BackgroundThe aim of this study was to determine whether PRENACEL (a bi-directional, mobile-phone based, short text message service (SMS)) increases the coverage of recommended antenatal care (ANC) practices.MethodsA parallel, cluster-randomized trial in which 20 public primary Health Care Units (PHCUs) were randomly allocated to the intervention (10 PHCUs) or control (10 PHCUs) group. The study population included pregnant women aged 18 or above with a gestational age of 20 weeks or less. Pregnant women receiving ANC in intervention PHCUs were invited through leaflets and posters to register in PRENACEL. Women who registered in PRENACEL received a weekly set of short text messages with health education and health promotion content related to pregnancy and childbirth and were also able to clarify ANC queries through SMS. All women received routine ANC. The primary outcome was the proportion of women with high ANC Score, a composite measure of coverage of recommended ANC practices. Chi-square or Fisher’s exact tests and multivariate log-binomial regression were used to analyze the outcomes.ResultsA total of 1210 eligible women received ANC in the participating PHCUs and took part of this study (770 in the intervention group and 440 in the control group). 20.4% (157/770) of intervention-group women registered in PRENACEL, but only 116 read all messages (73.9% of women who registered in PRENACEL, 116/157). The adjusted intention-to-treat analysis suggested no difference between intervention and control groups in the primary outcome (Adjusted Relative Risk (AdjRR): 1.05 (95% Confidence Interval (CI): 1.00–1.09). Both crude and adjusted per-protocol analysis suggested a positive effect of PRENACEL (Crude RR (95% CI): 1.14 (1.06–1.22), AdjRR (95% CI): 1.12 (1.05–1.21). The multivariate analysis also suggests that the PRENACEL group (women who read all SMS) had higher mean ANC score [48.5 (±4.2) vs 45.2 (±8.7), p < 0.01], higher proportion of women with ≥6 ANC visits (96.9% vs. 84.8%, p = 0.01), and higher rates of syphilis testing (40.5% vs. 24.8%, p = 0.03) and HIV testing (46.6% vs. 25.7%, p < 0.01) during ANC.ConclusionsA bi-directional, mobile-phone based, short text message service is potentially useful to improve the coverage of recommended ANC practices, including syphilis and HIV testing.Trial registrationClinical trial registry: RBR-54zf73, U1111–1163-7761.ResumoIntroduçãoO objetivo deste estudo foi determinar se o PRENACEL, um serviço bidirecional de mensagens curtas de texto (SMS) com base na telefonia celular, aumenta a cobertura das práticas recomendadas de cuidados pré-natais (PN).Métodosum ensaio paralelo, aleatorizado por conglomerados, no qual 20 unidades básicas de saúde (UBS) foram alocadas aleatoriamente para o grupo de intervenção (10 UBS) ou controle (10 UBS). A população estudada incluiu gestantes com idade igual ou superior a 18 anos com idade gestacional de 20 semanas ou menos. As gestantes que receberam PN em UBS intervenção foram convidadas através de folhetos e cartazes para se inscreverem n...
ResumoObjetivo: analisar fatores associados a não adesão ao Papanicolau em mulheres de 25 a 59 anos de idade atendidas pela Estratégia Saúde da Família em Feira de Santana, Bahia, Brasil, em 2010. Métodos: foi realizado estudo transversal; a amostragem foi aleatória, por conglomerados, com 230 mulheres entrevistadas; foi desenvolvida análise descritiva por estrato de interesse, estimada prevalência de não adesão e as razões de prevalência. Resultados: 12,6% das mulheres entrevistadas não realizaram o Papanicolau nos últimos três anos ou nunca fizeram o exame; a não adesão ao Papanicolau foi significativamente superior entre mulheres que nunca frequentaram escola, com quatro ou mais filhos, história de quatro ou mais partos, que não usavam método contraceptivo e tinham conhecimento inadequado sobre o exame. Conclusão: houve elevada cobertura de realização do Papanicolau; entretanto, mulheres com fatores de risco para o desenvolvimento da neoplasia cérvico-uterina, como pouca escolaridade e multiparidade, apresentaram cobertura abaixo do esperado.Palavras-chave: Esfregaço Vaginal; Prevenção Secundária; Saúde da Mulher; Saúde Pública. Santana-BA, Brazil, 2010 Abstract Objective: to analyse factors associated with Pap smear non-adherence among women aged 25-59 living in areas covered by the Family Health Strategy in Feira de
