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Out-of-pocket health expenditure for under-five illnesses in a semi-urban community in Northern Nigeria
MN Sambo, CL Ejembi, YM Adamu, AA Aliyu
Journal of Community Medicine and Primary Health Care , 2004,
Abstract: Background: Household expenditure on health is increasingly becoming a major source of health care financing in Nigeria. Recognizing the limitations of this pattern of financing health care, the government has introduced a social health insurance scheme policy that has provided for government meeting the health care costs of children. However, there is a dearth of information on the pattern and costs of under-five illnesses at community level. This study therefore sought to determine the magnitude and causes of illnesses among under-fives, sources of healthcare and out of pocket expenditure among children under-five in Layin Zomo, a semi-urban area of Northern Nigeria Methodology: A cross-sectional community-based descriptive study design was used to study a population of under-fives in the settlement. A 50% sample of all under-fives in the settlement was drawn using systematic sampling method. Information was sought from the mothers/caregivers on illness episodes in the three months preceding the study, place and cost of treatment among the 324 sampled population. Result: The findings showed that 26. 9% of the children had been ill within three months of the study with fever; cough and diarrhoea being the leading causes of illness. Majority of respondents, 41.7% sought treatment from patent medicine vendors. The median out of pocket expenditure on treatment per illness episode was 171 Naira ($ 1.2) and the estimated annual per capita out of pocket treatment cost per child was 255 Naira ($1.8). Conclusion: While the study has provided some data for computation of the out of pocket health expenditure for treatment of under-five illnesses, the poverty context within which such expenditures are incurred limits the utilization of such information to determine the premium rate for the proposed children under five programme under the National Health Insurance Scheme. Key Words: Healthcare; Out-of-pocket expenditure; Under-fives; Zaria Journal of Community Medicine & Primary Health Care Vol.16(1) 2004: 29-32
Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off
Barros,Aluísio J D; Santos,Iná S; Matijasevich,Alicia; Domingues,Marlos Rodrigues; Silveira,Mariangela; Barros,Fernando C; Victora,Cesar G;
Revista de Saúde Pública , 2011, DOI: 10.1590/S0034-89102011005000039
Abstract: objective: to describe the patterns of deliveries in a birth cohort and to compare vaginal and cesarean section deliveries. methods: all children born to mothers from the urban area of pelotas, brazil, in 2004, were recruited for a birth cohort study. mothers were contacted and interviewed during their hospital stay when extensive information on the gestation, the birth and the newborn, along with maternal health history and family characteristics was collected. maternal characteristics and childbirth care financing - either private or public healthcare (sus) patients - were the main factors investigated along with a description of c-sections distribution according to day of the week and delivery time. standard descriptive techniques, χ2 tests for comparing proportions and poisson regression to explore the independent effect of c-section predictors were the methods used. results: the overall c-section rate was 45%, 36% among sus and 81% among private patients, where 35% of c-sections were reported elective. c-sections were more frequent on tuesdays and wednesdays, reducing by about a third on sundays, while normal deliveries had a uniform distribution along the week. delivery time for c-sections was markedly different among public and private patients. maternal schooling was positively associated with c-section among sus patients, but not among private patients. conclusions: c-sections were almost universal among the wealthier mothers, and strongly related to maternal education among sus patients. the patterns we describe are compatible with the idea that c-sections are largely done to suit the doctor's schedule. drastic action is called for to change the current situation.
Momcilo Djordjevic,Gordana Djordjevic,,Bozidar Jovanovic,Jovan Jovanovic
Acta Medica Medianae , 2008,
Abstract: Breech presentation implies vertical position of the fetus, accounting for 3-4% of all monofetal deliveries. Perinatal morbidity and mortality are significantly higher in breech deliveries than in head presentation deliveries.The aim of the investigation was to examine the association between the anamnestic and population characteristics of the breech deliveries and the same characteristics in the head deliveries.Study group included 282 mothers who had breech deliveries and 282 mothers in control group who had head presentation deliveries. All the babies were delivered at the Clinic of Obstetrics and Gyneclogy Kragujevac.The population sample - the subject of the study encompassed mothers from Sumadija region with the center in Kragujevac as the capital and biggest city in the region.Distribution of probabilities according to profession or education of mothers was similar in both groups. The mean age of the mothers in both groups was 26.8 years. Significantly, the largest number of mothers from both groups was between 20 and 29 years of age, e.g. 70 %.With significantly high probability, the pregnancy progression in both groups was positive (85%), without maintaining pregnancy. The presence of associated disease was significantly higher, especially hypertension and diabetes in mothers who had breech deliveries compared to mothers who had head presentation deliveries.
