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Guimarães RM, Reis LGC, de Souza Mendes Gomes MA, Magluta C, de Freitas CM, Portela MC. Tracking excess of maternal deaths associated with COVID-19 in Brazil: a nationwide analysis. BMC Pregnancy Childbirth 2023; 23:22. [PMID: 36635674 PMCID: PMC9835215 DOI: 10.1186/s12884-022-05338-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic brought a new challenge to maternal mortality in Brazil. Throughout 2020, Brazil registered 549 maternal deaths, mainly in second and third-trimester pregnant women. The objective of this study was to estimate the excess maternal deaths in Brazil caused directly and indirectly by Covid-19 in the year 2020. In addition, we sought to identify clinical, social and health care factors associated with the direct maternal deaths caused by Covid-19. METHODS We performed nationwide analyses based on data from the Mortality Information System (SIM) for general and maternal deaths and the Influenza Epidemiological Surveillance System (SIVEP-Influenza) for estimates of female and maternal deaths due to COVID-19. Two distinct techniques were adopted. First, we describe maternal deaths directly caused by covid-19 and compare them with the historical series of deaths from covid-19 among women of childbearing age (15 to 49 years). Next, we estimated the total excess maternal mortality. Then, we calculated odds ratios for symptoms, comorbidities, social determination proxies and hospital care aspects between COVID-19 maternal deaths and deaths of women of childbearing age who were not pregnant or no maternal deaths. We chose women of childbearing age (15 to 49 years) as a reference because sex and age introduce differentials in the risk of COVID-19 death. RESULTS Most maternal deaths occurred during pregnancy compared to postpartum deaths month by month in 2020 (μ = 59.8%, SD = 14.3%). The excess maternal mortality in 2020 in Brazil was 1.40 (95% CI 1.35-1.46). Even considering excess mortality due to COVID-19 for the childbearing age female population (MMR 1.14; 95% CI 1.13-1.15), maternal mortality exceeded the expected number. The odds of being a black woman, living in a rural area and being hospitalized outside the residence municipality among maternal deaths were 44, 61 and 28% higher than the control group. Odds of hospitalization (OR 4.37; 95% CI 3.39-5.37), ICU admission (OR 1.73; 95% CI 1.50-1.98) and invasive ventilatory support use (OR 1.64; CI 95% 1.42-1.86) among maternal deaths were higher than in the control group. CONCLUSIONS There was excess maternal mortality in 2020 in Brazil. Even with adjustment for the expected excess mortality from Covid-19 in women of childbearing age, the number of maternal deaths exceeds expectations, suggesting that there were deaths among pregnant and postpartum women indirectly caused by the pandemic, compromising access to prenatal care., adequate childbirth and puerperium.
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Affiliation(s)
- Raphael Mendonça Guimarães
- grid.418068.30000 0001 0723 0931Fundação Oswaldo Cruz, COVID-19 Observatory, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21041-960 Brazil
| | - Lenice Gnocchi Costa Reis
- grid.418068.30000 0001 0723 0931Fundação Oswaldo Cruz, COVID-19 Observatory, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21041-960 Brazil
| | - Maria Auxiliadora de Souza Mendes Gomes
- grid.418068.30000 0001 0723 0931Fundação Oswaldo Cruz, Fernandes Figueira National Institute for Women, Children and Youth, Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ Brazil
| | - Cynthia Magluta
- grid.418068.30000 0001 0723 0931Fundação Oswaldo Cruz, Fernandes Figueira National Institute for Women, Children and Youth, Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ Brazil
| | - Carlos Machado de Freitas
- grid.418068.30000 0001 0723 0931Fundação Oswaldo Cruz, COVID-19 Observatory, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21041-960 Brazil
| | - Margareth Chrisostomo Portela
- grid.418068.30000 0001 0723 0931Fundação Oswaldo Cruz, COVID-19 Observatory, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21041-960 Brazil
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Gomes MADSM, Esteves-Pereira AP, Bittencourt SDDA, Augusto LCR, Lamy-Filho F, Lamy ZC, Magluta C, Moreira ME. Care for healthy newborns in Brazil: are we making progress in achieving best practices? Cien Saude Colet 2020; 26:859-874. [PMID: 33729342 DOI: 10.1590/1413-81232021263.26032020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/19/2020] [Indexed: 11/22/2022] Open
Abstract
This paper aims to compare best practices for healthy newborns in public and mixed hospitals affiliated with SUS, according to type of birth, between "Nascer no Brasil/2011" (NB - Birth in Brazil) and in the last assessment cycle of Rede Cegonha, here called "Avaliação da Rede Cegonha/2017" (ARC - Stork Network Assessment). NB included a sample with national representativeness of 266 hospitals, and ARC was conducted in 606 maternity hospitals included in the Rede Cegonha strategy, totaling 15,994 and 8,047 pairs of healthy mothers and newborns, respectively.Between the two studies, NB-2011 and ARC-2017, although the proportion of cesarean sections remained around 44%, the prevalence of skin-to-skin contact with newborns, breastfeeding in the delivery room and breastfeeding in the first 24h of life increased by 140%, 82% and 6%, respectively. The proportion of upper airway aspiration of newborns dropped 65%. The results indicate that the use of evidence-based guidelines for the care of healthy newborns has increased in clinical practice, considering the six-year period between the compared studies. Despite the progress, important challenges remain to ensure best practices for all women and newborns, especially in relation to cesarean births.
