Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire.A survey was conducted among 289 mothers aged 20–49 in Feicheng City.Results:Regarding accessibility,most respondents(133)reported that travel time to healthcare services exceeded 60 minutes,while 99 respondents indicated a travel time of 16–30 minutes.The issue of affordability was highlighted,with 86.85%of participants perceiving maternal healthcare services as costly,indicating a significant financial burden.More than 50%of respondents were satisfied with two specific dimensions(P<0.05)regarding the quality of maternal healthcare services.Conclusion:The study found that accessibility,affordability,and quality significantly affect mothers’satisfaction with maternal health services.Future research should focus on developing more suitable service pathways for rural mothers.

Availability and Quality of Emergency Obstetric Care, an Alternative Strategy to Reduce Maternal Mortality: Experience of Tongji Hospital, Wuhan, China

The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerably in last decade,To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital,Wuhan,China,this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009.Two baseline periods of equal length were used for the comparison of variables.A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations,either 71.35％ of all activities.No maternal death was recorded.Mean age of women was 29.31 years with a wide range of 14-52 years.About 96.26％ of women had higher levels of schooling,university degrees and above and received the education of secondary school or college.About 3.74％ received primary education at period two (P2) from 2005 to 2009,which was significantly higher than that of period one (P1) from 2000 to 2004 (P＜0.05) (OR:0.586; 95％ CI:0.442 to 0.776).About 65.69％ were employed as skilled or professional workers at P2,which was significantly higher than that of P1 (P＜0.05).About 34.31％ were unskilled workers at P2,which was significantly higher than that of P1 (P＜0.05).Caesarean section was performed for 9,930 women (88.48％) and the percentage of the procedure increased significantly from 19.25％ at P1 to 69.23％ at P2 (P＜0.05).We were led to conclude that,despite the progress,significant gaps in the performance of maternal health services between rural and urban areas remain.However,MM reduction can be achieved in China.Priorities must include,but not limited to the following:secondary healthcare development,health policy and management,strengthening primary healthcare services.

Mistreatment during Childbirth: Impact on Maternal Outcomes and Importance of Provider Perspectives

Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.

Investigating the Determinants of Maternal Care Services Utilization in the Brong Ahafo Region of Ghana

Ghanaian governments have made some social interventions in order to reduce risks associated with pregnancy and child delivery. However, most pregnant women do not seek maternal care. Previous studies have examined factors contributing to maternal care services utilization in Ghana using national data which limit such study applicability in some areas with specific background characteristics. These studies have mostly limited it to rural areas where the utilization is very low. This study seeks to bridge the gaps identified by exploring the factors which influence maternal care utilization in urban and rural communities in the Brong Ahafo Region of Ghana. The Chi-Square test of association and the logistic regression models are used to analyze data obtained from the 2014 Ghana Demographic and Health Survey (DHS). The data analyses were carried out using R and STATA softwares. The results revealed that women with at least 5 children were less likely (OR = 0.374, 95% CI: 0.173 - 0.796) to utilize antenatal care compared to those who had less than five live births. Educated women are three times likely (95% CI: 1.929 - 5.257) to deliver at a health facility compared to uneducated women. Women from the rich wealth quintile were nearly 16.9 times more likely (95% CI: 4.816 - 107.124) to deliver in a health facility compared to those from the poor wealth quintile. On the other hand, residing in rural communities makes it less likely (OR = 0.569, 95% CI: 0.350 - 0.913) for women to receive postnatal care within 2 months of delivery compared to living in urban communities. This study has demonstrated that maternal educational level plays a crucial role in maternal health care service utilization in the region. Therefore, government policies and programs aimed at providing more educational opportunities for girls in the region should be reinforced.

