Quality Of Prenatal Care Research Articles

Predisposing Factors For Incidence Of Congenital Syphilis

The study aims to synthesize the knowledge produced in articles about the predisposing factors for the incidence of Congenital Syphilis. An integrative review was conducted in May and June 2014. Three databases were consulted and all publications available at the pre-established time frame were collected. The descriptors congenital syphilis, incidence and causality in Portuguese, English and Spanish were used, resulting in 1723 articles, of which 23 were selected. The results show deficiency in prenatal care; poor diagnosis; inadequante care of the disease; unequal socioeconomic conditions; difficult access to health services; and poor guidelines. The increasing number of new cases of congenital syphilis is due to several factors that can be prevented through quality prenatal care. Therefore, care actions during pregnancy and puerperium need to be redirected so that they are based on early diagnosis, immediate treatment of the couple and health education.

Clinical Complications In Pregnancy And The Relationship With Low Birth Weight And Prematurity Of The Newborn

Study in order to know the results of prenatal care related to clinical complications of pregnancy, newborn’s low birth weight and prematurity in the context of the users of the service. Descriptive, exploratory research with quantitative approach developed with 305 users who underwent prenatal care in primary care in the city of Mossoró-RN. The data collection occurred from the application of a validated questionnaire, the IPR-PRENATAL index. The results indicate that over 50% of pregnant women had some type of complication during their pregnancy process, among intercurrent diseases in pregnancy, and experienced by users, the urinary tract infection was the most prevalent (28.0%), followed by anemia (19.3%) and hypertension (15.7%). Hypertension and anemia were the only events that interfere with the newborn’s weight, which showed that the existence of complications contributes in three times to the occurrence of low birth weight. In this sense, the quality of prenatal care can minimize that type of complication.

Profile and outcomes of women with pregnancy‐related acute kidney injury requiring dialysis at a center in Ethiopia

To describe the clinical profile and outcomes of women with pregnancy-related acute kidney injury (AKI) undergoing dialysis at Saint Paul's Hospital Millennium Medical College, Addis Ababa, where the first publicly funded large-scale dialysis service in Ethiopia was established. In a hospital-based retrospective study, clinical records were reviewed for all women with pregnancy-related AKI attending the hemodialysis unit at the study center between August 2013 and July 2015. In total, 42 pregnant women with pregnancy-related AKI underwent dialysis. Their mean age was 28.9±5.9years. The most common cause of pregnancy-related AKI was pre-eclampsia or eclampsia (31/42, 74%), followed by puerperal sepsis (6/42, 14%). The mean number of dialysis sessions was 4.8±4.6; the most common indication for dialysis was refractory fluid overload (35/42, 83%). Overall, 35 (83%) women were discharged with improvement, 5 (12%) died, and 2 (5%) absconded. Of the five maternal deaths, three women had pre-eclampsia-related AKI and two had puerperal sepsis-related AKI. Hypertensive disorders of pregnancy were the leading cause of pregnancy-related AKI, which can be easily prevented with early diagnosis and timely intervention. Improving the quality of prenatal care to recognize hypertensive disorders during pregnancy, coupled with prompt management, might help to reduce maternal morbidity and mortality related to AKI.

Predictors of Quality of Care Amongst Gestational Diabetic Patients in Community Hospital [16N

INTRODUCTION: The objective of our study was to determine factors that affect the quality of care received by a gestational diabetic patient. METHODS: A retrospective cohort study of gestational diabetic patients' who delivered from January 2013 to December 2015. Patients were given quality scores based on predefined quality of care parameters. Patients were then categorized into high quality vs low quality care based on their quality score. Logistics regression analysis was used to determine the relationship between quality of care and variables of interest. RESULTS: Of 514 eligible patients, 468 (91%) had high quality care and 46 (9%) had low quality care. The predictors of High quality of care are: GDMA type: Medication vs Diet Control (OR: -5.74, p = < 0.001); Sex of Infant: Male vs Female (OR:- 0.74, p = 0.352); Age: 20-35 yrs vs less than 19 yrs (OR: 5.2, p= 0.062) and Greater than 35 yrs vs 19 yrs (OR: 5.2, p= 0.071).Gestational age at Diagnosis of GDM: 24 – 30 wks vs less than 24 weeks (OR:0.42, p= 0.16) and greater than 30 wks vs less than 24 wks (OR: 0.17, p = 0.001).Gestational age at initiation of prenatal care: greater than 24 wks vs less than 24 wks (OR: 0.46, p=0.023). CONCLUSION: Patients on medication control, who had an early diagnosis of gestational diabetes and who initiated prenatal care early were more likely to have high quality. Early initiation of prenatal care and prompt diagnosis of GDM is beneficial to improving quality prenatal care.

