Dissertations / Theses on the topic 'Maternal and Child Health Section'
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1
El-Shal, Amira. "The effects of health sector reform interventions in Egypt on family planning and maternal and child health." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/18120/.
Abstract:
This thesis is composed of four essays that make empirical contributions to impact evaluations of health sector interventions in low- and middle-income countries, in light of the interventions introduced under Egypt's Health Sector Reform Program (HSRP) between 2000 and 2014. We are mainly interested in the effects on family planning and maternal and child health. Different methods are used in this context: difference-in-differences (DD), DD propensity score matching (PSM), fixed effects (FE), random effects (RE) and pooled ordinary least-squares (POLS). In chapter 3, we estimate the effect of improving the quality of health care through facility accreditation on the family planning, maternal health and child health outcomes that we expect to reflect the effect of compliance with quality standards, policies and procedures. We found that accreditation had multiple positive effects, especially on delivery care and child morbidity prevalence. No significant effects were observed, however, with respect to most antenatal care (ANC) outcomes. In chapter 4, we estimate the medium-term effect of introducing user fees on the utilization of family planning, ANC and delivery care services, women's access to health care, and child health status. With respect to ANC, we found that the positive effect of increased willingness to pay for an improved quality of service outweighed the negative effect of the price elasticity of demand. Introducing user fees was associated with a higher likelihood of receiving ANC by skilled health personnel, a higher likelihood of receiving at least four ANC visits and a higher likelihood of receiving iron supplements during pregnancy. However, the two effects offset each other with respect to the outcomes that reflect the utilization of family planning and delivery care services, women's access to health care, and child health status. No net effect at all was observed on these outcomes. Chapter 5 complements the analysis of chapter 4 by allowing us to estimate the net effect of combining user fees and two quality improvement interventions: facility accreditation and performance-based financing (PBF). Again, we observe positive effects on both the utilization and the quality of ANC services. More notably, a positive effect on access to care was observed during our first study period that is more likely to reflect the effect of quality improvements. These effects, however, were reversed during the second study period that is more likely to reflect the effect of user fee introduction. The positive effects reported in chapters 4 and 5 were mainly with respect to ANC. No effects were reported on the outcomes that reflect the utilization of family planning and delivery care services, and child health status. In chapter 6, we estimate the effect of discontinuing provider incentives on health outcomes that reflect the health services targeted by the PBF scheme as well as the quality of these services. We found that discontinuing the incentives had a negative effect on four out of seven health outcomes: knowledge of contraceptive methods, receiving ANC by skilled health personnel, receiving iron supplements during pregnancy, and more importantly, under-five child mortality. Our findings, first, suggest that improving the quality of care through facility accreditation could be particularly effective in improving delivery care and child health. However, a high level of commitment from the central government is indispensable to sustain the positive effects of quality improvement interventions. Second, introducing user fees will not necessarily have negative effects on access and utilization of family planning, maternal health and child health services. However, user fees are ineffective, in general, as a stand-alone policy. Third, negative effects of introducing user fees in low- and middle-income settings on the utilization of healthcare services can be mitigated by officially exempting the poor from any fees at the point of service. More importantly, this exemption should be known to the population. Fourth, combining quality improvement interventions with user fees will not necessarily add to the few positive effects obtained when user fees are introduced as a stand-alone policy. Finally, provider incentives should be introduced carefully in low- and middle-income countries as negative effects are observed when these incentives are discontinued.
2
Forero, Ilenia Anneth. "The Water Culture Beliefs of Embera Communities and Maternal and Child Health in the Republic of Panama." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4673.
Abstract:
Water has cultural and spiritual values to indigenous people. These beliefs expose them to unsafe water sources and make them vulnerable to waterborne diseases. This background is not taken into account when countries write their water legislations, therefor imposing a management of water not readily accepted by them. The Embera group is one of the indigenous groups from the Republic of Panama, who have strong water beliefs. They live along the shore of rivers in houses built on high stilts away from urban areas. The purpose of this cross-sectional community based study is to describe through a survey the relation between the water beliefs of Embera communities living inside the Chagres National Park and the health of women and children. A house to house visit was performed in two of the five Embera communities that reside inside the Chagres National Park to enroll them and complete the survey. Sixteen Embera households with 71 family members agreed to participate. Results showed that 18.5% were children under 5 years of age and 14.1% their corresponding mothers. One hundred percent of the households rely on rural aqueduct as their source of water, with no treatment performed to this water. Women that completed elementary school or had higher education level accounted for 53.4%. Analysis of frequency of more than three diarrheal episodes in children under 5 years of age with mother's education level and months of breastfeeding had no statistical significance (X2 of 1.935, p-value of >0.05; X2 of 0.258, p-value of >0.05). When the frequency of diarrheal episodes in women and their education level was analyzed a statistically significant association was found (X2 of 6.429, p-value of 0.011). Five (38.5%) out of 13 children under 5 years of age in these communities had complete immunization calendar for their ages, but 10 (76.9%) have completed immunization for Rotavirus. No deaths due to diarrhea were reported in any member of the household. Marginalization in this type of communities is frequent since they settle in vast areas far from access to safe roads, safe water, basic sanitation and health services. A similar study can be applied to the 5 communities living in the area to have a clear view of their water beliefs, diseases and needs in order to concentrate efforts to close any gaps.
3
Alarcón-Guevara, Samuel, Joshua Peñafiel-Sam, Sergio Chang-Cabanillas, and Reneé Pereyra-Elías. "Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015." Blackwell Publishing Ltd, 2021. http://hdl.handle.net/10757/655820.
Abstract:
El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Introduction: Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. Methods: Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. Results: Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother–child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3–30.2) and 6.9% (95% CI: 6.1–7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85–1.30). The sample did not have moderate or severe malnutrition. Conclusions: There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.
Revisión por pares
4
Yugbaré, Belemsaga Danielle, Anne Goujon, Aristide Bado, Seni Kouanda, Els Duysburgh, Marleen Temmerman, and Olivier Degomme. "Integration of postpartum care into child health and immunization services in Burkina Faso: findings from a cross-sectional study." BMC, 2018. http://epub.wu.ac.at/6734/1/document.pdf.
Abstract:
Background:
The
Missed Opportunities for Maternal and Infant Health (MOMI)
project, which aimed at upgrading
maternal and infant postpartum care (PPC), implemented a package of interventions including the integration of
maternal PPC in infant immunization services in 12 health facilities in Kaya Health district in Burkina Faso from 2013
to 2015. This paper assesses the coverage and the quality of combined mother-infant PPC in reproductive,
maternal, newborn and child health services (RMNCH).
Methods:
We conducted a mixed methods study with cross-sectional surveys before and after the intervention in
the Kaya health and demographic surveillance system. On the quantitative side, two household surveys were
performed in 2012 (
N
= 757) and in 2014 (
N
= 754) among mothers within one year postpartum. The analysis
examines the result of the intervention by the date of delivery at three key time points in the PPC schedule: the
first 48 h, days 6 -
10 and during weeks 6 - 8
and beyond. On the qualitative side, in depth interviews, focus group
discussions and observations were conducted in four health facilities in 2012 and 2015. They involved mothers in
the postpartum period, facility and community health workers, and other stakeholders. We performed a descriptive
analysis and a two-sample test of proportions of the quantitative data. The qualitative data were recorded,
transcribed and analysed along the themes relevant for the intervention.
Results:
The findings show that the WHO guidelines, in terms of content and improvement of maternal PPC, were
followed for physical examinations and consultations. They also show a significant increase in the coverage of
maternal PPC services from 50% (372/752) before the intervention to 81% (544/672) one year after the start of the
intervention. However, more women were assessed at days 6 -
10 than at later visits. Integration of maternal PPC
was low, with little improvements in history taking and physical examination of mothers in immunization services.
While health workers are polyvalent, difficulties in restructuring and organizing services hindered the integration.
Conclusion:
Unless a comprehensive strategy of integration within RMNCH services is implemented to address the
primary health care challenges within the health system, integration will not yield the desired results.
5
Buccini, Gabriela dos Santos. "Determinantes do uso da chupeta e mamadeira em crianças menores de um ano nas capitais brasileiras e Distrito Federal." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/6/6138/tde-05092012-111455/.