Essential Maternal and Newborn Care Skills Training for Midwives: Their Impact on Reducing Maternal and Neonatal Mortalities in Kenya

Continuing professional development (CPD) continues to gain acceptance as a model for health care professionals to engage in lifelong learning. Little is known about how CPD participants put the experience and the new knowledge into practice and whether it has impact on patient care outcomes. The primary objective of this study was to evaluate the effectiveness of CPD of Midwives on Essential Maternal and Newborn care skills on maternal and neonatal mortality in Embu County, Kenya. The study was an interventional non-randomized pretest post test study design of midwives from the participants of the 2010 ministry of health training on essential maternal and newborn care skills. Sixty (60) midwives working in maternity unit of Embu level five hospitals were targeted. The study was carried out in two phases. Phase one involved environmental scanning of the factors that support good performance in the workplace using a questionnaire. Phase two involved evaluation of the impact by testing a hypotheses using data collected by use of questionnaires, evaluation checklist and chart audit. Data were analyzed using qualitative content analysis and presented using percentages and frequency tables. Chi-square test and correlation analysis were used to show the association between variables, which are midwives essential maternal and newborn care skills and maternal and neonatal mortality. A chi-square χ2 = 14.143, df = 9 and a coefficient = 0.357. This coefficient is less than p-value at Alpha 0.05 and therefore is not significant, proving that the essential maternal and neonatal care skills do not contribute to reduction in mortalities as such two variables are almost independent of each other, whether one exists does not necessitate the existence of another nor does it reduce maternal and neonatal mortalities in Kenya.

Attitude toward Safety among Staffs in the Iranian Maternity Care Units of Public Hospitals with High Maternal Death Rate, 2015-2016

Background: Although extensive Mother-friendly Hospital initiatives have been improved the quality of maternity care in Iran, recent national reports have been indicated that obstetrics errors are still common. The current study aimed to assess safety attitude in the maternity care units of public hospitals in a region with high rate of maternal death in Iran. Materials and Methods: Data was collected from 314 midwives, specialist and also managers working in all public hospitals in 2016. The Cronbach’s alpha coefficient was used to analyze psychometric features of the Safety Attitudes Questionnaire (SAQ). Results: 86.2% of the participants (n = 314) completed the questionnaire. Results showed that lower scores in teamwork, safety climate and also job satisfaction subcomponents. The working conditions and stress recognition had the highest negative scores. There was a significant relationship between the following subcomponents and work load: teamwork (r = ﹣0.416, P-value = 0.05), stress recognition (r = 0.40, P-value = 0.05) and also working conditions (r = 0.421;P-value = 0.02). The score of midwives was significantly lower than specialists regarding job satisfaction (P-value = 0.014), working conditions (P-value = 0.02) and also the overall safety attitude score (P-value = 0.001). About 63% of respondents reported no error during the last year. The mean of error reporting during the last year significantly increased among specialists compared to midwives (P-value = 0.001). Conclusion: Maternity care units in the region with high maternal death have been faced with many intangible barriers related to safety attitude such as poor teamwork climate, working condition and also poor stress recognition. It is now needed to promote supportive environment for midwives and also strengthening staff cohesion through guiding the strategic direction of current maternity risk management system in creating open and just culture, improving leadership behaviors among senior managers and also addressing poor staffing levels.

Impact of Mobile Telephone on Maternal Health Service Care: A Case of Njoro Division

Every minute a woman dies due to pregnancy related complications globally, and half of these deaths occur in the developing countries. Despite knowing the main causes of these deaths, maternal mortality has remained high especially in Sub-Saharan Africa with 536,000 deaths annually. One of the main challenges is access to maternal health services. This study aims at assessing whether mobile telephone will improve uptake of selected maternal health services by expectant mothers at Njoro and Nessuit Health centers in Njoro Division, Nakuru. A total of 397 women were recruited between April 2012 and July 2012 and randomly categorized into two groups for follow up. One group of 191 women were routinely given prompts and advice about their health and scheduled visits while the other group of 206 women were allowed to continue with routine antenatal visits with no mobile telephone support. The results show 7.4% of those followed up had less than 4 antenatal visits while 18.6% of those not followed up had less than 4 visits P value 0.002 which shows there was a significantly higher proportion of women on follow up who had more than 4 antenatal visits. There was a significantly higher proportion of women on follow up who received diet and place of delivery counseling, malarial prophylaxis, iron and vitamin supplements and deworming drugs. There was however no difference in those who received tetanus toxoid and HIV counseling. 88.0% of the cases on follow up gave birth in a hospital as compared to 72.8% of those not on follow up with a P value of 0.000 which indicates strong association. Overall hospital delivery was 80.1% for this group a value much higher than national figures of 44%. Women provided with mobile telephone support are more likely to follow the scheduled antenatal advice and use the services as recommended than those who do not receive any support. Therefore mobile telephone should be used routinely to improve antenatal service uptake and communication with health providers.