TRANSMISSÃO VERTICAL DO HIV: DIFICULDADE NA ADESÃO AO PRÉ-NATAL

Objetivo: Averiguar nas produções científicas as dificuldades das mulheres HIV positivas em aderir o pré-natal. Metodologia: Trata-se de uma pesquisa bibliográfica de caráter descritiva e exploratória. A busca eletrônica dos artigos que atendiam aos critérios de inclusão foi realizada mediante consulta às bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Bases de Dados de Enfermagem (BDENF) e PUBMED, no período de 2005-2014. Resultados e discussão: Foram selecionadas 8 publicações, evidenciando que na literatura nos últimos dez anos há carência nas produções científicas no cenário da atenção básica, voltadas às dificuldades de mulheres HIV positivas em aderirem o pré-natal. A análise revela que diversos fatores como, aceitação da gravidez, descoberta tardia da gestação, dificuldade no acesso aos serviços de saúde e descontinuidade no pré-natal dificultam a adesão destas mulheres, interferindo diretamente no processo de prevenção da transmissão vertical do HIV. Considerações finais: Evidencia-se na literatura nos últimos dez anos carência nas produções científicas no cenário da atenção básica. Assim, espera-se que esta pesquisa possa contribuir para melhorar a qualidade do pré-natal no Brasil, a fim de captar e detectar precocemente as gestantes HIV positivas, intervindo de forma integral.

Effect of Prenatal Care Frequency, Timing, and Quality on Child Birth Weight in Tajikistan

We focus on identifying the effects of prenatal care on child birth weight in Tajikistan. We evaluate the effects of frequency, timing, and the quality of received care by estimating instrumental variable models. The results of two-stage least square (2SLS) indicate that an additional prenatal visit improves birth weight by 89 g, which constitutes approximately 2.7 percent of the original raw mean. Similarly, a one-unit increase in the quality of prenatal care improves birth weight by 130 g, which represents about 9.2 percent of the original mean. Likewise, having the first prenatal visit take place during the first trimester improves birth weight by 304 g, which is about 3.9 percent of the original mean. Although prenatal care in Tajikistan suffers from various inefficiencies, it nevertheless remains an instrumental factor in improving birth outcomes in the country. Finally, issues of endogeneity that result from self-selection and the importance of adjusting for child selection for being weighed are highlighted.

Prenatal care utilization in Zimbabwe: Examining the role of community-level factors

This paper assesses the importance of community-level factors on prenatal care utilization in Zimbabwe. The analysis is performed using data from the two most recent rounds of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 2005/06 and 2010/11 linked with other community-level data. We use logistic, generalized linear regressions as well as multilevel mixed models to examine the factors associated with the frequency, timing and quality of prenatal care. Our results suggest that contraceptive prevalence, religious composition, density of nurses, health expenditures per capita and availability of government hospitals in communities are important predictors of prenatal care use in Zimbabwe. These findings have important implications for public health policy in Zimbabwe – a country with unfavorable maternal and child health outcomes.

Examining the Quality of Prenatal Care Received by Women Attending Health Centers of Jiroft During 2015

Examining the Quality of Prenatal Care Received by Women Attending Health Centers of Jiroft During 2015

Knowledge and perceptions on toxoplasmosis among pregnant women and nurses who provide prenatal in primary care.

