云南省农村艾滋病母婴传播阻断模式及运转机制研究

目的:探讨提高农村艾滋病母婴传播阻断服务的可及性、可获得性和可接受性策略,制订农村艾滋病母婴传播阻断有效运转机制,增强其可持续性发展。方法:2005~2006年在云南6个县市开展现场研究。结果:农村艾滋病母婴传播阻断管理与服务由政府主导,多部门合作,明确职责,强化管理,综合服务,注重个性,优化氛围,主动参与。将艾滋病母婴传播阻断工作融入常规妇幼卫生与疾病预防控制工作中,并与现行的农村、妇幼卫生政策结合;建立责任制与监督指导评估制度,为HIV感染孕产妇提供保健、抗病毒治疗、住院分娩、儿童保健与追踪等系列服务。全程管理和抗病毒治疗及相关服务由专人负责,孕产妇保健和住院分娩服务开放,由接诊医生和住院医生负责。艾滋病母婴传播率显著下降。结论:农村艾滋病母婴传播阻断管理模式促进了农村预防艾滋病母婴传播的多方参与,运行机制为该项服务的可持续发展提供了保障,服务模式促进了农村妇女尽早接受艾滋病自愿咨询检测和艾滋病感染孕产妇对母婴阻断服务的可获得性、可及性和可接受性。     

广西艾滋病母婴传播强化干预效果分析

目的：探讨提高广西预防艾滋病母婴传播服务可及性和有效性的工作模式。方法收集2009年至2013年广西各市县预防艾滋病母婴传播工作月报表、HIV阳性孕产妇个案登记卡,查阅自治区、市、县项目年度督导及工作总结等资料,进行统计分析。结果形成了政府主导,多部门合作,全社会参与的工作氛围,建立目标管理责任制、监督指导和信息上报制度,将预防艾滋病母婴传播工作融入常规妇幼卫生工作中,并与其他项目紧密结合,为HIV阳性孕产妇提供保健、抗病毒治疗、住院分娩等服务;由专人对HIV阳性母亲所生婴儿进行全程强化管理。婚前保健人群、孕产期妇女HIV检测率分别从2009年的80.14%和83.07%上升到2013年的99.97%和99.86%;HIV阳性产妇及其所生婴儿应用抗病毒药物的比例分别从2009年的56.68%和77.78%上升到2013年的94.60%和97.69%;母婴传播率控制在5%以下。结论实施攻坚工程使广西预防艾滋病母婴传播各项措施得到了有效落实,目标人群HIV筛查率、HIV阳性孕产妇及其所生婴儿抗病毒药物用药率逐年上升。     

HIV感染儿童的母亲预防艾滋病母婴传播服务障碍分析

目的了解HIV感染儿童的母亲孕产期接受孕产期保健服务和预防艾滋病母婴传播服务的状况,为提高云南全省预防艾滋病母婴传播服务覆盖面提供科学依据。方法从云南省艾滋病综合防治数据信息系统中获得调查对象基本信息,统一培训后,使用自行设计的问卷通过一对一、面对面的询问方式,回顾性调查HIV感染儿童的母亲孕产期接受保健服务和预防艾滋病母婴传播服务的有关信息。结果 1HIV感染儿童母亲及父亲文化程度偏低,职业以农民为主,主要居住在云南省高疫情地区,母亲孕期产检比为53.17%,住院分娩比例为62.70%;孕产期HIV检测比例为46.83%,HIV阳性检出比为38.14%。不同类型医疗机构间HIV咨询检测服务质量存在较大差距。2HIV感染儿童母亲未进行产前检查的原因主要为"不知道怀孕后需要进行产检",孕产期未进行HIV检测的主要原因依次为"未到医疗机构产检或住院分娩"、"产检或住院分娩时医生未提供检测"。HIV抗体阳性孕产妇拒绝服用抗病毒药物的主要原因是对预防HIV母婴传播工作缺乏了解和信任。结论 HIV感染儿童的母亲缺乏孕产期保健意识,孕产期保健服务利用不足,医疗机构尤其是民营医疗机构的HIV咨询检测服务不规范,影响HIV感染孕产妇的及时发现和HIV感染孕产妇抗病毒药物应用。建议探索有针对性的服务模式,提高基础妇幼保健和预防艾滋病母婴传播工作的可及性。     

