Mortalidad materna y atención del parto bajo el modelo centinela. Estudio de caso

Irene Margarita Parada-Toro; Irene Parada-Toro; Juan Maldonado-Hernández; Ahidée Leyva-López; Margarita Márquez-Serrano

doi:10.19136/hs.a22n1.4837

Authors

Irene Margarita Parada-Toro National Institute of Public Health https://orcid.org/0000-0002-1442-7895
Irene Parada-Toro National Institute of Public Health https://orcid.org/0000-0002-1442-7895
Juan Maldonado-Hernández Department of Reproductive Health at the O.P.D. Health Services of the state of Jalisco. https://orcid.org/0000-0002-5833-1377
Ahidée Leyva-López Reproductive Health Directorate. Population Health Research Center. National Institute of Public Health https://orcid.org/0000-0002-8413-0771
Margarita Márquez-Serrano Directorate of Determinants and Challenges of Health Systems, Center for Research in Health Systems, National Institute of Public Health https://orcid.org/0000-0001-7987-180X

DOI:

https://doi.org/10.19136/hs.a22n1.4837

Abstract

Objective: Evaluate the coverage of eutocic delivery care in the Sentinel Unit (UC), of the first level of care, verify compliance with what is established in the model and identify the factors that prevent or favor its use, from the perspective of the providers of health and users.

Materials and methods: Qualitative and quantitative study, retrospective with information on the primary and secondary bases. Main variable: care of eutocic delivery. Analysis: Descriptive, percentages for categorical variables and δ means for continuous variables, statistical differences between two categorical variables, Pearson Chi2. Multivariate: logistic regression of factors associated with delivery care. Twelve semi-structured interviews were conducted with users and 8 service providers, the analysis was carried out based on Grounded Theory through Ethnograph v.5.

Results: Sample: 218 users, average age was 24.7 years. The UC provided prenatal control, 61% more than 5 consultations; however, the care of eutocic deliveries was only 17 deliveries (33.4%). The most important barriers referred to by the users and health providers were: lack of personnel, training, supplies and insufficient support and institutional legal protection in case of complications.

Conclusions: UC is a strategy to return delivery care to the first level of care, but it is necessary to implement a plan to improve and strengthen providers.

Keywords: Maternal mortality; Normal delivery; Access to health care; Health personnel; Prenatal care.

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Author Biographies

Irene Margarita Parada-Toro, National Institute of Public Health

Medical Surgeon from the Autonomous University of Guadalajara (UAG). Master of Science in Health Systems from the National Institute of Public Health- School of Public Health of Mexico (INSP-ESPM). Candidate for the Master's Degree in Child Clinical Psychology from the Autonomous University of the State of Morelos (UAEM). Researcher in Medical Sciences "C". Specialist Physician of the CISS. National Institute of Public Health Cuernavaca Morelos, Doctorate in Political and Social Sciences at the Center for Research and Teaching in Humanities of the State of Morelos (CIDHEM). Areas of interest: Health Systems, Health Economics and Political Economy, Health Policies. She has participated as a professor in the didactic units of the National Institute of Public Health from 1995 to date, Professor at the Autonomous University of Morelos 1989-1993. Postgraduate professor at the University of Valle de México 2013 to date. Doctor at the Carlos “Arvelo” Caracas Military Hospital, Venezuela 1982-1983. San Rafael Psychiatric Clinic 1986 -1987. Publications: 29 scientific articles in magazines II, III, and IV as well as 14 chapters of National and International books. 30 presentations at National and International Congresses.
Irene Parada-Toro, National Institute of Public Health