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Affiliation(s)
- Maria Auxiliadora de Souza Mendes Gomes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | | | | | | | - Fernando Lamy-Filho
- Departamento de Medicina III, Universidade Federal do Maranhão (UFMA). São Luís MA Brasil
| | | | - Cynthia Magluta
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Maria Elisabeth Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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Miranda ECS, Rodrigues CB, Machado LG, Gomes MADSM, Augusto LCR, Simões VMF, Magluta C, Lamy-Filho F. Neonatal bed status in Brazilian maternity hospitals: an exploratory analysis. Cien Saude Colet 2020; 26:909-918. [PMID: 33729346 DOI: 10.1590/1413-81232021263.21652020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Neonatal units should be organized as a progressive care line, with intermediate and intensive care beds (conventional and kangaroo). The aim of this study was to evaluate the status and adequacy of neonatal beds in maternity hospitals linked to the 'Stork Network' ("Rede Cegonha"). A descriptive study was conducted in 606 maternity hospitals in all regions of Brazil. The databases used belonged to the Stork Network Evaluation Survey and the National Live Birth System. To assess the distribution of neonatal beds by typology, the parameters proposed in Ordinance N. 930/2012 of the Ministry of Health were used. Most neonatal units are not organized as a progressive care line with the three types of bed planned. Kangaroo intermediate care beds comprise the minority of implanted beds. There is a concentration of intensive and intermediate beds in the Southeast and South regions, which show a kangaroo intermediate care bed deficit. Analyzing the adequacy of beds by the number of live births, one can observe an inadequacy of Kangaroo care beds in all regions of Brazil, as well as intensive bed deficit in the North and Northeast regions, and adequacy of conventional intermediate care beds in all regions.
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Affiliation(s)
- Elaine Cristina Silva Miranda
- Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
| | - Camila Brito Rodrigues
- Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
| | | | | | | | - Vanda Maria Ferreira Simões
- Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
| | - Cynthia Magluta
- Instituto Fernando Figueira, Fiocruz. Rio de Janeiro RJ Brasil
| | - Fernando Lamy-Filho
- Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
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Costa MDFDS, Magluta C, Gomes Junior SCDS. [Profile of service providers in high-risk neonatal care in the databases of the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2020; 36:e00219618. [PMID: 32267387 DOI: 10.1590/0102-311x00219618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 09/23/2019] [Indexed: 11/22/2022] Open
Abstract
The study aimed to analyze the profile of service providers in the Brazilian Unified National Health System (SUS) in relation to high-risk neonatal care procedures, based on data from the public-access database on Authorizations for Hospital Admissions (AIH) without identification of the neonatal patient. This cross-sectional study used data on AIH of unidentified newborns up to one day old, issued from January 2013 to December 2015, and from the National Registry of Healthcare Establishments. The TwoStep Cluster method was used to classify the establishments with similar characteristics. Regional differences were observed in the frequency of use of neonatal intensive care units and in special procedures recorded in the databases. The TwoStep Cluster method identified three groupings of providers: the first with 1,151 establishments and with low-complexity hospitalizations, the second with 84 establishments and surgical-profile hospitalizations, and the third with 393 establishments and higher complexity hospitalizations in neonatal care, including surgeries. The records on admissions jointly with multivariate analytical techniques have the potential to support decision-making by SUS administrators in the organization of neonatal care.