艾滋病母婴传播阻断抗病毒治疗依从性及影响因素

目的:探讨艾滋病母婴传播阻断抗病毒治疗的依从性水平与主要影响因素,为制定HIV阳性孕产妇及其所生婴儿抗病毒治疗规范用药的措施提供依据。方法:在云南省5个艾滋病高发县(市、区)及一家省级保健机构对艾滋病母婴传播阻断抗病毒治疗方案的依从性进行了现况调查。结果:抗病毒治疗依从性良好者占91.0%(111/122)。影响HIV阳性孕产妇及婴儿服药依从性的主要因素为医生对HIV阳性孕产妇的态度,医患间的沟通与合作程度,方案的复杂程度,家庭人均收入,家庭支持,是否在县级及以上助产机构住院分娩,以及患者对艾滋病抗病毒治疗方案的认识,对生育的态度。结论:HIV感染孕产妇艾滋病母婴传播阻断抗病毒治疗服药依从性较好,多个因素对HIV感染孕产妇服药依从性有影响。     

60例HIV感染孕产妇调查结果分析

目的:了解HIV感染孕产妇对预防艾滋病母婴传播服务的需求及服务利用中存在的主要障碍,以提高预防艾滋病母婴传播服务措施的效果。方法:对2005年1月～2006年7月在我院产前检查发现的60例HIV感染孕产妇进行问卷调查。结果:15%的孕产妇不愿意接受产前检查,25%的孕产妇不愿意住院分娩,怕歧视、担心检查和住院分娩费用高等是孕产妇不接受孕产期保健的主要原因;91.6%的孕产妇愿意本人和给孩子服用抗逆转录病毒药物预防艾滋病母婴传播,93.3%的孕产妇不希望其所生婴幼儿获得随访服务,怕别人知道自己感染HIV是不愿意接受随访的主要原因。结论:HIV感染孕产妇检测不及时、经济负担、社会歧视问题是预防艾滋病母婴传播服务利用的主要障碍。     

社会性别对艾滋病感染妇女利用PMTCT服务的影响

目的 从社会性别的视角了解少数民族地区艾滋病感染妇女所处的家庭环境,及对利用预防艾滋病母婴传播服务产生的影响.方法 采用定性研究方法,通过深入访谈和现场观察来获取研究资料.结果 大多数妇女是通过配偶感染艾滋病的,因夫妻间很少使用安全套;所调查的21名艾滋病感染妇女的妊娠结局为:1名人工终止妊娠,20名足月分娩,其中15名接受过1次产前保健,19名住院分娩,1名在家中分娩;有11名应用了抗病毒药物;足月分娩的婴儿中,有17名应用了抗病毒药物,18名采用人工喂养;所有的丈夫都支持妻子接受预防艾滋病母婴传播服务.结论 来自丈夫的支持是艾滋病感染孕产妇利用预防艾滋病母婴传播服务的促进因素.男性积极参与艾滋病防治将有利于预防艾滋病母婴传播服务的实施.     

云南省芒市采用高效抗反转录病毒治疗方案预防艾滋病母婴传播项目成果分析

目的对艾滋病感染孕产妇在孕期采用高效抗反转录病毒治疗(HAART)方案等综合措施预防艾滋病母婴传播,最大限度地控制母婴传播,保护妇女自身的健康,降低耐药的风险。方法 2006-2010年在云南省德宏州芒市,为接受产前保健的所有孕产妇提供艾滋病检测和咨询,对艾滋病感染孕产妇采用HAART方案、安全分娩及为其所生儿童提供预防性服用抗病毒药物等措施预防艾滋病母婴传播,规范孕产妇产后停药及儿童随访和转介服务,描述性分析孕产妇采用HAART方案的比例、用药副作用,以及预防艾滋病母婴传播效果。结果 5年间158名艾滋病感染孕产妇中,66%采用HAART方案预防母婴传播,采用HAART方案孕产妇所生105名活产儿中,有1名HIV阳性(1.0%)。结论在中国农村资源有限、边疆、民族地区,采用HAART方法预防HIV母婴传播是可行、安全和有效的。     

