta puerperal antes de completarem 42 dias de pós parto e que a maioria (84,9%) se concentra na consulta puerperal após 42 dias de pós parto. Em relação à imunização contra o Tétano, foi verificado que apenas 51,9% encontrava-se imunizada ou que já havia recebido a dose de reforço da vacina Dupla adulto. A discussão em torno dessas diferenças possibilitou ao término do estudo, concernir que o município de Franca (SP), enquanto fornecedor de dados ao sistema SISPRENATAL, nos anos considerados não teve êxito. Portanto, é pertinente que se realize a avaliação do processo nos anos subsequentes bem como as ações necessárias para a melhoria deste quadro. / The present study deals with a detailed evaluation of the prenatal attendance offered by the service municipal of health, to pregnant adolescents, who live in Franca, state of São Paulo. This evaluation was conducted to know if the protocols estabilished by the Portaria GM/MS n° 569, of June 1, 2000, of the Ministry of Health for the pregnant womans service in the whole pregnancy-puerperal cycle was being fullfilled. It is a study which has a theoretical referencial of the evaluation of the health service , using the process indicator in a way so as to describe how the attendance to the pregnant adolescent enrolled in the SISPRENATAL , in Franca (SP), in the years 2006 and 2007, is being rendered. Statistic data which was fed in the system, the indicators pointed out by the municipality, where the results in the prioritized items for the evaluation are shown, were used. They indicated the precariousness of the rendered service. However, those data needed to be confronted with the reality of the town, and for that, not only information on the background and the profile of the pregnant adolescent was gotten, but also, the conditions in which the collection of data was processed, were observed. Flaws in the whole process were found. While the infant mortality indicator approached the positive goal, proposed by the municipality, showing an effectiveness in the procedures that precede the childbirth - Pregnant women attendance, available hospital service - , the SISPRENATAL data fed in the system suggested that there was no attendance to pregnant women, in particular, to pregnant adolescents, being offered. At the end of the study, the discussion around those differences made it possible to reach a possible conclusion: Franca (SP), as a data supplier to the SISPRENATAL system in the considered years , was not successful. Nevertheless, constant changes in the practiced actions are developing favorably in all aspects. Those changes include: The preparation of the internal teams for the valorization and the understanding of the real data transformed into information by the system to the Ministry of Health, participation in the community through partnership with the for continuing secretary of the education awareness work (which is especially aimed at the school population in the age group that goes from childhood to adolescence and refers to a wide variety of themes, but mainly adolescence pregnancy), availability of safety contraceptive methods in all UBS´s, besides the decentralization of the Family Planning for the units in order to protect the women reproductive rights, providing them with an easier access to the services.