Abstract:
Introdução - O uso de bicos artificiais é um hábito cultural com alta prevalência em diversos países. Profissionais e mães acreditam que o uso desses utensílios seja inofensivo, ou mesmo necessário, para o desenvolvimento da criança, tendo atitude indiferente ou permissiva frente ao seu uso indiscriminado. Há mais de 30 anos, consenso científico internacional reconhece bicos artificiais e leites industriais como responsáveis por parte dos índices de morbimortalidade infantil e alterações na saúde da criança. Objetivo - Analisar a influência de fatores socioeconômicos, biológicos e da atuação dos serviços de saúde sobre o uso de bicos artificiais (chupetas e mamadeiras) entre crianças menores de um ano nas capitais brasileiras e Distrito Federal(DF). Métodos- Estudo com delineamento transversal realizado a partir do banco de dados da II Pesquisa de Prevalência de Aleitamento Materno nas Capitais e DF em 2008 na segunda fase da Campanha Nacional de Multivacinação. Foi utilizada amostra por conglomerados, com sorteio em dois estágios. O questionário era composto por questões fechadas incluindo perguntas sobre o uso de chupeta e mamadeira no dia anterior à pesquisa. Foram analisados os fatores associados ao uso de bicos artificiais considerando três desfechos: 1)Uso exclusivo da chupeta; 2)Uso exclusivo da mamadeira; e 3)Uso de bicos artificiais (chupeta e mamadeira). As razões de prevalência e os intervalos de confiança foram obtidos por meio da regressão de Poisson seguindo modelo hierárquico. Resultados Participaram 34.366 crianças menores de um ano. Identificou-se como fatores associados ao uso exclusivo de chupeta mãe trabalhar fora do lar (RP=1,18), primiparidade (RP=1,28), não ter mamado na 1ªhora (RP=1,15) e uso de chá no1ºdia em casa (RP=1,37). Para o uso exclusivo de mamadeira, identificou-se: mãe trabalhar fora do lar (RP=1,39), primiparidade (RP=1,28), baixo peso ao nascer (RP=1,21) não ter mamado na 1ªhora (RP=1,08), uso de leite artificial (RP=1,82) e do chá (RP=1,96) no 1ºdia em casa. O uso de bicos artificiais associou-se ao trabalho materno fora do lar (RP=1,43), primiparidade (RP=1,21), parto cesáreo (RP=1,06), bebês do sexo masculino (RP=1,07), baixo peso ao nascer (RP=1,11), ter nascido em hospital não credenciado como Amigo da Criança (RP=1,12), realizar acompanhamento de saúde na UBS/SUS (RP=0,91), ter ingerido leite artificial (RP=2,06), água (RP=1,18) e chá (RP=1,38) no 1ºdia em casa. Conclusão Caracterizaram-se diferentes perfis de usuários de bicos artificiais, chupetas e mamadeiras. Observaram-se semelhanças e diferenças para cada desfecho. As semelhanças indicam os fatores comuns aos quais profissionais da saúde devem estar atentos. Já as diferenças sugerem que a utilização de chupeta e/ou mamadeira envolve diversas dimensões da vida da mulher/criança/família, perpassando aspectos biopsicossociais e culturais.Introduction - The use of artificial nipples is a cultural habit with a high prevalence in many different countries. Professionals and mothers believe that the use of those tools is harmless or even necessary for the child\'s development therefore they do not discriminate their use having a permissive approach towards them. For over 30 years, international scientific consensus recognizes artificial nipples and industrialized milk as responsible for part of the morbidity and mortality rates and changes in child\'s health. Objective - To analyze the influence of socioeconomic, biological factors and the health services on the use of pacifier and baby\'s bottle among children under one year old in Brazilian Capitals and Federal District (FD). Methods Cross-sectional study conducted from the database of the Second Research Prevalence of Breastfeeding in all the Brazilian Capitals and FD performed in 2008 in the second phase of the National Vaccination Campaign. Cluster sampling was used, with a draw in two-stages. The questionnaire consisted of closed questions including questions about the use of pacifier and baby\'s bottle on the day preceding the survey. We analyzed the factors associated with the use of artificial nipples considering three possible outcomes: 1)Exclusive use of a pacifier, 2)Exclusive use of the baby\'s bottle, and 3)Use of artificial nipples (pacifiers and baby\'s bottle). Prevalence ratios (PR) and confidence intervals were obtained using Poisson regression following a hierarchical model. Results Sample included 34 366 children under one year old. It was identified as factors associated with exclusive use of a pacifier mother working outside the home (PR = 1.18), primiparity (PR = 1.28), not having breastfed within first hour (PR = 1.15) and use of tea on first day at home (PR = 1.37). For the exclusive use of a bottle, were identified: mother working outside the home (PR = 1.39), primiparity (PR = 1.28), low birth weight (PR = 1.21) had not suckled within first hour (PR = 1.08), use of artificial milk (PR = 1.82) and tea (PR = 1.96) on first day at home. The use of artificial teats was associated with maternal employment outside the home (OR = 1.43), primiparity (PR = 1.21), Cesarean section (PR = 1.06), male infants (PR = 1, 07), low birth weight (PR = 1.11), was born in a hospital is not accredited as \"Baby Friendly\" (PR = 1.12), perform health monitoring in the UBS / SUS (PR = 0.91) , having drunk formula (PR = 2.06), water (PR = 1.18) and tea (PR = 1.38) on first day at home. Conclusion - It was found various user profiles of of pacifier and/or baby\'s bottle. It was observed similarities and differences for each outcome. The similarities indicate common factors to which health professionals should be aware. And the differences suggest that the use of artificial nipples, pacifier or baby\'s bottle involves several dimensions of women\'s lives, biopsychosocial and cultural aspects.
6
Pinheiro, Leonor Ramos. "Uso de manobras de reanimação neonatal e internação em unidade de cuidado intensivo entre recém-nascidos de termo: análise secundária dos dados do estudo Nascer no Brasil." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/6/6136/tde-10072017-142957/.
Abstract:
Introdução: A assistência ao parto no Brasil tem enfrentado desafios nos últimos anos, no sentido de reduzir práticas desnecessárias e inseguras. No entanto, medidas utilizadas para acelerar o trabalho de parto e demais intervenções durante o trabalho de parto e parto ainda são frequentes e podem impactar negativamente as condições de vitalidade do recém-nascido. Objetivos: Analisar a associação entre os fatores sociodemográficos, organizacionais, obstétricos e assistenciais e desfecho neonatal desfavorável entre RNs de termo e estimar sua frequência. Método: Estudo transversal, a partir dos dados do inquérito nacional Nascer no Brasil, referentes à região Sudeste. A amostra foi composta por puérperas que tiveram RNs vivos, natimortos (peso 500 gramas e/ou idade gestacional 22 semanas), nascidos em hospitais com 500 partos em 2011 e 2012. Foram excluídos os recém-nascidos prematuros, gemelares e aqueles com malformações. A variável dependente desfecho neonatal desfavorável foi construída por meio da composição das variáveis intubação traqueal, massagem cardíaca, uso de drogas na reanimação neonatal, internação em UTI neonatal e Apgar <7 no 5.o minuto de vida no período pós-natal imediato. A associação entre as variáveis de interesse e a variável desfecho foi estimada por meio de regressão logística binária univariada e múltipla, calculando-se Odds ratio (OR) brutas e ajustadas com intervalos de confiança de 95 por cento (IC 95 por cento ). Resultados: A amostra foi composta por 8.783 mulheres e seus RNs. A proporção de RNs que apresentou desfecho neonatal desfavorável foi de 9,6 por cento (844). Ensino fundamental incompleto (OR=2,139; IC 95 por cento 1,292-3,540), baixo peso ao nascer (peso 2.500g; OR=2,822; IC 95 por cento 1,641-4,851), intercorrência obstétrica (OR=1,421; IC 95 por cento 1,055-1,914) e parto fórceps (OR=3,761; IC 95 por cento 1,824-7,754) constituíram fatores associados ao desfecho neonatal desfavorável. Discussão: Os fatores independentemente associados ao desfecho neonatal desfavorável na Região Sudeste do Brasil foram em sua maioria condições clínicas que têm influência sobre a condição do recém-nascido no período pós-parto imediato. Recém-nascidos com baixo peso e aqueles filhos de mulheres com problemas obstétricos têm condições como líquido amniótico reduzido ou insuficiência placentária que resultam em alterações da vitalidade. Mulheres com baixa escolaridade têm maior dificuldade em acessar os serviços de saúde, o que pode dificultar a identificação e tratamento de problemas obstétricos e baixo peso ao nascer. O parto fórceps pode representar a resolução de trabalhos de parto distócicos e também ser um marcador para os fetos cuja vitalidade encontrava-se alterada durante o trabalho de parto. Conclusões: Fatores clínicos e associados a desigualdades sociais têm impacto negativo sobre a vitalidade dos recém-nascidos. Os desfechos neonatais desfavoráveis ainda são pouco investigados, por isso ações que visem à melhoria da atenção pré-natal e do trabalho de parto, principalmente entre mulheres com baixa escolaridade e aquelas com complicações obstétricas, podem resultar em melhores desfechos de saúde para o recém-nascido. Encontramos uma proporção de 9,6 por cento (844) entre os recém-nascidos no termo gestacional que apresentaram desfecho neonatal desfavorável. Neste estudo foi possível observar a existência de associação entre fatores sociodemográficos, clínicos e assistenciais maternos e desfechos neonatais desfavoráveis entre os RNs de termoIntroduction: Childbirth care in Brazil has faced challenges in recent years to reduce unnecessary and unsafe practices. However, measures used to accelerate labour and other interventions during labour and delivery are still frequent and may negatively impact the vitality of the newborn. Objectives: To analyze the association between sociodemographic, organizational, obstetric and care factors and unfavorable neonatal outcomes among term newborns and to estimate the frequency of these outcomes. Method: A cross-sectional study, based on data from the national survey \"Birth in Brazil\" in the the Southeast region of Brazil. The sample consisted of mothers who had live births, stillbirths (weight 500 grams and / or gestational age 22 weeks) in hospitals with 500 births in 2011 and 2012. Premature babies, twins, preterm newborns and those with malformations were excluded from the analysis. The dependent variable \"unfavorable neonatal outcome\" was constructed through the composition of the variables tracheal intubation, cardiac massage, drug use in neonatal resuscitation, neonatal ICU admission, and Apgar <7 at the 5th minute of life in the immediate postnatal period. The association between the variables of interest and the outcome variable was estimated using univariate and multiple binary logistic regression, calculating crude and adjusted Odds Ratio (OR) with 95 per cent confidence intervals (95 per cent CI). Results: The sample consisted of 8,773 women and their newborns. The proportion of newborns who presented an unfavorable neonatal outcome was 9.6 per cent (844). Incomplete primary education (OR = 2.139, 95 per cent CI 1.292-3.540), low birth weight (weight 2.500g, OR = 2.822, 95 per cent CI 1.641-4.851), obstetric complication (OR = 1.421, 95 per cent CI 1.055-1.914) and Forceps (OR = 3.761, 95 per cent CI, 1.824-7.754) were factors associated with unfavorable neonatal outcome. Discussion: Factors independently associated with unfavorable neonatal outcomes in the Southeast Region of Brazil were mostly clinical conditions that influence the condition of the newborn in the immediate postpartum period. Infants with low birth weight and those of women with obstetric problems have conditions such as reduced amniotic fluid or placental insufficiency that result in changes in vitality. Women with low schooling have greater difficulty in accessing health services, which make it difficult to identify and treat obstetric problems and low birth weight. Forceps delivery may represent resolution of dystocic labor and was also be a marker for fetuses whose vitality was altered during labor. Conclusions: Clinical factors associated with social inequalities have a negative impact on the vitality of newborns. Negative neonatal outcomes are still poorly investigated, so actions aimed at improving prenatal care and labor, especially among women with low schooling and those with obstetric complications, may result in better health outcomes for the newborn. We found a proportion of 9.6 per cent (844) among neonates in the gestational term who presented an unfavorable neonatal outcome. In this study it was possible to observe the existence of an association between sociodemographic, clinical and maternal care factors and unfavorable neonatal outcomes among the term newborns
7
Silva, Aline Gaudard e. "As repercussões da violência entre parceiros íntimos na utilização de serviços de saúde nos primeiros seis meses de vida." Universidade do Estado do Rio de Janeiro, 2012. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=3549.