HIV抗体阳性孕产妇母婴阻断措施实施情况分析

目的 了解商丘市预防艾滋病病毒母婴传播措施的实施情况及母婴阻断效果,探讨预防艾滋病病毒母婴传播对策.方法 对2005-06/2007-07发现的48例HIV抗体阳性孕产妇进行问卷调查及随访,收集其妊娠结局、抗病毒药物服用情况、分娩方式、婴儿喂养方式、婴儿HIV感染情况等资料并进行分析.结果 23例孕妇实施人工流产,2例自然流产,4例处于妊娠期,19例已分娩.分娩的产妇有84.2%规律服用过抗病毒药物,47.4%采用了剖宫产;19例新生儿中,89.5%规律服用过抗病毒药物,94.7%采用人工喂养.10例婴儿在满18月龄时检测HIV抗体为阴性.结论 现行的预防艾滋病母婴传播措施是可行的.完善妇幼保健服务网络,提高孕期保健率,促进孕产妇HIV咨询检测工作,及时发现HIV感染孕产妇以及加强对阳性育龄妇女的随访是深化母婴阻断工作的重要途径.     

嘉兴市HIV感染孕产妇特征及艾滋病母婴阻断分析

目的分析2010—2018年嘉兴市HIV感染孕产妇特征及艾滋病母婴阻断情况,为完善艾滋病母婴阻断措施并消除艾滋病母婴传播提供依据。方法从国家妇幼卫生综合信息平台预防艾滋病、梅毒和乙肝母婴传播管理信息系统导出2010—2018年嘉兴市HIV感染孕产妇个案资料,描述性分析HIV感染孕产妇的人口学特征、抗病毒药物服用率、艾滋病暴露儿童早期诊断检测率和艾滋病母婴传播率等。结果 2010—2018年嘉兴市行HIV抗体检测孕产妇455 450人,平均HIV抗体检测率为98.97%,阳性率为2.96/万。HIV感染孕产妇135例,平均年龄(27.46±5.94)岁;以初中及以下文化程度为主,104例占77.04%;职业以家务及待业为主,70例占51.85%;外地户籍121例,占89.63%。确证感染时期主要为孕产期,73例占54.07%;感染途径主要为性接触,83例占61.48%。HIV感染孕产妇抗病毒药物服用率为69.49%;暴露儿童抗病毒药物服用率为92.73%,呈逐年上升趋势(P0.05)。HIV感染孕产妇分娩活产儿满18月龄的有35人,HIV抗体检测率为71.43%,阳性率为0,艾滋病母婴传播率为0。34名满3月龄儿童中,早期诊断检测率为88.23%,HIV抗体阳性率为0。结论嘉兴市HIV感染孕产妇以流动人口为主,文化程度较低,以性接触感染为主;2010—2018年未发生艾滋病母婴传播。     

2015-2019年温州市HIV感染孕产妇特征分析

目的了解2015-2019年温州市HIV感染孕产妇特征,为进一步改进预防艾滋病母婴传播工作的管理模式,降低艾滋病母婴传播率,提供科学依据。方法采用回顾性调查分析法,通过国家妇幼卫生综合信息平台预防艾滋病、梅毒和乙肝母婴传播管理信息系统,对2015年1月1日-2019年12月31日在温州医疗机构建册、产前检查及确诊的HIV感染孕产妇个案资料进行分析,比较本市户籍和非本市户籍(流动人口)孕产妇感染HIV阳性率的差别,分析HIV感染孕产妇特征及母婴传播率,并采用Logistic回归模型分析母婴传播影响因素。结果 2015-2019年温州市累计检测孕产妇507 014人,其中检出HIV感染孕产妇137例,感染率为27.02/10万。流动人口孕产妇HIV感染率高于户籍孕产妇,差异有统计学意义(P0.05),2015-2019年温州HIV孕产妇感染率呈逐年上升趋势,但以2018年感染率最高。多因素Logistic回归分析结果显示,在校正HIV感染孕产妇的年龄、文化程度、职业、孕产次等因素后发现,择期剖宫产、孕产妇孕期开始接受抗病毒治疗时间早为母婴传播的保护因素,急诊剖宫产为母婴传播的危险因素(均P0.05)。结论 2015-2019年温州市孕产妇HIV感染以25～35岁、初中文化程度、已婚家庭主妇/无业为主,且以流动人群比例高,确诊时间以孕期保健时发现为主。择期剖宫产、孕产妇孕期开始接受抗病毒治疗时间早为母婴传播的保护因素,急诊剖宫产为母婴传播的危险因素。因此,普及人群艾滋病母婴阻断宣传,加强性活跃年龄段、低学历、无业、流动人群孕产妇管理,早诊断、抗病毒治疗是控制艾滋病母婴传播的工作重点。     