Maternity or catastrophe: A study of household expenditure on maternal health care in India

Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in urban and rural areas separately. Additionally, it measures the effect of maternal health care expenditure on poverty incidence and examines the factors associated with such impoverishment due to maternal health care payments. We found that maternal health care expenditure in urban households was almost twice that of rural households. A little more than one third households suffered catastrophic payments in both urban and rural areas. Rural women from scheduled tribes (ST) had more catastrophic head counts than ST women from urban areas. On the other hand, the catastrophic head count was greater among illiterate women living in urban areas compared to those living in rural areas. After adjusting for out-of-pocket maternal health care expenditure, the poverty in urban and rural areas increased by almost equal percentage points (20% in urban areas versus 19% in rural areas). Increasing education level, higher consumption expenditure quintile and higher caste of women was associated with increasing odds of impoverishment due to maternal health care expenditure. To reduce maternal health care expenditure induced poverty, the demand-side maternal health care financing programs and policies in future should take into consideration all the costs incurred during prenatal, delivery and postnatal periods and focus not only on those women who suffered catastrophic expenditure and plunged into poverty but also those who forgo maternal health care due to their inability to pay.

Maternal complications and the utilisation of maternal health care services with special reference to West Bengal, India

The study aims to examine maternal complications in the eastern states of India. Further, an attempt is also made to understand the socioeconomic factors that determine the utilization of health care services during maternity in the state of West Bengal. The data used for the study are District Level Household Survey (DLHS) 2007-08, which reveals wide regional variations in maternal complications in India. But the state of West Bengal depicts a unique picture. It has the dubious distinction of achieving low fertility and mortality with high maternal complications. The utilisation of health care services in West Bengal was never near completion. Full utilisation of ANC which is essential for safe motherhood is just above national average. A large number of deliveries still take place out of the institution and are unsafe. Analysis reveals that higher age at motherhood increases the probability of utilising maternal health care services. Social groups, years of schooling, wealth index and place of residence also show significant relationship. The findings of the study provide an insight that efforts should be made to create awareness among socially and economically disadvantaged groups of the society about the benefits of utilisation of health care services. Further it also addresses the issue of creating awareness about MDG’s.

System barriers to the provision of quality maternal health care in two regional teaching and referral hospitals in Kenya:a qualitative study

Objective:Sub-Saharan Africa accounts for 66%of global maternal deaths.In Kenya,362 maternal deaths occur in every 100000 live births.Most of these deaths occur as a result of suboptimal quality care of mothers during labor,delivery,or within 24h of delivery.This study explored barriers that nurse-midwives encounter in trying to provide high-quality obstetric care during these periods.Methods:A qualitative research design utilizing focus group discussion as part of a mixed method study was used to find out the participants'experiences.Data were collected between February and March 2022 in the maternity units of two regional teaching and referral hospitals in Kenya.Eligible participants were nurse-midwives in charge of the maternity unit.The discussion was conducted in English,tape-recorded,and transcribed verbatim,Data were analyzed thematically,following Braun and Clarke 6-step framework.Nvivo version 7.0 computer software was used to facilitate this process.Results:Two focused group discussions each involving seven participants were conducted.The participants agreed that maternal mortality due to postpartum hemorrhage and pregnancy-induced hypertension is a major health concern.Further,maternal care in the two hospitals was substandard.Themes that emerged as barriers were:inadequate supplies;inadequate obstetric knowledge and skills;shortage of nurse-midwives,and inadequate support supervision.The underlying factors include inadequate funding by the county government and high staff turnover.Conclusion:This study showed that nurse-midwives are working under very difficult circumstances which are hindering the provision of quality maternal care.This is mainly due to system failures and inadequate nursemidwife numbers.Targeted strategies need to be urgently implemented to mitigate these challenges to improve the quality of maternal health care.

