Orientador: Mary Angela Parpinelli / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T14:35:41Z (GMT). No. of bitstreams: 1 Matias_JacintaPereira_D.pdf: 7455343 bytes, checksum: 539cc9a97df5792813218e5f0cde9a01 (MD5) Previous issue date: 2008 / Resumo: Objetivos: analisar a tendência da mortalidade de mulheres em idade reprodutiva por grupos de causas, enfatizando a mortalidade materna. Métodos: estudo populacional de série temporal, através de banco de dados eletrônico com informações da declaração de óbito (DO) emitido pela Fundação SEADE, correspondente ao total de óbitos de mulheres de 10 a 49 anos, residentes no município de Jundiaí, São Paulo, no período de 1985 a 2006. Realizou-se a conversão das causas básicas de todas as DO anteriores a 1996, codificadas pela Classificação Internacional de Doenças (CID), 9ª revisão, e a recodificação pela CID, 10ª. revisão. Calcularam-se os coeficientes específicos de mortalidade por capítulos da CID10, por algumas causas e por subgrupos etários por 100.000 mulheres. As estimativas populacionais e o número de nascidos vivos (NV) foram obtidos dos registros da Fundação SEADE. A análise de tendência foi realizada pelo método de regressão de Poisson ajustado pelos períodos de 1985-89, 1990-94, 1995-99, 2000-06, e por faixa etária. Os riscos relativos e os intervalos de confiança de 95% (IC95%) foram calculados. Calculou-se a razão de morte materna (RMM) oficial e corrigida para o período de 1999 a 2006. A investigação das causas maternas declaradas ou presumíveis foi realizada através dos arquivos do comitê municipal de investigação da morte materno-infantil (CMIMM). Resultados: a mortalidade geral de mulheres em idade reprodutiva apresentou tendência decrescente a partir do período de 1995-99, RR 0,85 (0,77-0,93), e de 2000-06, RR 0,47 (0,43-0,51). As doenças cardiovasculares (DCV), as neoplasias e as causas externas foram os principais grupos de causas. As mortes por DCV reduziram significativamente a partir de 1995 e passaram para a 2a causa de morte no período de 2000-06. A mortalidade por neoplasias manteve-se estável, com pequena variação nos coeficientes (23,8 em 1985-89 para 25,7 em 2000-06) e passou a ocupar a primeira causa de morte, no último período. Os coeficientes de mortalidade por causas externas foram significativamente decrescentes, no último período, e mantiveram-se como a terceira causa de morte. Não houve tendência de redução da mortalidade por agressões e por AIDS. A mortalidade materna foi a 10a causa de morte no último período. A RMM corrigida foi de 29,4 mortes por 100.000 NV, para o período de 1999 a 2006, com subnotificação de 50% e fator de correção 2. As mortes maternas foram por causas majoritariamente diretas, sendo as síndromes hipertensivas e a infecção as mais prevalentes. Conclusões: os resultados mostraram melhoria das condições de vida e de saúde das mulheres, entretanto a ausência de queda da mortalidade por causas evitáveis, como agressões e AIDS, aponta para a necessidade de políticas públicas sociais e de programas preventivos. A prevalência das causas obstétricas diretas, principalmente as síndromes hipertensivas, sugere a necessidade de revisão de protocolo assistencial e falha na integração entre os níveis de assistência obstétrica ambulatorial e hospitalar. É necessário aperfeiçoar a atribuição da causa materna de morte e promover a publicação periódica da investigação das mesmas pelo CMIMM / Abstract: Objectives: to analyze the mortality trend of reproductive age women per causal groups, emphasizing maternal mortality. Methods: a time series population study with death certificate (DC) information, through electronic database issued by the SEADE Foundation, corresponding to the total number of deaths from women age 10 to 49 years old, residing in the municipality of Jundiaí, São Paulo, in the period from 1985 to 2006. The basic cause of all DC conversion before 1996 was performed. Causes were coded by the International Classification of Diseases (ICD), 9th revision, recoding was performed by the ICD, 10th revision, was performed. The specific rates of mortality per ICD 10 chapters were calculated by some causes and age subgroups per 100.000 women. The population estimates and the number of live births (LV) were obtained from the SEADE Foundation records. The trend analysis was performed by the Poisson regression model adjusted for the periods of 1985-89, 1990-94, 1995-99, 2000-06, and age group. The