Current Issue : July - September Volume : 2012 Issue Number : 3 Articles : 7 Articles
Background: To build a reference curve for the area of Wharton�s jelly (WJ) in low-risk pregnancies from 13 to 40\r\nweeks and to assess its relationship with estimated fetal weight (EFW).\r\nMethods: 2,189 low-risk pregnancies had the area of WJ estimated by ultrasound and the 10th, 50th and 90th\r\npercentiles calculated using a third-degree polynomial regression procedure. EFW by ultrasound was correlated\r\nwith the measurement of the area of WJ.\r\nResults: The area of WJ increased according to gestational age (R2 = 0.64), stabilizing from the 32nd week onwards.\r\nThere was a significant linear correlation between area of WJ and EFW up to 26 weeks (R = 0.782) and after that 5t\r\nremained practically constant (R = 0.047).\r\nConclusion: The area of WJ increases according to gestational age, with a trend to stabilize at around 32 weeks of\r\ngestation. It is also linearly correlated with EFW only up to 26 weeks of gestation....
Background: Zimbabwe suffers from one of the greatest burdens of HIV/AIDS in the world that has been\r\ncompounded by social and economic instability in the past decade. However, from 2001 to 2009 HIV prevalence\r\namong 15-49 year olds declined from 26% to approximately 14%. Behavior change and condom use may in part\r\nexplain this decline.\r\nPSI-Zimbabwe socially markets the Protector Plus (P+) branded line of condoms. When Zimbabwe converted to a\r\ndollar-based economy in 2009, the price of condoms was greatly increased and new marketing efforts were\r\nundertaken. This paper evaluates the role of condom marketing, a multi-dimensional scale of brand peceptions\r\n(brand equity), and price in condom use behavior.\r\nMethods: We randomly sampled sexually active men age 15-49 from 3 groups - current P+ users, former users,\r\nand free condom users. We compared their brand equity and willingness to pay based on survey results. We\r\nestimated multivariable logistic regression models to compare the 3 groups.\r\nResults: We found that the brand equity scale was positive correlated with willingness to pay and with condom\r\nuse. Former users also indicated a high willingness to pay for condoms. We found differences in brand equity\r\nbetween the 3 groups, with current P+ users having the highest P+ brand equity. As observed in previous studies,\r\nhigher brand equity was associated with more of the targeted health behavior, in this case and more consistent\r\ncondom use.\r\nConclusions: Zimbabwe men have highly positive brand perceptions of P+. There is an opportunity to grow the\r\ntotal condom market in Zimbabwe by increasing brand equity across user groups. Some former users may resume\r\nusing condoms through more effective marketing. Some free users may be willing to pay for condoms. Achieving\r\nthese objectives will expand the total condom market and reduce HIV risk behaviors....
Background: Improving knowledge of obstetric danger signs and promoting birth preparedness practices are\r\nstrategies aimed at enhancing utilization of skilled care in low-income countries. The aim of the study was to\r\nexplore the association between knowledge of obstetric danger signs and birth preparedness among recently\r\ndelivered women in south-western Uganda.\r\nMethods: The study included 764 recently delivered women from 112 villages in Mbarara district. Community\r\nsurvey methods were used and 764 recently delivered women from 112 villages in Mbarara district were included\r\nin study. Interviewer administered questionnaire were used to collect data. Logistic regression analyses were\r\nconducted to explore the relationship between knowledge of key danger signs and birth preparedness.\r\nResults: Fifty two percent of women knew at least one key danger sign during pregnancy, 72% during delivery\r\nand 72% during postpartum. Only 19% had knowledge of 3 or more key danger signs during the three periods. Of\r\nthe four birth preparedness practices; 91% had saved money, 71% had bought birth materials, 61% identified a\r\nhealth professional and 61% identified means of transport. Overall 35% of the respondents were birth prepared.\r\nThe relationship between knowledge of at least one key danger sign during pregnancy or during postpartum and\r\nbirth preparedness showed statistical significance which persisted after adjusting for probable confounders (OR 1.8,\r\n95% CI: 1.2-2.6) and (OR 1.9, 95% CI: 1.2-3.0) respectively. Young age and high levels of education had synergistic\r\neffect on the relationship between knowledge and birth preparedness. The associations between knowledge of at\r\nleast one key danger sign during childbirth or knowledge that prolonged labour was a key danger sign and birth\r\npreparedness were not statistically significant.\r\nConclusions: The prevalence of recently delivered women who had knowledge of key danger signs or those who\r\nwere birth prepared was very low. Since the majority of women attend antenatal care sessions, the quality and\r\nmethods of delivery of antenatal care education require review so as to improve its effectiveness. Universal primary\r\nand secondary education programmes ought to be promoted so as to enhance the impact of knowledge of key\r\ndanger signs on birth preparedness practices....