Knowledge and Attitude of Nurse-Midwives Regarding Maternal Health Care Quality Standards in Two Regional Teaching and Referral Hospitals in Kenya

Introduction: Maternal mortality remains a major health concern in Sub-Saharan Africa and Kenya in particular. Providing quality maternal health care has the potential of preventing over 75% of maternal deaths. The quality of maternal health care requires the utilization of maternal health care quality standards. Objectives: The objective of this study was to determine the nurse-midwives knowledge and attitude toward the use of maternal health care quality standards. Methodology: This study was a descriptive cross-sectional survey carried out at Embu and Meru teaching and referral hospitals in Kenya, between August and December 2021. Eighty-five nurse-midwives working in the maternity unit participated in the study. Data was collected using a self-administered semi-structured questionnaire and analyzed using SPSS version 27.0. Pearson’s correlation coefficient and Chi-square at Alpha level of 0.05 were used to test the relationship between the variables which were the nurse-midwives knowledge, attitude, and use of the quality standards. Result: Most (84.7%, n = 72) nurse-midwives were female and 44.7% (n = 38) were aged 20 - 29 years. Majority (64.7%, n = 55) were diploma holders and almost half (44.7%, n = 38) had practiced for 1 - 9 years. The average score for knowledge was 5.0 with 69.4% (n = 59) having a score of <7. Most nurse midwives (88.2%, n = 75) supported the use of the standards even though only 67.1% (n = 57) indicated that they use them. The support for the standards is significantly related to the gender of the respondents and their duration in maternity. There was no significant association between knowledge and use of maternal health care quality standards (X2 = 0.433, r = -0.085). There is no association between support for the standards and their use (X2 = 0.008). Knowledge and attitude toward the maternal health care quality standards are not significantly associated (X2 = 0.156). Conclusion: The knowledge and attitude of the nurse-midwife neither influence each other nor do they influence the use of maternal health care quality standards.

Maternal Hospital Mortality in Cotonou: Incidence, Care-Associated Adverse Events and Causes

Introduction: Despite the many efforts made to combat preventable maternal deaths, these still remain high in Benin. It was therefore important to revisit the causes but especially the adverse events associated with care (EIS) in maternity. Objective: Determine the incidence, adverse events associated with care and causes of intra hospital maternal mortality in cotonou. Methods: This was a cross-sectional maternal mortality review study with retrospective data collection. It covered all cases of maternal death recorded between 2017 and 2021 in two (2) reference university maternities in Cotonou. Adverse events associated with care and the patient were analyzed using the maternal death audit grid validated for Benin. SPSS.26 software was used for data analysis. Results: The in-hospital maternal mortality ratio in Cotonou was 2028 maternal deaths per 100,000 live births in 2021. Only 7.2% (n = 36) of deaths were audited. The deceased mothers were 29.8 ± 7.4 years old, with no fixed monthly income in 82.7% (n = 420). Serious adverse events associated with care were: delay in decision to refer in 37% (n = 188), non-medical referral in 85.8% (n = 436) of cases, inadequate pre-referral treatment in 25.7% of cases. In receiving maternities, delay in diagnosis and inappropriate treatment at the receiving maternity were noted respectively in 22.9% and 28.6% of cases of maternal death. The direct causes of maternal death were dominated by serious obstetric hemorrhage in 43.9% (n = 223). As for the indirect causes, they were dominated by anemia excluding obstetric hemorrhages in 21.5% (n = 109). Conclusion: The in-hospital maternal mortality ratio was very high in Cotonou. The main cause was severe obstetric hemorrhage. There were several serious healthcare-associated adverse events whose correct management would significantly reduce the incidence of maternal deaths.

Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.

Women’s knowledge and preferences for midwife’s role within the range of maternal care professionals in Makkah, Saudi Arabia