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Affiliation(s)
- Maria de Fatima Dos Santos Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Cynthia Magluta
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Hariharan L, Gilbert CE, Quinn GE, Barg FK, Lomuto C, Quiroga A, McLeod-Omawale J, Zin A, Ortiz Z, Alda E, Bouzas L, Brussa M, Cattaino A, Dinerstein A, Erpen N, Fandiño A, Galina L, Manzitti J, Marinaro S, Sepúlveda T, Visintín P, Silva JC, Magluta C, Benitez A. Reducing Blindness from Retinopathy of Prematurity (ROP) in Argentina Through Collaboration, Advocacy and Policy Implementation. Health Policy Plan 2018; 33:654-665. [PMID: 29668967 DOI: 10.1093/heapol/czy004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 11/12/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a largely avoidable cause of blindness in children worldwide, requiring high-quality neonatal care, early detection and treatment. In middle-income countries throughout Latin America, Eastern Europe and South Asia, there has been a rise in ROP blindness due to a combination of increased survival of preterm infants, resource-scarce medical environments and lack of policies, training and human resources. However, Argentina is an example of country where rates of ROP blindness have declined and ROP programmes have been successfully and effectively embedded within the health and legal system. The purpose of this study is to describe the activities and stakeholders, including Ministry of Health (MoH) and UNICEF, involved in the process, from recognition of an epidemic of ROP blindness to the development of national guidelines, policies and legislation for control. Using a retrospective mixed methods case study design, data on rates of severe ROP was collected from 13 neonatal intensive care units from 1999 to 2012, and on the proportion of children blind from ROP in nine blind schools in seven provinces. Legislative document review, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, parents, MoH officials, clinical societies, legislators and UNICEF officials in seven provinces. Results are presented combining the stages heuristic policy framework and Shiffman including: agenda setting, policy formulation, implementation and evaluation. By 2012, ROP had declined as a cause of blindness in children in schools for the blind as had rates of severe ROP needing treatment in the NICUs visited. Multiple factors played a role in reducing blindness from ROP in Argentina and successfully coordinating its control including national advocacy, leadership, legislation and international collaboration. Lessons learned in Argentina can potentially be scaled to other LMICs in Latin America and beyond with further context-specific research.
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Affiliation(s)
- Luxme Hariharan
- Division of Ophthalmology, Children's Hospital of Philadelphia (CHOP), Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Clare E Gilbert
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Graham E Quinn
- Division of Ophthalmology, Children's Hospital of Philadelphia (CHOP), Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA
| | - Celia Lomuto
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Ana Quiroga
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | | | - Andrea Zin
- Instituto Fernandes Figueira, FIOCRUZ, Av. Rui Barbosa, 716 - Flamengo, Rio de Janeiro - RJ 20021-140, Brazil
| | - Zulma Ortiz
- UNICEF Argentina, Junin 1940 - Planta Baja, Codigo Postal C1113AAX, Buenos Aires, Argentina
| | - Ernesto Alda
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Liliana Bouzas
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Marina Brussa
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Adriana Cattaino
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Alejandro Dinerstein
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Norma Erpen
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Adriana Fandiño
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Lidia Galina
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Julio Manzitti
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Silvia Marinaro
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Teresa Sepúlveda
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Patricia Visintín
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
| | - Juan Carlos Silva
- Division of Blindness Prevention, Pan American Health Organization (PAHO), Calle (Street) 66, No.11-50, 6th Floor Building, Apartado Aéreo 253367, Bogotá, DC, Colombia
| | - Cynthia Magluta
- Instituto Fernandes Figueira, FIOCRUZ, Av. Rui Barbosa, 716 - Flamengo, Rio de Janeiro - RJ 20021-140, Brazil
| | - Alicia Benitez
- Argentina Ministry of Health: Multidisciplinary Collaborative ROP Group: Buenos Aires, Av. 9 de Julio 1925 - Ciudad Autónoma de Buenos Aires, C1073ABA Buenos Aires, Argentina
