Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi 710061, China.
BMC Public Health. 2010 Sep 22;10:566. doi: 10.1186/1471-2458-10-566.
Maternal care is an important strategy for protection and promotion of maternal and children's health by reducing maternal mortality and improving the quality of birth. However, the status of maternal care is quite weak in the less developed rural areas in western China. It is found that the maternal mortality rates in some western areas of China were 5.8 times higher than those of their eastern costal counterparts. In order to reduce the maternal mortality rates and to improve maternal care in western rural areas of China, the Chinese Ministry of Health (MOH) and the United Nations Children's Fund (UNICEF) sponsored a program named "Safe Motherhood" in ten western provinces of China from 2001 through 2005. This study mainly aims to evaluate the effects of "Safe Motherhood" program on maternal care utilization.
32 counties were included in both surveys conducted in 2001 and 2005, respectively. Ten counties of which implemented comprehensive community-based intervention were used as intervention groups, while 22 counties were used as control groups. Stratified 3-stage probability-proportion-to-size sampling method was used to select participating women. Two cross-sectional surveys were conducted with questionnaires about the prenatal care utilization in 2001 and 2005, respectively. Difference in difference estimation was used to assess the effect of intervention on the maternal care utilization while controlling for socio-economic characteristics of women.
After the intervention, the proportion of pregnant women who had their first prenatal visit in the first trimester was increased from 38.9% to 76.1%. The proportion of prenatal visits increased from 82.6% to 98.3%. The proportion of women mobilized to deliver in hospitals increased from 62.7% to 94.5%. Hospital delivery was improved greatly from 31.1% to 87.3%. The maternal mortality rate was lowered by 34.9% from 91.76 to 59.74 per 100,000 live births. The community-based intervention had increased prenatal visits rate by 5.2%, first prenatal visit in first trimester rate by 12.0% and hospital delivery rate by 22.5%, respectively. No effect was found on rate of women being mobilized to hospital delivery compared with that of the control group.
The intervention program seemed to have improved the prenatal care utilization in rural western China.
母婴保健是降低孕产妇死亡率和提高出生人口素质、保护和促进母婴健康的重要策略。然而，在中国西部欠发达农村地区，母婴保健的状况相当薄弱。研究发现，中国西部一些地区的孕产妇死亡率是东部沿海地区的 5.8 倍。为了降低中国西部农村地区的孕产妇死亡率，提高母婴保健水平，中国卫生部（MOH）和联合国儿童基金会（UNICEF）于 2001 年至 2005 年在我国西部 10 个省份开展了名为“母婴平安 120 行动”的项目。本研究主要旨在评估“母婴平安 120 行动”项目对母婴保健利用的影响。
2001 年和 2005 年分别进行了两次调查，共纳入 32 个县。其中 10 个实施全面社区综合干预的县为干预组，22 个县为对照组。采用分层三阶段概率比例规模抽样方法选择参与的妇女。分别于 2001 年和 2005 年进行了两次横断面调查，用问卷了解产前保健利用情况。采用差异差异估计方法评估干预对母婴保健利用的影响，同时控制妇女的社会经济特征。
干预后，孕妇在孕早期进行首次产前检查的比例从 38.9%增加到 76.1%，产前检查次数从 82.6%增加到 98.3%，动员到医院分娩的妇女比例从 62.7%增加到 94.5%，医院分娩率从 31.1%提高到 87.3%。孕产妇死亡率从每 10 万活产 91.76 人下降到 59.74 人，下降了 34.9%。社区综合干预使产前检查率提高了 5.2%，孕早期首次产前检查率提高了 12.0%，医院分娩率提高了 22.5%。与对照组相比，动员到医院分娩的妇女比例没有变化。
该干预计划似乎提高了中国西部农村地区的产前保健利用水平。
