Racial Disparity in Infant and Maternal Mortality: Confluence of Infection,and Microvascular Dysfunction

OBJECTIVES: Racial disparities in infant and maternal mortality have been attributed to the unique stresses faced by Black women in the United States, but the underlying pathophysiological pathways are poorly understood. This paper reviews the literature related to potential causes of racial disparities in infant and maternal mortality. METHODS: A review of the literature from 1966 to 2003 was conducted using a series of searches of Medline, obstetrical journals, and bibliographies. The review focused on potential contributing pathophysiological factors to infant and maternal mortality. RESULTS: Racial disparities in neonatal mortality largely result from excess rates of preterm birth, fetal growth restriction, and neonatal sepsis while racial disparities in maternal mortality reflect greater prevalence and/or severity of cardiovascular/preeclamptic complications, hemorrhage, and infection among African American women. A large body of epidemiological, placental, and pathophysiological evidence suggests that racial disparities in these disparate outcomes result from two distinct, but potentially converging, pathways: infection and vascular. Racial disparities in intrauterine infection and microvascular dysfunction during pregnancy may result from a constellation of environmental and intergenerational risk factors including psychosocial stress, douching, bottle-feeding, lead exposure, diet, intrauterine growth, and genes. CONCLUSIONS: Disparities in infant and maternal mortality appear to reflect a confluence of infections and microvascular dysfunction during pregnancy among African American women. Interventions that target these conditions offer promise for reducing racial disparities in these critical outcomes.     

大同市母婴安全保障工作结果分析及干预措施

目的:落实山西省大同市母婴安全保障工作,了解高危孕产妇的发生情况,达到降低孕产妇死亡率的目的。方法:根据山西省卫生健康委员会2017年发布的《山西省加强母婴安全保障工作实施方案》,查阅2018—2019年山西省大同市母婴安全保障工作统计报表以及孕产妇死亡评审资料,分析母婴安全保障工作结果。将妊娠风险评估为"橙色"以上的较高风险孕产妇定义为"高危"孕产妇。结果:2018年高危孕产妇1 477人,实施专案管理618人,救治危重孕产妇494人,孕产妇死亡4人;2019年高危孕产妇1 487人,实施专案管理1 427人,救治危重孕产妇524人,孕产妇死亡3人。2018年活产数29411人,孕产妇死亡率为13.6/10万,2019年活产数是31 890人,孕产妇死亡率为9.4/10万。结论:落实国家母婴安全5项核心制度,做好妊娠风险评估和专案管理,提高医疗机构危重孕产妇的救治能力,可降低孕产妇死亡率。     

Maternal Mortality and the Consequences on Infant and Child Survival in Rural Haiti

OBJECTIVE: To determine the odds of death of children when a woman of reproductive age dies from maternal or non maternal causes in rural Haiti. METHODS: Deaths among reproductive aged women between 1997 and 1999 in and around Jeremie, Haiti were classified as maternal or non maternal and matched to female, non-deceasesd controls based on village, age, and parity. Information regarding the health and survival of all of the offspring under 12 years old of the identified women was extracted from the Haitian Health Foundation (HHF) Health Information System (HIS). Additional demographic information was obtained through interviews with the mothers for controls and with family members for cases. Two analyses on child death were conducted; 1) the odds of death for each individual child after a mother's death and 2) the odds of one of the children in a family dying after the mother's death. FINDINGS: If a family experiences a maternal death, that family has a 55.0% increased odds of experiencing the loss of a child less than 12, whereas when a non maternal death occurs, no increased odds exists. When children of cases were compared to children of controls, mean weight z-scores were the same for the periods corresponding to before and after the maternal deaths. After a maternal death, dosage of BCG (Bacillus Calmette-Guerin) TB (tuberculosis) immunization for the surviving child is significantly lower, as are dosage of measles immunization and the first dose of vitamin A. CONCLUSIONS: This study shows that a maternal death significantly effects the survival of children in a family in a greater way than a non maternal death.     

城市社区妇幼保健服务现状研究

目的掌握当前社区妇幼保健服务基本情况和发展中面临的主要问题,并提出相应的发展建议。方法在武汉市随机抽取4个城区,将所属的41家社区卫生服务中心作为调查对象,采用定量调查和定性访谈方法,了解其妇幼保健部门设置、服务内容、方式及人员情况。结果社区妇幼保健服务现状为经费补偿机制不明确,保健人员年龄结构老化、技术能力薄弱,保健服务项目发展不均衡。计划免疫、产后访视、育儿指导项目开展得最充分,而妇幼心理咨询、营养指导、妇女病普查、婚后卫生指导、更年期保健等项目开展率低。结论政府需进一步明确社区妇幼保健服务经费补偿方式,完善服务项目,提高专业人员技术水平,取得社会的配合,提升妇幼保健服务水平。     