Abstract:
Fundação de Amparo à Pesquisa do Estado do Rio de JaneiroO objetivo principal desta Dissertação foi avaliar as relações entre a Violência Física entre Parceiros Íntimos (VFPI) nos primeiros seis meses após o parto e a utilização de serviços de saúde entre crianças menores de seis meses de idade. Para estudar o construto utilização de serviços de saúde utilizou-se o momento de início do acompanhamento e o número de consultas da criança em Unidades Básicas de Saúde (UBS). Adicionalmente, estimou-se a prevalência de VFPI nos primeiros seis meses após o parto entre mães de crianças desta faixa etária assistidas nas UBS do Rio de Janeiro. As informações que subjazem a pesquisa originaram-se de um estudo transversal realizado em 27 UBS do Município do Rio de Janeiro, entre junho e setembro de 2007. A população de estudo foi selecionada por meio de amostragem por conglomerado em dois estágios. As UBS unidades primárias de amostragem foram amostradas com probabilidade de seleção proporcional ao volume de consultas pediátricas realizadas conduzindo a uma amostra geograficamente representativa do município. As crianças unidades secundárias de amostragem foram selecionadas de forma sistemática, obedecendo à ordem de saída das consultas. A amostra incluiu 927 crianças nos primeiros seis meses de vida cujas mães relataram ter companheiro na ocasião da entrevista dentre aquelas que buscaram consulta pediátrica ou de puericultura. As informações foram obtidas por meio de entrevista com a mãe da criança utilizando-se um questionário estruturado, contendo escalas previamente validadas, como a Revised Conflict Tatics Scales (CTS2) para a mensuração da VFPI. O artigo inicial apresenta a prevalência de VFPI nos primeiros seis meses após o parto na população estudada e em certos subgrupos de acordo com características sociodemográficas e de saúde de mães e bebês. Elevadas frequências de violência conjugal foram evidenciadas, em especial entre mães em situação socioeconômica desfavorável e que apresentavam falhas no cuidado pré-natal, na amamentação e na utilização do serviço de saúde. Os outros dois artigos apontam que a VFPI após o parto apresenta um sério risco ao acompanhamento regular da criança nos serviços de saúde. O segundo artigo revelou que a VFPI é um fator de risco independente para o início tardio do acompanhamento da criança em UBS em mulheres que possuíam emprego informal ou não trabalhavam e entre aquelas que não haviam realizado um adequado acompanhamento pré-natal. Já o terceiro artigo mostrou que a VFPI aumenta o risco de crianças filhas de mães que não exerciam trabalho remunerado após o parto terem um número de consultas aquém do esperado para a idade nos seus primeiros seis meses de vida. Espera-se que a divulgação dos resultados desta Dissertação possa contribuir para aumentar a sensibilização de profissionais de saúde e dos planejadores de políticas públicas do Setor Saúde para a importância de ações de combate à violência e, assim, colaborar para a promoção da saúde no seu sentido mais amplo.
8
Gemma, Marina. "Fatores associados à integridade perineal e à episiotomia no parto normal: estudo transversal." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/6/6136/tde-25052016-125737/.
Abstract:
Introdução: Investigar os fatores associados à condição perineal no parto vaginal pode possibilitar modificações no cuidado com o períneo, de forma a contribuir para menores frequências de episiotomia e de lacerações perineais. Objetivos: Identificar os fatores associados à episiotomia; identificar os fatores associados à integridade perineal no parto vaginal; descrever os motivos apontados para a realização de episiotomia por enfermeiras obstétricas; e identificar as manobras de proteção perineal realizadas por enfermeiras obstétricas em um Centro de Parto Normal. Método: Estudo transversal com coleta de dados prospectiva por meio de formulário aplicado junto às enfermeiras obstétricas de um Centro de Parto Normal intra-hospitalar de São Paulo e que incluiu dados de todas as mulheres que deram à luz neste serviço no período de fevereiro de 2014 a janeiro de 2015. Na análise estatística, as associações entre as variáveis dependentes (episiotomia e integridade perineal) e as variáveis sociodemográficas, obstétricas e assistenciais foram estimadas por meio de Odds Ratios (OR), calculadas por meio de regressão logística binária univariada e múltipla com intervalos de confiança de 95 por cento (IC 95 por cento ), no programa estatístico SPSS versão 20. Foram realizadas análises separadas para cada variável dependente. Os motivos para a realização de episiotomia e o uso de manobras de proteção perineal foram descritos por meio de frequências e porcentagens. O estudo foi aprovado nos Comitês de Ética em Pesquisa das instituições proponente e coparticipante. Resultados: Foram analisados os dados de 802 mulheres (frequência de episiotomia de 23,8 por cento , 191 mulheres; integridade perineal de 25,9 por cento , 208 mulheres; laceração perineal de 50,3 por cento , 403 mulheres). Os fatores independentemente associados à episiotomia foram: não ter parto vaginal anterior (OR 26,72; IC 95 por cento 15,42-46,30), uso de ocitocina durante o trabalho de parto (OR 1,69; IC 95 por cento 1,12-2,57), puxos dirigidos (OR 2,05; IC 95 por cento 1,23-3,43), intercorrência no trabalho de parto (OR 2,61; IC 95 por cento 1,43-4,77) e posição semissentada no parto (5,45; IC 95 por cento 1,06-28,01). O uso de uma manobra de proteção perineal (OR 0,11; IC 95 por cento 0,04-0,26) ou de duas manobras ou mais (OR 0,09; IC 95 por cento 0,04-0,22) se apresentou como fator de proteção contra a episiotomia. Em relação à integridade perineal, os fatores independentemente associados foram: ter parto vaginal anterior (OR 3,88; IC 95 por cento 2,41-6,23) e cor da pele autorreferida não branca (OR 1,43; IC 95 por cento 1,01-2,04). As indicações para episiotomia incluíram, predominantemente, motivos relacionados às condições e dimensões do períneo. As manobras de proteção perineal foram utilizadas em aproximadamente 95 por cento dos partos vaginais, mas não impactaram as taxas de integridade perineal. Conclusões: As variáveis associadas à episiotomia incluíram, em sua maioria, fatores que podem ser controlados pelo profissional de saúde. Estas variáveis não impactaram as taxas de integridade perineal. Informar os profissionais que atuam na assistência ao parto e as mulheres que buscam esse atendimento sobre os fatores associados à condição perineal no parto vaginal pode contribuir para a redução da frequência de episiotomia e para preservar a integridade perineal no parto vaginal.Introduction: To investigate factors associated with perineal condition in vaginal delivery can result in modifications in the perineal care, in order to decrease the frequency of episiotomy and perineal lacerations in the vaginal delivery. Objectives: To identify factors associated with an episiotomy; to identify factors associated with perineal integrity in vaginal delivery; to describe the reasons for performing an episiotomy by nurse-midwives; and to identify the perineal protection maneuvers performed by nurse-midwives in a Birth Centre. Methods: Cross-sectional study with prospective data collection carried out through the application of a form to nurse-midwives in an In-hospital Birth Centre located in São Paulo city, Brazil, which included all women who gave birth in this service from February 2014 to January 2015. In the statistical analysis, the associations between the outcome variables (episiotomy and perineal integrity) and the sociodemographic, obstetric and care-related variables were estimated by Odds Ratios (OR), calculated in univariate and multivariate binary logistic regression models with a 95 per cent confidence intervals (95 per cent CI), in the SPSS software, version 20. Separated analyses were performed for each one of the outcome variables. The reasons for performing an episiotomy and the use of perineal protection maneuvers were described as frequencies and percentages. The study was approved in the Research Ethics Committees of the proposing and the co-participant institutions. Results: Data of 802 women were analysed (frequency of episiotomy of 23.8 per cent , 191 women; perineal integrity of 25.9 per cent , 208 women; perineal laceration of 50.3 per cent , 403 women). Factors identified as independently associated with an episiotomy were: no previous vaginal delivery (OR 26.72; 95 per cent CI 15.42-46.30), oxytocin use during labour (OR 1.69; 95 per cent CI 1.12-2.57), coached pushing (OR 2.05; 95 per cent CI 1.23-3.43), complications during labour (OR 2.61; 95 per cent CI 1.43-4.77) and semi-sitting position at delivery (OR 5.45; 95 per cent CI 1.06-28.01). The use of a perineal protective maneuver (OR 0.11; 95 per cent CI 0.04-0.26) or two maneuvers or more (OR 0.09; 95 per cent CI 0.04-0.22) was a protective factor against an episiotomy. Regarding the perineal integrity, the factors independently associated to this condition were: a previous vaginal delivery (OR 3.88; 95 per cent CI 2.41-6.23) and self-reported non-white skin color (OR 1.43; 95 per cent CI 1.01-2.04). Most of the indications for an episiotomy included reasons related to perineal conditions and dimensions. The perineal protection maneuvers were used in nearly 95 per cent of vaginal deliveries, but did not affect the perineal integrity rates. Conclusions: Most of the variables associated with an episiotomy were related to factors that can be controlled by the professional who provides labour and birth care. These variables did not influence the perineal integrity rates. To inform childbirth care professionals and women who are users of these services about the factors associated with the perineal condition at the childbirth can contribute for reducing the frequency of episiotomy and to preserve the perineal integrity in the vaginal delivery.