ABSTRACTBackground Toxoplasmosis is an infection that affects almost a third of the world population. In adults, it is often asymptomatic, although having important manifestation in children- infected by placental transmission. The prenatal is an important moment, requiring actions in women’s care during pregnancy, in order to prevent diseases that could compromise the mother and the child’s life.Methods This is a descriptive study of qualitative approach aimed to understand the perception of nurses and pregnant women about toxoplasmosis during primary – prenatal care. The study was conducted in five selected primary health care units, in the municipality of São Luis - MA. The sample consisted of 15 nurses working in nursing consultation and 15 pregnant women attended in prenatal care. For data collection, a semi-structured questionnaire and an interview guide covering issues related to knowledge and conduct on toxoplasmosis were used. For analysis, the content analysis technique was used.Results The answers were transcribed, organized and grouped thematically, where the following categories emerged: knowledge about examination requests; knowledge about toxoplasmosis; guidance during prenatal consultation; knowledge of nurses about the avidity test; procedures and guidelines on reagent cases. Pregnant women showed unawareness about toxoplasmosis and its effects. Nurses, although having basic knowledge about the subject, showed little applicability regarding pregnant women’s guidance.Conclusion The nurse plays an important role in educational activities regarding pregnant women, contributing to the quality of prenatal care. Pregnant women were shown to have some knowledge about toxoplasmosis, although they said they did not have assurance about prevention.

Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight

ObjectiveTo examine the association of women’s body weight with provider communication during prenatal care. MethodsWe coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication. ResultsCompared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44–0.99, p=0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32–0.82, p=0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51–0.91, p=0.01) and concern statements (IRR 0.68, 95% CI 0.53–0.86, p=0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19–0.84 p=0.02). ConclusionLess lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care. Practice implicationsInterventions to increase use of patient-centered communication – especially for women with overweight and obesity – may improve prenatal care quality.

The impact of prenatal care quality on neonatal, infant and child mortality in Zimbabwe: evidence from the demographic and health surveys.

The impact of the quality of prenatal care on child mortality outcomes has received less attention in sub-Saharan Africa. This study endeavoured to explore the effect of the quality of prenatal care and its individual components on neonatal, infant and under-five mortality. The empirical analysis uses data from the three most recent waves of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 1999, 2005/06 and 2010/11. The results indicate that a one-unit increase in the quality of prenatal care lowers the prospect of neonatal, infant and under-five mortality by approximately 42.33, 30.86 and 28.65%, respectively. These findings remained roughly the same even after adjusting for potential mediating factors. Examining the effect of individual prenatal care components on child mortality revealed that women who receive information on possible complications arising during pregnancy are less liable to experience a neonatal death. Similarly, women who had blood pressure checks and tetanus immunizations were less likely to experience an infant or under-five death. We did not find any statistically meaningful impact on child mortality outcomes of blood and urine sample checks, iron tablet consumption, and the receipt of malarial tablets. Overall, our results suggest the need for public health policymakers to focus on ensuring high-quality prenatal care to enhance the survival prospects of Zimbabwe's infants.

Underreporting of Congenital Syphilis as a Cause of Fetal and Infant Deaths in Northeastern Brazil.

IntroductionOf all syphilis-related pregnancy outcomes, fetal death is certainly the most common one, being directly related to the availability, accessibility and quality of prenatal care. The present study aimed to analyze the underreporting of fetal and infant deaths and other maternal factors associated with congenital syphilis (CS) death.MethodsThis cross-sectional study integrated data of infants that were diagnosed and/or died of CS from the Sistema de Informação de Agravos de Notificação–Sinan (Notifiable Diseases Information System) and the Sistema de Informação de Mortalidade–SIM (Mortality Information System) in Fortaleza, Northeastern Brasil to identify unreported cases of congenital syphilis. We assessed data during the period from 2007 to 2013.ResultsThe underreporting of CS as a cause of fetal or infant death increased from 41 to 415 cases (90.1%) during 2007–2013. Exactly 3,209 cases of CS were identified in Sinan and 6,578 deaths in SIM. After database linkage, we identified 382 cases that were reported in the SIM and SINAN databases consisting of 309 fetal deaths and 73 infant deaths related to CS. From the children notified at Sinan that born alive, 3.0% (78/2,542) died; Out of these, 39 (50.0%) were early and 25 (32.1%) were late neonatal deaths. The proportion of death by CS increased from 0.62 to 5.8 from 2007 to 2013. At logistic regression, the variable that maintained statistical significance with fetal and infant death outcomes was the presence of CS signs and/or symptoms at birth (OR = 3.20; IC 95% 1.54–6.62; p = 0.002).ConclusionsNeonatal and Infant deaths following CS-associated live births are underreported in Northeastern Brazil. Data base linkage identified unreported fetal and neonatal deaths due to CS leading to an increased awareness of fetal/infant mortality due to this infection.

