提高产前检查孕妇的机构分娩率：分娩准备咨询的效果
Increasing institutional deliveries among antenatal clients: effect of birth preparedness counselling.
作者信息
Soubeiga Dieudonné, Sia Drissa, Gauvin Lise
机构信息
Department of Health Management, Faculty of Medicine, University of Montreal, Montreal, QC, Canada, Department of Quality and Safety, Sainte Justine University Hospital Center, Montreal, QC, Canada, Institute for Health and Social Policy, McGill University, Montreal, QC, Canada and Department of Social and Preventive Medicine, Faculty of Medicine, University of Montreal, QC, Canada Department of Health Management, Faculty of Medicine, University of Montreal, Montreal, QC, Canada, Department of Quality and Safety, Sainte Justine University Hospital Center, Montreal, QC, Canada, Institute for Health and Social Policy, McGill University, Montreal, QC, Canada and Department of Social and Preventive Medicine, Faculty of Medicine, University of Montreal, QC, Canada
Department of Health Management, Faculty of Medicine, University of Montreal, Montreal, QC, Canada, Department of Quality and Safety, Sainte Justine University Hospital Center, Montreal, QC, Canada, Institute for Health and Social Policy, McGill University, Montreal, QC, Canada and Department of Social and Preventive Medicine, Faculty of Medicine, University of Montreal, QC, Canada.
出版信息
Health Policy Plan. 2014 Dec;29(8):1061-70. doi: 10.1093/heapol/czt089. Epub 2013 Nov 22.
The World Health Organization recommends birth and emergency preparedness (BEP) as essential components of the Focused Antenatal Care model. The purpose of providing BEP messages to women during their antenatal visits is to increase the use of skilled attendance at childbirth. However, the effectiveness of this component has not yet been clearly established in routine contexts. This retrospective cohort study examined the association between exposing women to BEP messages during antenatal visits and the use of the skilled attendance at childbirth in two rural districts of Burkina Faso (Koupela and Dori). The study included 456 antenatal care users in 30 rural health centres in these two districts. Data were collected using modified questionnaires from the Johns Hopkins Program for International Education in Gynecology and Obstetrics and from demographic and health surveys. Logistic regression was performed with a model of generalized estimating equation to adjust for clustered effects. In the Koupela district, where the rate of institutional deliveries (80%) was relatively high, the use of BEP messages was not associated with an increase in institutional deliveries. In contrast, in the district of Dori, where the rate of institutional deliveries (47%) was lower, messages regarding danger signs [Adjusted Odds Ratio (AOR) = 1.93; 95% Confidence Interval (CI): 1.07, 3.49] and cost of care (AOR = 2.13; 95% CI: 1.09, 4.22) were associated with an increased probability of institutional births. Based on these results, it appears that birth and emergency preparedness messages provided during antenatal visits may increase the use of skilled attendance (increase the rate of institutional births) in areas where institutional births are low. Therefore, it is important to adapt the content of the messages to meet the particular needs of the users in each locality. Furthermore, BEP counselling should be implemented in health facilities.
世界卫生组织建议将分娩与应急准备（BEP）作为集中产前护理模式的重要组成部分。在产前检查期间向孕妇提供BEP信息的目的是增加熟练接生服务的使用率。然而，这一组成部分在常规情况下的有效性尚未明确确立。这项回顾性队列研究考察了在布基纳法索的两个农村地区（库佩拉和多里），孕妇在产前检查期间接触BEP信息与熟练接生服务使用率之间的关联。该研究纳入了这两个地区30个农村卫生中心的456名产前护理使用者。数据通过修改后的约翰·霍普金斯妇产科国际教育项目问卷以及人口与健康调查进行收集。采用广义估计方程模型进行逻辑回归以调整聚类效应。在机构分娩率相对较高（80%）的库佩拉地区，使用BEP信息与机构分娩率的增加无关。相比之下，在机构分娩率较低（47%）的多里地区，有关危险信号的信息[调整后的优势比（AOR）=1.93；95%置信区间（CI）：1.07，3.49]和护理费用（AOR = 2.13；95%CI：1.09，4.22）与机构分娩概率的增加相关。基于这些结果，产前检查期间提供的分娩与应急准备信息似乎可能会在机构分娩率较低的地区增加熟练接生服务的使用（提高机构分娩率）。因此，根据每个地区使用者的特定需求调整信息内容很重要。此外，应在卫生设施中实施BEP咨询。
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