9
Aihara, Yoko Sirikul Isaranurug. "Effect of maternal and child health handbook on maternal and child health promoting belief and action /." Abstract, 2005. http://mulinet3.li.mahidol.ac.th/thesis/2548/cd375/4737949.pdf.
10
Smith, Emily Rose. "Maternal and Child Health, Nutrition, and Hiv." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:32644541.
Abstract:
Reducing maternal and child mortality was established as a global priority with the signing of the Millennium Declaration in September 2000. Neonatal vitamin A supplementation and very early breastfeeding initiation are scalable interventions which may improve infant survival. Although breastfeeding has proven benefits for infant health, the potential health consequences of breastfeeding for HIV-infected women are not well studied.
In paper one, “The effect of neonatal vitamin A supplementation on morbidity and mortality at 12 months: A randomized trial”, we assessed the efficacy of neonatal vitamin A supplementation (NVAS) in reducing infant morbidity and mortality. Using data from an individually randomized clinical trial of 31,999 infants in Tanzania, we found that NVAS did not affect the risk of death or the incidence of morbidities. However, we noted that postpartum maternal vitamin A supplementation modified the effect of neonatal vitamin A supplementation on infant mortality.
In paper two, “Effect of delayed breastfeeding initiation on infant survival: a systematic review and meta-analysis”, our objective was to synthesize the evidence regarding the association between breastfeeding initiation time and infant morbidity and mortality. We pooled five studies, including 136,047 infants. We found a clear dose-response relationship; the risk of neonatal mortality increased with increased delay in breastfeeding initiation. We found a similar pattern when the analysis was restricted to exclusively breastfed infants or low birthweight infants. There was limited evidence regarding the association between breastfeeding initiation time and infant morbidity and growth. We concluded that health policy frameworks and models to estimate newborn and infant survival should consider the independent survival benefit associated with early initiation of breastfeeding.
In paper three, “Breastfeeding and Maternal Health among HIV-infected Women in Tanzania”, our objective was to assess the relationship between infant feeding practices and the incidence of maternal mortality, morbidity, and indicators of poor nutritional status from six weeks to two years postpartum in a prospective cohort of Tanzanian women living with HIV. We concluded that breastfeeding may be associated with mixed health outcomes. Additional research should investigate whether HIV-infected women require nutritional support, in addition to antiretroviral therapy, during and after lactation.
11
Bodas, Mandar V. "Three Essays on Maternal and Child Health." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5543.
Abstract:
This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the implementation of the JSY and the NRHM. Finally, we found that adequacy of health facilities was not associated with the likelihood of mothers in high-focus states having an institutional delivery. In the second essay, I examined whether a key social determinant of health in South Asia- gender inequality, is associated with physical health outcomes among Indian women. I found that the gender inequality expressed as the gendered household practice of seclusion was negatively associated with body weight of Indian women. Further, I found that participation in all household decisions by women of the household was generally not associated with body weight outcomes. The association between gendered household practices and women’s body weight outcomes was generally similar among rural and urban Indian women. In the final essay, I examined whether perinatal food environments (FE), maternal gestational weight gain (GWG) and early childhood weight (ECW) outcomes are associated. I used data on mother-children dyads from the Early Childhood Longitudinal Study – Birth cohort (ECLS-B), Area Resource Files (ARF) and Current Business Practices (CBP). I found that maternal GWG was associated with ECW outcomes. I also found that measures of food environment were associated with ECW outcomes. Specifically, I found that having an additional full-service restaurant per one thousand population in the maternal perinatal county of residence was associated with lower Body Mass Index (BMI) among children at age two years. Finally, I found that GWG did not mediate the association between food environment and ECW outcomes.
12
Nickelson, Joyce E. "A modified obesity proneness model in the prediction of weight status among high school students." [Tampa, Fla] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002410.
13
Nicolais, Christina J. "Maternal Health and Child Behaviors as Risk Factors for Child Injury." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3381.
Abstract:
Evidence suggests that child behavior, parent mental health, parent supervision, and home environment conditions impact a child’s risk of injury. Vulnerable families are at greater risk for the occurrence of child behavior problems, poor health, decreased supervision, and hazardous home conditions. Consistent with a model that proposes that parent, child, and environment factors interact within the lens of sociocultural factors to predict injury, the current study aimed to test a statistical model with maternal physical health and child externalizing behaviors as predictors of child injury, and home hazards and supervision as mediators of these relations. Analyses were conducted using a nationally representative sample of 3,288 vulnerable mother-child dyads. Results showed significant relations between parent physical health and child injury, and child aggression and child injury, though home hazards and supervision did not mediate either of these relations. Further research should continue to examine the mechanisms of action in the parent health- child injury relation so that injury prevention interventions can be developed.
14
Hagan, Teresa. "Under-utilisation of maternal and child health care." Thesis, Sheffield Hallam University, 1988. http://shura.shu.ac.uk/3084/.
Abstract:
The central aim of this study is to identify and describe the experiences of first time mothers who are underusers of child care clinics. An attempt is made to counterbalance the tendency of researchers in this area to be judgmental of underusers who "neglect" their children, and their own health care needs, -by reporting the mothers' views of the child health services in their own terms. Underusers within a certain Health Authority area were identified using a purposely developed Index of Uptake. The achieved sample of predominantly working class mothers constituted a group of people who are particularly difficult to research. It is believed that success in locating and eliciting evidence from this group was in itself an important contribution to the research literature. In depth interviews were undertaken, and the data analysed in two ways; (1) A Subsample, made up of those having made least use of the services available to them, was analysed interpretively to provide detailed material of an idiographic kind on the lifeworld of the person and the place of medical care within it; (2) All interviews were subjected to content analysis to provide a more general picture of mothers' experiences of health care provision. The main findings include the following; (1) The particular population studied had a generally low level of visage as assessed by the index, but use of specifically medical provision was greater. A process of rational decision making is implicated. (2) Accounts of underusers' experiences highlight as a central theme the mothers' vulnerability to personal undermining by many aspects of health care provision. The thesis concludes with a discussion of the approach which health care providers adopt towards'underusers, and argues that there must be an explicit recognition of the point of view of the clients if the services are to reach this deprived segment of the community. Such recognition is rarely found in research or comment on the problem of underusage. In fact apparently irrational and blameworthy behaviour by underusers can be. rendered explicable when considered in the light of the individuals' perceptions and experiences, and this leads to a serious questioning of the utility and appropriateness of the negative judgements made of them.
15
Wood, David L. "Child Poverty and Its Impact on Child Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5178.
16
M'soka, Namakau C. S. "Beliefs of women receiving maternal and child health services at Chawama Clinic in Lusaka, Zambia regarding pregnancy and child birth." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/509.
Abstract:
Thesis M. Med.(Family Medicine))University of Limpopo (Medunsa Campus), 2010.The experience of child birth occurs in all cultures and is important for the continuation of a community. Beliefs related to pregnancy and child birth though usually harmless may at times be detrimental to the health and well being of women that may practice them. The adherence to such beliefs depends on the socio cultural background of individuals and the importance they place on their cultural practices. Aim and objectives The study aimed to explore the health beliefs regarding pregnancy and childbirth of women attending the antenatal clinic at Chawama Health Center in Lusaka Zambia. The main study objectives were to determine the demographic characteristics of the women and ascertain their beliefs regarding diet, behaviour and belief in the use of herbs during pregnancy, delivery and the post natal period. Methods A descriptive, cross-sectional survey was conducted. A 32 item questionnaire was administered to 294 women over a four week period by two research assistants, after obtaining informed consent. Results Results indicate that traditional beliefs were wide spread among the participants though few significant associations were demonstrated. Dietary beliefs that what is eaten could ix affect the progress of labor or the unborn child’s appearance or behaviour were popular. Negative behaviour such as quarrelling or infidelity was believed could lead to difficult labour or adverse outcomes. Herbs were generally believed to be useful for certain indications such as to assist labour or for ‘cleansing’ after miscarriage. Conclusion Health beliefs regarding pregnancy and child birth are an integral part of the community and to be discussed in order to have some influence on them. Continued dialogue is recommended though current clinic health education sessions and qualitative studies to explore other beliefs and myths that are arising out of new health concerns such as HIV.
17
Leiferman, Jennifer Ann. "The effect of maternal depressive symptomatology on maternal behaviors associated with child health /." Digital version accessible at:, 2000. http://wwwlib.umi.com/cr/utexas/main.
18
Carreon-Bailey, Rebecca Socorro. "Influences of maternal parenting behaviors: Maternal mental health, attachment history and eduction." CSUSB ScholarWorks, 2006. https://scholarworks.lib.csusb.edu/etd-project/2989.
Abstract:
Studies have found that the type of parenting a child receives affects his or her subsequent development. This study investigates the relative influence of maternal parenting behavior and the impact of multiple variables influencing the quality of mothers' parenting behaviors. This knowledge will help to understand how early attachment experiences impact future parenting behavior.
19
Percy, Ray. "Maternal verbal communication and the treatment of children with anxiety disorders in the context of maternal anxiety disorder." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/370404/.