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Costa MDFDS, Gomes Junior SC, Magluta C. Análise da distribuição dos nascimentos com marcadores de gravidade em maternidades com unidade de terapia intensiva neonatal no Sistema Único de Saúde. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/1414-462x201800020419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo Introdução No Brasil, os óbitos neonatais são a principal componente da mortalidade infantil sendo necessário informações para subsidiar a reorganização dos sistemas locais e o planejamento da oferta do cuidado neonatal. Objetivo Verificar a potencialidade do Sistema de Informação sobre Nascidos Vivos (SINASC) para descrever a distribuição dos nascimentos com marcadores de gravidade em maternidades com unidade de terapia intensiva neonatal no Sistema Único de Saúde. Método Trata-se de estudo transversal com o uso do SINASC. O peso de nascimento e o escore de Apgar no 5º minuto foram utilizados para a construção dos marcadores de gravidade. A complexidade das maternidades foi descrita pela existência de unidade de terapia intensiva neonatal níveis II ou III. Resultados No Brasil, 55% dos nascimentos e 38% daqueles com marcadores de gravidade ocorreram em estabelecimentos sem terapia intensiva. Os menores de 1.500 g apresentaram maiores percentuais de nascimentos em estabelecimentos que dispõem de terapia intensiva. Observou-se uma maior frequência de nascimento em terapia intensiva nas regiões Sudeste e Sul. Conclusão O SINASC, mesmo tendo problemas no registro de variáveis importantes para definição dos marcadores de gravidade neonatal, apresentou potencial para ser usado por pesquisadores e gestores de saúde na análise do cuidado neonatal.
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Catarino CF, Gomes MADSM, Gomes SCDS, Magluta C. [Records of congenital heart disease in infants under one year in information systems on birth, hospitalization and death in Rio de Janeiro State, Brazil, 2006-2010]. Epidemiol Serv Saude 2017; 26:535-543. [PMID: 28977178 DOI: 10.5123/s1679-49742017000300011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 03/20/2017] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to describe the occurrence of cases of congenital heart disease in infants under one year recorded in health information systems of Rio de Janeiro State, from 2006 to 2010. METHODS descriptive study with data from the Information System on Live Births (Sinasc), Hospital Information System of the Brazilian National Health System (SIH/SUS) and Mortality Information System (SIM). RESULTS a total of 345 records were found on Sinasc, there were 1,089 hospitalized children (SIH/SUS) and 1,121 deaths (SIM) of children under one year of age whose underlying cause was congenital heart disease; the prevalence of congenital heart disease was 3.18/10,000 live births; heart diseases were the main causes of death in the group of congenital malformations, with a mortality coefficient of 1.03/1,000 live births. CONCLUSION there was underreporting of cases of congenital heart disease on Sinasc, demonstrating the difficulty of early diagnosis.
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Affiliation(s)
- Camilla Ferreira Catarino
- Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria 'Martagão Gesteira', Rio de Janeiro-RJ, Brasil
| | | | - Saint Clair Dos Santos Gomes
- Fundação Instituto Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente 'Fernandes Figueira', Rio de Janeiro-RJ, Brasil
| | - Cynthia Magluta
- Fundação Instituto Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente 'Fernandes Figueira', Rio de Janeiro-RJ, Brasil
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Costa AMAM, Magluta C, Gomes Junior SC. Evaluation of continuing education of family health strategy teams for the early identification of suspected cases of cancer in children. BMC Med Educ 2017; 17:155. [PMID: 28882154 PMCID: PMC5590150 DOI: 10.1186/s12909-017-0993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND This study evaluated the influence of continuing education of family health strategy teams by the Ronald McDonald Institute program on the early diagnosis of cancer in children and adolescents. METHODS The study applied Habicht's model to evaluate the adequacy and plausibility of continuing education by using as outcome the number of children with suspected cancer who were referred to the hospital of references in the 1 year before and 1 year after intervention and the number of patients referred by intervention group and control group family health strategy teams. Medical records from each hospital of reference were used to collect information of suspect cases of cancer. Descriptive analyses were performed using frequencies and mean values. Chi-square tests were used to assess statistically significant differences between the groups and periods by using p-values < 0.05. RESULTS The results showed a 30.6% increase in the number of children referred to the hospital of reference for suspected cancer in the post-intervention period; in addition, the family health strategy teams that underwent the intervention referred 3.6 times more number of children to hospital of references than did the control group. Only the intervention group showed an increase in the number of confirmed cases. CONCLUSIONS This evaluation of a continuing education program for early identification of pediatric cancer showed that the program was adequate in achieving the established goals and that the results could be attributed to the program.
