以社区为基础的干预方案在改善发展中国家围产期健康方面的效果:证据综述。

Community-based intervention packages for improving perinatal health in developing countries: a review of the evidence.

机构信息

International Center for Advancing Neonatal Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.

出版信息

Semin Perinatol. 2010 Dec;34(6):462-76. doi: 10.1053/j.semperi.2010.09.008.

Abstract

The Lancet Neonatal Survival Series categorized neonatal health interventions into 3 service delivery modes: "Outreach," "Family-Community Care," and "Facility-based Clinical Care." Family-Community Care services generally have a greater potential impact on neonatal health than Outreach services, with similar costs. Combining interventions from all 3 service delivery modes is ideal for achievement of high impact. However, access to clinical care is limited in resource-poor settings with weak health systems. The current trend for those settings is to combine neonatal interventions into community-based intervention packages (CBIPs), which can be integrated into the local health care system. In this article, we searched several large databases to identify all published, large-scale, controlled studies that were implemented in a rural setting, included a control group, and reported neonatal and/or perinatal mortality as outcomes. We identified only 9 large-scale studies that fit these criteria. Several conclusions can be reached. (1) Family-Community Care interventions can have a substantial effect on neonatal and perinatal mortality. (2) Several important common strategies were used across the studies, including community mobilization, health education, behavior change communication sessions, care seeking modalities, and home visits during pregnancy and after birth. However, implementation of these interventions varied widely across the studies. (3) There is a need for additional, large-scale studies to test evidence-based CBIPs in developing countries, particularly in Africa, where no large-scale studies were identified. (4) We need to establish consistent, clearly defined terminology and protocols for designing trials and reporting outcomes so that we are able to compare results across different settings. (5) There is an urgent need to invest in research and program development focusing on neonatal health in urban areas. (6) It is crucial to integrate CBIPs in rural and urban settings into the already existing health care system to facilitate sustainability of the program and for scaling up. It is also important to evaluate the packages and to demonstrate the health impact of large-scale implementation. (7) Finally, there is a need for improving the continuum of care between home and facility-based care.

摘要

柳叶刀新生儿生存系列将新生儿健康干预措施分为 3 种服务提供模式:“外展”、“家庭-社区护理”和“以设施为基础的临床护理”。家庭-社区护理服务对新生儿健康的影响通常比外展服务更大,成本也相似。将所有 3 种服务提供模式的干预措施结合起来,对于实现高影响力是理想的。然而,在资源匮乏、卫生系统薄弱的环境中,获得临床护理的机会有限。目前,这些环境的趋势是将新生儿干预措施纳入基于社区的干预包(CBIP),这些干预包可以整合到当地的医疗保健系统中。在这篇文章中,我们搜索了几个大型数据库,以确定所有已发表的、大规模的、在农村环境中实施的、有对照组且报告新生儿和/或围产期死亡率为结局的对照研究。我们只确定了 9 项符合这些标准的大规模研究。可以得出以下几个结论。(1)家庭-社区护理干预措施可以对新生儿和围产期死亡率产生重大影响。(2)几项重要的共同策略在这些研究中得到了应用,包括社区动员、健康教育、行为改变沟通会议、寻求医疗模式以及在怀孕和分娩后进行家访。然而,这些干预措施在研究中的实施情况差异很大。(3)需要在发展中国家,特别是在没有发现大规模研究的非洲,开展更多的、大规模的研究,以检验基于证据的 CBIP。(4)我们需要建立一致、明确的术语和方案,用于设计试验和报告结果,以便我们能够比较不同环境下的结果。(5)迫切需要投资于城市地区新生儿健康的研究和方案制定。(6)将 CBIP 整合到农村和城市环境中现有的医疗保健系统中,以促进方案的可持续性和扩大规模,这一点至关重要。评估这些方案并展示大规模实施的健康影响也很重要。(7)最后,需要改善家庭护理和设施护理之间的护理连续性。

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