20
O'Keefe, Maree Frances. "Maternal perspectives of child health consultations by medical students." Title page, contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09pho4121.pdf.
Abstract:
"June 2002" Errata inside back cover. Bibliography: leaves 244-256. The first aim of this thesis was to determine the relationship between medical student clinical competence and patient-centredness, and maternal satisfaction and subsequent recall of information in child health consultations. The second aim was to test the application of this knowledge in medical student teaching programmes. The study demonstrated the ability of mothers to assess the clinical competence and patient-centredness of medical students in videotaped consultations. Applications in medical student learning were also developed and evaluated.
21
Moucheraud, Corrina. "Evaluation of Strategies and Outcomes in Maternal and Child Health." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121157.
Abstract:
Maternal and child mortality, particularly during the neonatal period, are among the most challenging global health issues of this era. This burden disproportionately affects the poorest populations, across and within countries. And although many of these deaths would be avertable, improvements in most countries have been slow. This dissertation explores three main research questions: (1) what is the effect of maternal health on infant outcomes?; (2) what survival gains could be attained through improved interventions, across the continuum of care?; and (3) how do health system characteristics affect the potential impact and cost-effectiveness of such interventions? The first paper uses decision modeling to evaluate how increased use of family planning and of improved intrapartum care could reduce maternal deaths in Nepal—as well as the cost-effectiveness of doing so, and of accompanying interventions to achieve these targets. The second paper estimates the potential impact of administering interventions from the Safe Childbirth Checklist at health facilities in India, and how “real world” implementation might see different results due to health system characteristics. Lastly, the third paper examines child survival outcomes following a maternal death in Ethiopia, using a long-term household-level longitudinal dataset. Together, these papers aim to provide new insights on approaches to reducing the high level of mortality among women and children.Global Health and Population
22
Gonzalez, Citlalli R. "Maternal Behavioral Determinants and Child Dietary Quality in Latino Families." Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10784465.
Abstract:
The purpose of this study was to conduct a secondary analysis to examine the association between the change from baseline to follow-up in Latino mothers’ self-reported nutrition knowledge, self-efficacy, intentions, food label use, and role modeling from baseline to follow-up with their reports of children’s dietary intake measured at follow-up. Data were obtained from from Sanos y Fuertes, a culturally-tailored community-based nutrition education intervention. The participants were Latino mothers and their children ages 2 to 8 years old. A dietary quality scoring system was created using food frequency data. To account for reported frequencies, five set points were created to define criteria for high dietary quality. Logistic regression tests were conducted for the five set points. The change in nutrition knowledge (p = .019) and role modeling (p = .034) of the mothers significantly predicted probability of higher child dietary quality at follow-up. Findings suggest the need for interventions that focus on increasing parental dietary knowledge while emphasizing the importance of role modeling. Further research is needed to explore cultural-related dietary differences between Latinos and non-Latinos.
23
Kanu, Alhassan Fouard. "Health System Access to Maternal and Child Health Services in Sierra Leone." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7394.
Abstract:
The robustness and responsiveness of a country's health system predict access to a range of health services, including maternal and child health (MCH) services. The purpose of this cross-sectional study was to examine the influence of 5 health system characteristics on access to MCH services in Sierra Leone. This study was guided by Bryce, Victora, Boerma, Peters, and Black's framework for evaluating the scaleup to millennium development goals for maternal and child survival. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment dataset, which comprised 100% (1, 284) of the country's health facilities. Data analysis included bivariate and multivariate logistic regressions. In the bivariate analysis, all the independent variables showed statistically significant association with access to MCH services and achieved a p-value < .001. In the multivariate analysis; however, only 3 predictors explained 38% of the variance (R� = .380, F (5, 1263) = 154.667, p <.001). The type of health provider significantly predicted access to MCH services (β =.549, p <.001), as did the availability of essential medicines (β= .255, p <.001) and the availability of basic equipment (β= .258, p <.001). According to the study findings, the availability of the right mix of health providers, essential medicines, and basic equipment significantly influenced access to MCH services, regardless of the level and type of health facility. The findings of this study might contribute to positive social change by helping the authorities of the Sierra Leone health sector to identify critical health system considerations for increased access to MCH services and improved maternal and child health outcomes.
24
Moonesar, Immanuel Azaad. "The Role of UAE Health Professionals in Maternal and Child Health Policy." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1649.
Abstract:
Maternal and child health (MCH) mortality is a formidable challenge for health systems around the world according to the World Health Organization. Health professionals and practitioners within the United Arab Emirates were studied to determine the extent they were involved in the policy-making process, and the potential impact that analysis may have on new or revised MCH policies. Research on MCH policy-making and development processes are limited. The Andersen model of healthcare services utilization provides an appropriate framework for this research, enabling the analysis that influences the policy-making process in the area of MCH. Independent variables included nationality, education, work experience, and organizational support, and the dependent variable included policy-making process. The quantitative methodology included the data collection from a sample of 380 health professionals and practitioners. The results of the study revealed statistical correlations where the most significant predictor of policy-making was organizational support, which explained the 42% variation in policy-making. This predictor was followed by nationality and education. The research adds value for decision-makers when considering and evaluating the extent of MCH policy, laws and regulations, current challenges, and strategies. The research findings could positively influence decision makers' action plan in formulating new guidelines, public policies, and strategies for the development of maternal and child health across the UAE region. Future research should aim to include other factors that may have an influence on the policy-making process.
25
Clements, Andrea D., A. L. Acuff, Wallace E. Jr Dixon, and C. Snyder. "Maternal and Child Temperament and Parenting Style." Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/4936.
26
Winstanley, Alice. "Maternal and infant contributions to development following premature deliveries." Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/47366/.
Abstract:
The focus of this thesis is on the early caregiving environment and social interactions of preterm infants. Chapter one introduces the topic of premature delivery, including infant outcomes, parent’s caregiving role, infant’s role in their own development, and dyadic interactions between parents and their premature infants. Chapter two introduces methodological difficulties in the study of preterm infants. The chapter also provides an overview of the longitudinal study of preterm infants’ development that provided the majority of the data for this thesis. Chapter three introduces a new measure of parenting principles and practices, the Baby Care Questionnaire (BCQ). The BCQ measures how parents approach caring for their infant in three contexts – sleeping, feeding and soothing. The chapter documents the development and psychometric properties of the BCQ. Chapter four studies the impact of premature birth on maternal cognitions and principles about caregiving. The chapter presents data on the consistency of maternal cognitions about child development and caregiving at an individual and group level. Chapter five studies the impact of premature birth on infant attention, in particular social attention. The chapter reports data on the style of preterm infants’ looking to a novel stimulus, how these infants followed an experimenter’s attention to a target and their regulation abilities (as reported by their mother). Chapter six studies the impact of premature birth on interactions between mothers and their infants. The chapter uses statistical techniques to represent streams of behaviour to examine different responding to person- and object-directed behaviours by mothers and their premature infants. Chapter seven brings together these findings and discusses future work.
27
Nasrullah, Muazzam [Verfasser]. "Child marriage and its impact on maternal and child health in Pakistan / Muazzam Nasrullah." Bielefeld : Universitätsbibliothek Bielefeld, 2015. http://d-nb.info/1077605277/34.
28
Lydon-Rochelle, Mona Theresa. "Method of delivery and risk of subsequent adverse maternal health outcomes /." Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/7286.
29
Fertuck, Deborah. "Children with chronic physical disorder : maternal characteristics and child outcomes." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=56618.
Abstract:
The purpose of this study was to examine child psychosocial adjustment (i.e., behavioural problems and self-esteem) as a function of maternal well-being, parenting competence, and maternal stress in a sample of children (8 to 16 years) with a chronic physical disorder (CPD) (n = 60) as compared to a sample of non-chronically disabled children (n = 60). While the groups did not differ on either maternal variables or child behavioural problems, CPD children had higher self-esteem than comparison group children. For both groups, mothers with high well-being, high competence, and low stress had children with fewer behavioural problems. Furthermore, mothers of older CPD children perceived themselves as more competent parents, which in turn was related to fewer behavioural problems and higher self-esteem in the child. Mothers who assessed their child's condition as less stressful also had a higher sense of well-being and/or perceived themselves as more competent mothers. While this sample consisted of children whose conditions were of mild to moderate severity, children with more severe conditions had higher self-esteem.
30
Tauheed, Jannah. "Arsenic, Lead and Manganese as Risk Factors for Child and Maternal Neurotoxicity." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27201739.
Abstract:
Metals such as arsenic, lead and manganese are naturally occurring elements readily found in the earth’s crust. Numerous studies have shown that these metals can be neurotoxic though the exact mechanism remains unknown. In our neurobehavioral study, we found a significant association between prenatal lead concentrations and the scores of Adaptive Skills domain of the BASC-2 (β = -5.99, p-value 0.025). Positive cognitive home environment was consistently associated with better neurobehavioral outcomes. In our investigation, we found that arsenic was significantly associated with increased postpartum depression in mothers in the Tar Creek cohort. β (SE) =1.03 (0.45). The association was statistically significant (p =0.01). We also found a significant interaction between lead and arsenic (β = 1.13, p=0.017). Results of an epigenetic study suggest mothers of children with neural tube defects may have different maternal plasma histone levels than unaffected children. We found a significant association, β (SE)=0.41 (0.014), p=0.006, between H3K27me3 levels and NTD case status. Among mothers with low folate, H3 was negatively associated, β (SE) = -10.5 (4.05), p =0.016 with maternal arsenic exposure.
31
Plant, Dominic. "When one childhood meets another : maternal child maltreatment and offspring child psychopathology." Thesis, Canterbury Christ Church University, 2016. http://create.canterbury.ac.uk/15001/.