Background: Pregnancy is a good time to develop healthy lifestyle habits including regular exercise and good\r\nnutrition. Programs of physical exercise for pregnant women have been recommended; however, there are few\r\nreferences on this subject in the literature. The objective of this study was to evaluate the knowledge, attitude and\r\npractice of pregnant women with respect to appropriate physical exercise during pregnancy, and also to\r\ninvestigate why some women do not exercise during pregnancy.\r\nMethods: A descriptive study was conducted in which 161 women of 18 to 45 years of age were interviewed in\r\nthe third trimester of pregnancy. These women were receiving prenatal care at National Health Service (SUS)\r\nprimary healthcare units and had no pathologies for which physical exercise would constitute a risk. The women\r\nwere selected at an ultrasonography clinic accredited to the SUS in Campinas, S�£o Paulo. A previously elaborated\r\nknowledge, attitude and practice (KAP) questionnaire was used to collect data, which were then stored in an\r\nEpinfo database. Statistical analysis was conducted using Pearsonâ��s chi-square test and Fisherâ��s exact test to\r\nevaluate the association between the study variables (p < 0.05).\r\nResults: Almost two-thirds (65.6%) of the women were sufficiently informed about the practice of physical exercise\r\nduring pregnancy and the vast majority (93.8%) was in favor of it. Nevertheless, only just over 20% of the women\r\nin this sample exercised adequately. Significant associations were found between an adequate knowledge of\r\nphysical exercise during pregnancy and education level (p = 0.0014) and between the adequate practice of\r\nphysical exercise during pregnancy and having had fewer pregnancies (p = 0.0001). Lack of time and feeling tired\r\nand uncomfortable were the principal reasons given by the women for not exercising.\r\nConclusion: These results suggest that womenâ��s knowledge concerning the practice of physical exercise during\r\npregnancy is reasonable and their attitude is favorable; however, relatively few actually exercise during pregnancy....
Objectives: to evaluate mother-to-child transmission (MTCT) rates and related factors in HIV-infected pregnant\r\nwomen from a tertiary hospital between 2000 and 2009.\r\nSubjects and method: cohort of 452 HIV-infected pregnant women and their newborns. Data was collected from\r\nrecorded files and undiagnosed children were enrolled for investigation. Statistical analysis: qui-square test, Fisher\r\nexact test, Student t test, Mann-Whitney test, ANOVA, risk ratio and confidence intervals.\r\nResults: MTCT occurred in 3.74%. The study population displayed a mean age of 27 years; 86.5% were found to\r\nhave acquired HIV through sexual contact; 55% were aware of the diagnosis prior to the pregnancy; 62% were not\r\nusing HAART. Mean CD4 cell-count was 474 cells/ml and 70.3% had undetectable viral loads in the third trimester.\r\nHAART included nevirapine in 35% of cases and protease inhibitors in 55%; Zidovudine monotherapy was used in\r\n7.3%. Mean gestational age at delivery was 37.2 weeks and in 92% by caesarian section; 97.2% received intravenous\r\nzidovudine. Use of AZT to newborn occurred in 100% of them. Factors identified as associated to MTCT were: low\r\nCD4 cell counts, elevated viral loads, maternal AIDS, shorter periods receiving HAART, other conditions (anemia,\r\nIUGR (intra uterine growth restriction), oligohydramnium), coinfecctions (CMV and toxoplasmosis) and the\r\noccurrence of labor. Use of HAART for longer periods, caesarian and oral zidovudine for the newborns were\r\nassociated with a decreased risk. Poor adhesion to treatment was present in 13 of the 15 cases of transmission; in\r\n7, coinfecctions were diagnosed (CMV and toxoplasmosis).\r\nConclusion: Use of HAART and caesarian delivery are protective factors for mother-to-child transmission of HIV.\r\nMaternal coinfecctions and other conditions were risk factors for MTCT....
Background: WHO develops evidence-based guidelines for setting global standards and providing technical\r\nsupport to its Member States and the international community, as a whole. There is a clear need to ensure that\r\nWHO guidance is relevant, rigorous and up-to date. A key activity is to ascertain the guidance needs of the\r\ncountries. This study provides an international comparison of priority guidance needs for maternal and perinatal\r\nhealth. It incorporates data from those who inform policy and implementation strategies at a national level, in\r\naddition to targeting those who use and most need the guidance at grassroot level.\r\nMethods: An online multi-country survey was used to identify WHO guidance priorities for the next five years in\r\nthe field of maternal and perinatal health. WHO regional and country offices were requested to respond the survey\r\nand obtain responses from Ministries of Health around the world. In addition, the survey was disseminated through\r\nother networks and relevant electronic forums.\r\nResults: A total of 393 responses were received, including 56 from Ministries of Health and 54 from WHO/UN\r\ncountry offices. 75% of responses were from developing countries and 25% from developed countries. Guidance\r\non strategies focusing on ââ?¬Ë?quality of careââ?¬â?¢ issues to reduce all-cause maternal/perinatal mortality was considered\r\nthe most important domain to target, which includes for instance guidance to improve access, dissemination,\r\nimplementation of effective practices and health professionalsââ?¬â?¢ education.\r\nConclusions: This study provides a panorama of international priority guidance needs for maternal and perinatal\r\nhealth. Although clinical guidance remains a priority, there are other areas related to health systems guidance,\r\nwhich seem to be even more important. Overall, the domain ranked highest in terms of greatest need for\r\nguidance was around quality of care, which included questions related to educational needs, access to and\r\nimplementation of guidance....
Background: In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality\r\nand improving maternal health by 2015.\r\nObjective: To evaluate the results of a new education and referral system for antenatal/intrapartum care as a\r\nstrategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.\r\nMethods: Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical\r\nSchool, Sao Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data\r\ncollection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in\r\nBotucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures:\r\nYearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data\r\nanalysis: Simple linear regression models were adjusted to estimate the referral system�s annual effects on the total\r\nnumber of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were\r\nassessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was\r\nevaluated by a diagnostic test (Leverage), with p < 0.05.\r\nResults: Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths\r\n(maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births).\r\nThe C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level\r\nIII hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at\r\nthe level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at\r\nthe level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.\r\nConclusions: This safe motherhood referral system was a good strategy in reducing perinatal mortality and direct\r\ncauses of maternal mortality and decreasing the overall rate of C-sections....
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