BACKGROUND: Regular collection and monitoring of data describing the dynamics of the utilization of healthcare services, especially in teaching hospitals (TH), which provide model quality medical services, are critical for COVID-19 pandemic preparedness.
METHODS: The researchers analyzed data and information derived from service statistics reports from June 1st to July 15th, 2020 in terms of hospital resources, as well as utilization patterns of beds, ICU, and ventilators, for 11 screening hospitals affiliated with the General Organization of Teaching Hospitals and institutes in Egypt assigned by the Ministry of Health and Population to provide medical care for COVID-19 patients. Hospital indicators in terms of COVID-19 screening services, as well as utilization patterns of inpatient beds, ICU beds, and ventilators were computed.
RESULTS: A total of 78,869 non-medical personnel and 2,176 medical personnel were presented with COVID-19 triage symptoms. Investigations conducted in the targeted 11 hospitals delineated that 22.2% of non-medical personnel and 27.9% of medical personnel were COVID-19 PCR-confirmed cases. The inpatient bed occupancy rate was 70% for non-medical patients and 67% for medical staff patients. For ICU, the bed occupancy rate was 92 % for non-medical patients and 88% for medical patients. Among the confirmed cases, 38% of medical patients utilized a ventilator vs. 36% of medical personnel cases. Hospital ranking according to utilization pattern among non-medical personnel, Hospital H ranked first in terms of the high load of screening services. Hospital C ranked first regarding the number of confirmed cases, whereas Hospital D ranked first for high ICU utilization among all teaching hospital ICU cases. With respect to medical personnel, Hospital G ranked first for the high load of screening services for the total studied cases. Hospital G ranked first for the number of confirmed cases. Hospital B ranked first regarding high ICU utilization among all teaching hospital ICU cases.
CONCLUSIONS: Teaching hospitals have demonstrated preparedness for the COVID-19 pandemic by maintaining an inpatient bed occupancy rate of 70% or less and ventilator utilization at <40% of confirmed cases. However, the ICU bed occupancy rate was more than 90% indicating a shortage of resources. In addition, there is variance across hospitals regarding caseload for resource reallocation decisions.

The Nairobi Birth Survey was planned with the following objectives: 1) establish the social, obstetric and epidemiological characteristics of the obstetric population of Nairobi, Kenya; 2) examine the pattern and distribution of antenatal and delivery care; and 3) assess the true incidence of stillbirths and 1st 24-hour neonatal deaths, congenital abnormalities and major obstetric complications. The Survey consisted of 1) a study of all stillbirths and 24-hour neonatal deaths over a period of 7 months (March-September 1981), and 2) recording of all births taking place in Nairobi over a 7 week period (June 15-August 4, 1981). During the 7 week period there were 5,293 single births, including 187 perinatal deaths, with a stillbirth rate of 23/1,000 births and a 24-hour neonatal death rate of 12/1,000. The obstetric population was found to be predominantly young, with 57.8% of all mothers being under 25 years of age. Nearly 20% were teenagers. 23% of the mothers were having their 5th or more children at the time of the Survey. In 79.3% of the mothers the antenatal period was uncomplicated. Hypertensive disease in pregnancy was found to be the leading cause of complications, existing in 10.4% of the pregnancies. The majority of the mothers delivered in public institutions. Together with the student midwives, midwives conducted 79.7% of the births. The 3 maternal deaths in this survey give a maternal mortality rate of .56/1,000 deliveries. 701 perinatal deaths occured in the 7 month study, which corresponds to 71.2%. These deaths were mostly associated with complications of labor, including prolonged and difficult labor. In 40.9% of the cases the deaths could have been avoided with appropriate action. In 436 babies that were autopsied, 33 had congenital abnormalities.