Abstract:
Studies have shown that a mother’s history of child maltreatment is associated with her child’s experience of internalising and externalising difficulties. This study aimed to characterise the mediating pathways that may underpin this association. Data on a mother’s history of child maltreatment, depression during pregnancy, depression after birth, maladaptive parenting practices and her child’s experience of maltreatment and preadolescent internalising and externalising difficulties were analysed in a sample of 9,397 mother-child dyads followed prospectively from pregnancy to child age 13. The results showed that maternal history of child maltreatment was significantly associated with child internalising and externalising difficulties in preadolescence. Maternal antenatal depression, post-birth depression, maladaptive parenting and child maltreatment were observed to significantly mediate this association. The study concluded that psychological and psychosocial interventions focused around treating maternal depression, particularly during pregnancy, and improving parenting skills, could be offered to mothers with traumatic childhood experiences to help protect against psychopathology in the next generation.
32
Kachimanga, Chiyembekezo. "Improving utilization of maternal health related services: the impact of a community health worker pilot programme in Neno Malawi." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29240.
Abstract:
Introduction: Malawi has one of the highest maternal mortality ratio (MMR) in sub-Saharan Africa (SSA). Despite investments in family planning and emergency obstetric care (EmOC), Malawi’s Millennium Development Goal (MDG) target of reducing maternal deaths to 155 deaths per 100,000 live births was not met by the end of 2015. Between 2010 and 2015, Malawi was only able to reduce the MMR from 675 to 439 per 100,000 live births. Inadequate utilisation of perinatal services is the contributing factor to the MMR target not being achieved. One approach for improving the utilisation of perinatal services is to invest in community health workers (CHWs). CHWs can be trained to: identify women of child bearing age (WCBA) who need perinatal services; provide community education; encourage timely referral of clients to the nearest health facility; and undertake community follow up for WCBA who are pregnant and/or have recently given birth. We evaluated changes in utilisation of antenatal care (ANC), facility based births, and postnatal care (PNC) after CHW deployment to conduct monthly home visits to WCBA for pregnancy identification and escorting women to ANC, labour and facility birth and PNC clinics in Neno district, Malawi. The CHW programme was implemented in two catchment areas from March 2015 to June 2016.
Methodology: We employed a retrospective quasi-experimental study design to evaluate the impact of CHWs on changes in the utilisation of ANC, facility based births, and PNC in Neno district, Malawi between March 2014 and June 2016 (pre-intervention period: March 2014 to February 2015, and post- intervention period: March 2015 to June 2016). Monthly outcomes were compared between a combined CHW intervention area and its synthetic control area using the synthetic control method. The synthetic control area (or synthetic counterfactual of the CHW) was the control area that was created from multiple available control sites where the CHW programme was not implemented to allow the comparison of outcomes between the sites where CHWs were implemented and the sites where CHWs was not implemented. Two hundred and eleven CHWs (128 existing CHWs plus 83 new CHWs from the community) were trained in maternal health and deployed to cover an estimated 5,132 WCBA living in a catchment area of about 20,530 people. The primary focus of the CHWs was to conduct monthly household visits to identify pregnant women, and then escort pregnant women to their initial and subsequent ANC appointments, facility births, and to PNC check-ups. As part of package of care, community mobilisation and improvements in services to achieve a minimum package of services at the local health centres were also added. Using the synthetic control method, as developed by Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) and a Bayesian approach of synthetic control developed by Brodersen (2015), a synthetic counterfactual of the CHW intervention was created based on six available public control facilities. The synthetic counterfactual trend was created to have similar preintervention characteristics as the CHW intervention trend. The impact of the CHW intervention was the difference between the CHW intervention site and its synthetic counterfactual
Results: CHWs in the intervention areas visited an average of 3,147 (range 3,036 – 3,218) of WCBA monthly, covering 61.0% of WCBA. During these visit 3.6% (97 women per month) of WCBA were suspected to be pregnant every month. Of those women suspected to be pregnant, 67.8% (66 women per month) were escorted to health facilities immediately every month. CHWs visited an average of 254 pregnant women enrolled in ANC and 64 women in postpartum period monthly. ANC and facility births utilisation in the CHW intervention site increased in comparison to the control site. Firstly, the number of new pregnant women enrolled in ANC per month increased by 18.0 % (95% Credible Interval (CrI) 8.0%, 28.0%), from 83 to 98 per pregnant women. Secondly, the proportion of women starting ANC in first trimester increased by 200.0% (95% CrI 162.0%, 234.0%), from 9.5% to 29.0% per month. Thirdly, the number of women attending four or more ANC visits increased by 37.0% (95% CrI 31.0%, 43.0%), from to 28.0% to 39.0%. Lastly, the number of facility births increases by 20% (CrI 13.0%, 28.0%), from 85 women to 102 per month. However, there was no net difference on PNC visits between the CHW intervention site and its counterfactual unit (-37.0%, 95% CrI -224.0%, 170.0%).
Conclusions: CHW intervention significantly increased the utilisation of ANC and facility based births in Neno, Malawi. However, CHWs had no net difference on PNC utilisation.
33
Prado, Daniela Siqueira. "Práticas obstétricas e influência do tipo de parto em resultados neonatais e maternos em Sergipe." Pós-Graduação em Ciências da Saúde, 2018. http://ri.ufs.br/jspui/handle/riufs/8552.
Abstract:
Background: Brazil has high frequency of inappropriate obstetric practices and cesarean sections. This procedure may be associated with increased maternal and perinatal morbidity. Objective: to describe practices and interventions used during labor and childbirth and factors associated with such practices and to evaluate the impact of mode of delivery in breastfeeding incentive practices and in neonatal and maternal complications. Methods: A Cohort study was conducted, between june 2015 and april 2017, at the 11 maternity hospitals in Sergipe with 768 puerperal women, interviewed in the first 24 hours after delivery, 45-60 days and 6-8 months after delivery. The associations between good practices and interventions used during labor and delivery with exposure variables were described by simple frequencies, percentages, crude and adjusted odds ratios (ORA) with the confidence interval and the association between breastfeeding incentive practices, neonatal and maternal, both short term and late complications and the exposure variables were evaluated by the relative risk (95% IC) and the Fisher exact test. Results: were fed 10.6% of women and 27.8% moved during labor; non-pharmacological measures for pain relief were performed in 26.1%; the partograph was filled in 39.4% of the charts and the companion was present in 40.6% of deliveries. Oxytocin, amniotomy and analgesia occurred in 59.1%, 49.3% and 4.2% of women, respectively. The delivery occurred in the lithotomy position in 95.2% of the cases, there was episiotomy in 43.9% and Kristeller's maneuver in 31.7%. The factors most associated with cesarean section were the private health sector (ORA = 4.27,95% CI: 2.44-7.47), had higher education (ORA = 4.54,95%CI 2.56 -8.3) and high obstetric risk (ORA = 1.9,95%CI: 1.31-2.74). Private-sector users had a greater presence of the companion (ORA = 2.12,95% CI:1.18-3.79) and analgesia (ORA = 4.96,95% CI:1.7-14.5). The C-section delivery resulted in less skin-to-skin contact immediately after delivery (intrapartum c-section: RR=0.18;95%CI:0.1-0.31 and elective c-section: RR=0.36;95%CI:0.27-0.47) and less breastfeeding within one hour of birth (intrapartum C-section: RR=0.43;95%CI:0.29-0.63 and elective C-section: RR=0.44;95%CI:0.33-0.59). Newborns from elective c-section were less frequently breastfed in the delivery room (RR=0.42;95%CI:0.2-0.88) and stayed less in rooming- in (RR=0.85;95%CI:0.77-0.95). Women who were submitted to intrapartum c-section had greater risk of early complications (RR=1.3;95%CI:1.04-1.64; p=0.037) and sexual dysfunction (RR=1.68;95%CI:1.14-2.48; p=0.027). There was no difference in the frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery. Conclusions: good obstetric practices are poorly performed and unnecessary interventions are frequent, and the factors most associated with cesarean delivery have been the private health sector, higher schooling and high obstetric risk. C-section was negatively associated to breastfeeding incentive practices. C-section after labor increased the risk of early maternal complications and sexual dysfunction, six to eight months after delivery.Introdução: No Brasil, verifica-se elevada frequência de práticas obstétricas inadequadas e de cesáreas. Este procedimento pode associar-se a aumento de risco de morbidade materna e neonatal. Objetivo: descrever as práticas utilizadas durante o trabalho de parto e parto e fatores associados e avaliar práticas de incentivo à amamentação, complicações neonatais e maternas precoces e tardias segundo tipo de parto. Pacientes e Métodos: estudo tipo coorte, no período de junho de 2015 a abril e 2016, nas 11 maternidades de Sergipe, com 768 puérperas entrevistadas após 6h do parto, 45 a 60 dias e 6 a 8 meses após o parto e análise de dados do prontuário das puérperas e dos recém-nascidos. As associações entre as boas práticas e intervenções utilizadas durante o trabalho de parto e parto com as variáveis de exposição foram descritas em frequências simples, percentuais, razões de chances brutas (OR) e ajustadas (ORA) com o intervalo de confiança e as associações entre as práticas de incentivo à amamentação, as complicações neonatais e maternas precoces e tardias e as variáveis de exposição foram descrias por risco relativo (IC=95%) e pelo teste exato de Fisher. Resultados: alimentaram-se 10,6% das mulheres e 27,8% movimentaram-se durante o trabalho de parto; medidas não farmacológicas para alívio da dor foram realizadas em 26,1%; o partograma estava preenchido em 39,4% dos prontuários e o acompanhante esteve presente em 40,6% dos partos. Ocitocina, amniotomia e analgesia ocorreram em 59,1%, 49,3% e 4,2% das mulheres, respectivamente. O parto ocorreu na posição de litotomia em 95,2% dos casos, houve episiotomia em 43,9% e manobra de Kristeller em 31,7%. Os fatores mais associados à cesárea foram ser do setor privado de saúde (ORA=4,27;95%CI:2,44-7,47), ter maior escolaridade (ORA=4,54;95%CI:2,56-8,3) e alto risco obstétrico (ORA=1,9;95%CI:1,31-2,74). Usuárias do setor privado tiveram maior presença do acompanhante (ORA=2,12;95%CI:1,18-3,79) e analgesia (ORA=4,96;95%CI: 1,7-14,5). Os recém-nascidos de puérperas que se submeteram a cesárea tiveram menor frequência de contato pele a pele com suas mães imediatamente após o parto (cesárea intraparto: RR=0,18;95%CI:0,1-0,31 e cesárea eletiva: RR=0,36;95%CI:0,27-0,47) e mamaram menos na primeira hora de vida (cesárea intraparto: RR=0,43;95%CI:0,29-0,63 e cesárea eletiva: RR=0,44; 95%CI:0,33-0,59). Recém-nascidos de cesárea eletiva foram menos frequentemente colocados para mamar na sala de parto (RR=0,42;95%CI:0,2-0,88) e ficaram em menor frequência em alojamento conjunto (RR=0,85;95%CI:0,77-0,95). As mulheres submetidas a cesárea intraparto tiveram maior risco de complicações precoces (RR=1,3;95%CI:1,04-1,64; p=0,037) e de disfunção sexual (RR=1,68;95%CI:1,14-2,48; p=0,027). Não houve diferença nas frequências de complicações neonatais, incontinência urinária e de depressão segundo tipo de parto. Conclusões: boas práticas obstétricas são pouco utilizadas e intervenções desnecessárias são frequentes e os fatores mais associados à operação cesariana foram ser do setor privado de saúde, ter maior escolaridade e alto risco obstétrico. A cesárea associou-se negativamente às práticas de incentivo à amamentação. A cesárea após trabalho de parto associou-se a maior risco de complicações maternas precoces e a disfunção sexual seis a oito meses pós-parto.
