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Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-03T17:49:42Z No. of bitstreams: 1 TESE Elsa Jacinto. 2014.pdf: 1738962 bytes, checksum: 82ca23f0f1c93d9a758beb2e1f4aec45 (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-07T14:07:04Z (GMT) No. of bitstreams: 1 TESE Elsa Jacinto. 2014.pdf: 1738962 bytes, checksum: 82ca23f0f1c93d9a758beb2e1f4aec45 (MD5) / Made available in DSpace on 2014-10-07T14:07:04Z (GMT). No. of bitstreams: 1 TESE Elsa Jacinto. 2014.pdf: 1738962 bytes, checksum: 82ca23f0f1c93d9a758beb2e1f4aec45 (MD5) / Introdução: Morbidade Materna Grave (MMG) é um quadro clínico observado em mulheres no ciclo gravídico-puerperal, composto por condições graves a extremamente graves, que ao sobreviverem são conhecidos por near miss materno; estes últimos são identificados por sinais de disfunção orgânica subsequentes a condições ameaçadoras da vida. As evidências vêm mostrando a carga da pandemia do HIV/AIDS sobre as condições clínicas de pacientes portadoras de outras doenças. Objetivos: estimar a incidência da razão de resultado materno grave e investigar os fatores associados à MMG em Maputo. Métodos: estudo caso-controle realizado na Cidade de Maputo, Moçambique, no período de Março a Novembro de 2012. As participantes elegíveis para o grupo de casos foram mulheres residentes em Maputo com MMG, segundo a definição da OMS. Os controles foram pacientes admitidas nos mesmos hospitais e no mesmo período, seguindo os mesmos critérios para a seleção dos casos, à excepção da condição clínica exigida para estes. Para o cálculo do tamanho da amostra utilizou-se o programa Epi Info, considerando-se um poder do estudo de 80%, um alfa=0,05, nível de confiança=0,95, relação caso/controle 1:2 e Odds Ratio (OR) esperada de 1,5, obtendo-se uma amostra com 485 casos e 970 controles. A exposição foi a infeção pelo HIV/AIDS, sendo utilizadas variáveis sócio-demográficas, clínico-assistenciais e comportamentais, como o uso de álcool e fumo. Os dados coletados de morbidade materna grave e near miss materno foram extrapolados para o período de doze meses por Regressão Linear Simples, utilizando-se termos quadrático e cúbico e calculados os indicadores. Para a diferença entre proporções utilizou-se o teste 2 de Pearson. A medida de associação entre HIV/AIDS e MMG (desfecho) foi a OR e seus intervalos de confiança a 95% por Regressão Logistica não condicional. Nas análises foi utilizado o pacote estatístico STATA versão 10.0. Resultados: A Razão de Resultado Materno Grave foi de 1,7/1.000 NV, Razão de NMM 0,4/1.000 NV, Razão near miss/morte materna de 28:100, Indice de Mortalidade de 78,3% e Razão de mortalidade materna de 133/100.000 NV. As principais causas de MMG foram as doenças hipertensivas (69,7%) seguidas das hemorrágicas (19,0%); entre as near miss materno foram as hemorrágicas (64,3%) e entre as mortes maternas foi a AIDS (50,0%). Foram fatores associados a um maior risco da gravidade o antecedente de aborto (OR=2,2; IC=1,4 -3,7); HIV positivo (OR=2,5; IC=1,9 – 3,3), puérpera (OR=2,7; IC=2,1 – 3,6), parto cesáreo (OR=14,9; IC=7,3 – 30,4) e tempo de trajeto entre casa e hospital superior a 30 minutos (OR=2,1; IC=1,4 – 3,2). A procura direta do hospital de referência atuou como fator protetor OR=0,6; IC=0,5 – 0,8. A associação entre a infeção por HIV e morbidade materna grave foi de OR=2,7 (IC=2,1 – 3,5). A Fração Atribuível Populacional ao HIV foi de 21,3% Conclusões: A morbidade materna grave é cerca de três vezes maior nas grávidas ou puérperas infectadas pelo