Maternal and Child Health Journal
Volume 19, Issue 4, April 2015
http://link.springer.com/journal/10995/19/4/page/1

Reducing Child Mortality: The Contribution of Ceará State, Northeast of Brazil, on Achieving the Millennium Development Goal 4 in Brazil
Anamaria Cavalcante e Silva, Luciano Lima Correia…

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Explaining Inequity in the Use of Institutional Delivery Services in Selected Countries
Mai Do, Rieza Soelaeman, David R. Hotchkiss

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Influenza Vaccination of Pregnant Women: Attitudes and Behaviors of Oregon Physician Prenatal Care Providers
Robert F. Arao, Kenneth D. Rosenberg, Shannon McWeeney, Katrina Hedberg
Abstract
In spite of increased risk of influenza complications during pregnancy, only half of US pregnant women get influenza vaccination. We surveyed physician prenatal care providers in Oregon to assess their knowledge and behaviors regarding vaccination of pregnant women. From September through November 2011, a state-wide survey was mailed to a simple random sample (n = 1,114) of Oregon obstetricians and family physicians. The response rate was 44.5 %. Of 496 survey respondents, 187 (37.7 %) had provided prenatal care within the last 12 months. Of these, 88.5 % reported that they routinely recommended influenza vaccine to healthy pregnant patients. No significant differences in vaccine recommendation were found by specialty, practice location, number of providers in their practice, physician gender or years in practice. In multivariable regression analysis, routinely recommending influenza vaccine was significantly associated with younger physician age [adjusted odds ratio (AOR) 2.01, 95 % confidence interval (CI) 1.29–3.13] and greater number of pregnant patients seen per week (AOR 1.95, 95 % CI 1.25–3.06). Among rural physicians, fewer obstetricians (90.3 %) than family physicians (98.5 %) had vaccine-appropriate storage units (p = 0.001). Most physician prenatal care providers understand the importance of influenza vaccination during pregnancy. To increase influenza vaccine coverage among pregnant women, it will be necessary to identify and address patient barriers to receiving influenza vaccination during pregnancy.

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Healthy Start: Description of a Safety Net for Perinatal Support During Disaster Recovery
Gloria Giarratano, Emily W. Harville, Veronica Barcelona de Mendoza, Jane Savage, Charlotte M. Parent
Abstract
Publicly funded programs and safety net organizations have key roles during post disaster recovery to care for vulnerable populations, including pregnant women with low resources. The objective of this study was to compare the health of prenatal women who accessed the New Orleans Healthy Start program to those women who only used traditional prenatal care (PNC) during long-term recovery from the Hurricane Katrina disaster. During 2010–2012, this descriptive, cross-sectional study recruited 402 prenatal women (24–40 weeks) from prenatal clinics and classes. All women were enrolled in PNC, with 282 experiencing only traditional PNC, while 120 women added Healthy Start participation to their usual PNC. Measures were obtained to determine, past hurricane experience, hurricane recovery, perceptions of prenatal care, mental health, and birth outcomes. Women accessing Healthy Start-New Orleans were more socially “at risk” (younger, lower income, not living with a partner, African American), lived through more hurricane trauma, and had a higher incidence of depression (40 %) and post-traumatic stress disorder (PTSD) (15 %) than women in traditional PNC (29 % depression; 6.1 % PTSD). Women using Healthy Start reported more mental health counseling and prenatal education than did women in only traditional PNC. Birth outcomes were similar in the two groups. The Healthy Start participants with less resources and more mental health difficulties after disaster, represented a more vulnerable population in need of additional support. This study underscores the necessity for community and governmental programs to develop disaster response plans that address needs of vulnerable populations during prolonged recovery.

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Factors Associated with Safe Delivery Service Utilization Among Women in Sheka Zone, Southwest Ethiopia
Abyot Asres, Gail Davey