São Cristóvão, SE
34
Panjsheri, Saiqa. "Child health: mother knows best the association between child malnutrition and maternal education in Nepal /." CONNECT TO ELECTRONIC THESIS, 2007. http://hdl.handle.net/1961/6769.
35
Singogo, Irene Miti. "Perinatal deaths in Lusaka, Zambia : mothers’ experiences and perceptions of care." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/6015.
36
Hood, Robert Baltasar. "Hepatitis C virus and maternal and child health in the United States." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1587213372856517.
37
Carvalho, Natalie. "Health Impacts and Economic Evaluations of Maternal and Child Health Programs in Developing Countries." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10264.
Abstract:
This dissertation is motivated by two of the health-related Millennium Development Goals (MDGs): MDG 4, focused on reducing child mortality, and MDG 5, which aims to improve maternal health. My three papers evaluate the health and economic impact, and cost-effectiveness, of interventions to improve maternal and child health in three areas of the developing world using methods from decision sciences and statistics. In paper 1, I use a decision-analytic model that simulates the natural history of pregnancy and pregnancy-related complications to assess the expected health outcomes, costs, and cost-effectiveness of strategies to reduce maternal mortality in Afghanistan. Increasing family planning was found to be the most effective single intervention to reduce maternal mortality. Further findings suggest that a stepwise approach that couples increased family planning with incremental improvements in access to appropriate intrapartum care could prevent 3 out of 4 maternal deaths and would be cost-effective. Paper 2 explores the value of community-based disease management programs for reducing mortality from childhood pneumonia and malaria in 24 countries of sub-Saharan Africa. I use a model-based framework that combines symptom patterns, care-seeking behavior, and treatment coverage from an empirical assessment of household survey data with information on diagnostic algorithms and disease progression from the literature. Results indicate that a community health worker program modeled on currently-existing programs could avert over 100,000 under-five deaths combined across the 24 countries and would be regarded as cost-effective compared to the status quo under typical benchmarks for international cost-effectiveness analysis. My third paper evaluates the effect of Janani Suraksha Yojana (JSY), a conditional cash transfer program intended to promote the use of reproductive health services in India, on childhood immunizations and other reproductive and child health indicators. Using observational data from the most recent district-level household survey, I conduct a matching analysis with logistic regression to assess the associations of interest. Results show that receipt of financial assistance from JSY led to a significant increase in childhood immunizations rates, post-partum check-ups, and some healthy breastfeeding practices, but no impact was found on exclusive breastfeeding and care-seeking behaviors.
38
Jaffer, Khadija. "Child safety in day care centres within the Western Cape." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/27004.
Abstract:
The aim of the study is to explore aspects of child safety in registered day care centres situated in a lower socio-economic area of the Cape Town Metropole. This can be achieved by: a) describing the physical environment in day care centres b) assessing the infrastructure of day care centres to deal with potential injurjes c) reviewing injury reporting systems already in place d) highlighting the issue of child safety in the course of conducting the study.
39
Dow-Fleisner, Sarah Jeanne. "Defying the odds: Child health and wellbeing in the context of maternal depression." Thesis, Boston College, 2017. http://hdl.handle.net/2345/bc-ir:107610.
Abstract:
Thesis advisor: Summer S. HawkinsPreventing poor health in childhood is a national social work and public health priority in the United States. Importantly, child health and wellbeing is explicitly linked with maternal health. Thus, maternal depression, a common mental illness, is a concern not only for the mother, but for the health of her offspring. The purpose of this three-paper dissertation was to extend the understanding of child health and wellbeing at age 9 years old in the context of maternal depression. Analyses utilized data from the Fragile Families and Child Wellbeing study and were guided by a resilience perspective, life course perspective, family systems theory, and ecological systems theory. Paper 1 examined the unique impact of maternal depression on child physical health outcomes utilizing a series of logistic regression analyses. Findings indicated that multiple individual-, maternal-, and family-level risk and protective factors influenced the association between maternal depression and child physical health. Paper 2 utilized latent profile analysis and multinomial logistic regression analyses to examine child physical health and psychosocial wellbeing in the context of maternal depression. Five distinct profiles of child health and wellbeing were identified, suggesting the traditional dichotomy of healthy versus unhealthy may fail to capture the complex nature of child health and wellbeing for those experiencing maternal depression. Results showed that maternal depression was associated with increased risk of poor health and wellbeing, yet also emphasized the ability for children to achieve resilient functioning. Paper 3 explored the impact of maternal depression on the maternal-child relationship and the protective nature of interpersonal supports and community resources. Findings indicated that interpersonal and community resources directly and indirectly supported a positive maternal-child relationship for mothers with depression. Altogether, results extend the literature base by providing a more nuanced and complete examination of child health and wellbeing in the context of maternal depression, with a focus on the potential for resilient functioning among this at-risk population. Findings provide evidence that even in the context of risk, protective factors exist that support resilient functioning. Results have important policy and practical implications, including continued screenings for maternal depression in a primary care setting
Thesis (PhD) — Boston College, 2017
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social Work
40
Minden, Maureen Marguerite. "Discrepancy between maternal health policy and practice : The case of maternal child health workers at sub-health posts in a rural district in Nepal." Thesis, University of London, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.536773.
41
Moser, Michele R., T. Clark, and Andres Pumariega. "Mental Health Disparities in Child Welfare." Digital Commons @ East Tennessee State University, 2004. https://dc.etsu.edu/etsu-works/4973.
42
Stephenson, Robert Brian. "The impact of rural-urban migration on child survival in India." Thesis, University of Southampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.313189.
43
Sinha, Aakanksha. "India’s Child Malnutrition Paradox: Role of Maternal Autonomy & Health Related Awareness." Thesis, Boston College, 2016. http://hdl.handle.net/2345/bc-ir:105064.
Abstract:
Thesis advisor: Ruth G. McRoyIndia has the world’s highest burden of child undernutrition. Lack of income has been attributed as the primary cause of child undernutrition. However, evidence suggests that despite steady economic growth and investments in social services directed towards child welfare, undernutrition rates in India are persistent. Thus factors impacting child undernutrition are entrenched within the social fabric of a community. Previous studies indicate that countries that have higher gender inequality have poorer health outcomes for women and children. India with its dominant patriarchal structure and deep-rooted gender biases has disproportionately worse outcomes for women and children. This dissertation study was designed to do the following: 1) emphasize the importance of maternal autonomy and health related awareness as factors significantly impacting maternal health and child nutritional status and 2) use a strengths-based approach to make recommendations for child welfare policy. By applying an asset-based approach, the social capital within a community is recognized interventions can be developed using community and individual level strengths. This study fills the gap in literature on the role of maternal autonomy and health related awareness on child nutritional status, particularly in communities with high levels of gender inequality. The current study utilized data from the India National Family Health Survey Round-3 (NFHS-3) to conduct a cross sectional analysis. The study sample consisted of urban married women between ages of 15-49 years who had at least one living child between the ages of 0-5 years (N= 9,092). It utilized the UNICEF ‘model of care’ and three distinct theories (i) Ecological Systems Theory, (ii) Capability Approach, and (iii) Positive Deviance Inquiry to develop the conceptual framework. Scales measuring maternal autonomy and health related awareness were developed and validated. Ordered Logistic Regression and Kohler mediation model were utilized to examine the relationship between maternal autonomy and health related awareness and child nutritional status and the mediation effect of maternal health. Implications are provided for child welfare policy and practice, social work policy and research
Thesis (PhD) — Boston College, 2016
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social Work
44
Zhang, Yuzheng, and 张誉铮. "Monitoring the impact of maternal health interventions on child mortality in Philippines." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206949.