Análise da incidência de óbitos fetais entre municípios da nona regional de saúde do Paraná

Resumo: O objetivo do estudo foi analisar os óbitos fetais entre municípios da nona regional de saúde do Paraná. Pesquisa descritiva com abordagem quantitativa. A coleta aconteceu no primeiro semestre de 2015, no Sistema de Informação de Nascidos Vivos, no Sistema de Informação sobre Mortalidade e nos relatórios do Comitê de Mortalidade Materno e Infantil da nona Regional de Saúde do Paraná. Cinco municípios tiveram aumento nos óbitos fetais entre 2010 e 2013, sendo que, Itaipulândia apresentou os piores índices e Santa Terezinha de Itaipu um aumento de cinco vezes. Entre os óbitos fetais, destacaram-se fetos do sexo masculino, com peso entre 500 e 1499 gramas e idade gestacional de 28 a 36 semanas. Quanto à idade materna, predominou a faixa etária de 20 a 39 anos. Em 2010, a maior parte dos óbitos fetais acorreu com mães de baixa escolaridade, já em 2013, não se observou esta relação. Para a maioria, o tipo de parto foi vaginal, mas ainda se observa que o parto cirúrgico aconteceu em muitos casos de óbito fetal. A construção de estudos sobre a saúde fetal com diferentes enfoques de abordagem torna-se relevante, pois estes têm sido pouco explorados, apesar de sua incontestável importância em termos de saúde pública como indicador da qualidade da assistência pré-natal e ao parto.

Racial and Ethnic Disparities in Infant Mortality in North Carolina, 2008-2009.

This study was designed to investigate whether racial and ethnic disparities in infant mortality still exist in North Carolina and to examine predictors of infant mortality using the North Carolina Vital Statistics Dataverse. This was a retrospective, cross-sectional, observational study that included all 257,543 births in North Carolina in 2008-2009. Infant mortality was assessed based on birth records included in the database. Infant births and deaths were summarized by demographic and maternal/infant characteristics. A multivariate logistic regression model was constructed to jointly assess predictors of infant mortality. The overall infant mortality rate in North Carolina was 0.8%. Adjusting for confounders through the construction and assessment of a multivariate logistic regression model, statistically significant associations were found between infant mortality and each of the following: maternal race (both black and 'other' versus white), infant sex, both premature and preterm gestation (versus full term), birth weight (both low and high versus normal), maternal education (both less than high school graduate and more than high school versus college graduate), prenatal care (both intermediate and inadequate versus adequate), and maternal tobacco use. Maternal race was limited to white, black, and other. Data on socioeconomic status, maternal medical risk factors, and quality of prenatal care were not available. At the time of the analysis, data for years beyond 2009 were limited. Racial disparities in infant mortality persist in North Carolina; specifically, infants of nonwhite mothers have a higher mortality rate than do infants of white mothers. Other factors that continue to play a significant role in infant mortality in North Carolina include preterm and premature births, male infant sex, low birth weight, maternal education less than college graduate, maternal tobacco use, and less than adequate prenatal care.

Do Health Care Providers Respond to Demand-Side Incentives? Evidence from Indonesia

This paper exploits the subdistrict randomization of Indonesia's household Conditional Cash Transfer (CCT) program to analyze how the program affects the local health care market. The CCT program is associated with increased use of midwives as the main delivery attendants. The program is also associated with a 10 percent increase in both the number of midwives and the delivery fees charged by midwives in treated communities. Program participants report receiving a higher quality of prenatal care. This is due, however, not to improvements in quality of care in the market, but to increased utilization among program participants. (JEL H51, I13, I18, I32, I38, O15)

A case–control study of risk factors for surgical site infection after cesarean delivery in eastern Burkina Faso