Coorte de nascimentos de Pelotas, 2004: metodologia e descri??o
Barros,Aluísio J D; Santos,Iná da Silva dos; Victora,Cesar G; Albernaz,Elaine P; Domingues,Marlos R; Timm,Iandora K; Matijasevich,Alicia; Bertoldi,Andréa D; Barros,Fernando C;
Revista de Saúde Pública , 2006, DOI: 10.1590/S0034-89102006000300007
Abstract: objective: to describe a birth cohort which started in 2004, aiming to assess pre and perinatal conditions of the newborns, infant morbimortality, early life characteristics and outcomes, and access, use and financing of health care. methods: all children born in the urban area of pelotas and cap?o do le?o municipalities (southern brazil) in 2004 were identified and their mothers invited to join the study. in the first year of the study the children were seen at birth, at three and 12 months of age. these visits involved the application of a questionnaire to the mothers including questions on health; life style; use of health services; socioeconomic situation; estimation of gestational age; anthropometric measurements on the newborn (weight, length, head, chest and abdominal circumferences); anthropometric measurements on the mother (weight and height) and assessment of infant development. results: out of the eligible infants (4,558), more than 99% were recruited to the study at birth. follow-up rates were 96% at three months and 94% at 12 months of age. among the initial results we highlight the following. infant mortality rate was 19.7 per thousand, with 66% of infant deaths occurring in the neonatal period. there were frequencies of 15% premature babies and 10% low birthweight. cesarean sections represented 45% of deliveries. conclusions: the third pelotas birth cohort showed an infant mortality rate similar to that of 11 years ago, with most deaths occurring in the neonatal period. the rates of prematurity and cesarean sections increased substantially.
Depress?o pós-parto e altera??es de sono aos 12 meses em bebês nascidos na zona urbana da cidade de Pelotas/RS
Lopes, Eliane Rozales;Jansen, Karen;Quevedo, Luciana de ávila;Vanila, Russélia Godoy;Silva, Ricardo Azevedo da;Pinheiro, Ricardo Tavares;
Jornal Brasileiro de Psiquiatria , 2010, DOI: 10.1590/S0047-20852010000200002
Abstract: objective: verify whether there is association between sleep disorders in babies at 12 months of age and postpartum depression in motherhood. methods:cross sectional study. the sample was made up of women who had done their prenatal medical care at the national health system (sus), at the health basic units in pelotas and who had their deliveries from june, 2006. the 12 month old babies from these women are also part of the sample. in order to assess depressive symptoms in the mothers, edinburgh postnatal depression scale was used and the following sleeping behaviors of the babies were investigated: hours of sleep per day, regularity of sleep and wake up time, disturbed sleep and night awakening. poisson regression was used for the analysis. results: 35.7% of the babies showed alterations in their sleeping patterns. after adjusting for the proposed hierarchal model, sleep alteration of the babies was still associated with the depressive symptoms of the mothers (p < 0,01). conclusions: health professionals should regularly investigate sleeping behaviors of babies and pay attention to mothers' mental health in order to identify problems early and offer support in the management of babies' sleep.
Maternal-child health in Pelotas, Rio Grande do Sul State, Brazil: major conclusions from comparisons of the 1982, 1993, and 2004 birth cohorts
Barros, Fernando C.;Victora, Cesar G.;
Cadernos de Saúde Pública , 2008, DOI: 10.1590/S0102-311X2008001500012
Abstract: important changes were observed in maternal characteristics, health care indicators, and child health during the 22 years covered by the three population-based birth cohort studies conducted in the city of pelotas, southern brazil. maternal education levels improved, cigarette smoking during pregnancy was reduced, and birth intervals became longer. also, there were more single mothers, and maternal obesity increased. coverage of antenatal and delivery care by professionals improved, but inductions and caesarean sections increased markedly, the latter accounting for 45% of deliveries in 2004. with regard to child health, the reductions in neonatal and infant mortality rates were modest, and the significant increase in preterm births - 14.7% of all births in 2004 - appears to have colluded with this stagnation. other infant health indicators, such as immunization coverage and breastfeeding duration, showed improvements over the period. regarding infant nutrition, malnourishment at age 12 months decreased, but the prevalence of overweight was higher in 2004. the existence of three population-based birth cohorts using comparable methodology allowed for the study of important secular trends in maternal and child health.
