Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-11-13T14:19:06Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao Josy Pinho.pdf: 1226133 bytes, checksum: eb4114659ac7eea459d334e4f15bb04f (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-11-13T14:19:16Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao Josy Pinho.pdf: 1226133 bytes, checksum: eb4114659ac7eea459d334e4f15bb04f (MD5) / Made available in DSpace on 2017-11-13T14:19:16Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao Josy Pinho.pdf: 1226133 bytes, checksum: eb4114659ac7eea459d334e4f15bb04f (MD5) Previous issue date: 2017 / Viva Rio / Objetivo: Análise da morbidade materna grave (near miss materno), por meio de revisão sistemática de estudos no Brasil. Métodos: Foram examinados estudos que relataram dados quantitativos, causas e fatores associados à morbidade materna grave (near miss materno). A busca foi feita pelos sites MEDLINE e LILACS, sendo as palavras-chave: maternal near miss or severe maternal morbidity and Brazil. Foram extraídos dados utilizando-se um protocolo pré-definido (autor, ano, desenho do estudo, população estudada, cenário e contexto, análise estatística, critérios de near miss e resultados). A razão de near miss e os indicadores derivados foram descritos ou estimados, quando não relatados. Resultados: Identificamos 55 estudos, a maioria de desenho transversal (32). Predominaram estudos (40) de base hospitalar (local ou nacional); outros usaram sistemas de informação de saúde ou pesquisas nacionais de saúde. Diferentes definições e terminologias para “near miss” foram adotadas. A Razão de near miss materno variou de 2,4/ 1000 NV a 188,4/ 1000 NV, dependendo dos critérios e do cenário epidemiológico. O índice de mortalidade near miss materno variou entre 3,3% e 32,2%. Doenças hipertensivas e hemorrágicas foram as morbidades mais comuns. As causas indiretas vêm aumentando nos últimos anos. A ausência de cuidados pré-natais e outras demoras nos cuidados de saúde foram associados ao near miss, como também fatores sociodemográficos (cor da pele não branca, adolescência/ idade≥35 anos, baixo nível de escolaridade). Conclusão: O near miss materno no Brasil está associado a iniquidades e demoras na assistência à saúde. Existem grandes diferenças entre as regiões e de acordo com a classificação/ definição usada nos estudos. Os casos de near miss devem ser monitorados rotineiramente em unidades de saúde. Pesquisas futuras sobre casos de near miss materno devem usar os critérios da OMS e expandir o conceito de morbidade materna / Objective: Analysis of severe maternal morbidity (maternal near miss), through systematic review of studies in Brazil. Methods: We examined studies that reported quantitative data, causes, and associated factors on severe maternal morbidity (maternal near miss). The search was through MEDLINE and LILACS, and keywords were: maternal near miss or severe maternal morbidity and Brazil. We extracted data, using a pre-defined protocol (author, year, study design, population studied, setting and context, statistical analysis, criteria of near miss, and results). Near miss ratios, and near miss indicators were described or estimated, when not reported. Results: We identified 55 studies, mainly cross-sectional (32). Most of them (35) were health facility-based (local or national); others used health information systems or national health surveys. Different definitions and terminologies for maternal near miss were adopted. Near miss ratio ranged from 2,4/1000 LB to 188,4/1000 LB, depending on criteria and epidemiological scenario. Mortality index for maternal near miss ranged from 3.3%-32.2%. Hypertensive diseases and hemorrhage were the commonest morbidities. Indirect causes have been increasing in last years. Absence of prenatal care and other delays in health care were associated with near miss, as sociodemographic factors (skin color, adolescence and age > 35 years, low educational level). Conclusion: Maternal near miss in Brazil is associated with health iniquities and delays in health care. Large differences exist between regions and depending on the classification/setting of the studies. Near miss cases should be surveyed routinely in health facilities. Future research on maternal near misses should use WHO criteria and expand the concept of maternal morbidity

