Findley Sally E, Doctor Henry V, Ashir Garba M, Kana Musa A, Mani Abu S, Green Cathy, Afenyadu Godwin Y
Mailman School of Public Health, Columbia University, New York, NY, USA
United Nations Office on Drugs and Crime, Abuja, Nigeria.
J Prim Care Community Health. 2015 Apr;6(2):88-99. doi: 10.1177/2150131914549383. Epub 2014 Sep 12.
Maternal health outcomes in Nigeria, the most populous African nation, are among the worst in the world, and urgent efforts to improve the situation are critical as the deadline (2015) for achieving the Millennium Development Goals draws near.
To evaluate the results of an integrated maternal, newborn, and child health (MNCH) program to improve maternal health outcomes in Northern Nigeria.
The intervention model integrated critical health system and community-based improvements aimed at encouraging sustainable MNCH behavior change. Control Local Government Areas received less intense statewide policy changes.
We assessed the impact of the intervention on maternal health outcomes in 3 northern Nigerian states by comparing data from 2360 women in 2009 and 4628 women in 2013 who had a birth or pregnancy in the 5 years prior to the survey.
From 2009 to 2013, women with standing permission from their husband to go to the health center doubled (from 40.2% to 82.7%), and health care utilization increased. The proportions of women who delivered with a skilled birth attendant increased from 11.2% to 23.9%, and the proportion of women having at least 1 antenatal care (ANC) visit doubled from 24.9% to 48.8%. ANC was increasingly provided by trained community health extension workers at the primary health center, who provided ANC to 34% of all women with recent pregnancies in 2013. In 2013, 22% of women knew at least 4 maternal danger signs compared with 10% in 2009. Improvements were significantly greater in the intervention communities that received the additional demand-side interventions.
The improvements between 2009 and 2013 demonstrate the measurable impact on maternal health outcomes of the program through local communities and primary health care services. The significant improvements in communities with the complete intervention show the importance of an integrated approach blending supply- and demand-side interventions.
尼日利亚是非洲人口最多的国家，其孕产妇健康状况在世界上处于最差之列。随着实现千年发展目标的最后期限（2015年）临近，迫切需要做出努力来改善这一状况。
评估一项综合孕产妇、新生儿和儿童健康（MNCH）项目在改善尼日利亚北部孕产妇健康状况方面的效果。
该干预模式整合了关键的卫生系统和基于社区的改进措施，旨在鼓励可持续的孕产妇、新生儿和儿童健康行为改变。对照地方政府区域接受的全州范围政策变化力度较小。
通过比较2009年的2360名妇女和2013年的4628名妇女的数据，评估该干预措施对尼日利亚北部3个州孕产妇健康状况的影响，这些妇女在调查前5年内有过生育或怀孕。
从2009年到2013年，获得丈夫许可前往保健中心的妇女数量翻了一番（从40.2%增至82.7%），医疗保健利用率有所提高。由熟练助产士接生的妇女比例从11.2%增至23.9%，至少进行1次产前检查（ANC）的妇女比例翻了一番，从24.9%增至48.8%。初级保健中心受过培训的社区卫生推广工作者越来越多地提供产前检查，2013年他们为所有近期怀孕妇女中的34%提供了产前检查。2013年，22%的妇女至少知晓4种孕产妇危险迹象，而2009年这一比例为10%。在接受额外需求侧干预措施的干预社区，改善情况更为显著。
2009年至2013年期间的改善情况表明，该项目通过当地社区和初级卫生保健服务对孕产妇健康状况产生了可衡量的影响。全面干预社区的显著改善表明了将供给侧和需求侧干预措施相结合的综合方法的重要性。
