Department of Obstetrics and Gynaecology, Bugando Medical Centre and Teaching Hospital, Mwanza, Tanzania.
Trop Med Int Health. 2013 Apr;18(4):435-43. doi: 10.1111/tmi.12069. Epub 2013 Feb 5.
To determine the effectiveness of birth plans in increasing use of skilled care at delivery and in the postnatal period among antenatal care (ANC) attendees in a rural district with low occupancy of health units for delivery but high antenatal care uptake in northern Tanzania.
Cluster randomised trial in Ngorongoro district, Arusha region, involving 16 health units (8 per arm). Nine hundred and five pregnant women at 24 weeks of gestation and above (404 in the intervention arm) were recruited and followed up to at least 1 month postpartum.
Skilled delivery care uptake was 16.8% higher in the intervention units than in the control [95% CI 2.6-31.0; P = 0.02]. Postnatal care utilisation in the first month of delivery was higher (difference in proportions: 30.0% [95% CI 1.3-47.7; P < 0.01]) and also initiated earlier (mean duration 6.6 ± 1.7 days vs. 20.9 ± 4.4 days, P < 0.01) in the intervention than in the control arm. Women's and providers' reports of care satisfaction (received or provided) did not differ greatly between the two arms of the study (difference in proportion: 12.1% [95% CI -6.3-30.5] P = 0.17 and 6.9% [95% CI -3.2-17.1] P = 0.15, respectively).
Implementation of birth plans during ANC can increase the uptake of skilled delivery and post delivery care in the study district without negatively affecting women's and providers' satisfaction with available ANC services. Birth plans should be considered along with the range of other recommended interventions as a strategy to improve the uptake of maternal health services.
在坦桑尼亚北部一个农村地区，尽管分娩保健单位入住率低，但产前护理利用率高，确定生育计划在增加参与产前护理的产妇在分娩时和产后使用熟练护理的效果。
在阿鲁沙地区的恩戈罗恩戈罗区进行了一项群组随机试验，涉及 16 个保健单位（每个组 8 个）。招募了 905 名怀孕 24 周及以上的孕妇（干预组 404 名），并随访至产后至少 1 个月。
干预组的熟练分娩护理使用率比对照组高 16.8%[95%置信区间为 2.6-31.0；P=0.02]。在分娩后的第一个月中，接受产后护理的比例更高（差异比例为 30.0%[95%置信区间为 1.3-47.7；P<0.01]），且开始得更早（平均持续时间为 6.6±1.7 天 vs. 20.9±4.4 天，P<0.01）。两组妇女和提供者对护理满意度（接受或提供）的报告差异不大（差异比例为 12.1%[95%置信区间为-6.3-30.5]，P=0.17 和 6.9%[95%置信区间为-3.2-17.1]，P=0.15）。
在 ANC 期间实施生育计划可以增加研究地区熟练分娩和产后护理的使用率，而不会对妇女和提供者对现有 ANC 服务的满意度产生负面影响。生育计划应与其他推荐的干预措施一起考虑，作为提高产妇保健服务使用率的一种策略。