Saúde perinatal em Pelotas, RS, Brasil: fatores sociais e biológicos
Barros,Fernando C.; Victora,Cesar G.; Granzoto,José Aparecido; Vaughan,J. Patrick; Lemos Júnior,Ari Vieira;
Revista de Saúde Pública , 1984, DOI: 10.1590/S0034-89101984000400005
Abstract: all hospital births occurring during 1982 in pelotas, southern brazil (pop. 260,000) were studied. this a highly representative perinatal population, since in this city less than 1% of the deliveries occur at home. the study was performed through: hospital interviews with mothers and evaluation of the newborn; home visits of a random sample of 15% of the births after the seventh day of life; and monthly checking of birth and death certificates. overall, the perinatal mortality rate (pnmr) for singletons was 31.9/1,000 births, fetal mortality rate (fmr) being 16.2/1,000 and early neonatal mortality rate (enmr) 15.9/1,000. the incidence of low birth weight (lbw) babies was 8.1%. main causes of death were immaturity, anoxia and hyaline membrane disease. in 40% of the deaths the actual cause was not clarified. social factors were strongly associated with perinatal health indicators. babies whose families earned up to 1 minimum wage per month presented a pnmr of 44.0/1,000 and lbw in 12.6% of the cases, whereas those newborns of high income families (more than 10 minimum wages/month) showed a pnmr of 13.2/1,000 and 4.2% of lbw. the association of perinatal performance with maternal age and provenience, birth order and smoking was also studied. when a comparison was made between the perinatal outcome of pelotas babies with that of a highly developed country (sweden), using standardization techniques, it was seen that although our birth weight distribution may be held responsible for part of our poor performance, failures in our health services are probably still more important.
An audit of deliveries and outcome at Queen Elizabeth Central Hospital, Blantyre, in 1999
C Kalumbi, E Tadesse
Malawi Medical Journal , 2001,
Abstract: A one-year audit of deliveries at Queen Elizabeth Central Hospital, Blantyre, was undertaken for 1999. The main objective of the audit was to obtain baseline data on forms of deliveries and pregnancy outcome. A total of 12,293 births occurred during the study period. Of these, 11,565 were singleton deliveries, 349 twin deliveries and 10 triplets. Characteristics of singleton deliveries were analysed further when data were available. The age distribution of the mothers ranged from 10 to 55 years with a mean age of 23.4 years. Of 10,314 singleton deliveries, 8710 (84.4%) were spontaneous vertex deliveries, 1121 (10.8%) were caesarian section, 304 (2.94%) were vacuum extraction and 169 (1.63%) were assisted breech deliveries. Breech deliveries had the worst outcome. The maternal mortality rate for the year 1999 was 1224 per 100,000 live births and the perinatal mortality rate was 49.3 per 1000 live births. Malawi Medical Journal Vol 13, No.3 (Sept 2001): pp34-35
The Professional Medical Journal , 2008,
Abstract: Objective: To compare the maternal and neonatal complications after instrumental deliveries.Design: Prospective study. Setting: At MH Rawalpindi. Period: Six months from April 15, 2006 to October 14, 2006.Results: Total 96 instrumental deliveries were carried out; of which 46 were ventouse and 50 were forceps deliveries.58% of forceps deliveries were carried out in nulliparous and 42% in mulitparous patients as compared to 61% ofventouse deliveries in nulliparous and 39% in multiparous patients. Fetal distress was indication in 68% of forcepsdeliveries and 61% ventouse deliveries. Prolong second stage (>1 hr) was the second commonest indication i.e., in18% of forceps deliveries and 13% of ventouse deliveries. Success rate was 90% in ventouse and 97% in forcepsdeliveries. Extension of episiotomy was more likely to occur with ventouse deliveries and third degree perineal tearoccurred more with forceps deliveries. 14 babies were admitted to NICU and 90% of them were due to meconiumstaining. There was only one intrapartum death in the ventouse delivery group and that was due to intrapartumasphyxia. Conclusion: Forceps are more likely to be used in primigravidas and less likely to fail. Most commonindication of instrumental deliveries is fetal distress followed by prolonged second stage. Cephalhaematoma andjaundice are more common in ventouse deliveries. Extension of episiotomy and low apgar score at one minute is morelikely to occur with ventouse deliveries where as third degree perineal tear and subconjuctival haemorrhage are morelikely to occur in forceps deliveries.
Why Still Home Deliveries in Urban Slum Dwellers?
S D Kotnis, R M Gokhale, M V Rayate
National Journal of Community Medicine , 2012,
Abstract: Background: The current policy of Government of India under N.R.H.M.and R.C.H. is to encourage an institutional delivery which is an important step in lowering the maternal mortality. Methodology: Cross- sectional, community based descriptive study. Conducted in Urban Health Centre area in September 2007, to study various factors associated with home deliveries. Present study reports the home delivery cases in the last six years in the slum areas under Urban Health Centre. A pretested & prestructured semi-open-ended proforma was used. Results: Out of total 1441 deliveries 91(6.32%) were home deliveries, 62(68.13%) mothers were literate. 71 (78.02%) belonged to S.E. class III & lV.73 (80.22%) from joint families. 72(79.12%) deliveries were in multiparous women. 61, (67.03%) were conducted by untrained persons. Common reasons were- custom (26.37%), spontaneous delivery (24.18%), monetary problems(25.27%), homely atmosphere (13.19%), health services not satisfactory (10.99%). Conclusion: The leading factors associated as evident are low socio economic status, customs, spontaneous delivery , monetary problems, and homely atmosphere. Health education to mothers and dialogue with the health staff can be the remedial measures to encourage hospital deliveries.
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