Background:The midwife plays a critical role in health counselling and education,not just for women but also for their families and communities.At the current time,with the growth of the midwifery workforce globally,there is still a lack of understanding regarding the full scope and role of the midwife.Aim:To evaluate the current situation of knowledge of midwives’role among women in Makkah.In addition,this study identifies the effect of women’s knowledge on their preferences for receiving maternity care from health professionals.Methods:This study employed a descriptive quantitative cross-sectional method.The total resultant sample size(N)equalled 379 global respondents,of which 306,with a response rate=of 80.73%completed the entire survey as requested.An electronic questionnaire in the Arabic language was used in this study.Results:Results revealed that most women had incorrect knowledge regarding three aspects of the midwives’roles during pregnancy 53.9%,labour 52.8%and childbirth 61.9%.Also,results presented that most women preferred obstetricians to follow up on an uncomplicated pregnancy,labour,childbirth,and maternity care 69.6%,53.9%,64.7%and 46.1%,respectively.The study found that the women’s knowledge about midwives’roles affects their preferences for healthcare professionals in receiving maternity care(P<0.05).Conclusion:Responses showed that most participants had no experience and had negative views about midwives’roles.Thus,it would affect their health professionals’preferences for receiving maternity care.Therefore,midwifery services and maternity care professionals should prioritize educating women about midwives’competencies in maternity care.

The evolution of socioeconomic statusrelated inequalities in maternal health care utilization:evidence from Zimbabwe,1994–2011

Background:Inequalities in maternal health care are pervasive in the developing world,a fact that has led to questions about the extent of these disparities across socioeconomic groups.Despite a growing literature on maternal health across Sub-Saharan African countries,relatively little is known about the evolution of these inequalities over time for specific countries.This study sought to quantify and explain the observed differences in prenatal care use and professional delivery assistance in Zimbabwe.Methods:The empirical analysis uses four rounds of the nationwide Zimbabwe Demographic and Health Survey administered in 1994,1999,2005/06 and 2010/11.Two binary indicators were used as measures of maternal health care utilization;(1)the receipt of four or more antenatal care visits and(2)receiving professional delivery assistance for the most recent pregnancy.We measure inequalities in maternal health care use using the Erreygers corrected concentration index.A decomposition analysis was conducted to determine the underlying drivers of the measured disparities.Results:The computed concentration indices for professional delivery assistance and prenatal care reveal a mostly pro-rich distribution of inequalities between 1994 and 2011.Particularly,the concentration index[95%confidence interval]for the receipt of prenatal care was 0.111[0.056,0.171]in 2005/06 and 0.094[0.057,0.138]in 2010/11.For professional delivery assistance,the concentration index stood at 0.286[0.244,0.329]in 2005/06 and 0.324[0.283,0.366]in 2010/11.The pro-rich inequality was also increasing in both rural and urban areas over time.The decomposition exercise revealed that wealth,education,religion and information access were the underlying drivers of the observed inequalities in maternal health care.Conclusions:In Zimbabwe,socioeconomic disparities in maternal health care use are mostly pro-rich and have widened over time regardless of the location of residence.Overall,we established that inequalities in wealth and education are amongst the top drivers of the observed disparities in maternal health care.These findings suggest that addressing inequalities in maternal health care utilization requires coordinated public policies targeting the more poor and vulnerable segments of the population in Zimbabwe.

Maternal investment and reproductive success in Chinese water deer

Among cervids,maternal investment,estimated as the amount of resources and care allocated to the offspring,was expected to be related to species body size. Therefore,maternal investment in a herd of captive Chinese water deer Hydropotes inermis,a relatively small species of cervid,was investigated over 3 years. Except during the lactation period,reproductive females spent about 2-fold more time resting than feeding. During lactation,the amount of time spent feeding increased highly (25.3 min/h during lactation vs 17.3 min/h during the gestation period). Females spent less than 30% of time in communal behaviours with offspring. They did not reject alien fawns during this care period. Frequency and duration of suckling events decreased exponentially from the second week onwards. More than 10% of suckling bouts were non-filial. Prenatal investment leads to a mean litter mass (about 12% of maternal mass) higher than in most cervid species. Postnatal investment in fawns represents a daily mass gain of ca. 85 g/d during the first 2 weeks,without any sexual difference. Female production,timing and synchrony of births and survival of fawns characterized reproductive success. Seventy percent of mature females gave birth,with a mean of 1.9 offspring per female. The sex ratio was even. Births were synchronous,80% of births occurring in 25 days. In this herd,0.74 fawn per female was successfully weaned and 0.56 fawn per female survived through their first year. Based on these results we conclude that reproductive strategy of Chinese water deer was efficient and characterized by mother-offspring relationships typical of hiders and high levels of pre-and postnatal investments. This strategy seems typical of small species of cervids without marked sexual dimorphism.