妇幼保健机构医护人员工作倦怠调查分析

目的了解妇幼保健医护人员的工作倦怠状况,为妇幼保健管理提供参考依据。方法应用马斯勒倦怠量表（MBI-HSS）对342名妇幼保健医护人员进行了调查。结果 （1）分别有99.4和31.6的医护人员有中、重度的情绪衰竭和情感疏远,但89.8的医护人员成就感较高;（2）工作倦怠不受性别、婚姻的影响;（3）30岁以下医护人员的情感疏远程度最高;（4）高学历医护人员的情绪衰竭较高,其个人成就感也较高;（5）值夜班医护人员在情绪衰竭、情感疏远及个人低成就感上均显著高于不值夜班者。结论妇幼保健医护人员存在一定的工作倦怠现象,应从组织、个人和工作特征等层面预防和缓解倦怠。     

世界银行—云南省妇幼卫生扶贫资金服务的利用

分析,比较了世界银行－云南省妇幼夫贫资金项目实施前后1年间,3个经济水平组常规孕产妇保健服务的利用情况,结果显示：妇幼卫生扶贫资金促进了特困,次贫困家庭（南润）的孕产妇对常规孕产妇保健服务的利用,提高了其对服务的利用率。     

高危妊娠转诊对母婴保护作用的研究

目的探讨农村高危妊娠母婴安全的措施,以有效地降低孕产妇死亡率和围产儿死亡率。方法建立高危妊娠转诊网络和信息系统,实现资源共享,免费转运;形成县镇村一体化,实行产前、产时及产后一条龙服务,合理解决劳务工效益工资;对特困户实行住院分娩救助,住院分娩费用纳入社会医疗开支范畴。对实施运转前后母婴的安全情况进行比较,用χ2检验其差异性。结果实施运转3年后母婴安全系数上升,孕产妇死亡率从2006年的25.42/10万下降到2009年的17.15/10万;新生儿死亡率从6.91‰下降到4.12‰。结论高危妊娠转诊可降低母婴死亡率,对保护母婴的安全和健康起到积极的作用。     

福建省性传播艾滋病病毒感染者/艾滋病病人生存状况分析

目的 分析福建省性传播艾滋病病毒感染者（HIV）/艾滋病病人（AIDS）生存状况及其影响因素。方法 利用中国疾病预防控制信息系统艾滋病综合防治信息系统,收集自1987年福建省报告首例经性传播病例-2014年11月30日病例基本信息和随访资料,采用回顾性队列研究分析相关数据。结果 6 146例研究对象平均生存时间为（189.91±7.58）月,中位生存时间216月;首次确诊HIV抗体阳性时年龄<50组死亡风险低于年龄≥50岁组（P均<0.0001）;大专以上文化程度病例死亡风险低于其他文化水平患者（95%CI=0.20~0.87,P=0.020）,重点人群、羁押人群发现病例死亡风险低于医疗机构发现病例（P分别为0.010、0.046）;CD4⁺T淋巴细胞≤500个/μL病例死亡风险高于CD4⁺T淋巴细胞>500个/μL病例（P均<0.000 1,95%CI=19.04~83.03、6.17~28.33、1.89~8.26）;未治疗组死亡风险高于治疗组（P<0.000 1,95%CI=4.12~7.21）。结论 年龄、文化程度影响HIV/AIDS的生存时间。     

Experiences of Stigmatization and Discrimination in Accessing Health Services: Voices of Persons Living With HIV in Ghana

Drawing on Earnshaw and Chaudoir’s HIV stigma framework, this study explored the experiences of persons living with HIV and AIDS regarding stigmatization and discrimination in accessing health services. Using a qualitative research methodology, 42 participants were purposively recruited during support group meetings of persons living with HIV and AIDS (PLWHA) at Amasaman in Accra, Ghana. Four focus group discussions (n = 22) and 10 in-depth interviews were conducted. Discussions and interviews were audio-taped, transcribed, and categorized based on the objectives of the study. The findings indicated that PLWHAs had knowledge of stigma that was experienced through enacted, anticipated, and internalized stigma mechanisms. Evidence showed that PLWHA did not experience stigma and discrimination when they accessed services at the Korle-Bu Teaching Hospital, the largest hospital in Ghana. However, the situation was different when they accessed services at other public health facilities. Based on the findings, implications are discussed for policy, social work, and public health practices.     

