United Nations has lately stated ambitious health targets for 2030 in the Sustainable Development Goal agenda, following the already achieved progress between 1990 and 2015 when the number of children dying before the age of five was reduced by more than half. However, the mortality reduction in the first month of life after birth has not kept the same pace. Furthermore, a large number of stillbirths have previously not been accounted for. The aim of this thesis was to evaluate the impact of clinical training in neonatal resuscitation, and to identify strategies for an effective implementation at a maternal health facility in Nepal. Focus group discussions were used to explore the perceptions of teamwork among staff working closest to the infant at the facility. A prospective cohort study with nested referents was applied to determine effect on birth outcomes after an intervention with Helping Babies Breathe, a simplified protocol for neonatal resuscitation. Sustainability of the acquired skills after training was addressed by employing a quality improvement cycle. Video recordings of health workers performance were collected to analyse adherence to protocol. Midwives described the need for universal protocols in neonatal resuscitation and management involvement in clinical audit and feedback. There was a reduction of intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and neonatal mortality within 24 hours of life (aOR 0.51, 95% CI 0.31–0.83) after the intervention. Ventilation of infants increased (OR 2.56, 95% CI 1.67–3.93) and potentially harmful suctioning was reduced (OR 0.13, 95% CI 0.09–0.17). Neonatal death from intrapartum-related complications was reduced and preterm infants survived additional days in the neonatal period after the intervention. Low birth weight was not found to be a predictor of deferred resuscitation in the studied context. This study confirmed the robustness of Helping Babies Breathe as an educational tool for training in neonatal resuscitation. Accompanied with a quality improvement cycle it reduced intrapartum stillbirth and mortality on the day of delivery in a low-income facility setting. Improved postnatal care is needed to maintain the gains in survival through the neonatal period. Increased management involvement in audit and quality of care could improve clinical performance among health workers.

Made available in DSpace on 2016-04-26T20:30:10Z (GMT). No. of bitstreams: 1 Paulo Somlanyi Romeiro.pdf: 652652 bytes, checksum: 32b64f7b48c295b4e882d41c4ce19301 (MD5) Previous issue date: 2010-05-07 / This research aims to demonstrate the role played by the Special Zones of Social Interest (ZEIS) in the materialization of a new paradigm on the treatment of informal settlements occupied by low-income population. This paradigm shift regards to how these settlements are handled since the introduction of Brazilian s new urban legal framework as a result of the 1988 Constitution and its consolidation with the promulgation of the Statute of the City in 2001. Through the analysis of the national doctrine, of the recent advances of federal legislation on urban law and of the conduct of public administration, we intend to demonstrate that this paradigm shift is due to the possibility of the beginning of a process to effect the principle of the social function of property. It also follows the establishing in our legal system of the general guidelines for urban policy, in particular the ones that constitute the right to sustainable cities, to democratic management of cities and to urbanization and land regularization of areas occupied by low-income population. These innovations operate profound changes in the Brazilian legal system, as they recognize, to the residents of informal settlements occupied by low-income population, a subjective right to land regularization. The materialization of this differential treatment stems from the possibility of establishing a special legal scheme for urbanization and land regularization, when these settlements are recognized as ZEIS by the Master Plan or other municipal law. We demonstrate the meaning of the new legal framework, especially of ZEIS, in a change in the way of using the zoning tool as an instrument for urban planning. We analyze the consequences of the general guideline of the urban policy for the democratic management of the city in the process of implementation of the ZEIS, as its special scheme determines the adoption of a democratic and participatory process. We also demonstrate the role played by ZEIS in the equilibrium between the right to the urbanistic order and the right to an ecologically balanced environment, establishing a special scheme for the application of environmental standards in processes of land regularization. Finally, this research examines aspects of the implementation process of ZEIS by municipalities, such as its regulation, preparation, approval and registration of the land regularization project and its urban control / Esta pesquisa tem como objetivo demonstrar o papel desempenhado pelas zonas especiais de interesse social (ZEIS) na materialização de um novo paradigma no tratamento de assentamentos informais ocupados por população de baixa renda. Essa mudança de paradigma diz respeito à forma de tratamento desses assentamentos a partir da inauguração do novo marco legal urbano brasileiro com a Constituição Federal de 1988 e sua consolidação com a promulgação do Estatuto da Cidade em 2001. Por meio da análise da doutrina nacional, dos avanços recentes da legislação federal em matéria de direito urbanístico, e da conduta da administração pública, pretendemos demonstrar que essa mudança de paradigma é decorrente da possibilidade de início de um processo de efetivação do princípio da função social da propriedade, mas também decorrente da consagração em nosso ordenamento jurídico das diretrizes gerais da política urbana. Em especial as que estabelecem o direito à cidades sustentáveis, à gestão democrática das cidades e à urbanização e regularização fundiária de áreas ocupadas por população de baixa renda. Essas inovações operam transformações profundas no ordenamento jurídico brasileiro, na medida em que reconhecem aos moradores de assentamentos informais ocupados por população de baixa renda um direito subjetivo à regularização fundiária. A materialização desse tratamento diferenciado decorre da possibilidade do estabelecimento de um regime jurídico especial para urbanização e regularização fundiária desses assentamentos quando reconhecidos como ZEIS pelo Plano Diretor ou outra lei municipal. Demonstraremos o significado do novo marco legal, e especialmente das ZEIS, em uma mudança na forma de utilização do instrumento do zoneamento como instrumento de planejamento urbano. Analisaremos as conseqüências da diretriz geral da política urbana da gestão democrática da cidade no processo de implementação das ZEIS, na medida em que seu regime especial determina a adoção de um processo democrático e participativo. Demonstraremos ainda o papel desempenhado pela ZEIS no equilíbrio entre o direito à ordem urbanística e ao meio ambiente ecologicamente equilibrado, estabelecendo também um regime especial para a aplicação de normas ambientais em processos de regularização fundiária. Por fim, esta pesquisa analisa aspectos do processo de implementação das ZEIS pelos municípios, tais como sua regulamentação, elaboração, aprovação e registro do projeto de regularização fundiária e seu controle urbano