Background: The partner has an important role when he participates of the prenatal care as showed in the positive results relate to the mother and the child health. For this reason it is an important strategy to bring future fathers closer to health services and to improve their link with paternity. Aim: To evaluate whether the implementation of SMS technology, through the PRENACEL program for the partner as a health education program, is a useful supplement to the standard prenatal monitoring. Methods: A parallel cluster randomized trial was carried out, with the clusters representing primary care health units. The 20 health units with the largest number of pregnant women in 2013 were selected for the study. There was a balance of the health units according to the size of the affiliated population and the vulnerability situation and these were allocated in intervention and control health units by the randomization. The partners of the pregnant women who started prenatal care prior to the 20th week of gestation were the study population of the intervention group. The participants received periodic short text messages via mobile phone with information about the pregnancy and birth. In the control group units the partners, together with the women, received the standard prenatal care. Results: One hundred eighty-six partners were interviewed, 62 from the PRENACEL group, 73 from the intervention group that did not opt for PRENACEL and 51 from the control group. A profile with a mean age of 30 years was found and the majority of respondents (51.3%) declared themselves as brown race/color. The interviewees presented a mean of 9.3 years of study. The majority of the men (95.2%) cohabited with their partner and 63.7% were classified as socioeconomic class C. The adherence to the PRENACEL program was 53.4%. In relation to the individual results, there was a greater participation of the PRENACEL partners in the prenatal consultations, as well as a greater presence of them accompanying the woman at the moment of the childbirth when compared to the other groups. Conclusion: The study showed that a health education strategy using communication technology seems to be a useful prenatal care supplement; the intervention had a good acceptability and has a promising role in men's involvement in prenatal, labour and postpartum care of their partners.
Resumo: Este estudo objetivou investigar a ocorrência de morbidade materna grave, os critérios diagnósticos mais frequentes e a qualidade da assistência obstétrica nos hospitais públicos de Ribeirão Preto, São Paulo, Brasil. Trata-se de uma pesquisa quantitativa de vigilância das morbidades maternas graves, utilizando os critérios da Organização Mundial da Saúde (OMS) para condições potencialmente ameaçadoras à vida e near miss materno. Os casos foram identificados entre 1º de agosto de 2015 e 2 de fevereiro de 2016. Participaram 259 mulheres com morbidade materna grave (condições potencialmente ameaçadoras à vida/near miss materno) durante o ciclo gravídico-puerperal, internadas para o parto nas quatro instituições públicas com assistência obstétrica no município. Realizou-se análise descritiva a partir das frequências absolutas e relativas dos critérios diagnósticos para condições potencialmente ameaçadoras à vida e near miss materno, além da descrição das mulheres pesquisadas (caracterização sociodemográfica, antecedentes obstétricos, assistência pré-natal e ao parto). Indicadores de qualidade da assistência estabelecidos pela OMS a partir da morbimortalidade também foram calculados. Ocorreram 3.497 partos, 3.502 nascidos vivos em todos os hospitais do município, 2 mortes maternas e 19 near miss materno. A razão do near miss materno foi de 5,4 casos por 1.000 nascidos vivos, e a razão de mortalidade materna foi de 57,1 óbitos por 100 mil nascidos vivos. A taxa de mortalidade entre os casos com desfecho materno grave (somados os casos de near miss materno e morte materna) foi de 9,5%. Observou-se importante frequência de casos de condições potencialmente ameaçadoras à vida e near miss materno no presente estudo. A ocorrência de óbitos por causas hemorrágicas mostra a necessidade de melhoria da qualidade da assistência prestada. Os resultados poderão contribuir para o aprimoramento da política local de assistência obstétrica.
This study aimed to identify the treatment itineraries of Brazilian women with severe maternal morbidity. This was a qualitative, descriptive, exploratory study in a university referral hospital for high-risk pregnancy in the interior of São Paulo State, Brazil. The sample included 16 women with severe complications during pregnancy, childbirth, or postpartum. Data were collected with semi-structured, taped, transcribed interviews subsequently submitted to Content Analysis. The results showed that at the onset of illness, the women take various paths to reach low and high-complexity services, while also relying on neighbor women, pharmacies, and self-medication. They encounter obstacles in the services' receptiveness, continuity of care, case-resolution capacity, and referrals within the healthcare network. Critical points were observed in obstetric care: women are frequently subjected to trekking from one health service to another to obtain care, delays in referrals, and institutional violence. The tertiary hospital was described as receptive and effective. The study identified problems in the entire chain of obstetric care, helping explain how the healthcare system is organized to deal with severe maternal complications.
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