Evaluation of the Maternal Health Indicators: An Ecological Study from 2000 to 2014

The aiming of this worksheet is to evaluate and to compare the quantity of prenatal appointment indicators;childbirth by kind of delivery;maternal mortality coefficient and maternal deaths number. It is about an ecological, descriptive and analytical study, made through the appreciation of secondary data related to the maternal mortality in Rio Grande do Norte, from 2000 to 2014. To that, it was used information from SISPACTO to compare real data to the estimated goals. The results show that there was an increase on the number of women who performed seven or more prenatal queries, in turn, there was an increase of alive newborns through cesarean, moreover, it is observed an oscillation on the maternal deaths number by residence during the studied period, achieving superior values to the agreed goals during the last two analyzed years. It is concluded that the maternal health, in Rio Grande do Norte, negative indicators are being presented concerning the maternal mortality, in spite of presenting an improvement on the prenatal access.

Maternal Anxiety 16 Months after the Great East Japan Earthquake Disaster Area: First Report

The Great East Japan Earthquake, a magnitude 9.0 quake that occurred on March 11, 2011, left more than 20,000 killed or missing and resulted in more than 400,000 people being displaced. The Fukushima Nuclear Power Plant accident released large amounts of radioactive material into the air. Among the victims of this combined disaster were many pregnant and parturient women, and this study aimed to determine post-disaster anxiety among this specific population and measures for the future. Participants were 259 women (mean age 33.02 ± 4.79 years) who gave birth around the time of the earthquake in Miyagi Prefecture, one of the disaster areas. Sixteen months after the earthquake, we administered survey questionnaires on anxiety. We transcribed questionnaire responses, coded raw data by context, and categorized these codes by commonality. After extracting subcategories of anxiety-related factors, we categorized them into more abstract concepts. Among the participants, 126 (48.6%) reported having no available professionals with whom they could consult about childrearing. Participants reported anxiety in the following 12 categories: “radiation,” “child’s physical and mental growth/development,” “recurrence of earthquake and tsunami,” “financial issues,” “childrearing environment,” “living environment,” “maternal employment,” “stigma,” “familial issues,” “maternal health,” “childrearing,” and “the future”. A beneficial way to reduce maternal anxiety in the 12 areas identified would be to develop support systems that provide continuous support for children’s mental health care needs, psychological guidance, community support for maternal empowerment, outreach for individual support, and professional consultation for mothers who have high anxiety about radioactivity.

Qualification of nursing potential in maternal mortality in Mexico

Objectives:To develop a method that measures nursing potential through the factor analysis of relevant nursing data and social context by taking maternal mortality as the study problem.Methods:A Cross-sectional and analytical study,a multivariate analysis was performed.The Nursing Coverage Index,the Human Development Index,population density and the proportion of nurses with a bachelor's degree or upper degree,are studied by federative entity,only data from government sources are used.The Index of Nursing Qualification in Mexico(INQM)was constructed through principal component analysis.Results:The highest correlation was between the INQM and the Nursing Coverage Prioritization Index(NCPI),which was 0.849(P<0.01)and showed a strong positive linear relationship.The Population Density Prioritization Index(PDPI)shows a strong positive correlation with the INQM(0.716,P<0.01).Three factors were extracted by principal component analysis and the INQM was generated with the three main components in a model.There is very low correlation between INQM and maternal mortality rate(MMR)and no statistical significance was found.Conclusions:This study shows that nursing qualification must include economic,geographic and social variables.The INQM is an indicator that summarises the potential of each federative entity.Given these results,a contribution is provided for the application of these indices,which can help determine nursing potential in a specific geographical region.

Less hypoglycaemias in single room maternity care

In January 2006, the Canisius-Wilhelmina Hospital introduced the concept of Single Room Maternity Care (SMRC) by realizing 13 labour rooms for mother, infant and partner. Benefits of this new care concept not only include maternal satisfaction and increased staff satisfaction, but also significant health benefits for the neonate. Since the introduction of the concept, we registered a sharp decrease in the number of hypoglycaemias (from 15.6% in 2005 to 2.5% in 2009). Varying causes, such as successful breastfeeding and/or improved attachment between mother and infant may contribute to the decrease of hypoglycaemias.