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Affiliation(s)
- Ana Maria Aranha Magalhaes Costa
- Unidade de Pesquisa Clínica, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz ( Fiocruz ), Av. Rui Barbosa 716 Flamengo, Rio de Janeiro, 22250-020 Rio de Janeiro Brazil
| | - Cynthia Magluta
- Unidade de Pesquisa Clínica, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz ( Fiocruz ), Av. Rui Barbosa 716 Flamengo, Rio de Janeiro, 22250-020 Rio de Janeiro Brazil
| | - Saint Clair Gomes Junior
- Unidade de Pesquisa Clínica, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz ( Fiocruz ), Av. Rui Barbosa 716 Flamengo, Rio de Janeiro, 22250-020 Rio de Janeiro Brazil
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Zin AA, Magluta C, Pinto MFT, Entringer AP, Mendes-Gomes MA, Moreira MEL, Gilbert C. Retinopathy of prematurity screening and treatment cost in Brazil. Rev Panam Salud Publica 2014; 36:37-43. [PMID: 25211676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To assess the additional cost of incorporating the detection and treatment of retinopathy of prematurity (ROP) into neonatal care services of Brazil's Unified Health System (SUS). METHODS A deterministic decision-tree simulation model was built to estimate the direct costs of screening for and treating ROP in neonatal intensive-care units (NICUs), based on data for 869 preterm infants with birth weight less than 1 500 g examined in six governmental NICUs in the capital city of Rio de Janeiro, where coverage was 52% and 8% of infants were treated. All of the parameters from this study were extrapolated to Brazilian newborn estimates in 2010. Costs of screening and treatment were estimated considering staff, equipment and maintenance, and training based on published data and expert opinion. A budget impact analysis was performed considering the population of preterm newborns, screening coverage, and the incidence of treatable ROP. One- and two-way sensitivity analyses were performed. RESULTS In Rio de Janeiro, unit costs per newborn were US$ 18 for each examination, US$ 398 per treatment, and US$ 29 for training. The estimated cost of ROP diagnosis and treatment for all at-risk infants NICUs was US$ 80 per infant. The additional cost to the SUS for one year would be US$ 556 640 for a ROP program with 52% coverage, increasing to US$ 856 320 for 80% coverage, and US$ 1.07 million or 100% coverage. CONCLUSIONS The results of this study indicate that providing ROP care is affordable within the framework of the SUS in Brazil, and might be feasible elsewhere in Latin America, considering the evidence of the effectiveness of ROP treatment and the social benefits achieved.
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Affiliation(s)
- Andrea A Zin
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Cynthia Magluta
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Márcia F T Pinto
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Aline P Entringer
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Maria A Mendes-Gomes
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Maria E L Moreira
- Department of Clinical Research, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil,
| | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, United Kingdom
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Entringer AP, Pinto MT, Magluta C, Gomes MADSM. Impacto orçamentário da utilização do Método Canguru no cuidado neonatal. Rev Saude Publica 2013; 47:976-83. [DOI: 10.1590/s0034-8910.2013047004569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 07/01/2013] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO Estimar o impacto orçamentário da utilização do Método Canguru na rede municipal de saúde. MÉTODOS Um modelo de decisão analítico foi desenvolvido para simular os custos do Método Canguru e Unidade Intermediária Neonatal no Rio de Janeiro, RJ, em 2011. A população de referência foi constituída pelos recém-nascidos estáveis clinicamente, que podem receber assistência nas duas modalidades de cuidado. O impacto orçamentário foi estimado para uma coorte hipotética de 1.000 recém-nascidos elegíveis em um ano. A proporção de recém-nascidos elegíveis que recebem assistência nas duas modalidades foi obtida por coleta de dados nas maternidades incluídas no estudo. As probabilidades dos eventos e o consumo de recursos de saúde, no período da assistência, foram incorporados ao modelo. Cenários foram desenvolvidos para refletir a adoção do método Canguru em maior ou menor escala. RESULTADOS A utilização do Método Canguru significou redução de gastos equivalente a 16% em um ano, se todos os recém-nascidos elegíveis fossem assistidos por esse método. CONCLUSÕES A opção Método Canguru é de menor custo comparado com a da Unidade Intermediária Neonatal. A análise de impacto orçamentário da utilização desse método no Sistema Único de Saúde indicou economia importante para o período de um ano.
