社区基础母婴安全促进员在改善产科保健利用方面的效果。坦桑尼亚姆特瓦拉农村地区的案例。
Effectiveness of community based Safe Motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania.
机构信息
Department of Community Health, Tumaini University-Kilimanjaro Christian Medical Centre, P.O. Box, 2240, Moshi, Kilimanjaro, Tanzania.
出版信息
BMC Pregnancy Childbirth. 2010 Apr 1;10:14. doi: 10.1186/1471-2393-10-14.
BACKGROUND
In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%), only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania.
METHOD
This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs). Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues.
RESULTS
Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (rho < 0.05). Early ANC booking (4 to 16 weeks) rose significantly from 18.7% at baseline to 37.7% in 2005 and 56.9% (rho < 0.001) at final assessment. After two years 44 (88%) of the SMPs were still active, 79% of pregnant women were visited. Further benefits included the enhancement of male involvement in safe motherhood issues.
CONCLUSION
The study has demonstrated the effectiveness of community-based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.
背景
在坦桑尼亚，孕产妇死亡率仍高达 578/10 万活产，这一数字令人无法接受。尽管产前护理覆盖率很高（96%），但只有 44%的分娩在正规卫生服务机构进行。尽管如此，“确保分娩时有熟练的接生员”仍然被认为是减少孕产妇死亡的最有效干预措施之一。本研究旨在探索基于社区的干预措施在提高产科护理利用方面的潜力，目的是在坦桑尼亚姆特瓦拉农村地区开发、测试和评估一项基于社区的安全孕产干预措施。
方法
本项基于社区的干预措施设计为前后对照研究，覆盖了总人口为 8300 人的 4 个村庄。干预活动由 50 名经过培训的安全孕产宣传员（SMP）实施。他们的任务重点是促进早期和全面的产前护理就诊以及由熟练接生员接生。2004 年 10 月至 2006 年 11 月期间所有 512 例分娩的数据由 SMP 收集，并与卫生服务记录交叉核对。此外，还对 242 名受访者进行了有关安全孕产问题知识和对 SMP 表现看法的访谈。熟练接生员接生是我们的主要结果；次要结果包括产前护理就诊和安全孕产问题知识。
结果
有熟练接生员接生的分娩比例从 34.1%显著增加到 51.4%（rho < 0.05）。早期 ANC 预约（4-16 周）从基线时的 18.7%显著增加到 2005 年的 37.7%和最终评估时的 56.9%（rho < 0.001）。两年后，仍有 44 名（88%）SMP 仍在活跃，79%的孕妇接受了家访。进一步的好处包括增强了男性对安全孕产问题的参与。
结论
本研究表明，基于社区的安全孕产干预措施在促进产科护理和分娩时使用熟练接生员方面是有效的。这种改善归因于 SMP 的家访以及与现有社区结构和卫生服务的密切合作。
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