安徽省县级妇幼保健机构孕产期保健与资源配置的相关性研究简

目的了解安徽省104个区、县妇幼保健机构的孕产期保健和资源配置现况以及两者的相关性。方法运用网络报告系统将妇幼保健机构数据实时填报,描述机构内的孕产期保健服务和辖区内的部分孕产期保健指标现况以及资源配置情况,并进行比较和相关分析。结果区级机构中开展各项孕产期保健服务的构成比均低于80.0%,区、县的孕早期检查率分别为64.7%和55.9%,孕产妇系统管理率分别为61.3%和52.7%。结论县级妇幼保健机构孕产期保健服务整体水平较低,孕产期保健服务水平与人财物资源存在不同程度的相关性。     

Promotion of Maternal and Child Health: A Path Model of Care for Substance Using Pregnant Women

Maternal use of licit and illicit substances during pregnancy has been shown to have serious effects on the fetus, the pregnancy outcome, and the physical, emotional, and social growth of children after birth. Such children require specialized and intensive care during their growing years. Substance using women themselves face a series of related consequences in physical and mental health, and in social functioning, which in turn limit their parenting abilities, often resulting in neglect and abuse of children. Many substance using pregnant women coming to public attention are economically disadvantaged and Medicaid recipients, requiring costly intensive care during pregnancy and subsequently in the development of children. Four fields of human services, namely, Public Health, Substance Abuse Treatment, Child Welfare, and Criminal Justice, have responded to these problems in recent years. This paper examines the existing treatment models in these fields, and proposes a comprehensive, coordinated, and managed care model for improving the current service delivery.     

Expressed Human Milk In The Dietary Management Of Infants At High Risk Of Infection

Feeding expressed human milk to a group of low-birth-weight infants at high risk for developing life-threatening infections resulted in a dramatic reduction in infections and mortality rates.     

实行妇幼保健保偿 提高保健质量

常熟市通过８年推行妇幼保健保偿工作，提高了社会效益和经济效益。１９９６年孕产妇系统管理率达９１．８０％，儿童系统管理率达９５．００％，围产儿死亡率降至１３．５０‰，婴儿死亡率降至１０．８８‰，５岁以下儿童死亡率降至１４．９０‰，无孕产妇死亡发生。本文介绍了制订切合实际的妇幼保健保偿实施办法的几个要点；总结了要切实体现保健保偿的优越性，必须扎扎实实，在提高保健服务质量上下功夫的做法与体会；提出了不断总结经验，完善保健保偿制的几点建议。     

Nonresponse in Follow-Back Surveys of Ethnic Minority Groups: An Analysis of the Puerto Rican Maternal and Infant Health Study

Objectives: This study documents the levels and sources of nonresponse in the first large-scale maternal–infant health survey administered to representative samples of Puerto Rican mothers on both the U.S. mainland and the island of Puerto Rico. Methods: The data source is the Puerto Rican Maternal and Infant Health Study, which was administered to a vital records-based sample of 2763 mothers of infants. An additional 805 women were nonrespondents. Nonresponse is examined as a function of several characteristics measured from vital records using logistic regression. Results: The response rate for this survey compares favorably to response rates for similar surveys. Although nonresponse is not associated with most characteristics measured from vital records, it is higher among mainland residents and mothers of infants who died. The absence of significant associations is due to opposite relationships between several covariates and the failure to locate and refusal. For example, nonresponse in the birth sample is not associated with migration, despite the difficulty of locating migrants. The lower likelihood of locating migrants is offset by their willingness to participate. Conclusions: Selectivity due to nonresponse is minimal. Nevertheless, researchers who design binational surveys should be aware of setting-specific circumstances that affect the ability to locate sampled individuals and secure their cooperation.     

The Relation of FIMR Programs and Other Perinatal Systems Initiatives with Maternal and Child Health Activities in the Community

OBJECTIVES: To evaluate the association of the presence of a fetal and infant mortality review (FIMR) program, other perinatal systems initiative (PSI), or both in a community with the performance of essential maternal and child health (MCH) services by local health departments (LHDs). METHODS: Data were obtained from telephone interviews with professionals from LHDs across the United States. Logistic regression was used to estimate the odds of a LHD conducting each essential MCH service in communities with and without FIMR programs or with and without PSIs, adjusted for geographic area. RESULTS: Of the 193 communities in the sample, 41 had only a FIMR program, 36 had only a PSI, 47 had both programs, and 69 had neither. The presence of a FIMR was related to greater performance of essential MCH services in LHDs in six areas: data assessment and analysis; client services and access; quality assurance and improvement; community partnerships and mobilization; policy development; and enhancement of capacity of the health care work force. Similar findings were noted for the same broad essential services for PSIs. The comparisons of LHDs in FIMR and non-FIMR communities, however, showed greater involvement of communities with a FIMR program in essential MCH services related to data collection and quality assurance than were found for comparisons of LHDs in communities with and without a PSI. The presence of a PSI was uniquely associated with conducting needs assessments for pregnant women and infants, participation in coalitions for infants, promoting access for uninsured women to private providers and involving local officials and agencies in health plans for both populations. When both programs were present, LHDs had a greater odds of engaging in essential MCH services related to assessment and monitoring of the health of the population, reporting on progress in meeting the health needs of pregnant women and infants, and presenting data to local political officials than when either program alone was in the community. CONCLUSIONS: Local health departments in communities with FIMR programs or PSIs appear to be more likely to conduct essential MCH services in the community. Some of these relations are unique to FIMR, particularly for data collection and quality assurance services, and some are unique to PSIs, for example those that involve interaction with other community agencies or groups. Performance of the essential MCH services also appears to be enhanced when both a FIMR program and a PSI are present in the community.     