母亲参与婴幼儿保健对母子交流情况的影响

目的:促进儿童早期身心全面发展,探讨母亲参与婴幼儿保健对母婴交流情况的影响。方法:在中山某社区内实施促进儿童早期发展干预活动后,对参加项目的母亲进行问卷调查以了解母亲与孩子交流的情况,并与对照组进行比较。结果:实验组母亲更擅于与孩子交流,例如在经常主动对孩子说话、经常和孩子一起做游戏、能够多数知道孩子哭闹或不高兴的原因、孩子半岁内能够经常抚摸孩子等方面,两组比较有显著性差异。结论:让母亲参与婴幼儿保健促进了母子之间的情感交流,更有利于儿童健康成长。     

妇幼卫生服务需求与产褥期妇女个体因素的典型相关分析

目的探讨产褥期妇女妇幼卫生服务需求与个体因素关系密切的各种因素,为妇幼保健机构有针对性地对其开展妇幼卫生服务项目提供理论依据。方法自行设计调查表,采取面对面访谈形式对产褥期妇女妇幼卫生服务需求与个体因素进行调查。数据运用典型相关进行统计分析。结果产褥期妇女妇幼卫生服务需求与个体因素相互联系、相互制约,其关联主要是婴幼儿疾病的早期发现、产后康复指导、新生儿喂养及辅食添加指导与产褥期妇女的职业、居住地、家庭收入的数额范围之间的相关。结论妇幼保健机构应针对不同职业、不同地区、不同经济收入的产褥期妇女的需求,大力开展母亲和儿童的卫生保健项目,努力提高基本医疗卫生服务的可获得性,以期更好的全面促进母婴健康,提高妇幼卫生服务水平。     

曹县成功阻断1起艾滋病的母婴传播

曹县利用计生网络开展孕妇HIV抗体筛查,对1例HIV抗体阳性孕妇实施孕期保健指导、孕期检查随访、母婴阻断用药、剖宫产手术、新生儿预防服药等措施,成功阻断了母婴途径传播的发生。     

Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana

Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub‐Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care‐seeking behaviours have focused on identifying the norms of non‐use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor–patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non‐state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor–patient relational practices that positively influence women's healthcare‐seeking behaviours. Copyright © 2015 John Wiley & Sons, Ltd.     

Proactive infant security: how New Jersey hospitals reacted to a kidnapping incident

A number of hospitals in New Jersey have taken steps to tighten security procedures to prevent infant abductions, including the use of electronic technology and efforts to further restrict access to unauthorized persons in their maternity wards. Highlighting the need for increased attention to safety and security, hospital and security officials say, was an abduction at St. Joseph's Hospital and Medical Center, Paterson, NJ, on August 20, 1997, in which a 16-year-old female allegedly took a two-day-old baby from a room while the mother was showering and left the hospital. The mother and suspect, according to police reports, had engaged in friendly conversation for about an hour. The mother then asked the teenager to watch the baby while she showered. When she returned, both the teenager and child were missing from the room. The baby was found unharmed by Paterson police later that night and returned to the hospital. The teenage suspect was arrested. In this report, we'll present examples of what other New Jersey hospitals, some part of healthcare systems, are doing to prevent similar infant abduction incidents at their institutions. In nearly all cases, officials at these hospitals report there has never been an infant abduction, but say preventive action has been taken to be proactive and improve the safety consciousness of staff and patients.     