related risks and confidence intervals of 95% (CI 95%) were calculated. The official maternal mortality ratio (MMR) was calculated and corrected for the period from 1999 to 2006. The investigation of the stated or presumptive maternal causes was performed through the files of ¿Comitê Municipal de Investigação da Morte Materno-infantil¿ (CMMMI). Results: the general mortality of reproductive age women displayed a decreasing trend from the period of 1995-99, RR 0.85 (0.77-0.93), and of 2000-06, RR 0.47 (0.43-0.51). The cardiovascular diseases (CVD), neoplasm and external causes were the main groups of causes. The deaths per CVD were reduced from 1995, with significant trend and turned into the second cause of death in the period of 2000-06. The mortality per neoplasm was kept stable, with little rate variation (23.8 in 1985-89 to 25.7 in 2000-06) and started occupying the first cause of death in the latter period. The mortality rates per external causes decreased, with a significant trend in the latter period, and continued as the third cause of death. There wasn¿t decrease in mortality per aggressions and AIDS. The maternal mortality was the 10th cause of death in the latter period. The corrected MMR was 29.4 deaths per 100.000 LB, for the period from 1999 to 2006, with an underreporting rate of 50% and a correction factor of 2. The maternal deaths were mostly direct causes and hypertensive syndromes and infection predominated. Conclusions: the results point out to an improvement in and health and quality of life in these women. However, an increase in mortality for avoidable causes, such as aggressions and AIDS, points to the need of social public policies and prevention programs. The prevalence of direct obstetric causes as determining factors, mainly the hypertensive syndromes, suggests the need of healthcare protocol review and possible failure of integration between the obstetric outpatient and healthcare levels. It is necessary to improve the attribution of the maternal mortality cause and promote periodic publication of death causes investigation by the CMMMI / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

Magister Public Health - MPH / Although the Kenyan government implemented safe motherhood programme two decades ago, available data indicate that prevalence of home delivery is still high among women in Garissa District. The aim of this thesis was to investigate the factors influencing the choice of place of childbirth. Methodology: A descriptive cross-sectional study was carried out among 224 women who delivered babies two years prior to December 2010. Using a statcalc program in Epi Info 3.3.2, with expected frequency of home delivery at 83% +5% and a 95% confidence level, the calculated sample size was 215. Furthermore, with a 95% response rate the adjusted minimum sample size was 226.There were two none-responses hence 224 women were interviewed. Stratified sampling was used. Data were collected using pre-tested structured questionnaires and analyzed using SPSS. Descriptive, bivariate and multivariate analysis was performed. A binary logistic regression analysis using the Enter method was performed to determine independent predictors for use or non-use of healthcare services for childbirth. The threshold for statistical significance was set at 0.05. Results: The result was presented in text and tables. The study found 67% (n=224) women delivered at home and 33% delivered in hospital. The study found low level of education, poverty, none-attendance of ANC, distance, cost of services, poor quality services, negative attitude towards midwives, experience of previous obstetric complications and decision-making to be significant predictors in home delivery at the bivariate level (p<0.05). The study did not find relationship between age, marital status, religion and place of childbirth (p>0.05). At multivariate level, the following variables were still found to be significant predictors of home delivery: no education OR=8.36 (95% CI; 4.12-17.17), no occupation OR=1.43(95% CI; 1.08–5.49) experience of obstetric complications OR=1.38 (95% CI; 1.15-2.12), none-attendance of antenatal clinic OR=1.11 (95% CI; 1.03–1.51), Rude midwives OR=5.60 (95% CI; 2.66-11.96). Conclusions: high prevalence of home delivery was noted due to lack of education, poverty and inaccessible maternity services hence the need to empower women in education and economy to enhance hospital delivery.