The Nationwide Evaluation of Fetal and Infant Mortality Review (FIMR) Programs: Development and Implementation of Recommendations and Conduct of Essential Maternal and Child Health Services by FIMR Programs

OBJECTIVE: An evaluation of fetal and infant mortality review (FIMR) programs nationwide was conducted to characterize their unique role in improving the system of perinatal health care. The aim of this paper is to examine intermediate outcomes of the FIMR, in particular the development and implementation of recommendations produced by the FIMRs and the conduct of essential MCH services by the FIMRs. METHODS: We report on 74 FIMRs whose communities were selected for the nationwide evaluation and for whom we had data from the FIMR director or comparable respondent. We focus on the recommendations of the FIMRs and the essential maternal and child health (MCH) services conducted by the FIMRs as intermediate outcomes (or outputs) and then examine how selected characteristics of the FIMR may influence these. RESULTS: FIMRs developed recommendations on a broad range of topics but there were some areas for which nearly all programs had developed recommendations. The FIMRs relied primarily on strategies related to programs and practices, with few FIMRs reporting attention to policy-oriented approaches. Implementation of recommendations was high. Factors that influenced likelihood of implementing recommendations and conduct of essential MCH services included structure of the FIMR and training received by FIMR directors and staff. CONCLUSIONS: The focus of FIMR recommendations and the likelihood of implementation vary across FIMRs as does the conduct of essential MCH services. FIMR team structure and training of the director and staff are important areas to consider in efforts to maximize the impact of FIMR.     

艾滋病母婴阻断效果分析

目的及时掌握预防艾滋病母婴传播工作效果。方法对防城区2011-2012年有妊娠结局的34例HIV感染的孕产妇及所生的婴儿进行回顾性分析．满18月龄的儿童为15例,中其有3例儿童死亡,2例失访。结果儿童死亡率33．79％,现存活的满18月的儿童为10例,其中1例为18月龄确证为HIV阳性,9例为HIV阴性,儿童HIV阳性感染率为10％,阴性率为90％。结论对在孕期或产时HIV感染的孕产妇及所生的婴儿实施预防性抗病毒药物应用后,发生儿童死亡及儿童HIV感染的机会减少,可明显降低母婴传播风险;反之,HIV染的孕产妇和其所生的婴儿在围生期未使用抗病毒药物治疗,未选择剖宫产分娩,HIV感染母亲所生儿童的死亡率会增加,增加了儿童感染HIV的机会。现行的预防艾滋病母婴传播措施是有效的     

县区级妇幼保健机构运行现状与思考

对张掖市6所县区级妇幼保健机构运行情况进行调查,结合近几年业务发展和公共卫生项目执行情况进行分析,进一步探讨县区级妇幼保健机构的定位与发展.公共卫生工作和能力建设必须齐抓共管,互相促进,共同发展,既要坚持基层妇幼保健机构的公益性不放松,又要把基础医疗和临床保健工作做精做强,为妇女儿童提供全面的基本医疗服务和保健服务,同时政府要加大对基层保健机构的投入,解决基础设备落后、编制不足和人才短缺的问题.     

县域医共体背景下浙江省县级妇幼保健机构功能实现状况分析

从妇幼健康服务功能、辖区业务管理和技术指导功能、承接基层转诊功能3个维度调研浙江省东阳市、桐乡市、德清县三地县级妇幼保健机构在县域医共体背景下功能实现的状况。调研发现,县级妇幼保健机构无论是否参与或以何种方式参与县域医共体,与基层医疗卫生机构建立稳定联系以及坚持临床与保健相结合是其功能实现的重要基础。政府应充分考虑县级妇幼保健机构与医共体的协调发展,县级妇幼保健机构应加强保健与临床的结合,同时构建医共体下妇幼健康统一指导考核机制。