Villadsen Sarah Fredsted, Negussie Dereje, GebreMariam Abebe, Tilahun Abebech, Girma Tsinuel, Friis Henrik, Rasch Vibeke
Department of Nutrition, Exercise and Sport, Faculty of Science, University of Copenhagen, Rolighedsvej 25, 1958 Frb. C, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oester Farimagsgade 5, Post box 2099, 1014 Copenhagen K, Denmark.
Department of Obstetrics and Gynaecology, Jimma University Specialized Hospital, Post Box 480, Jimma, Ethiopia.
Midwifery. 2016 Sep;40:87-94. doi: 10.1016/j.midw.2016.06.009. Epub 2016 Jun 8.
health systems in low-income settings are not sufficiently reaching the poor, and global disparities in reproductive health persist. The frequency and quality of health education during antenatal care is often low. Further studies are needed on how to improve the performance of health systems in low income settings to improve maternal and child health.
to assess the effectiveness of a participatory antenatal care intervention on health behaviours and to illuminate how the different socioeconomic groups responded to the intervention in Jimma, Ethiopia. SETTING, INTERVENTION AND MEASUREMENTS: an intervention was designed participatorily and comprised trainings, supervisions, equipment, health education material, and adaption of guidelines. It was implemented at public facilities. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in health behaviours (number of antenatal visits, health facility delivery, breast feeding, preventive infant health check, and infant immunisation) from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression.
on the basis of 1357 women included before and 2262 after the intervention, there were positive effects of the intervention on breast feeding practices (OR 3.0, 95% CI: 1.4; 3.6) and preventive infant health check (OR 2.4, 95% CI: 1.5; 3.5). There was no effect on infant immunisation coverage and negative effect on number of antenatal visits. The effect on various outcomes was modified by maternal education, and results indicate increased health facility delivery (OR 2.4, 95% CI: 0.8; 6.9) and breast feeding practices (OR 18.2, 95% CI: 5.2;63.6) among women with no education.
the facility based intervention improved some, but not all health behaviours. The improvements indicated amongst the most disadvantaged antenatal care attendants in breast feeding and health facility delivery are encouraging and underline the need to scale up priority of antenatal care in the effort to reduce maternal and child health inequity.
低收入地区的卫生系统未能充分惠及贫困人口，生殖健康方面的全球差距依然存在。产前保健期间健康教育的频率和质量往往较低。需要进一步研究如何提高低收入地区卫生系统的绩效，以改善孕产妇和儿童健康。
评估参与式产前保健干预对健康行为的有效性，并阐明埃塞俄比亚吉马不同社会经济群体对该干预措施的反应。地点、干预措施和测量方法：参与式设计了一项干预措施，包括培训、监督、设备、健康教育材料以及指南的调整。该措施在公共设施中实施。在干预前（2008年）和干预后（2010年），对所有在过去12个月内分娩的妇女进行了家庭调查。通过使用逻辑混合效应回归，比较干预地点与对照地点在干预期间前后健康行为（产前检查次数、在医疗机构分娩、母乳喂养、婴儿预防性健康检查和婴儿免疫接种）的变化，评估干预措施的效果。
基于干预前纳入的1357名妇女和干预后纳入的2262名妇女，该干预措施对母乳喂养行为（比值比3.0，95%置信区间：1.4；3.6）和婴儿预防性健康检查（比值比2.4，95%置信区间：1.5；3.5）有积极影响。对婴儿免疫接种覆盖率没有影响，对产前检查次数有负面影响。孕产妇教育对各种结果的影响存在差异，结果表明未受过教育的妇女在医疗机构分娩（比值比2.4，95%置信区间：0.8；6.9）和母乳喂养行为（比值比18.2，95%置信区间：5.2；63.6）方面有所增加。
基于设施的干预改善了部分而非全部健康行为。在母乳喂养和医疗机构分娩方面，最弱势的产前保健服务对象所显示出的改善令人鼓舞，并强调在努力减少孕产妇和儿童健康不平等现象时，需要加大产前保健的优先力度。