ObjectiveTo identify the risk factors for surgical site infection after cesarean delivery in a rural area in eastern Burkina Faso. MethodsA matched case–control study was conducted in Fada N'Gourma Regional Hospital Center and the Diapaga Medical Center with Surgical Antenna using data from 2011–2014. A total of 99 cases of surgical site infection after cesarean delivery were included in the study. Each case was matched with a control patient similar for age, admission date, and facility where the cesarean took place. Risk factors were identified using conditional logistic regression. ResultsMultivariate analysis identified hyperthermia at admission (OR 2.37; P=0.035), the presence of caput succedaneum in newborns (OR 7.07; P=0.001), and difficult delivery (OR 3.69; P=0. 019) as risk factors for surgical site infection. ConclusionProvision of quality prenatal care, use of the partograph during labor, and the responsiveness of health workers during labor can reduce surgical site infection after cesarean delivery.

Cuidado de enfermagem na gestação de alto risco: revisão integrativa

Aim: to analyze the scientific production regarding the nursing care provided to high-risk pregnant mothers. Method: this is an integrative review, performed between September and October 2015 via PubMed, CINAHL, Web of Science, SCOPUS, SciE LO, ME D LI NE , LI LA C S and B D E NF databases, using the key terms “Nursing C are A ND Pregnancy”, and “H igh-Risk”, which resulted in 23 articles. The analysis of data was processed through IRAMUTEQ® software. Results: there were six classes, which represented interfaces of nursing care to high-risk pregnant mothers and that are related to: motivations, specialized care, education, nursing strategies, multi-professional assistance, and context of care. Conclusion: the care of high-risk pregnant mothers was evident through a quality pre-natal and home care, from the plan of individualized care organized by the nurse and by the multi-professional team, under family support and via use of light technologies.

A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum.

Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980-1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda. Conclusion We conclude that increasing women's access to high quality prenatal care will require substantial effort at the clinical, community, policy, and system levels. Only when attention is paid to all phases of the reproductive/perinatal health continuum with an emphasis on continuity between all periods, and on the social determinants that affect health and well-being, will our nation be able to ensure the health of all women across the life course (whether or not they ever become mothers), while simultaneously fulfilling our nation's promise that all children-no matter their income or race/ethnicity-will have the opportunity to be born well.

Do active patients seek higher quality prenatal care?: A panel data analysis from Nairobi, Kenya

Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these “active” patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the “slums” of) Nairobi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received. We define active antenatal care (ANC) patients as those women who switch ANC providers and explore the prevalence, characteristics and care-seeking behavior of these patients. We analyze whether active ANC patients appear to be seeking out higher quality facilities and whether they are more satisfied with their care. Women in our sample visit over 150 different public and private ANC facilities. Active patients are more educated and more likely to have high risk pregnancies, but have otherwise similar characteristics to non-active patients. We find that active patients are increasingly likely to pay for private care (despite public care being free) and to receive a higher quality of care over the course of their pregnancy. We find that active patients appear more satisfied with their care over the course of pregnancy, as they are increasingly likely to choose to deliver at the facility providing their ANC.

Clinical profile and outcome of patients with acute kidney injury requiring dialysis-an experience from a haemodialysis unit in a developing country.

BackgroundThe first government funded and sustainable dialysis unit was established in Ethiopia at Saint Paul’s Hospital Millennium Medical College (SPHMMC). This has led to the development of a unique cohort of patients about which very little is known. This study was conducted to describe the clinical profile and outcome of adult Acute Kidney Injury (AKI) patients treated with intermittent haemodialysis at the dialysis center of SPHMMC.MethodsA retrospective review of clinical records of cases of AKI who required haemodialysis support during the time period from August 1, 2013 to February 1, 2015 was conducted.ResultsA total of 151 cases AKI requiring dialysis were included for the study. Overall, the patients were generally younger with a mean age of 36.7 years and thus with few premorbid conditions. The most common causes of AKI were hypovolemia (22.5 %), acute glomerulonephritis (AGN) (21.9 %) and pregnancy related causes (18.5 %). Nearly a third (29.1 %) of patients succumbed to the AKI.ConclusionInfections, AGN, obstetric causes and nephrotoxins were the primary causes of dialysis requiring AKI. Most of these causes can be prevented with simple interventions such as health education on oral rehydration, quality prenatal and emergency obstetric care, appropriate management of infections and taking appropriate precautions when prescribing potentially nephrotoxic medications.