vírus do HIV/AIDS do que nas não infectadas. A Razão de Resultado Materno Grave em Maputo é relativamente elevada, sendo as principais causas as doenças hemorrágicas e a infeção pelo HIV/AIDS. Os fatores associados estão relacionados sobretudo aos antecedentes reprodutivos das mulheres, orientando para uma maior atenção ao grupo de maior risco, pelo uso de normas e procedimentos padronizados. / Introduction: Severe Maternal Morbidity (SMM) is a clinical condition of women in their pregnancy and childbirth, composed of conditions ranging from severe to extreme severity, which are known when survive by maternal near miss (MNM); these cases are identified by signs of organ dysfunction subsequent to life-threatening conditions. Furthermore, surveys have shown evidence of the burden of the HIV / AIDS pandemic on the clinical condition of patients with other diseases. Objectives: To estimate the incidence of Severe Maternal Outcome Ratio (SMOR) and investigate factors associated with SMM in Maputo. Methods: case-control study conducted in Maputo, Mozambique, from March to November 2012. Eligible participants for the group of cases were resident women living with SMM, according to the WHO definition. Controls were patients admitted to the same hospitals during the same period, using the same criteria for selection of cases, with the exception of the clinical condition for these. To calculate the sample size we used the Epi Info program, considering a study power of 80%, an alpha = 0.05, confidence level = 0.95, compared case / control 1:2 and an expected odds ratio (OR) of 1.5. 485 cases and 970 controls were obtained. The exposure was the infection with HIV / AIDS; socio-demographic, clinical, healthcare and behaviour variables such as smoking e alcool utilization being used. The data for SMM and MNM were extrapolated to the period of twelve months by Simple Linear Regression with quadratic and cubic terms and calculated indicators. For the difference between proportions used the 2 test of Pearson. The measure of association between HIV / AIDS and SMM (outcome) was the OR and confidence intervals at 95% by unconditional Logistic Regression. For the analysis STATA version 10.0 was used. Results: SMOR was 1,7/1.000 LB, MNM Ratio 0,4/1.000 LB, maternal near miss/maternal death ratio of 28:100, mortality index of 78.3% and maternal mortality ratio of 133/100.000 LB. The main causes of SMM were hypertensive disorders (69,7%) followed by bleeding disorders (19.0%); among maternal near miss were bleeding (64.3%) and among maternal deaths were AIDS (50,0%). Factors associated with an increased risk of severity were history of abortion (OR = 2.2, CI = 1.4 - 3.7), HIV positive (OR = 2,5, CI = 1.9 to 3.3), pospartum period (OR = 2.7, CI = 2.1 to 3.6), caesarean delivery (OR = 14.9, CI = 7.3 to 30.4) and time between home and hospital exceeding 30 minutes (OR = 2.1, CI = 1.4 to 3.2) .The association between HIV infection and severe maternal morbidity was OR = 2.7 CI =( 2.1 to 3.5). The direct search of the reference hospital acted as a protective factor OR = 0.6; CI = 0.5 to 0.8. The Population Attributable Fraction of HIV was 21.3%. Conclusions: Severe maternal morbidity is about three times higher in pregnant or postpartum HIV / AIDS infected women than in uninfected. SMOR is high in Maputo and the main causes are bleeding disorders and infection by HIV / AIDS. Associated factors are mainly related to reproductive history of women, requiring greater attention to the high risk group, by the use of standards and standardized procedures.