An archival study was done of 500 medical records from a community clinic serving a low income predominantly Hispanic area of Los Angeles. The data collected included demographic characteristics and presented symptoms or reasons for visit, as well as diagnosis and treatment. The greatest number of patient visits were made for family planning services. A large porportion of the patients who received initial family planning services failed to return to the clinic for follow ups or additional supplies. A total of 208 pregnancy tests were performed in 151 of the 500 cases sampled. Of these, 152 were positive. The most frequently stated reason for requesting pediatric services was for physical exams, accounting for 30% of the visits. It should be noted that the discontinuity of care and insufficient utilization of preventive care seen in these results deserve serious attention by medical clinic administrators. The rate of patients who do not return for family planning after the initial visit is worrisome. A greater effort to attract women to family planning services at the time they request pregnancy verification could reduce the need for abortion of unwanted pregnancy. The data also indicate that changes in the wording of certain questions commonly asked of clients may be needed. This study allowed service providers to obtain important information about their performance, their needs, and the future direction that their services might take. This type of analysis is relatively low in cost and can yield important benefits, espicially if done on a periodical base in a search for policy implications.

BACKGROUND: Many of the individual components of antenatal care have been studied in randomised controlled trials, but few studies have compared whole programmes of antenatal care. Our aim was to test the hypothesis that a new programme of antenatal care with fewer goal-oriented visits would give an equivalent or better result in the outcomes associated with pregnancy and delivery.
METHODS: In a randomised clinical trial in Harare, Zimbabwe, we compared a new programme of antenatal care with the standard programme. The new programme consisted of fewer but more objectively oriented visits and fewer procedures per visit. Seven primary care clinics were randomly assigned to the two programmes-three to the standard programme and four to the new programme.
RESULTS: Over a 2-year period, 15,994 women were recruited into the study at the time they booked antenatal care. 97% of the women were followed up, 9,394 who had followed the new programme, and 6,138 from clinics with the standard one. Women allocated to the new programme made, as planned, fewer visits than those in the standard programme (median 4 vs 6 visits, respectively). The proportion of antenatal referrals was also lower (13.6 vs 15.3%; odds ratio 0.87 [95% CI 0.79-0.95]) because of significantly fewer referrals for pregnancy-induced hypertension (2.5 vs 3.8%; 0.66 [0.55-0.79]). Nevertheless, there were significantly fewer labour referrals for severe hypertension or eclampsia (2.1 vs 2.6%; 0.81 [0.66-1.00]). The risk for preterm (< 37 weeks) delivery was significantly lower for women on the new programme (10.1 vs 11.5%; 0.86 [0.78-0.96]). There were no other significant differences between the programmes in other major indices of pregnancy outcome, including antenatal referrals for other causes, labour referrals, obstetric interventions, low birthweight, and perinatal and maternal mortality and morbidity.
CONCLUSIONS: An antenatal care programme with fewer more objectively oriented visits can be introduced without adverse effects on the main intermediate outcome pregnancy variables.
Many of the individual components of prenatal care have been studied in randomized controlled trials, but few studies have compared whole programs of prenatal care. The objective of this study was to test the hypothesis that a new program of prenatal care with fewer goal-oriented visits would give an equivalent or better result in pregnancy and delivery outcomes. A new program of prenatal care was compared with the standard program in a randomized clinical trial in Harare, Zimbabwe. The new program consisted of fewer but more objectively oriented visits and fewer procedures per visit. Seven primary care clinics were randomly assigned to the two programs: three to the standard program and four to the new program. Over a two-year period between July, 1989, and July, 1991, 15,994 women were recruited into the study at the time they were booked for prenatal care. 97% of the women were followed up: 9394 followed the new program and 6138 were from clinics with the standard one. The median number of visits was reduced from 7 to 6 in the standard program and from 7 to 4 in the new program. The proportion of prenatal referrals was also lower (13.6% vs. 15.3%; odds ratio [OR] 0.87 [95% confidence interval [CI] 0.79-0.95]) because of significantly fewer referrals for pregnancy-induced hypertension (2.5% vs. 3.8%; OR 0.66 [CI 0.55-0.79]). Nevertheless, there were significantly fewer referrals in labor for severe hypertension or eclampsia (2.1% vs 2.6%; OR 0.81 [CI 0.66-1.00]). The risk for preterm ( 37 weeks) delivery was significantly lower for women in the new program (10.1% vs. 11.5%; OR 0.86 [CI 0.78-0.96]). There were no other significant differences between the programs in other major indices of pregnancy outcome, including prenatal referrals for other causes, labor referrals, obstetric interventions, low birth weight, and perinatal and maternal mortality and morbidity. A prenatal care program with fewer, more objectively oriented visits can be introduced without adverse effects on the main intermediate outcome pregnancy variables.