产科床位利用情况研究

采用定性研究的方法，对《区域卫生规划项目》地区（浙江省金华市、江西省九江市、陕西省宝鸡市）产科床位使用率低的原因进行了研究。结果表明，产科床位使用率低的原因有：住院分娩率低、产科平均住院日少、个别地区产科床位有些偏多以及分娩的季节差异。同时也了解了孕产妇保健服务中的一些问题，进而提出了提高住院分娩率、提高产科服务质量，确保孕产妇和婴儿安全的措施。     

妊娠期糖尿病86例临床分析

目的:分析妊娠期糖尿病对母婴的影响。方法:对86例妊娠期糖尿病孕妇与86例正常孕妇妊娠结局进行分析。结果:妊娠期糖尿病组妊高征、胎儿窘迫、剖宫产、早产、巨大儿、新生儿窒息、新生儿低血糖发生率高于对照组。结论:妊娠期糖尿病严重影响母婴健康,应该及时发现此病并控制血糖,降低母婴并发症。     

妊娠期糖尿病85例临床分析

目的：探讨妊娠期糖尿病对母婴的影响。方法：分析我院住院分娩的妊娠期糖尿病孕妇和健康孕妇各85例的妊娠结局。结果：妊娠期糖尿病孕妇妊娠期高血压疾病、羊水过多、胎儿窘迫、剖宫产、巨大儿、早产、新生儿窒息、新生儿低血糖发生率高于对照组。结论：妊娠期糖尿病严重影响母婴健康，应及时发现妊娠期糖尿病并控制血糖，减少母儿并发症。     

Are breastfeeding rates higher among mothers delivering in Baby Friendly accredited maternity units in the UK?

BACKGROUND: The promotion and support of breastfeeding is a global priority with benefits for maternal and infant health, particularly in low-income and middle-income countries where its relevance for child survival is undisputed. However, breastfeeding rates are strikingly low in some higher-income countries, including the UK. Evidence to support the effectiveness of public health interventions to increase rates of breastfeeding initiation and duration in this setting is limited. We examined whether mothers were more likely to start and continue to breastfeed if they delivered in a UNICEF UK Baby Friendly accredited maternity unit, in a cohort with a high representation of disadvantaged and lower socioeconomic groups with traditionally low rates of breastfeeding. METHODS: We analysed maternally reported breastfeeding initiation and prevalence of any breastfeeding at 1 month for 17 359 singleton infants according to maternity unit Baby Friendly Initiative participation status at birth (accredited, certificated, or neither award). RESULTS: Mothers delivering in accredited maternity units were more likely to start breastfeeding than those delivering in units with neither award [adjusted rate ratio: 1.10, 95% confidence interval (CI) 1.05-1.15], but were not more likely to breastfeed at 1 month (0.96, 95% CI 0.84-1.09), after adjustment for social, demographic, and obstetric factors. Antenatal class attendance (1.14, 95% CI 1.11-1.17), vaginal delivery (1.05, 1.03-1.08), a companion at delivery (1.09, 1.04-1.16), and maternal post-partum hospital stay >24 h (1.06, 1.04-1.09) were also independently associated with breastfeeding initiation. CONCLUSIONS: Policies to increase the proportion of maternity units participating in the UNICEF UK Baby Friendly Initiative are likely to increase breastfeeding initiation but not duration. Other strategies are required in order to support UK mothers to breastfeed for the recommended duration.     

Direct Cost of Maternity-care Services in South Delhi: A Community Survey

The study was conducted to estimate the direct maternity-care expense for women who recently delivered in South Delhi and to explore its sociodemographic associations. A survey was conducted using the two-stage cluster-randomized sampling technique. Two colonies each from high-, middle- and low-income areas were selected by simple random sampling, followed by a house-to-house survey in each selected colony. Information was collected by recall of healthcare expenses for mother and child. In total, 249 subjects (of 282 eligible) were recruited. The mean expense for a normal vaginal delivery (n=182) was US$ 370.7, being much higher in a private hospital (US$ 1,035) compared to a government hospital (US$ 61.1) or a delivery in the home (US$ 55.3). Expenses for a caesarean delivery (n=67) were higher (US$ 1,331.1). Expenses for the lowest-income groups were ∼10% of their annual family income at government facilities and ∼26% at private hospitals. The direct maternity expense is high for large subsections of the population.Key words: Community survey, Healthcare cost, Health expenditure, Maternal health services, Maternity care, India