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Entringer AP, Gomes MADSM, Pinto M, Caetano R, Magluta C, Lamy ZC. [Cost analysis of hospital care for newborns at risk: comparison of an Intermediate Neonatal Care Unit and a Kangaroo Unit]. CAD SAUDE PUBLICA 2013; 29:1205-1216. [PMID: 23778552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 02/01/2013] [Indexed: 06/02/2023] Open
Abstract
The aim of this study was to compare the direct costs of implementation of the Kangaroo Method and an Intermediate Neonatal Care Unit, from the perspective of the Brazilian Unified National Health System (SUS) in Rio de Janeiro, Brazil. Newborns were eligible for inclusion if they were clinically stable and were able to receive care in those two modalities. A decision tree model was developed that incorporated baseline variables and costs into a hypothetical cohort of 1,000 newborns, according to the literature and expert opinions. Daily cost was BR$343.53 for the second stage of the Kangaroo Unit and BR$394.22 for the Intermediate Neonatal Care Unit. The total cost for the hypothetical cohort was BR$5,710,281.66 for the second and third stages of the Kangaroo Unit and R$7,119,865.61 for the Intermediate Neonatal Care Unit. The Intermediate Neonatal Care Unit cost 25% more than the Kangaroo Unit. The study can contribute to decision-making in health, in addition to providing support for studies related to economic evaluation in neonatal health.
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Affiliation(s)
- Aline Piovezan Entringer
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
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Entringer AP, Gomes MADSM, Pinto M, Caetano R, Magluta C, Lamy ZC. Análise de custos da atenção hospitalar a recém-nascidos de risco: uma comparação entre Unidade Intermediária Convencional e Unidade Canguru. CAD SAUDE PUBLICA 2013. [DOI: 10.1590/s0102-311x2013000600017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
O objetivo deste estudo foi realizar uma análise comparativa entre o custo da Unidade Canguru e da Unidade Intermediária Convencional sob a perspectiva do SUS, no Município do Rio de Janeiro, Brasil. A população de referência é de recém-nascidos estáveis clinicamente, que podem receber assistência nas duas modalidades de cuidado. Um modelo de análise de decisão para uma coorte hipotética de mil recém-nascidos elegíveis foi elaborado para comparar os custos em cada estratégia avaliada. As probabilidades dos eventos e o consumo de recursos de saúde foram incorporados ao modelo com base na literatura e consulta a especialistas. O custo da diária foi de R$343,53 para a 2ª etapa da Unidade Canguru e de R$394,22 para a Unidade Intermediária Convencional. O custo para a coorte hipotética foi de R$5.710.281,66 para a assistência na 2ª e 3ª etapa da Unidade Canguru e de R$7.119.865,61 para a Unidade Intermediária Convencional. A Unidade Intermediária Convencional apresentou custos 25% superiores aos da Unidade Canguru. O estudo pode contribuir para a tomada de decisão na área da saúde, além de fornecer subsídios para pesquisas relacionadas à avaliação econômica na área neonatal.
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Entringer AP, Gomes MADSM, Pinto M, Caetano R, Magluta C, Lamy ZC. Análise de custos da atenção hospitalar a recém-nascidos de risco: uma comparação entre Unidade Intermediária Convencional e Unidade Canguru. CAD SAUDE PUBLICA 2013. [DOI: 10.1590/s0102-311x2013001000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Magluta C, Gomes MADSM, Wuillaume SM. Difficulties in the dissemination and implementation of clinical guidelines in government neonatal intensive care units in Brazil: how managers, medical and nursing, position themselves. J Eval Clin Pract 2011; 17:744-8. [PMID: 21501340 DOI: 10.1111/j.1365-2753.2011.01681.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Clinical guidelines are tools that systematize scientific evidence and help to achieve proper care. Several difficulties are reported regarding the effective use, such as the shortcomings in the level of knowledge and attitudes by the professionals, the service structure and the preferences appointed by patients. An analysis of these difficulties was the objective of this study in the context of government Neonatal Intensive Care Units (NICU) in Brazil. METHOD A semi-structured survey was carried out with 53 managers (medical and nursing) of the 15 NICU in a convenient sample of two groups of government units in Brazil. The managers chose their answers from a list of difficulties to implement the guidelines based on the analytical model of Cabana and graded the difficulties found on a 5-point scale with no reference to quality. RESULTS Respondents have reported several difficulties with the following priority: lack of professionals to provide care, being perceived as more critical within the nursing and physiotherapy crews, minor participation of professionals in the discussion process and inadequate infrastructure. The lack of acquaintance with the guidelines by the professionals has been reported by few of the surveyed. CONCLUSION These findings show some common ground to literature pointing the importance of adequate infrastructure. Managers showed a low valuation of both the level of knowledge and the professionals' adhesion to the guidelines.
