Hiroya Matsuo

A cross-sectional analytic study of postpartum health care service utilization in the Philippines.

Background The maternal mortality ratio in the Philippines remains high; thus, it will be difficult to achieve the Millennium Development Goals 5 by 2015. Approximately two-thirds of all maternal deaths occur during the postpartum period. Therefore, we conducted the present study to examine the current state of postpartum health care service utilization in the Philippines, and identify challenges to accessing postpartum care. Methods A questionnaire and knowledge test were distributed to postpartum women in the Philippines. The questionnaire collected demographical characteristics and information about their utilization of health care services during pregnancy and the postpartum period. The knowledge test consisted of 11 questions regarding 6 topics related to possible physical and mental symptoms after delivery. Sixty-four questionnaires and knowledge tests were analyzed. Results The mean time of first postpartum health care visit was 5.1±5.2 days after delivery. Postpartum utilization of health care services was significantly correlated with delivery location (P<0.01). Women who delivered at home had a lower rate of postpartum health care service utilization than women who delivered at medical facilities. The majority of participants scored low on the knowledge test. Conclusion We found inadequate postpartum health care service utilization, especially for women who delivered at home. Our results also suggest that postpartum women lack knowledge about postpartum health concerns. In the Philippines, Barangay health workers may play a role in educating postpartum women regarding health care service utilization to improve their knowledge of possible concerns and their overall utilization of health care services.

Sound Environments Surrounding Preterm Infants Within an Occupied Closed Incubator

UNLABELLEDnPreterm infants often exhibit functional disorders due to the stressful environment in the neonatal intensive care unit (NICU). The sound pressure level (SPL) in the NICU is often much higher than the levels recommended by the American Academy of Pediatrics. Our study aims to describe the SPL and sound frequency levels surrounding preterm infants within closed incubators that utilize high frequency oscillation (HFO) or nasal directional positive airway pressure (nasal-DPAP) respiratory settings.nnnDESIGN AND METHODSnThis is a descriptive research study of eight preterm infants (corrected age<33 weeks) exposed to the equipment when placed in an incubator. The actual noise levels were observed and the results were compared to the recommendations made by neonatal experts.nnnRESULTSnIncreased noise levels, which have reported to affect neonates ability to self-regulate, could increase the risk of developing attention deficit disorder, and may result in tachycardia, bradycardia, increased intracranial pressure, and hypoxia.nnnCONCLUSION AND PRACTICE IMPLICATIONSnThe care provider should closely assess for adverse effects of higher sound levels generated by different modes of respiratory support and take measures to ensure that preterm infants are protected from exposure to noise exceeding the optimal safe levels.

Physiological Evaluation of Neck and Shoulder Pain (Katakori in Japanese) in Postpartum Japanese Women

Objective: Neck and shoulder pain (NSP) is the most common symptom in Japanese women. NSP is often accompanied by unpleasant symptoms. The objective of this study is to elucidate the pathophysiology of NSP in relation to specific mental and physical states in postpartum women. nMethods: Data was collected by questionnaire, It consisted of the subject’s characteristics, details of NSP and degree disturbance of daily life due to NSP (level 0 (none) to 10). Evaluation of psychological stress was using the Profile of Mood States - Brief Japanese version (POMS-B). Moreover, we examined measurement of muscle hardness, blood flow, autonomic nervous system (ANS) activity and angles of breastfeeding posture. Participants were 62 postpartum women from one month to six months after delivery. nResults: The worsening of NSP after birth was associated with psychological distress by POMS-B. ANS activity was compared with “less than 25% of the quartile” and “more than 75% of the quartile” of POMS-B score, using t-test. High-Frequency (HF) tended to be lower in “more than 75%” than in “less than 25%” score for Fatigue. The mean score of “disturbance of daily life due to NSP” in postpartum women with NSP was 4.7±2.3. The surface skin temperatures in “disturbance of daily life due to NSP ≧ 4.7” were significantly lower than those in “< 4.7”. LF/ HF ratio in “≧ 4.7” was significantly higher than that in “< 4.7”. Breastfeeding posture angles showed significant differences in head angle between “worse after birth” and “no-change/relief after birth”. nConclusions: The results suggested that psychological stress in postpartum women might be related to worsening of NSP through the modification of ANS activity and worsening of NSP after birth was associated with breastfeeding posture.

Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study

Background A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. Methods This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher’s exact test, and Mann–Whitney U test were used. Results There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility (P<0.01). There was significant difference in the utilization of antenatal checkup (P<0.01) during pregnancy, whilst there was no significant difference in utilization of healthcare services during the postpartum period. Women who delivered at home were more likely to experience feeling of irritated eyes and headaches, and continuous abdominal pain (P<0.05). Conclusion Financial and environmental barriers might hinder the utilization of healthcare services by women who deliver at home in the Philippines. Low utilization of healthcare services in women who deliver at home might result in more frequent abnormal symptoms during postpartum.

Understanding postpartum healthcare services and exploring the challenges and motivations of maternal health service providers in the Philippines: a qualitative study

Background: Given the shortage of medical professionals in the Philippines, Barangay Health Workers (BHWs) may play a role in providing postpartum healthcare services. However, as there are no reports regarding BHW activities in postpartum healthcare, we conducted this study to understand postpartum healthcare services and to explore the challenges and motivations of maternal health service providers. Methods: Focus group interview (FGI) of 13 participants was conducted as qualitative research methodology at Muntinlupa City. The results were analyzed according to the interview guide. The proceedings of the FGI were transcribed verbatim, and researchers read and coded the transcripts. The codes were then used to construct categories. Results: Four important activities were highlighted among 11 analysis codes. These activities were “Assessment of postpartum women’s conditions,” “Recommendation to visit a health facility,” “Measurement of blood-pressure and vitamin intake,” and “Providing postpartum health information.” Among five analysis codes, we identified three challenges that BHWs face, which were “No current information regarding postpartum care,” “Some postpartum women do not want to receive healthcare services from BHW,” and “Too many assigned postpartum women.” Among five analysis codes, we identified two reasons for continuing BHW activities, which were “Hospitality to help postpartum women and their family in the community” and “Performance of mission in providing BHW services.” Conclusion: This study is the first to evaluate BHW activities in postpartum healthcare services. Our results indicate that BHWs play a potentially important role in evaluating postpartum women’s physical and mental conditions through home-visiting services. However, several difficulties adversely affected their activities, and these must be addressed to maximize the contributions of BHWs to the postpartum healthcare system.