Darmstadt Gary L, Hussein Mohamed Hassan, Winch Peter J, Haws Rachel A, Gipson Reginald, Santosham Mathuram
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA.
J Health Popul Nutr. 2008 Mar;26(1):36-45.
Neonatal deaths account for almost two-thirds of infant mortality worldwide; most deaths are preventable. Two-thirds of neonatal deaths occur during the first week of life, usually at home. While previous Egyptian studies have identified provider practices contributing to maternal mortality, none has focused on neonatal care. A survey of reported practices of birth attendants was administered. Chi-square tests were used for measuring the statistical significance of inter-regional differences. In total, 217 recently-delivered mothers in rural areas of three governorates were interviewed about antenatal, intrapartum and postnatal care they received. This study identified antenatal advice of birth attendants to mothers about neonatal care and routine intrapartum and postpartum practices. While mothers usually received antenatal care from physicians, traditional birth attendants (dayas) conducted most deliveries. Advice was rare, except for breastfeeding. Routine practices included hand-washing by attendants, sterile cord-cutting, prompt wrapping of newborns, and postnatal home visits. Suboptimal practices included lack of disinfection of delivery instruments, unhygienic cord care, lack of weighing of newborns, and lack of administration of eye prophylaxis or vitamin K. One-third of complicated deliveries occurred at home, commonly attended by relatives, and the umbilical cord was frequently pulled to hasten delivery of the placenta. In facilities, mothers reported frequent use of forceps, and asphyxiated neonates were often hung upside-down during resuscitation. Consequently, high rates of birth injuries were reported. Priority areas for behaviour change and future research to improve neonatal health outcomes were identified, specific to type of provider (physician, nurse, or daya) and regional variations in practices.
新生儿死亡占全球婴儿死亡总数的近三分之二；大多数死亡是可以预防的。三分之二的新生儿死亡发生在出生后的第一周，通常是在家中。虽然此前埃及的研究已经确定了导致孕产妇死亡的医疗服务提供者行为，但没有一项研究关注新生儿护理。我们对接生员报告的行为进行了一项调查。采用卡方检验来衡量区域间差异的统计学显著性。总共对三个省农村地区的217名近期分娩的母亲进行了访谈，询问她们接受的产前、产时和产后护理情况。这项研究确定了接生员向母亲提供的关于新生儿护理以及常规产时和产后做法的产前建议。虽然母亲们通常从医生那里接受产前护理，但大多数分娩由传统接生员（dayas）进行。除了母乳喂养方面的建议外，其他建议很少。常规做法包括接生员洗手、无菌剪脐带、及时包裹新生儿以及产后家访。不理想的做法包括分娩器械未消毒、脐带护理不卫生、未给新生儿称重以及未进行眼部预防用药或注射维生素K。三分之一的复杂分娩在家中进行，通常由亲属协助，为了加速胎盘娩出，脐带经常被拉扯。在医疗机构中，母亲们报告频繁使用产钳，窒息新生儿在复苏过程中经常被倒挂。因此，报告的出生损伤发生率很高。确定了行为改变和未来研究的优先领域，以改善新生儿健康结局，这些领域因医疗服务提供者类型（医生、护士或daya）以及做法的区域差异而异。
