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An Evaluation of the Timing and Use of Healthcare during Pregnancy in Birmingham, UK and Pretoria, South Africa.

ABSTRACT: Objective. A pilot study to compare the rates of antenatal healthcare use in Birmingham, UK and Pretoria, South Africa, and identify differences in knowledge and perception of antenatal healthcare. Subjects. 62 women, 31 at each location <24 hours after delivery. Results. Women from Birmingham use healthcare services earlier (P ? .0001) and more often during pregnancy (P ? .0001). Women from Birmingham identified more conditions that may affect pregnancy (median 6 versus 3 reasons) and were less aware of HIV. In addition they perceived antenatal healthcare as relatively more important for advice and reassurance about pregnancy, whilst women from Pretoria had more problems with transport and clinic overcrowding. Conclusions. Increasing education on the importance of antenatal healthcare and medical problems during pregnancy may help improve antenatal healthcare use in Pretoria. Improving transport links and overcrowding in clinics in Pretoria may also help increase use. Measuring maternal outcomes and confirming these findings in a larger population are important for future studies.

SUBMITTER: Openshaw MR

PROVIDER: S-EPMC3102581 | biostudies-literature | 2011

REPOSITORIES: biostudies-literature

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An Evaluation of the Timing and Use of Healthcare during Pregnancy in Birmingham, UK and Pretoria, South Africa.

Openshaw Mark Robert MR Bomela Hlwelekazi N HN Pretlove Sam S

ISRN obstetrics and gynecology 20110126

Objective. A pilot study to compare the rates of antenatal healthcare use in Birmingham, UK and Pretoria, South Africa, and identify differences in knowledge and perception of antenatal healthcare. Subjects. 62 women, 31 at each location <24 hours after delivery. Results. Women from Birmingham use healthcare services earlier (P ≤ .0001) and more often during pregnancy (P ≤ .0001). Women from Birmingham identified more conditions that may affect pregnancy (median 6 versus 3 reasons) and were less ...[more]

PMID: 21637359

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Project description:BackgroundThe COVID-19 pandemic created unprecedented pressure on hospitals globally. Digital tools developed before the crisis provided novel aspects of management, and new digital tools were rapidly developed as the crisis progressed. In our institution, a digitally mature NHS Trust in England which builds software systems, development during the early months of the crisis allowed increased patient safety and care, efficient management of the hospital and publication of data. The aim of this paper is to present this experience as a case study, describing development and lessons learned applicable to wider electronic healthcare record development.MethodsRequest, triage, build and test processes for the digital systems were altered in response to the pandemic. Senior Responsible Officers appointed for the emergency triaged all changes and were supported by expert opinion and research active clinicians. Build and test cycles were compressed. New tools were built or existing ones modified in the central Electronic Healthcare Record, PICS (Prescribing, Information and Communication System), Clinical Dashboards and video platforms for remote consultation were developed.Findings2236 patients were admitted to UHB with suspected COVID-19 between March and May 2020. Dashboards and visualisation tools enabled by efficient real-time data collection for all new patients, contributed to strategic, operational and clinical decision making.Over 70 urgent changes were made to digital systems, including a screening proforma, improved infection control functions, help and order panels, data dashboards, and updated prescribing features. Novel uses were found for existing functions.InterpretationDigital tools contributed to a co-ordinated response to COVID-19 in an area with a high disease burden. Change management processes were modified during the pandemic and successfully delivered rapid software modifications and new tools. Principal benefits came from the ability to adapt systems to rapidly changing clinical situations. Lessons learned from this intense development period are widely applicable to EHR development.Lay summaryDigital tools, which are well designed, can help clinicians and safeguard patients. Health crises such as the COVID pandemic drove rapid development of digital tools. This case study outlines accelerated development within a governance framework that successfully reused existing tools and built new ones. The lessons from this development are generalizable to digital developments in healthcare.

Project description:BackgroundSouth Africa has 6.4 million adults over the age of 15 living with HIV. Gender inequality issues continue to drive the HIV epidemic in South Africa, where Black African women bear the greatest HIV burden. Limited access to services; little capacity to negotiate sex and condom use; and other legal, social, and economic inequities make women highly vulnerable to HIV infection. Behavioral interventions have been shown to decrease risk behaviors, but they have been less successful in reducing HIV incidence. Conversely, biomedical prevention strategies have proven to be successful in reducing HIV incidence, but require behavioral interventions to increase uptake and adherence. Consequently, there is a need for integrated approaches that combine biomedical and behavioral interventions. Effective combination prevention efforts should comprise biomedical, behavioral, and structural programming proven in randomized trials that focuses on the driving forces and key populations at higher risk of HIV infection and transmission.Methods/designThis prospective, geographically clustered randomized field experiment is enrolling participants into two arms: a control arm that receives standard HIV testing and referral for treatment; and an intervention arm that receives an evidence-based, woman-focused behavioral intervention that emphasizes risk reduction and retention, the Women's Health CoOp. We divided the city of Pretoria into 14 mutually exclusive geographic zones and randomized these zones into either the control arm or the intervention arm. Outreach workers are recruiting drug-using women from each zone. At baseline, eligible participants complete a questionnaire and biological testing for HIV, recent drug use, and pregnancy. Follow-up interviews are completed at 6 and 12 months.DiscussionThe biobehavioral intervention in this study merges an efficacious behavioral HIV prevention intervention for women with biomedical prevention through HIV treatment as prevention using a Seek, Test, Treat and Retain strategy. This combination biobehavioral intervention is designed to (1) improve the quality of life and reduce HIV infectiousness among women who are HIV positive, and (2) reduce HIV risk behaviors among women regardless of their HIV status. If efficacious, this intervention could help control the HIV epidemic in South Africa.Trial registrationTrial registration no: NCT01497405.

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An Evaluation of the Timing and Use of Healthcare during Pregnancy in Birmingham, UK and Pretoria, South Africa.

Publications

An Evaluation of the Timing and Use of Healthcare during Pregnancy in Birmingham, UK and Pretoria, South Africa.

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