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Affiliation(s)
- Cynthia Magluta
- Clinical Research Unit, Fernandes Figueira Institute/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Magluta C, Noronha MFD, Gomes MAM, Aquino LAD, Alves CA, Silva RSD. Estrutura de maternidades do Sistema Único de Saúde do Rio de Janeiro: desafio à qualidade do cuidado à saúde. Rev Bras Saude Mater Infant 2009. [DOI: 10.1590/s1519-38292009000300011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: avaliar a estrutura de maternidades pertencentes ao Sistema Único de Saúde (SUS) do Estado do Rio de Janeiro. MÉTODO: REalizou-se uma avaliação normativa, com corte transversal de maternidades selecionadas, vinculadas ao SUS no ano de 2005. Foram selecionadas 67 maternidades por amostragem de conveniência. Foram empregados um roteiro de observação e um de entrevistas com chefes de serviço e profissionais. Aspectos da estrutura destes serviços foram analisados, utilizando-se como referência a conformidade com as normas disponibilizadas pelo Ministério da Saúde e preconizadas na literatura. Esses aspectos foram: instalação, equipamentos, equipe de saúde, capacitação de profissionais e disponibilidade de diretrizes clínicas. RESULTADOS: a presença dos requisitos da estrutura avaliados difere entre os estratos de complexidade, sendo menos frequente nas maternidades de menor complexidade. Os aspectos da estrutura física, disponibilidade de diretrizes clínicas e a presença dos profissionais nos serviços foram mais adequados do que a capacitação oferecida pelos serviços. CONCLUSÕES: SÃo necessários investimentos na capacitação dos profissionais, ampliação da disponibilidade de diretrizes clínicas e melhoria da estrutura física, visando qualificar o cuidado perinatal e adequá-lo às regulamentações nacionais.
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Méio MDBB, Magluta C, Mello RRD, Moreira MEL. Análise situacional do atendimento ambulatorial prestado a recém-nascidos egressos das unidades de terapia intensiva neonatais no Estado do Rio de Janeiro. Ciênc saúde coletiva 2005. [DOI: 10.1590/s1413-81232005000200007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A diminuição da mortalidade neonatal contribui para o aumento de crianças que necessitam de maior atenção em relação a morbidades clínicas e à evolução do desenvolvimento neuropsicomotor. O objetivo deste estudo foi discutir a situação da assistência às crianças egressas das Unidades de Terapia Intensiva Neonatais (UTIN) em cinco unidades em diferentes regiões do Estado do Rio de Janeiro; em nenhuma havia informações sobre o perfil dos egressos da UTIN. Evidenciou-se restrição ao acesso e baixa estruturação da rede em relação à assistência prestada a esses bebês. Não há uniformidade no atendimento prestado, e ambulatórios específicos para essa população concentram-se na cidade do Rio de Janeiro. Constatou-se deficiência de profissionais nas áreas de reabilitação - fisioterapia motora, terapia ocupacional, fonoaudiologia e psicologia -, e de especialistas para atendimento oftalmológico adequado e para a criança portadora de deficiência auditiva. Os autores discutem possíveis explicações para essa situação, propondo a organização de um sistema de atendimento em graus de complexidade para poder viabilizar o acesso das crianças de risco a um atendimento diferenciado, importante para detecção precoce de anormalidades do desenvolvimento.
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Magluta C. Análise estratégica em saúde e gestão pela escuta. CAD SAUDE PUBLICA 2004. [DOI: 10.1590/s0102-311x2004000600045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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