Nigerian women, especially those from the North-East sub-region continue to suffer preventable maternal mortality. Recent statistics places Nigeria as the highest contributor of maternal deaths globally. These avoidable deaths disproportionately affect women from the North-East due to socio-economic inequalities that are discriminatory. More so, the low socio-economic status of women in the region has been further worsened by humanitarian crisis with attendant increase in the incidence of maternal mortality. Maternal mortality has been framed a human rights issue that can be mitigated through a human rights-based approach. Thus this research engages with a multi-disciplinary approach in uncovering the factors that contribute to the worrisome statistics of maternal deaths in the North-East and investigates through a human rights-based perspective the need for a holistic approach to ending preventable maternal deaths in the sub-region. Findings reveal many interrelated socio-economic factors intersect to inflame the continued tragedy of maternal mortality in the region. For the North-East to break the negative cycle of maternal mortality, a holistic approach is imperative considering the complexities of the predispositions to maternal mortality, the socio-economic reality of the region and the inadequacies of legal framework. / Mini Dissertation (LLM)--University of Pretoria, 2019. / Centre for Human Rights, University of Pretoria. / Centre for Human Rights / LLM / Unrestricted

Background: Restrictions on induced abortion varies widely across the globe and so does the rate of induced abortion and maternal mortality (MM). Safe abortions – done by trained providers in hygienic settings and early medical abortions carry fewer health risks and reduce maternal mortality rates (MMR). However, nearly 7 million women in developing countries are treated for complications from unsafe abortions annually, and at least 22,000 die from abortion-related complications every year. Aim: The aim was to explore national and regional patterns of abortion laws, the abortions percentages and the maternal mortality rates (MMR), to see if patterns could be distinguished and how they differentiate to each other. Method: With a shape-file containing polygons representing the world’s countries, and the computer program ArcMap, was used to gather and join data. Result: The result showed that many African countries has a restrictive abortion law, and they also have a high MMR. In the Nordic countries they have a liberalized abortion law and they have low MMR. Another finding is that a restricted abortion law does not correspond to a low percentage of abortions. This is clearly demonstrated in South America, where they have a high abortion percentage, and extremely restricted abortion laws. Conclusion: This result revealed patterns showing that countries with restricted abortion laws, does not contribute to a low MMR, and restricted abortion law does not decrease the percentage of abortions.

Background: Uganda is one the leading countries around the world which account for 60% of the total number of maternal deaths globally. Following the unsuccessful trajectory of MDG 5, no comprehensive research was conducted to determine why targets were not achieved, and maternal health priorities were reorganized under SDG 3. However, the efficacy of this approach remains uncertain. Methods: A meta-narrative review (MNR) provided insight into maternal health trajectories within Uganda prior to and during MDG 5, and informed the development of questions for key informant interviews. Interviews were conducted with 7 key informants to explore the development and implementation of maternal health policy in relation to MDG 5 and SDG 3. Thematic coding analysis was conducted using NVivo 12, in accordance with the criteria of constructivist grounded theory, to identify recurring themes. Findings: Four major themes were identified: i) the current narrative surrounding maternal health is deterring investment in SDG 3, ii) Uganda’s fragmented health care system impedes access to maternal health care, iii) empowerment issues among women, and iv) increased collaboration efforts are needed from Uganda’s government to improve maternal health outcomes. Implications & Contributions: Uganda has failed to advance women’s rights, as the government focusses on infrastructure development to drive economic development. However, Uganda will not progress if women continue to be oppressed and die as a result of its multifaceted maternal mortality crisis. Implications for maternal health policy: MDG 5 and SDG 3 were imposed on Uganda and do not necessarily reflect its best interests or its collective needs related to improving its maternal health outcomes. Striving to achieve SDG 3 would likely further oppress women and disadvantage the country overall. Thus, Uganda’s government must increase multisector collaboration to develop realistic and sustainable goals towards improving maternal health outcomes to better counteract its maternal mortality crisis. / Thesis / Master of Science (MSc) / Under the lens of intersectional theory, this study aspired to determine what lessons can be learned from Uganda’s attempt to achieve Millennium Development Goal (MDG) 5, related to maternal health, from 2000-2015, and also how these lessons will inform its transition to Sustainable Development Goal (SDG) 3 between 2016-2030. The barriers and challenges surrounding Uganda’s maternal health outcomes were also investigated, and four themes were found. This study demonstrates how various aspects of women’s social identities intersect and form the basis for much of the oppression they encounter surrounding their maternal health, with implications for policy-makers, health care workers, and women. Attainment of SDG 3 seems unlikely for Uganda, and also not in its best interests. Rather than attempting to meet globally developed targets to improve its maternal outcomes, Uganda should engage in multisector collaboration to enable realistic and sustainable progress in its quest to counteract its maternal mortality crisis.