Made available in DSpace on 2014-07-29T15:04:32Z (GMT). No. of bitstreams: 1 Dissertacao Lorena de Almeida Ribeiro Prudente.pdf: 339298 bytes, checksum: 85271945cc6981d1e0a7a1803021dcad (MD5) Previous issue date: 2008-08-08 / Pregnancy, birth, and postpartum bring alterations to women s body. In such periods, there is a redefinition of their identity, with altered relationship between the couple, within the family as well as with other members in the social context (MINISTÉRIO DA SAÚDE, 2002). The reproductive process was not idealized to end up in maternal death, since this is such a tragic episode which should never occur to women. Aims: to investigate maternal mortality in Goiás from 1999 to 2005; to describe epidemiological characteristics of women who died due to before and after birth complications; to identify the frequency distribution of maternal mortality rates by macroregional of health in Goiás and present the reason for maternal mortality in Goiás State. Method: this is an ecological descriptive epidemiologic study. For the description of maternal death occurring from 1999 to 2005, we identified the epidemiologic characteristics and causes related to this phenomenon, having as variables the place of occurrence, the year, the age, the educational status, race, marital status, causa mortis, and pregnancy-puerperal period in which death has occurred. The born alive rate of was obtained from the SINASC database. Data about the reason for maternal mortality in Goiás and in Brazil was obtained from DATASUS. Outcomes: 348 deaths were found in the sum of respective years. In Goiás, this study made clear the reality concerning maternal deaths. Dark-skinned and white women with 4 and 7 years of school completion, in reproductive age (20-29 years), and living in the Midwestern macroregion mainly due to direct obstetric causes, which are preventable. Conclusion: in sum, evidences shown in this study make it visible the importance to implement the birth humanization care program, provides to care managers and to healthcare workers both the knowledge and reflection upon obstetric practices and therapeutic management adopted in the assistance to pregnant women during and after birth. / A gravidez, o parto e puerpério apresentam alterações no organismo da mulher e ocorre uma redefinição da sua identidade. No Brasil a mortalidade materna é considerada um grave problema de saúde pública, uma vez que ocorre na plenitude da vida da mulher e provoca orfandade e a dissolução familiar (MINISTÉRIO DA SAÚDE, 2002). Objetivos: Investigar a mortalidade materna em Goiás no período de 1999 a 2005; descrever as características epidemiológicas das mulheres que obituaram em decorrência dos agravos relacionados ao período gravídico-puerperal; identificar a distribuição de freqüência dos índices de mortalidade materna por macrorregional de saúde em Goiás e apresentar a razão da mortalidade materna no estado de Goiás. Metodologia: estudo epidemiológico retrospectivo e descritivo, do tipo ecológico, dos óbitos maternos ocorridos no período de 1999 a 2005. Para identificar as causas relacionadas com o fenômeno se utilizou como variáveis o local de ocorrência, o ano, a faixa etária, a escolaridade, a raça, o estado civil, a causa da morte e o período gravídico-puerperal no qual ocorreu o óbito. A população do estudo foram os registros das mortes maternas cadastrados no DATASUS, e o número de nascidos vivos a partir da base de dados do SINASC. Resultados: No estudo constatou-se que Goiás nos anos de 1999 a 2005 ocorreram 348 óbitos maternos. Morreram mulheres de cor parda e branca, com escolaridade entre quatro e sete anos de estudo, em plena idade reprodutiva (20-29 anos), residente na macrorregional Centro-Oeste, principalmente, óbitos por causas obstétricas diretas, que são preveníveis. Propicia aos gestores e profissionais de saúde o conhecimento das características epidemiológicas das mulheres que obtuaram em decorrência da gravidez, parto e puerpéiro, identifica a distribuição de freqüência dos óbitos conforme a macrorregional de ocorrência e apresenta a razão da mortalidade materna no Estado de Goiás, o que nos permite refletir acerca das práticas obstétricas e condutas terapêuticas adotadas na assistência à mulher no período gravídico-puerperal.

