Jennings L, Yebadokpo A, Affo J, Agbogbe M
USAID Health Care Improvement Project, University Research Co. LLC, Bethesda, MD, USA,
Matern Child Health J. 2015 Mar;19(3):557-65. doi: 10.1007/s10995-014-1537-5.
This study examined the effect of a job aids-focused intervention on quality of facility-based postnatal counseling, and whether increased communication improved in-hospital newborn care and maternal knowledge of home practices and danger signs requiring urgent care. Ensuring mothers and newborns receive essential postnatal services, including health counseling, is integral to their survival. Yet, quality of clinic-based postnatal services is often low, and evidence on effective improvement strategies is scarce. Using a pre-post randomized design, data were drawn from direct observations and interviews with 411 mother-newborn pairs. Multi-level regression models with difference-in-differences analyses estimated the intervention's relative effect, adjusting for changes in the comparison arm. The mean percent of recommended messages provided to recently-delivered women significantly improved in the intervention arm as compared to the control (difference-in-differences [∆i - ∆c] +30.9, 95 % confidence interval (CI) 19.3, 42.5), and the proportion of newborns thermally protected within the first hour (∆i - ∆c +33.7, 95 % CI 19.0, 48.4) and delayed for bathing (∆i - ∆c +23.9, 95 % CI 9.4, 38.4) significantly increased. No significant changes were observed in early breastfeeding (∆i - ∆c +6.8, 95 % CI -2.8, 16.4) which was nearly universal. Omitting traditional umbilical cord substances rose slightly, but was insignificant (∆i - ∆c +8.5, 95 % CI -2.8, 19.9). The proportion of mothers with correct knowledge of maternal (∆i - ∆c +27.8, 95 % CI 11.0, 44.6) and newborn (∆i - ∆c +40.3, 95 % CI 22.2, 58.4) danger signs grew substantially, as did awareness of several home-care practices (∆i - ∆c +26.0, 95 % CI 7.7, 44.3). Counseling job aids can improve the quality of postnatal services. However, achieving reduction goals in maternal and neonatal mortality will likely require more comprehensive approaches to link enhanced facility services with community-based initiatives.
本研究考察了以工作辅助工具为重点的干预措施对机构化产后咨询质量的影响，以及沟通的增加是否改善了住院新生儿护理以及母亲对家庭护理做法和需要紧急护理的危险信号的了解。确保母亲和新生儿获得包括健康咨询在内的基本产后服务对他们的生存至关重要。然而，基于诊所的产后服务质量往往较低，且关于有效改进策略的证据稀缺。采用前后随机设计，数据来自对411对母婴的直接观察和访谈。使用差异分析的多层次回归模型估计了干预措施的相对效果，并对对照组的变化进行了调整。与对照组相比，干预组向近期分娩妇女提供的推荐信息的平均百分比显著提高（差异分析[∆i - ∆c]+30.9，95%置信区间（CI）19.3，42.5），出生后第一小时内得到体温保护的新生儿比例（∆i - ∆c +33.7，95%CI 19.0，48.4）以及延迟洗澡的比例（∆i - ∆c +23.9，95%CI 9.4，38.4）显著增加。早期母乳喂养方面未观察到显著变化（∆i - ∆c +6.8，95%CI -2.8，16.4），因为早期母乳喂养几乎普及。不使用传统脐带处理物质的情况略有上升，但不显著（∆i - ∆c +8.5，95%CI -2.8，19.9）。对母亲和新生儿危险信号有正确认识的母亲比例大幅上升（母亲方面：∆i - ∆c +27.8，95%CI 11.0，44.6；新生儿方面：∆i - ∆c +40.3，95%CI 22.2，58.4），对几种家庭护理做法的知晓情况也是如此（∆i - ∆c +26.0，95%CI 7.7，44.3）。咨询工作辅助工具可以提高产后服务质量。然而，要实现降低孕产妇和新生儿死亡率的目标，可能需要更全面的方法，将强化的机构服务与基于社区的举措联系起来。