Maternal mortality in Nigeria is unacceptably high, accounting for 14 percent of global maternal deaths, thereby making it a global public health issue. Given that maternal mortality is essentially a women problem, it is a matter of justice and discrimination. In addition, significant regional disparities in maternal mortality exist within Nigeria, particularly between the northern and southern parts of the country. The maternal mortality ratio in the North is six to ten times greater than that of the South. The country's maternal mortality crisis occurs along regional and socioeconomic lines-the poorer northern Nigeria has a disproportionately higher maternal mortality ratio than the wealthier southern Nigeria. This thesis explores the disparities in maternal health across different regions in Nigeria from an intersectional perspective, taking into account economic, religious, cultural, rural, and urban differences. The study adopts intersectionality theory to examine how these factors intersect to impact maternal health outcomes in Nigeria. Furthermore, the thesis employs a functional comparative law approach, using India and South Africa as comparators, to assess how the constitutional courts of these countries have applied intersectional perspective to right to health. It highlights the importance of adopting an intersectional approach to understanding maternal health disparities in Nigeria, as it considers the multiple and interconnected factors that contribute to poor maternal health outcomes. This is particularly crucial in the Nigerian context, where maternal mortality rates remain high and access to quality maternal health services is limited, particularly in rural and underdeveloped regions. The comparative analysis of India and South Africa sheds light on how these countries have approached constitutionalizing the right to health and intersectionality in their courts. In South Africa, the Constitutional Court has played a crucial role in advancing the right to health and applying an intersectional perspective in its judicial decisions, leading to improvements in maternal health outcomes. In India, the Supreme Court has also played an important role in interpreting the right to health to include other associated factors, but its impact on maternal health outcomes remains limited, particularly in rural areas. The thesis concludes by advocating for constitutionalizing maternal health in Nigeria, through incorporation of the right to health in the Nigerian Constitution to ensure that this right is enforceable through the court processes. The study recommends that an adoption intersectional perspective in the implementation of maternal health policies and programs, in order to address the multiple and interconnected factors that contribute to maternal health disparities in Nigeria. The findings of this thesis contribute to the existing literature on maternal health and the right to health, and have important implications for policymakers and health practitioners working to improve maternal health outcomes in Nigeria and other developing countries. By incorporating an intersectional and comparative approach, the thesis provides a comprehensive understanding of the challenges and opportunities for constitutionalizing maternal health in Nigeria and highlights the need for a more nuanced and integrated approach to maternal health policy and practice.