Maternal mortality remains a severe problem in many parts of the world, despite efforts to reach MDG 5. Assessing progress towards this goal is difficult because maternal mortality is difficult to measure and the information available at country level does not generally permit the establishment of good baseline data. Countries with high maternal mortality ratios neither have adequate vital registration systems nor adequate resources to carry out surveys. Only few low-income countries have been able to establish a comprehensive reporting system and even where such vital registration systems are in place, maternal deaths are often underreported or misclassified as non-maternal even in large well developed cities. <p>Ghana belongs to the group of low-income countries with high maternal mortality ratios (point estimate 560, lower bound 200 and upper bound 1300) per 100,000 live births and inadequate data on maternal deaths. Previous studies have demonstrated that most of these deaths could be prevented with existing effective practices.<p><p>In this dissertation, we looked at the registration system of births and deaths in the Greater Accra Region of Ghana. We assessed completeness of registration of maternal deaths and data quality. We also looked at the degree of underreporting of maternal deaths, assessed causes of maternal deaths and substandard care of these cases through a confidential enquiry. This enabled us to identify problems associated with measuring of maternal mortality in Ghana and the standard of care of the cases. Through our findings we were able to make recommendations to achieve MDG 5 in the country by 2015 if implemented. Other maternal and child health (MCH) interventions were also looked as working to improve MCH is a continuum, and no aspect should be neglected. The first relates to seeking evidence based practice in presence of potentially complicated obstetrical conditions like premature rupture of membranes and the second pertains to preventive activities in MCH and concentrates on the results of tetanus immunisation of women in their reproductive age in the Northern Region of Ghana.<p><p>Objectives<p>1.\ / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

Master of Public Health - MPH / The Health Extension Program (HEP) is an innovative, community based comprehensive primary health care program that Ethiopia introduced in 2003. It gives special emphasis to the provision of preventive and promotive services at community and household level. However, utilization of the HEP packages is low and reasons for this underutilization are not well known. The aim of this study is to assess the availability and utilization of the Health Extension Program Service in Akaki District of Oromia Region, Ethiopia. Quantitative study using a cross-sectional survey design. The study was conducted in Akaki District of Oromia Regional State in Ethiopia with 79,162 inhabitants. Random sampling was used to select 355 households. A structured data collection tool/ questionnaire was employed to collect data from the study participants. Data were analyzed using SPSS for Windows version 19. Descriptive statistics were used to analyze socio demographic characteristics of the study participants and to assess the availability and utilization of each service component. The response rate of the study was 100% with complete data obtained from 335 (94.4%) of the households. The majority (93.1%) of respondents were women. The availability of HEP services as described by the household visit of Health Extension Workers (HEWs) is very high with 86.6% visiting at least monthly and 11.3% visited sometimes. There was a highly significant association between the health extension workers’ visit to households and health extension service utilization during pregnancy (OR=16.913, 95% CI 8.074-35.427 at p<0.001). HIV testing utilization showed a tenfold increase among households who received education. Participation of households in the Model family initiative was another key factor associated with high levels of HEP services utilization. Though HEP services are available for most households, the frequency of household visits by HEWs and the involvement of Households in model family training greatly influenced service utilization. Improving frequency of services availability at household level and consistent health education will greatly improve services utilization.

As the statistics for maternal mortality have declined all over the world, it has also been rising in the US for the past two decades. The data clearly shows that the group with the highest risk for maternal mortality are black women, whilst white women are the group with the lowest risk. This study aims to investigate three policys related to maternal care: Affordable Care Act, Preventing Maternal Deaths Act and Improving Access to Maternal Care Act. By using Carol Bacchi's What’s the Problem Represented to Be-method of analysis, the study looks deeper into what underlying presumptions and assumptions the policys carry, and what consequences these have. Together with intersectionality as a theoretical framework, the study was able to uncover issues between the policies that are currently in place, and the categories and power positions within the people involved in the policy process and the people affected by the policies. The results show that the underlying assumptions and presumptions is that women work as a homogenous group and that the policies are focused on low-income individuals within that group. This results in continuous disparities in maternal mortality for black women, with concerning consequences. There is a great need for research, not only for accurate data surrounding maternal mortality (on deeper levels, not for women as a homogenous group), but also for development of policies and health care.

No description available.