Abstract:
Introduction
A future healthy world is highly associated with the children and their mothers, the Millennium Development Goals (MDGs) prioritize the child and maternal health with the targets “the under-five mortality rate should be reduced by two thirds from 1990 to 2015”. A transform program in the Philippines, launched by a NGO, aims to change the life of ultra-poor, and the interventions’ impact was measured in this study.
Method
The study selected participants who had completed the surveys in the short term (n=2183) and long term (n=196). The Chi-square test, Cochran-Armitage trend test, and Generalized Estimating Equation (GEE) model were applied to examine the hypotheses: (1) the program would have positive impacts on child health, (2) the child mortality is related to the maternal social-demographic factors and health behaviors. In the GEE model, the univariate and multivariate binary logistic regression was used to estimate the crude and adjusted odds ratio (OR).
Result
The univariate and multivariate analysis both show the maternal age is closely associated with the child mortality, and the child mortality of older women is higher than the younger in the short term survey (univariate: OR:8.36, 95%CI:4.17-16.77, multivariate: OR: 8.89, 95%CI: 4.27-18.54). In the long term, the results demonstrate that the child mortality of delivering in hospital (OR:0.29, 95%CI:0.11-0.76) and birthing home (OR: 0.46, 95%CI: 0.21-0.98) both lower than home (reference group). Compared to Bacolod, the child mortality rate of Gensan and Koronadal is lower in the short term. We found no difference in other maternal social-demographic factors and health behaviors. During the survey period, the literacy, PhilHealth, institutional delivery, delivery care provider, postnatal home visits, breastfeeding, and child mortality all improved, and the improvements of PhilHealth, postnatal home visits, breastfeeding were statistically significant.
Conclusion
The findings suggest that the program needs to constantly deliver more community-based interventions, such as: institutional delivery, skilled birth attendance, postnatal care, which would transform the children health of ultra poverty in the long run.published_or_final_version
Public Health
Master
Master of Public Health
45
Sandiford, Peter. "The impact of maternal literacy on child survival during Nicaragua's health transition." Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266223.
46
Mbabazi, Muniirah. "Exploring the efficacy of maternal, child health and nutrition interventions in Uganda." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/48215/.
Abstract:
Introduction and background: Malnutrition, particularly undernutrition remains a major development challenge for sub-Saharan Africa. There has been mixed progress in reducing undernutrition and the numbers remain unacceptably high. However, high impact nutrition interventions have been recommended for implementation in high burden malnutrition countries to address undernutrition. Countries have responded by designing policies and programmes that reflect these recommendations. However, there is limited evidence of what works and how in local contexts. Objectives: This research explored the efficacy of nutrition interventions and modality of delivery of interventions and programmes in Uganda at national, local government and community levels. Specifically this study examined key stakeholders’ experiences of current nutrition interventions at district level in Uganda; assessed the effectiveness of previous nutrition specific and nutrition sensitive interventions on maternal and child health outcomes in Uganda; and examined the relationship between socio demographic and health factors on nutrition outcomes in Uganda. Methods and subjects: Using a combination of methods (mixed methods), this study explored nutrition interventions targeting mothers of reproductive age and children (0-5 years) in three separate studies. A systematic review was conducted to explore existing evidence on the nature of maternal and child health and nutrition interventions; and methods used to deliver them since 1986-2014. Studies were included if they were done in Uganda and reported health and nutrition related outcomes among the study group. Included studies were assessed for quality using the Newcastle Ottawa Scale. Twenty-two predominantly cross-sectional and longitudinal studies were included in the review. A qualitative study covering project implementers and project beneficiaries (n=85) in local communities was conducted using face-to-face interviews. Interviews explored methods used to deliver interventions and implementers’ and community participants’ perspectives and experiences of on-going nutrition interventions at local government (LG) and community level. Community beneficiaries were mothers or caretakers of children aged 0-59 months accessing interventions from two studied projects, while implementers were project staffs or health workers on the same projects. Interviews were transcribed verbatim and thematically analysed. Population based data of the 2011 Uganda demographic and health Survey (DHS) was quantitatively analysed. Logistic regressions analyses were done to establish factors that influence child stunting and anaemia in Uganda. Models were constructed based on 2350 stunted and 2056 child anaemia cases in the data set. Using a multilevel model design of mixed methods research, findings from each study were triangulated to obtain complementary information on the study phenomena. Results: Results suggest that planning and implementation of nutrition interventions in Uganda has transformed from random to systematic implementation since 1986. Nutrition interventions delivered diverse activities to address multiple causes of undernutrition in Uganda. However, activities were predominantly non-integrated delivered specifically at facilities or in communities. Methods of delivering interventions were broad to include community and health system compatible strategies (community mobilisation, outreaches and individual or group nutrition education and counselling) to prevent, manage and treat undernourished cases at facilities and within communities. Results further showed that maternal anaemia status, age of child and geographic factors were associated with stunting and anaemia in children. Further, the qualitative study showed, there was a conducive policy environment to implement multi-sectoral nutrition interventions in Uganda. There were linkages, collaborations and partnerships to delivery multi-sectoral integrated nutrition actions in communities and LG. Results however reveal that the dominance of external partners in implementing nutrition interventions; and absence of functional coordinating structures and mechanisms hinders intervention scale up. Further there was a need to address system and community barriers that affect implementation to improve nutrition outcomes and scale up at LG and community level. Conclusion: There have been great strides towards solving challenges of malnutrition in Uganda. Integrated approaches using community mobilisation and nutrition education and counselling at health facilities were among common delivery methods. However, bottlenecks exist in prioritisation and commitment to scale. There is a need to strengthen integrated approaches to delivering interventions across the LG and communities for multi-sectoral programming and implementation to reduce the number of undernourished Ugandans.
47
Kuo, Alice, David L. Wood, James H. Duffee, and J. M. Pasco. "Poverty and Child Health in the United States." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/5138.
Abstract:
Almost half of young children in the United States live in poverty or near poverty. The American Academy of Pediatrics is committed to reducing and ultimately eliminating child poverty in the United States. Poverty and related social determinants of health can lead to adverse health outcomes in childhood and across the life course, negatively affecting physical health, socioemotional development, and educational achievement. The American Academy of Pediatrics advocates for programs and policies that have been shown to improve the quality of life and health outcomes for children and families living in poverty. With an awareness and understanding of the effects of poverty on children, pediatricians and other pediatric health practitioners in a family-centered medical home can assess the financial stability of families, link families to resources, and coordinate care with community partners. Further research, advocacy, and continuing education will improve the ability of pediatricians to address the social determinants of health when caring for children who live in poverty. Accompanying this policy statement is a technical report that describes current knowledge on child poverty and the mechanisms by which poverty influences the health and well-being of children.
48
Evans, Subhadra. "The interface of maternal and child psychological and physical health: What maternal chronic pain means for children's functioning." Thesis, University of Canterbury. Psychology, 2004. http://hdl.handle.net/10092/4513.
Abstract:
A series of questions regarding the impact of maternal chronic pain on children were addressed in this dissertation. Firstly, the physical and psychosocial functioning of 39 mothers suffering from chronic pain was compared to 35 control healthy mothers in order to determine the extent to which mothers with chronic pain may be compromised and their children may be at risk. It was found that mothers with chronic pain had decreased physical, mental and social functioning, as well as reduced parenting efficacy. Secondly, the children of these mothers were compared on a range of physical and psychosocial health outcome measures. The 55 children in the maternal chronic pain group experienced maladjustment, as reported by children, mothers and fathers. This included reduced physical and mental health compared to the 48 control children, as well as reduced attachment security and social skills. Thirdly, although a number of maternal psychosocial variables, such as maternal mental health were correlated with child functioning, only one variable – parenting - consistently emerged as a significant predictor of child problems. In particular, the warmth of the mother-child relationship, and the mother's use of over-reactive discipline strategies were significant mediators. The findings reflect that maternal chronic pain is a source of risk for many children. Consistent with much of the maternal chronic stressor literature, the mechanism of transmission from physical compromise in the mother to maladjustment in the child appears to largely involve dysfunctional parenting practices. The findings are discussed in terms of the cost of maternal chronic pain to children and society. In particular, intervention needs to be targeted at suffering mothers and their children. This will reduce the deleterious consequences for children and the potential demands of a new generation of sufferers on the public health system.
49
Brind'Amour, Katherine. "Maternal and Child Health Home Visiting Evaluations Using Large, Pre-Existing Data Sets." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1468965739.
50
Mukasa, Bakali. "Maternal and Child Health Access Disparities Among Recent African Immigrants in the United States." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2297.
Abstract:
Health care disparities are U.S. national public health concerns that disproportionately affect minority populations. The focus of published studies on the health of larger immigrant populations from Europe, Asia, South America, and the Caribbean has revealed a knowledge gap on the health of African and other minority immigrants. The purpose of this phenomenological study was to explore disparities in access to maternal and child health (MCH) care as well as the causes and effects of such disparities to care-seeking experiences of recent African immigrants. Andersen's behavioral model of health services use provided the theoretical lenses to interpret study findings. Eleven recent African immigrant mothers living in metropolitan Boston, Massachusetts, participated in semistructured questions that generated data used in this study. NVivo 11 was used to manage data, which enabled convenient use of Colaizzi's data analysis technique to identify themes and subthemes that were synthesized into final findings. Study results indicated that although participants used MCH care services, factors such as racial/ethnic discrimination, insurance differences, immigration, and socioeconomic status marred the process of seeking care, with notable access disparities that negatively affect MCH care experiences. The field of health for African immigrants is ripe for research. Other researchers could replicate this study elsewhere in the United States and other traditional immigrant-destination countries. Study findings could benefit health care providers, public health professionals, researchers, and immigrant populations. Actions for sustainable positive social change may result in the form of improved health care access and health outcomes for minority immigrants in the United States and beyond.