在乌干达东部资源匮乏的农村地区,社区-医疗机构联动干预措施对孕产妇保健服务利用率和新生儿护理的影响。

IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY BMC Pregnancy and Childbirth Pub Date : 2024-10-22 DOI:10.1186/s12884-024-06883-4
Solomon T Wafula, Rornald Muhumuza Kananura, Gerald Pande, Felix Kizito, Sarah Namutamba, Betty Kyobe, Geraldine Agiraembabazi, Elizabeth Ekirapa-Kiracho, Peter Waiswa
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引用次数: 0

摘要

背景:改善偏远地区的孕产妇和新生儿护理(MNC)对于加快实现可持续发展目标(SDGs)至关重要。2017 年至 2020 年期间,我们在乌干达东部农村地区实施了 "母亲和新生儿茁壮成长社区(COMONETH)项目",以减少获得孕产妇和新生儿护理服务的障碍。我们评估了 COMONETH 干预措施对提高乌干达卢卡地区利用孕产妇和新生儿服务以及采取适当护理措施的效果:方法:我们采用前后比较的设计方法来衡量 COMONETH 干预措施对母婴传播指标的影响。我们对社区保健工作者(CHW)进行了培训,让他们对孕妇进行教育,并在需要时将孕妇转介到医疗机构。我们还向孕妇播放了识别妊娠危险征兆的视频,指导和模拟卫生工作者使用 PRONTO,并改善了转诊机构的产科手术。我们对产前护理(ANC)、设施内分娩、产后护理(PNC)和新生儿护理实践进行了评估。我们采用了最优化的完全倾向得分匹配和加权逻辑回归,然后按几率比法估算了干预措施对 MNC 结果的平均治疗效果(ATT):共有 583 名妇女参加了基线研究,619 名妇女参加了终点研究。干预增加了接受 4 次产前检查(OR = 1.26,95% CI = 1.07-1.49)、8 次产前检查(OR = 2.27,95% CI = 1.06-4.82)和利用产前保健服务(OR = 1.40,95% CI = 1.20-1.63)的几率。我们没有观察到干预与早期产前检查就诊率(OR = 0.88,95% CI = 0.80-1.00)和设施接生率(OR = 0.99,95% CI = 0.93-1.06)之间存在明显关联。干预策略与以下做法的改进有关:延迟洗澡(OR = 1.22,95% CI = 1.06-1.40)、不在脐带上放任何东西(OR = 1.42,95% CI = 1.27-1.59)和立即包裹婴儿(OR = 1.08,95% CI = 1.03-1.14):研究结果表明,供需挂钩的干预措施有可能改善低资源环境下的新生儿疾病治疗效果,应在类似环境中推广。通过干预措施提高医疗机构的护理质量并缩小需求方的差距,可以改善农村地区的新生儿数控操作,降低发病率和死亡率。
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Effect of community - facility linked interventions on maternal health service utilization and newborn care in rural low-resource settings in Eastern Uganda.

Background: Improving maternal and newborn care (MNC) in hard-to-reach areas is essential for accelerating progress towards sustainable development goals (SDGs). We implemented the "Communities in which Mothers and Newborns Thrive (COMONETH) project" in rural settings of eastern Uganda between 2017 and 2020 to reduce barriers to accessing MNC services. We evaluated the effect of the COMONETH intervention on enhancing the utilization of MNC services and the adoption of appropriate care practices in Luuka district, Uganda.

Methods: We used a pre- and post-comparison design to measure the effect of a demand-supply linked COMONETH intervention on MNC indicators. We trained Community Health Workers (CHW) to educate and refer expectant mothers to health facilities when needed. We also showed videos to pregnant women on identification of pregnancy danger signs, mentored and simulated health workers with PRONTO, and improved obstetric surgery at the referral facilities. We assessed antenatal care (ANC), facility delivery, postnatal care (PNC), and newborn care practices. We used optimal full propensity score matching, and weighted logistic regression and then estimated average treatment effect on the treated (ATT) of the intervention on MNC outcomes on the odds ratio scale.

Results: A total of 583 women at baseline and 619 at endline participated in the study. The intervention was associated with increased odds of attending 4 ANC visits (OR = 1.26, 95% CI = 1.07-1.49), 8 ANC visits (OR = 2.27, 95% CI = 1.06-4.82) and utilization of PNC services (OR = 1.40, 95% CI = 1.20-1.63). We did not observe a significant association between intervention and early ANC attendance (OR = 0.88, 95% CI 0.80-1.00) and facility deliveries (OR = 0.99, 95% CI = 0.93-1.06). The intervention strategy was associated with improvements in practices: delayed bathing (OR = 1.22, 95% CI = 1.06-1.40), putting nothing on the cord (OR = 1.42, 95% CI = 1.27-1.59) and wrapping of babies immediately (OR = 1.08, 95% CI = 1.03-1.14).

Conclusions: The findings demonstrated the potential of a demand-supply linked intervention to improve MNC outcomes in low-resource settings and should be promoted in similar settings. Interventions that strengthen the quality of care at health facilities and bridge demand-side gaps can improve MNC practices and reduce morbidity and mortality in rural settings.

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来源期刊
BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth OBSTETRICS & GYNECOLOGY-
CiteScore
4.90
自引率
6.50%
发文量
845
审稿时长
3-8 weeks
期刊介绍: BMC Pregnancy & Childbirth is an open access, peer-reviewed journal that considers articles on all aspects of pregnancy and childbirth. The journal welcomes submissions on the biomedical aspects of pregnancy, breastfeeding, labor, maternal health, maternity care, trends and sociological aspects of pregnancy and childbirth.
期刊最新文献
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