Background Pregnancy and childbirth are normal physiological processes but the internal and external circumstances in which the child is conceived and born affect the life of the mother and child. Every pregnancy is associated with unpredictable risks and complications. Therefore, having a birth preparedness and complication prevention plan including safe motherhood are paramount to reduce maternal and infant mortality rates. Purpose of the study This study aimed to establish the pregnant women’s knowledge, perceptions and practices regarding birth preparedness planning, complication readiness and safe motherhood at Raleigh Fitkin Memorial Hospital to help reduce some of the avoidable causes of maternal and infant mortality rates. Research design and methods An exploratory, descriptive and qualitative research design was used for the study. Women who had delivered within a period of one week were purposively selected from the research site and interviewed using a structured interview guide until saturation of data. Ethical considerations were adhered to and measures of trustworthiness were applied. Giorgi’s analytic method was used for data analysis. Findings The findings revealed that most participants were not well informed about birth preparedness although some had managed to save for baby requirements and hospital fees. Transportation to the hospital for ANC and delivery was a problem to those who ended up delivering their babies at home or on the way to hospital. Knowledge about complications of birth was poor and only a few participants could name bleeding and prolonged labour. Most participants were not sure about safe motherhood, whilst some mentioned contraception and post-natal care. Conclusion Evidence from the study reveal that as much as pregnant women prepare baby’s clothes and money for labour and delivery, psychological preparation and transport preparation seemed poor. Complication readiness was not known by most participants. / Health Studies / M.A. (Health Sciences)

The maternal mortality rate in the USA is the highest in the industrialized world. Black women in the USA are three times more likely to die due to pregnancy and childbirth-related health issues than their white counterparts. According to 2017–2019 data from the CDC, 80% of these deaths are preventable.The purpose of this thesis is to understand how women’s bodily autonomy is both racialized and politicized. Key questions here are: What is the relationship between access to healthcare and reproductive rights? How are reproductive rights racialized? How is bodily autonomy racialized and politicized?This research is based on a literature review and a case study of the documentary Aftershock, released in July 2022. Aftershock charts the deaths of two young Black American women after they gave birth and shows how their partners and families stood together and became effective activists determined to fight the Black maternal mortality epidemic in the US, and thereby increase awareness and bring about change in society.

The purpose of this study was to analyse and describe the factors that influence the choice of site of delivery by pregnant women in Mukono district. By employing quantitative, non experimental research methods, 431 women were interviewed by using structured questionnaires. These women had either delivered at; home, TBA, private or public clinic and 72% had been delivered by skilled attendants. Choice of delivery site was influenced by the attitudes of health workers which were rather poor in public sites, proximity of site, attendance of antenatal clinic at a site, availability of supplies and drugs, plus level of care including emergency obstetric care. / Health Studies / M. A. (Public Health)