Etre mère est une aspiration pour de nombreuses femmes, même si à Douala, elles continuent de payer du lourd tribut de leur vie, l’accouchement. Paradoxalement, la réalité vécue par elles, enceintes et le personnel affecté à leur prise en charge reste méconnue ou ignorée par le grand public. Afin de comprendre ce phénomène, nous avons mené une enquête sur la base d’observation et d’entretiens avec les femmes enceintes, le personnel médical et paramédical et la parentèle de la parturiente de mars 2008 à décembre 2010 dans cinq établissements hospitaliers de la ville de Douala et ses environs. Cette recherche appréhende les éléments du discours pour re-construire le contexte anthropologique qu’il génère et dont il est le produit. Elle a permis de comprendre la contradiction entre la valorisation du statut de la parturiente et l’a-normalité des comportements pendant la parturition. Il en résulte un problème de concordance entre des attitudes culturellement marquées et des normes sanitaires. Les femmes, sans toutefois ignorer leur vulnérabilité et les conditions qui favorisent une fin heureuse de la grossesse, ne commencent que tardivement les consultations prénatales. / Becoming a mother is the yearning of many women, even though in Douala, they continue to heavily pay with their very lives the act of childbirth. Paradoxically, the reality about what they go through while being pregnant, and the personnel assigned to manage them remains unrecognized or ignored by the general public. In order to understand this phenomenon, we carried out an enquiry based on observations and discussions with pregnant women, the medical/paramedical personnel, and the relatives of the parturient from March 2008 to December 2010, in five health institutions in the town of Douala. This research takes into account the various elements of discussion to rebuild the anthropological context generated by it, and of which it is also the product. It enables us to understand the contradiction between the valorisation of the parturient status, and the behavioural abnormalities during parturition. As a result, a concordance problem arises between the culturally marked attitudes, and the health norms. Though being vulnerable and aware of the conditions that favour a happy end of the pregnancy, the women still begin prenatal consultations late.

In its efforts to reduce maternal mortality and prevent Mother-to-Child Transmission of HIV, the government of Swaziland developed and implemented several programmes including a special antenatal care package for HIV-positive pregnant women in line with the WHO (2009) guidelines. Since the implementation of this latest special ANC package for HIV-positive women, little is known about how these services are experienced by the intended recipients. The purpose of this study was to explore and describe the actual experiences of HIV-positive women with the antenatal care services provided at a regional referral hospital in Swaziland, with the view of providing more insight into the quality of ANC services from the users' perspectives. A qualitative descriptive, exploratory design was used to address the above purpose. The researcher used purposive sampling to select the participants who met the inclusion criteria for the study. Semi-structured individual interviews were used and saturation was reached after 18 individual face-to-face interviews. Thematic content analysis was used to analyse the collected data. Forteen themes related to the participants experiences with the ANC services and seven related to measures for improvement emerged from data. In general HIV positive pregnant women expressed positive views towards ANC services they received at the target institution. The results give an indication on the quality of the focussed ANC package provided at the hospital and specific recommendations for improvement are outlined. / Health Studies / M. A. (Nursing Science)

In its efforts to reduce maternal mortality and prevent Mother-to-Child Transmission of HIV, the government of Swaziland developed and implemented several programmes including a special antenatal care package for HIV-positive pregnant women in line with the WHO (2009) guidelines. Since the implementation of this latest special ANC package for HIV-positive women, little is known about how these services are experienced by the intended recipients. The purpose of this study was to explore and describe the actual experiences of HIV-positive women with the antenatal care services provided at a regional referral hospital in Swaziland, with the view of providing more insight into the quality of ANC services from the users' perspectives. A qualitative descriptive, exploratory design was used to address the above purpose. The researcher used purposive sampling to select the participants who met the inclusion criteria for the study. Semi-structured individual interviews were used and saturation was reached after 18 individual face-to-face interviews. Thematic content analysis was used to analyse the collected data. Forteen themes related to the participants experiences with the ANC services and seven related to measures for improvement emerged from data. In general HIV positive pregnant women expressed positive views towards ANC services they received at the target institution. The results give an indication on the quality of the focussed ANC package provided at the hospital and specific recommendations for improvement are outlined. / Health Studies / M. A. (Nursing Science)