Callaghan-Koru Jennifer A, Estifanos Abiy Seifu, Sheferaw Ephrem Daniel, de Graft-Johnson Joseph, Rosado Carina, Patton-Molitors Rachel, Worku Bogale, Rawlins Barbara, Baqui Abdullah
Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, MD, USA.
International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Acta Paediatr. 2016 Dec;105(12):e568-e576. doi: 10.1111/apa.13597. Epub 2016 Oct 20.
To assess the effects of a facility and community newborn intervention package on coverage of early skin-to-skin contact (SSC) and exclusive breastfeeding - the therapeutic components of kangaroo mother care.
A multilevel community and facility intervention in Ethiopia trained health workers in 10 health centres and the surrounding communities to promote early SSC and exclusive breastfeeding for all babies born at home or in the facility. Changes in SSC and exclusive breastfeeding were assessed by comparing baseline and endline household surveys.
Overall practice of SSC at any time following delivery increased significantly from 13.1 to 44.1% of mothers. Coverage of immediate SSC also increased significantly from 8.4 to 24.1%. Breastfeeding within the first hour increased from 51.4 to 67.9% and exclusive breastfeeding within the first three days increased from 86 to 95.8%. At endline, SSC was significantly higher among facility births than home births and community health workers had limited contact with mothers.
While targeted behaviours improved overall, the programme did not achieve adequate increases in SSC and exclusive breastfeeding among home deliveries to expect a reduction in mortality for low birthweight babies. Newborn care programs in Ethiopia should continue to encourage facility delivery while strengthening coverage of community programmes.
评估一套机构与社区新生儿干预方案对早期皮肤接触（SSC）覆盖率及纯母乳喂养的影响，这两者均为袋鼠式护理的治疗性组成部分。
在埃塞俄比亚开展的一项多层次社区与机构干预项目，对10个健康中心及周边社区的卫生工作者进行培训，以促进所有在家中或机构出生的婴儿进行早期皮肤接触和纯母乳喂养。通过比较基线和终期家庭调查来评估皮肤接触和纯母乳喂养的变化情况。
产后任何时间进行皮肤接触的总体比例从13.1%显著提高到44.1%。即时皮肤接触的覆盖率也从8.4%显著提高到24.1%。产后一小时内进行母乳喂养的比例从51.4%提高到67.9%，产后三天内纯母乳喂养的比例从86%提高到95.8%。在终期调查时，机构分娩中皮肤接触的比例显著高于家庭分娩，且社区卫生工作者与母亲的接触有限。
虽然目标行为总体上有所改善，但该项目未能使家庭分娩中的皮肤接触和纯母乳喂养覆盖率充分提高，从而无法预期降低低体重儿的死亡率。埃塞俄比亚的新生儿护理项目应继续鼓励在机构分娩，同时加强社区项目的覆盖范围。