Dans le cadre d’une stratégie nationale visant les objectifs du Millénaire pour le développement 4 et 5 au Maroc - réduire la mortalité maternelle et infantile -, un plan d’action a été développé au sein des trois systèmes (socioculturel, éducationnel, disciplinaire) dans lesquels évolue un rôle professionnel de la santé et ce, pour renforcer le rôle professionnel de la sage-femme. La présente thèse vise à évaluer le niveau d’implantation du plan d’action et à comprendre les facteurs contextuels ayant affecté son implantation et susceptibles d’empêcher l’atteinte de ses effets. Le cadre conceptuel adopté dérive du modèle de Hatem-Asmar (1997) concernant l’interaction entre les systèmes éducationnel, disciplinaire et socioculturel pour changer un rôle professionnel de la santé; et le cadre de Damschroder et al. (2009) pour l’analyse de l’implantation d’une intervention en santé. Le devis est une étude de cas unique à trois niveaux d’analyse. Les données sont recueillies à partir de multiples sources de données : 11 entrevues individuelles semi-structurées, 20 groupes de discussion, observations d’activités de formation, analyse de documents. Les résultats ont montré des déficits notables au niveau de l’implantation. Seize barrières et sept facilitateurs ont été catégorisés sous les construits du cadre de Damschroder et al. (2009) et sous les dimensions des trois systèmes. Un alignement inadéquat entre les dimensions (valeurs, méthodes, acteurs et finalités) du système socioculturel et celles (valeurs, méthodes, acteurs) des systèmes éducationnel et disciplinaire d’une part, avec le plan d’action d’autre part empêche son implantation globale. La structure bureaucratique et le manque de préparation du système socioculturel ont constitué les barrières les plus influentes sur: la diffusion de l’information; l’implication des acteurs du terrain dans le processus; et l’état de préparation du système éducationnel. Les principaux facilitateurs étaient : les valeurs promues à l’égard des droits humains et le mouvement politique pour renforcer le rôle professionnel de la sage-femme et réduire la mortalité maternelle. Quant au plan, il a été perçu comme étant bénéfique mais complexe et émanant d’une source externe. Les résultats mettent l’accent sur la nécessité de contourner les barrières identifiées dans les trois systèmes afin d’obtenir des contextes propices à la production des effets. Par ailleurs, les résultats ont soulevé aussi sept barrières qui risquent de compromettre l’atteinte des effets désirés. Elles concernent: le cadre légal, les représentations sociales et le support médiatique au niveau du système socioculturel; le réseautage et les mécanismes de communication, les caractéristiques liées au rôle, à l’environnement de pratique, et le niveau de préparation du système disciplinaire. Notre recherche confirme qu’un changement visant le système éducationnel isolément représente une vision réductrice pour le renforcement du rôle des sages-femmes. Une combinaison des conditions contextuelles favorables au niveau des dimensions des trois systèmes est requise pour atteindre le but de la stratégie gouvernementale, soit fournir des sages-femmes qualifiées selon les normes globales de la Confédération Internationale des sages-femmes, capables d’offrir des soins de qualité en santé de la reproduction qui permettront de contribuer à réduire la mortalité maternelle et néonatale. / As part of a national strategy for reaching the Millennium Development Goals 4 and 5 in Morocco – to reduce maternal and infant mortality - an action plan covering the three systems (socio-cultural, educational, disciplinary) in which evolves a health professional role was developed in order to strengthen the midwifery professional role. This thesis aims to assess the level of implementation of the action plan and to understand the contextual factors affecting its implementation and that may prevent reaching the targeted outcomes. We used a conceptual framework that builds on Hatem-Asmar’s model regarding the interaction between the socio-cultural, educational and disciplinary systems to change a health professional role; and on the Consolidated Framework for Implementation Research (CFIR) for the implementation analysis of a health intervention. A single case study design with three levels of analysis was chosen for this thesis. The data were collected through multiple data sources: 11 individual semi-structured interviews, 20 focus groups, observations of training activities, analysis of documents. The results showed a significant deficit in the implementation. Sixteen barriers and seven facilitators encountered during the implementation were categorized into the four system’s dimensions. Misalignment between the dimensions (values, methods, actors and targets) of the socio-cultural system and those (values, methods, actors) of the educational and disciplinary systems on the one hand, and with the action plan on the other hand, prevent its global implementation. The bureaucratic structure and lack of readiness of the socio-cultural system were among the most influential barriers on: diffusion of information; involvement of key actors in the process, readiness of the educational system. The main facilitators were the values promoted with respect to human rights, and the political movement to strengthen midwives’ professional role and to reduce maternal mortality. The plan was perceived as beneficial but complex and externally driven. The results emphasize the need to overcome the barriers identified in the three systems in order to obtain contextual conditions favorable to achieve outcomes. In addition, seven barriers were identified in the analysis that may compromise the achievement of the targeted outcomes. They relate to the: legal framework, social representations and media support at the socio-cultural system; and the practice environment, networks and communication mechanisms, characteristics related to the role and the readiness of the disciplinary system. Our research confirms that conducting a change in the educational system represents a partially focused view for strengthening the midwives’ role. A combination of favorable contextual conditions at the dimensions of the three systems is required to achieve the goal of the government's strategy which is to provide qualified midwives according to the International Confederation of Midwives global standards for midwifery, able to provide quality reproductive health care, and to contribute to reducing maternal and neonatal mortality.