Koffi Alain K, Mleme Tiope, Nsona Humphreys, Banda Benjamin, Amouzou Agbessi, Kalter Henry D
Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA.
National Statistics Office, Zomba, Malawi.
J Glob Health. 2015 Jun;5(1):010416. doi: 10.7189/jogh.05.010416.
The Every Newborn Action Plan calls for reducing the neonatal mortality rates to fewer than 10 deaths per 1000 live births in all countries by 2035. The current study aims to increase our understanding of the social and modifiable factors that can be addressed or reinforced to improve and accelerate the decline in neonatal mortality in Malawi.
The data come from the 2013 Verbal and Social Autopsy (VASA) study that collected data in order to describe the biological causes and the social determinants of deaths of children under 5 years of age in Balaka and Salima districts of Malawi. This paper analyses the social autopsy data of the neonatal deaths and presents results of a review of the coverage of key interventions along the continuum of normal maternal and newborn care and the description of breakdowns in the care provided for neonatal illnesses within the Pathway to Survival framework.
A total of 320 neonatal deaths were confirmed from the VASA survey. While one antenatal care (ANC) visit was high at 94%, the recommended four ANC visits was much lower at 41% and just 17% of the mothers had their urines tested during the pregnancy. 173 (54%) mothers of the deceased newborns had at least one labor/delivery complication that began at home. The caregivers of 65% (n = 75) of the 180 newborns that were born at home or born and left a health facility alive perceived them to be severely ill at the onset of their illness, yet only 44% (n = 80) attempted and 36% (n = 65)could reach the first health provider after an average of 91 minutes travel time. Distance, lack of transport and cost emerged as the most important constraints to formal care-seeking during delivery and during the newborn fatal illness.
This study suggests that maternal and neonatal health organizations and the local government of Malawi should increase the demand for key maternal and child health interventions, including the recommended 4 ANC visits, and ensure urine screening for all pregnant women. Early recognition and referrals of women with obstetric complications and interventions to promote maternal recognition of neonatal illnesses and care-seeking before the child becomes severely ill are also needed to improve newborn survival in Balaka and Salima districts of Malawi.
《每一位新生儿行动计划》呼吁到2035年将所有国家的新生儿死亡率降至每1000例活产儿死亡少于10例。本研究旨在增进我们对社会因素以及可加以应对或强化的因素的理解，以改善并加速马拉维新生儿死亡率的下降。
数据来自2013年的口头和社会尸检（VASA）研究，该研究收集数据以描述马拉维巴拉卡和萨利马地区5岁以下儿童死亡的生物学原因和社会决定因素。本文分析了新生儿死亡的社会尸检数据，并呈现了对正常孕产妇和新生儿护理连续过程中关键干预措施覆盖情况的审查结果，以及在“生存之路”框架内对新生儿疾病护理中断情况的描述。
VASA调查共确认了320例新生儿死亡。虽然一次产前检查（ANC）的就诊率较高，为94%，但建议的四次ANC就诊率则低得多，为41%，且仅有17%的母亲在孕期接受了尿液检测。173名（54%）死亡新生儿的母亲至少有一项在家中开始出现的分娩并发症。在家中出生或出生后离开医疗机构时存活的180名新生儿中，65%（n = 75）的照料者在其发病之初就认为他们病情严重，但平均经过91分钟的行程时间后，只有44%（n = 80）的人尝试就医，36%（n = 65）的人能够找到首位医疗服务提供者。距离、缺乏交通工具和费用成为分娩期间及新生儿致命疾病期间寻求正规医疗服务的最重要制约因素。
本研究表明，马拉维的孕产妇和新生儿健康组织以及地方政府应增加对关键孕产妇和儿童健康干预措施的需求，包括建议的四次ANC就诊，并确保对所有孕妇进行尿液筛查。还需要尽早识别并转诊有产科并发症的妇女，以及采取干预措施，促进母亲在孩子病情严重之前识别新生儿疾病并寻求护理，以提高马拉维巴拉卡和萨利马地区的新生儿存活率。
