BackgroundIn Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies.MethodsNationwide cross-sectional hospital-based study “Birth in Brazil: national survey into labor and birth” conducted in 2011–2012. Data from 209 hospitals classified as public (public funding and management) or mixed (public or private funding and private management) that generate estimates for 1148 Brazilian hospitals. Interview with hospital managers provided data for the structure adequacy assessment covering four domains: human resources, medications, equipment for women emergency care and support services. We conducted analysis of the structure adequacy rate according to type of hospital (public or mixed), availability of ICU and the woman obstetric risk using the X 2 test to detect differences in categorical variables with the level of statistical significance set at p <0.05.ResultsGlobal rate of adequacy of 34.8 %: 42.2 % in public hospitals and 29.0 % in mixed hospitals (p < 0.001). Public and mixed hospitals with ICU had higher scores of adequacy than hospitals without ICU (73.3 % × 24.4 % public hospitals; 40.3 % × 10.6 % mixed hospitals). At a national level, 32.8 % of women with obstetric risk were cared for in hospitals without ICU and 29.5 % of women without risk were cared for in hospitals with ICU. Inequalities were observed with the North, Northeast and non-capital regions having the lower rates of hospitals with ICU.ConclusionsThe majority of maternity wards across the country have a low rate of adequacy that can affect the quality of labor and birth care. This holds true for women at high obstetric risk, who suffer the possibility of having their care compromised by failures of hospital infrastructure, and for women at low obstetric risk, who may not receive the appropriate care to support the natural evolution of their labor when in a technological hospital environment.
O sucesso da erradicação da transmissão autóctone do vírus da poliomielite nas Américas, levou os Ministros da Saúde dos países membros da Organização Pan-Americana da Saúde -OPAS a assumirem, em 1994, a meta de eliminação do sarampo até o ano 2000. O Plano de Eliminação do Sarampo inclui as estratégias: imunização das crianças de 9 meses a 14 anos de uma só vez e a manutenção de altas coberturas vacinais em menores de 1 ano; campanhas periódicas a cada 2 a 4 anos para menores de 4 anos; a implementação dos sistemas de vigilância epidemiológica, para detectar casos suspeitos de sarampo. O impacto das ações adotadas em vários países da América caracterizou-se pela drástica redução da incidência da doença, estimulando a OPAS a realizar uma avaliação, visando conhecer a verdadeira situação epidemiológica da doença e a capacidade dos sistemas de vigilância epidemiológica em detectar casos/surtos oportunamente e aplicar as medidas de controle de forma ágil. A metodologia, desenvolvida pela OPAS, é de caráter qualitativo com componentes quantitativos. Apresenta-se neste trabalho a avaliação realizada no Brasil nos Estados de São Paulo e Bahia. Os resultados apontam para um sistema de vigilância moroso, que não permite a detecção oportuna de casos ou surtos e que o Plano de Eliminação não representava prioridade política nos anos posteriores a sua implementação em 1992.Palavras-Chave: Vigilância Epidemiológica; Sarampo; Plano de Eliminação do Sarampo. SummaryThe successful eradication of the transmission of autochthonous wild poliomyelitis virus in the Americas, encouraged the Ministers of Health of the members States of the Pan-American Health Organization -PAHO -in 1994 to adopt the goal of eliminating measles in the Region by the year 2000. The Measles Elimination Plan consist of four basic strategies: a one time vaccination of all children between 9 months and 14 years in national campaign; maintenance of high vaccination coverages in children less than 1 year; periodic vaccination campaigns, every 2/4 years to detect suspected cases of measles in children less than 4 years and the implementation and strengthening of epidemiological surveillance system. A drastic reduction in the incidence of the disease was observed in the Americas which stimulated PAHO, to carry out an evaluation of the measles epidemiological surveillance system with the objective to determine the true epidemiological situation and the systems capacity in to detect suspected cases of measles or outbreaks and implement control measures in a timely fashion. The methodology was developed by PAHO, and consists mainly on qualitative attributes with quantitative components. The evaluation was realized in the Brazilian States of Bahia and São Paulo and revealed that the measles surveillance system is slow, not allowing the timely detection of cases or outbreaks and that the Elimination Plan was not considered a political priority in the years following its implementation in 1992.
ResumoEste estudo tem como objetivo identifi car os ambientes, a intensidade da sua produção e a gestão no Estuário Amazônico. As informações utilizadas neste trabalho foram obtidas a partir de pesquisas bibliográfi cas e questionários aplicados aos atores da pesca. Os resultados mostraram que a piramutaba é explorada tanto pela pesca artesanal quanto industrial na área do Estuário Amazônico. A produção das pescarias na área atingiu 16.063,50 toneladas em 1999, caiu para 12.010,00 toneladas no ano seguinte e atingiu o pico de produção de 24.701,00 toneladas em 2006. A análise da tendência da produção conforme a avaliação dos atores da pesca indica diminuição dos estoques nos últimos 10 anos e que a perspectivas futuras para a produção das pescarias artesanais e industriais apontam que haverá diminuição dos desembarques na área do Estuário. AbstractThis study aims to identify the environments, the intensity of their production and management actions in the Amazon Estuary. Information used in this study was obtained from literature reviews and questionnaires applied to diverse stakeholder's groups of piramutaba fi sheries. The results showed that the piramutaba is exploited by both industrial and artisanal fi sheries in the area of the Amazon Estuary. The production of fi sheries in the area totaled 16,063.50 tons in 1999, fell to 12,010.00 tons in the following year and reached peak production of 24,701.00 tons in 2006. As indicated by the actor's assessments of fi shing stocks the production presented a decrease in the last 10 years and it is expected that the landings of artisanal and industrial fi sheries in the Estuary area will be reduced.Novos Cadernos NAEA v. 14, n. 1, p. 115-129, jun. 2011, ISSN 1516 Os ambientes, a pesca e a gestão das pescarias da piramutaba (Brachyplatystoma vaillantii)
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