Peabody J W, Gertler P J, Leibowitz A
RAND, Santa Monica, CA 90407-2138, USA.
Health Policy. 1998 Jan;43(1):1-13. doi: 10.1016/s0168-8510(97)00085-7.
We investigated if better structural and process elements of prenatal care relate to higher birth weights in the Jamaican population.
We used data from two surveys: (1) a national sample of randomly selected households; and (2) a concurrent facility survey of the public health clinics in Jamaica. In the household survey, all women aged 14-50, who had a pregnancy lasting 7 months during the previous 5 years (n = 913) were interviewed. From the household survey, we gathered information on the maternal, clinical and socioeconomic risk factors and on the newborns birth weight (the outcome measure). The facility survey collected data from all public primary care clinics in the country (n = 366). This gave us information on the quality of care (structure and process measures) provided in the clinics.
Prenatal care in Jamaica, while generally available, provides care to many women who are at particular risk because of parity, age and poverty. Structural measures of the facilities show that clinics are in general disrepair, have only 70% of the basic equipment and are insufficiently stocked with supplies or medication. Many facilities had poor process of care, as measured by assessing the clinical examination and counseling. The average birth weight was 3232 g and 9.8% weighed < 2500 g. The relationships between birth weight and the quality of care were estimated using multiple regression. The biologic and socioeconomic risk factors related to birth weight in the expected direction. None of the structural quality measures were statistically significant. Among the process measures, women who had access to a more complete examination, had infants that weighed an average of 128 g more at birth.
Better quality of care, provided by a more thorough clinical evaluation, has a more powerful effect on birth weight in the population than upgraded facilities or equipment. In developed or developing countries, where resources are limited, policy should focus on education and training to improve birth outcomes.
我们调查了牙买加人群中，更好的产前保健结构要素和过程要素是否与更高的出生体重相关。
我们使用了两项调查的数据：（1）全国随机抽取家庭样本；（2）同时对牙买加公共卫生诊所进行的机构调查。在家庭调查中，对所有年龄在14 - 50岁、过去5年内有过持续7个月妊娠经历的女性（n = 913）进行了访谈。从家庭调查中，我们收集了有关孕产妇、临床和社会经济风险因素以及新生儿出生体重（结果指标）的信息。机构调查收集了该国所有公立基层医疗诊所（n = 366）的数据。这为我们提供了诊所提供的护理质量（结构和过程指标）的信息。
牙买加的产前保健虽然普遍可及，但为许多因生育次数、年龄和贫困而处于特殊风险的女性提供护理。机构的结构指标显示，诊所普遍失修，只有70%的基本设备，物资或药品储备不足。通过评估临床检查和咨询发现，许多机构的护理过程不佳。平均出生体重为3232克，9.8%的婴儿体重<2500克。使用多元回归估计出生体重与护理质量之间的关系。生物学和社会经济风险因素与出生体重的关系符合预期方向。没有一项结构质量指标具有统计学意义。在过程指标中，接受更全面检查的女性所生婴儿出生时平均体重多128克。
更全面的临床评估所提供的更高质量护理，对人群出生体重的影响比升级设施或设备更为显著。在资源有限的发达国家或发展中国家，政策应侧重于教育和培训以改善出生结局。