Medical Surgeon from the Autonomous University of Guadalajara (UAG). Master of Science in Health Systems from the National Institute of Public Health- School of Public Health of Mexico (INSP-ESPM). Candidate for the Master's Degree in Child Clinical Psychology from the Autonomous University of the State of Morelos (UAEM). Researcher in Medical Sciences "C". Specialist Physician of the CISS. National Institute of Public Health Cuernavaca Morelos, Doctorate in Political and Social Sciences at the Center for Research and Teaching in Humanities of the State of Morelos (CIDHEM). Areas of interest: Health Systems, Health Economics and Political Economy, Health Policies. She has participated as a professor in the didactic units of the National Institute of Public Health from 1995 to date, Professor at the Autonomous University of Morelos 1989-1993. Postgraduate professor at the University of Valle de México 2013 to date. Doctor at the Carlos “Arvelo” Caracas Military Hospital, Venezuela 1982-1983. San Rafael Psychiatric Clinic 1986 -1987. Publications: 29 scientific articles in magazines II, III, and IV as well as 14 chapters of National and International books. 30 presentations at National and International Congresses
Juan Maldonado-Hernández, Department of Reproductive Health at the O.P.D. Health Services of the state of Jalisco.

Work experience

State head of the Reproductive Health department at the O.P.D. Jalisco Health Services. November 1 to present
Private Secretary of the General Directorate of the O.P.D. Jalisco Health Services. January 1 to October 31, 2021
State Head of the Department of Gender Equity and Reproductive Health. January 1
2019 to November 30, 2020 (Quintana Roo)
Federal Supervisor of the Maternal Health Program. National Center for Gender Equity and Reproductive Health. January 1, 2018 to December 31, 2018.
Head of the Epidemiological Surveillance Unit at the Comprehensive Medical Care Center. (Mexico City) June 2017 to December 31, 2017
Nursing Assistant at Autlán Regional Hospital Secretary of Health Jalisco June 1, 2014 to August 31, 2015

Studies

Doctorate in Senior Management in Health Establishments, Postgraduate Center of the State of Mexico. Title and ID.
Master's in Public Health with a Concentration Area in Epidemiology, National Institute of Public Health. Title and ID.
Master's Degree in Administration of Hospitals and Health Services, Cuauhtemoc University. Title and ID.
Bachelor of Nursing, University of Guadalajara. Title and ID.
Ahidée Leyva-López, Reproductive Health Directorate. Population Health Research Center. National Institute of Public Health

Pharmaceutical Biologist from the Autonomous University of Sinaloa (UAS); Master's degree in Health Sciences with a concentration area in epidemiology from the School of Public Health of Mexico (INSP). Doctorate in Public Mental Health from the Autonomous University of Mexico (UNAM). SNI level: I.

National Institute of Public Health. Researcher in Medical Sciences at the Population Health Research Center. She is the Titular Coordinator of the MSP with a concentration area in Cuernavaca Headquarters Epidemiology. She has more than 20 scientific publications. She has supervised undergraduate and master's theses. She has taught basic and applied Epidemiology, Research Methodology I and II, Epidemiological Surveillance, Applied Epidemiology of Sexual and Reproductive Health. Area (s) of interest: her main areas of interest are: Mental Health and Addictions, Quality of life of family caregivers of people with intellectual disabilities, mental health in adolescents.
Margarita Márquez-Serrano, Directorate of Determinants and Challenges of Health Systems, Center for Research in Health Systems, National Institute of Public Health

Head of the Department of Research Management in Health Equity, Researcher in Medical Sciences at the Center for Research in Health Systems of the National Institute of Public Health. She is a candidate for a Doctorate in Political and Social Sciences from the Center for Research and Teaching in Humanities of the State of Morelos (CIDHEM); She has a master's degree in Social Medicine from the Autonomous Metropolitan University and a Bachelor's degree in Economics from the National Autonomous University of Mexico. She has been Full Professor in the Masters of Public Health, Master of Sciences, Nursing Specialization in Public Health of the School of Public Health / National Institute of Public Health; at the School of Nursing of the Autonomous University of the State of Morelos. She is coordinator of the Social and Behavioral Sciences concentration area of the Master's in Public Health. She is a member of the College of Teachers of Social Sciences and Health and of Education and Health. She has participated as a teacher for 28 years in 169 didactic units as Full Professor in the Masters of Public Health in its different areas of concentration and in face-to-face, virtual, blended modalities, in the Master of Sciences, Specialization in Nursing in Public Health and in summer courses at the National Institute of Public Health. Publications: 31 scientific articles in national and international journals, 16 book chapters, and 5 book co-authors. 117 participations in National and International Congresses. Areas of interest: aging and health, social determinants of health, gender and health, health promotion, family violence, occupational health.