Comitês de Mortalidade Materna, que não investigam todos os óbitos de mulheres de 10 a 49 anos, utilizam lista de causas presumíveis de morte materna para a busca ativa de causas maternas de óbito. Mediante dados do Comitê de Estudo e Prevenção da Mortalidade Materna, para o Município de São Paulo (CMMSP), e do “Estudo de mortalidade de mulheres de 10 a 49 anos, com ênfase na mortalidade materna", realizado nas capitais de estados brasileiros e Distrito Federal (GPP), analisou-se a utilização da lista de causas presumíveis do Manual dos Comitês de Mortalidade Materna do Ministério da Saúde. Conforme investigação do CMMSP, em relação às causas maternas declaradas em 2001, houve um acréscimo de 72,7% de causas maternas. A análise dos dados com a utilização da lista mostrou que 39,4% eram causas maternas presumíveis e 33,3% não eram causas presumíveis. Entre as Declarações de Óbito (D.O.) originais do primeiro semestre de 2002, do estudo do GPP, em que causas maternas não estavam declaradas e se tornaram causas maternas, verificou-se que 52,6% eram presumíveis e 47,4% não eram presumíveis. Quanto à variável da D.O., que informa se a mulher estava grávida no momento da morte, ou esteve grávida nos doze meses que antecederam a morte, verificou-se a ausência de preenchimento dos campos 43 e 44, em mais de 50% das D.O. com outras causas declaradas e que se tornaram causas maternas, tanto na investigação do CMMSP quanto na do GPP. Concluiu-se que os Comitês de Prevenção da Mortalidade Materna deveriam investigar todas as mortes de mulheres de 10 a 49 anos. / Committees of Maternal Mortality, which do not investigate all the deaths of women between 10 and 49 years old, use a list of presumable causes of maternal death for the active search of maternal causes of death. Based on the data from the Committee of Studies and Prevention of Maternal Mortality for the Municipality of São Paulo (CMMSP) and on the “Study of mortality of women between 10 and 49 years old with an emphasis on maternal mortality", developed for the Brazilian state capitals and the Federal District (GPP), the utilization of the list of presumable causes from the Health Ministry Manual of the Committees of Maternal Mortality was analyzed. According to the CMMSP data, there was an increase of 72,7% of maternal causes in relation to the declared maternal causes in 2001. The analysis of data with the use of the list showed that 39,4% were presumable maternal causes and 33,3% were not presumable causes. Among the maternal causes which were not declared in the original Death Certificates of the GPP Study for the first semester of 2002, it was verified that 52,6% were presumable and 47,4% were not presumable. As to the pregnancy variable of Death Certificates, it was verified the absence of information in the form in more than 50% of the Certificates with other causes declared and that were maternal causes in the CMMSP and in the GPP investigation. The conclusion is that the Committees of Prevention of Maternal Mortality should investigate all the deaths of women in ages between 10 to 49 years old.

Maternal mortality, an example of poor maternal health outcomes, is widely accepted as an indicator of the overall health of a population. One of the Millennium Development Goals was reduction in maternal mortality by 3 quarters by 2015. These goals were not met in Nigeria and it is important to look at some of the reasons why. Education has been shown to have positive impact on pregnancy outcomes; however, the characteristics of pregnant women, their health literacy level, their usage of antenatal care services and how these impact pregnancy outcomes are yet to be analyzed in Lagos, Nigeria. Guided by the social cognitive theory and health belief model, the purpose of this cross-sectional quantitative study was to determine if there is a relationship between maternal health literacy, antenatal care visits, development of medical conditions during pregnancy, and pregnancy outcomes (measured by healthy or unhealthy baby) in Lagos, Nigeria. The research question for this study tested if there was a relationship between these variables. Lisa Chew's health literacy assessment tool was used in a sample of 130 women in Shomolu local government in Nigeria who met the inclusion criteria. Using binary logistic correlations, only problems developed during pregnancy is statistically significant with pregnancy outcomes (p < .05). The results suggested an increase in problems developed during pregnancy most likely will increase the chance of having negative pregnancy outcomes. Results from this study could promote positive social change by helping health professionals identify the characteristics of at-risk women during antenatal education sessions. The results could also help health professionals in the development of targeted antenatal care interventions.