Teenagers wait an average of about 1 year before seeking birth control help at a family planning clinic. Nearly 4 in 10 teens come to the clinic only because they fear they are pregnant; only 1 in 7 come for help in anticipation of their 1st sexual encounter. While 3/4 use a nonprescription method at some time before they arrive at the clinic, most use methods of doubtful effectiveness and 1/2 of these used no method at last intercouse. Blacks are more likely than whites to come to the clinic as virgins or soon after beginning intercourse. Fear of pregnancy is the main reason given for finally going to the clinic, and fear that the family would find out was often mentioned. Shorter delays found among users of nonmedical methods suggest that initiative to expand and improve such usage may help teenagers prevent pregnancies during the early part of their sexual careers and also accelerate their adoption of more effective methods. If clinics become known as a source of free supplies of nonprescription methods as well as of general contraceptive advice, they might be more utilized by teenagers earlier. Thorough counseling about these methods as a backup to prescription methods is also needed. The importance of emphasizing confidentiality is noted, although it is also noted that teenagers who are able to talk to their parents about such matters are more likely to come to the clinic before or soon after they begin having intercourse. Data came from a 1980 survey of a wide range of family planning services in 8 cities, representing over 1200 adolescents.

To test the effectiveness of a special health care program for adolescent mothers (17 years old or younger) and their infants, 243 mother-infant pairs were randomly assigned to one of two groups. All of the mothers were unwed, on Medicaid, and black. The control group received routine well-baby care. The experimental group received routine care and services that included rigorous follow-up, discussions with the mother about her plans for return to school and use of family planning methods, and extra health teaching. The dropout rate in the experimental group (60%) was significantly less after 18 months than the control group (82%). In spite of the high dropout rate, 91% of the mothers were located for the 18 month follow-up interview. The repeat pregnancy rate in the experimental group was 12% after 18 months, and 28% in the control group. There was no significant difference in the percentage returning to school. After 12 months, the infants in the experimental group were more likely to be fully immunized (33%) than the infants in the control group (18%). Mothers in the special care program who continued to attend clinic used the emergency room less than the mothers who continued to attend in the control group. These results suggest that a comprehensive health care program is one way to bring about better outcomes for both adolescent mothers and their infants.
120 adolescent mothers who delivered at a large teaching hospital in Philadelphia, Pennsylvania, and their infants were assigned to an experimental group who had received special care which included rigorous follow-up, discussions with the mothers about plans to return to school and use of family planning, and additional health education. Another 123 mothers formed the control group and received only routine well-baby care. A nurse practitioner directed the experimental clinic. All the cases and controls were African American, on Medicaid, and unmarried. Mothers in the control group were more likely to return for all well-baby visits (at 2 weeks, 92% vs. 76%; at 18 months, 40% vs. 18%; p = 0.002). At 18 months, the dropout rate was high for both groups, but it was less for the experimental group than the control group (60% vs. 82%). Nevertheless, clinic staff were able to locate 91% of the mothers at 18 months postpartum. At 18 months, mothers in the experimental group had a lower repeat pregnancy rate than did those in the control group (12% vs. 28%; p = 0.003). More than 50% of mothers from both groups returned to school with no significant difference between the 2 groups. Children of mothers in the experimental group were more likely to be fully immunized at 18 months than those in the control group (33% vs. 18%; p 0.02). Experimental group mothers who still attended the clinic at 18 months were less likely to use the emergency room for infant care at least once than control group mothers who still attended the clinic (81% vs. 100%; p 0.03). These findings indicate that a comprehensive health care program improves outcomes for adolescent mothers and their infants. The high dropout rates from clinic attendance suggests a need for more research into developing programs targeting adolescent mothers.