Comitês de Mortalidade Materna, que não investigam todos os óbitos de mulheres de 10 a 49 anos, utilizam lista de causas presumíveis de morte materna para a busca ativa de causas maternas de óbito. Mediante dados do Comitê de Estudo e Prevenção da Mortalidade Materna, para o Município de São Paulo (CMMSP), e do “Estudo de mortalidade de mulheres de 10 a 49 anos, com ênfase na mortalidade materna”, realizado nas capitais de estados brasileiros e Distrito Federal (GPP), analisou-se a utilização da lista de causas presumíveis do Manual dos Comitês de Mortalidade Materna do Ministério da Saúde. Conforme investigação do CMMSP, em relação às causas maternas declaradas em 2001, houve um acréscimo de 72,7% de causas maternas. A análise dos dados com a utilização da lista mostrou que 39,4% eram causas maternas presumíveis e 33,3% não eram causas presumíveis. Entre as Declarações de Óbito (D.O.) originais do primeiro semestre de 2002, do estudo do GPP, em que causas maternas não estavam declaradas e se tornaram causas maternas, verificou-se que 52,6% eram presumíveis e 47,4% não eram presumíveis. Quanto à variável da D.O., que informa se a mulher estava grávida no momento da morte, ou esteve grávida nos doze meses que antecederam a morte, verificou-se a ausência de preenchimento dos campos 43 e 44, em mais de 50% das D.O. com outras causas declaradas e que se tornaram causas maternas, tanto na investigação do CMMSP quanto na do GPP. Concluiu-se que os Comitês de Prevenção da Mortalidade Materna deveriam investigar todas as mortes de mulheres de 10 a 49 anos. / Committees of Maternal Mortality, which do not investigate all the deaths of women between 10 and 49 years old, use a list of presumable causes of maternal death for the active search of maternal causes of death. Based on the data from the Committee of Studies and Prevention of Maternal Mortality for the Municipality of São Paulo (CMMSP) and on the “Study of mortality of women between 10 and 49 years old with an emphasis on maternal mortality”, developed for the Brazilian state capitals and the Federal District (GPP), the utilization of the list of presumable causes from the Health Ministry Manual of the Committees of Maternal Mortality was analyzed. According to the CMMSP data, there was an increase of 72,7% of maternal causes in relation to the declared maternal causes in 2001. The analysis of data with the use of the list showed that 39,4% were presumable maternal causes and 33,3% were not presumable causes. Among the maternal causes which were not declared in the original Death Certificates of the GPP Study for the first semester of 2002, it was verified that 52,6% were presumable and 47,4% were not presumable. As to the pregnancy variable of Death Certificates, it was verified the absence of information in the form in more than 50% of the Certificates with other causes declared and that were maternal causes in the CMMSP and in the GPP investigation. The conclusion is that the Committees of Prevention of Maternal Mortality should investigate all the deaths of women in ages between 10 to 49 years old.

Dissertation submitted in fulfilment of the requirements for the degree Doctor of Technology: Informatics in the Faculty of Informatics and Design at the Cape Peninsula University of Technology / Background: Daily activities within a health care organization are mediated by information communication processes (ICP), which involve multiple health care professionals. During pregnancy, birth and motherhood a woman may encounter different professionals including midwives, doctors, laboratory personnel and others. Effective management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as; inadequate critical information, misconception of information and uninformed decisions being made. Method: Multi method, multiple case study approach was used to explore and describe the complexities involved in the (ICP), during the management of the intrapartum period. During the study the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. 24 In-depth interviews with skilled birth attendants were conducted, observer- as- participant role was utilized during the observation, fild notes, reflective diaries and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. Findings: The findings illuminated that there are expectations of accessibility to care of the woman during pregnancy birth and the intrapartum, especially linked to referral processes. The actual ICP focused on documentation and communication of the information within and between organizations. Communication was marked by inadequate documentation and therefore errors in the information communicated. The desires for communication were illuminated by the need to change the current situation. Further a framework for effective information communication was developed: the FAAS framework for the effective management of the intrapartum period. Conclusion: In conclusion what is expected is not what is actually happening. The skilled birth attendants (SBAs) do not necessarily have the answers for change but the challenges were identified as desires for change. I urge that the framework will provide a basis for the evaluation of the effectiveness involved in the ICP for the effective management of the intrapartum period.