Wilmot Efua, Yotebieng Marcel, Norris Alison, Ngabo Fidele
College of Public Health, The Ohio State University, Columbus, OH, USA.
Edward Via College of Osteopathic Medicine, Spartanburg, SC, USA.
Matern Child Health J. 2017 May;21(5):1121-1129. doi: 10.1007/s10995-016-2210-y.
Objective Administered in a timely manner, current evidence-based interventions could reduce neonatal deaths from infections, intrapartum injuries and complications due to prematurity. The three delays model (delay in seeking care, in arriving at a health facility, and in receiving adequate care), which has been applied to understanding maternal deaths, may be useful for understanding neonatal deaths. We assess the main causes of neonatal deaths in Rwanda and their associated delays. Methods Using a cross-sectional study design, we evaluated data from 2012 from 40 facilities in which babies were delivered. Audit committees in each facility reviewed each neonatal death in the facility and reported finding to the Ministry of Health using structured questionnaires. Information from questionnaires were centralized in an electronic database. At the end of 2012, records from 40 health facilities across Rwanda's five provinces (mainly district hospitals) were available in the database and were used for this analysis. Results Of the 1324 neonates, the major causes of death were: asphyxia and its complications (36.7%), lower respiratory tract infections (LRTI) (22.5%), and prematurity (22.4%). At least one delay was experienced by nearly three-quarters of neonates: Maternal Delay in Seeking Care 22.1%, Maternal Delay in Arrival to Care 11.2%, Maternal Delay in Adequate Care 14.2%, Neonatal Delay in Seeking Care 8.1%, Neonatal Delay in Arrival to Care 9.3%, and Neonatal Delay in Adequate Care 29.1%. Neonates with each of the main causes of death had statistically significantly increased odds of experiencing Maternal Delay in Seeking Care. Asphyxia deaths had increased odds of experiencing all three Maternal Delays. LRTI deaths had increased odds of all three Neonatal Delays. Conclusion Delays for women in seeking obstetrical care is a critical factor associated with the main causes of neonatal death in Rwanda. Improving obstetrical care quality could reduce neonatal deaths due to asphyxia. Likewise, reducing all three delays could reduce neonatal deaths due to LRTI.
目的 及时实施当前基于证据的干预措施可减少因感染、产时损伤和早产并发症导致的新生儿死亡。已用于理解孕产妇死亡情况的三延误模型（寻求医疗服务的延误、到达医疗机构的延误和获得充分治疗的延误），可能有助于理解新生儿死亡情况。我们评估卢旺达新生儿死亡的主要原因及其相关延误。方法 采用横断面研究设计，我们评估了2012年来自40家有婴儿分娩的医疗机构的数据。每个医疗机构的审核委员会审查该机构内的每例新生儿死亡情况，并使用结构化问卷向卫生部报告调查结果。问卷信息集中在一个电子数据库中。2012年底，卢旺达五个省（主要是地区医院）的40家医疗机构的记录已录入该数据库并用于本分析。结果 在1324例新生儿中，主要死亡原因是：窒息及其并发症（36.7%）、下呼吸道感染（22.5%）和早产（22.4%）。近四分之三的新生儿经历了至少一种延误：孕产妇寻求医疗服务的延误22.1%、孕产妇到达医疗机构的延误11.2%、孕产妇获得充分治疗的延误14.2%、新生儿寻求医疗服务的延误8.1%、新生儿到达医疗机构的延误9.3%以及新生儿获得充分治疗的延误29.1%。每种主要死亡原因的新生儿经历孕产妇寻求医疗服务延误的几率在统计学上均显著增加。窒息死亡经历所有三种孕产妇延误的几率增加。下呼吸道感染死亡经历所有三种新生儿延误的几率增加。结论 妇女寻求产科护理的延误是与卢旺达新生儿死亡主要原因相关的关键因素。改善产科护理质量可减少因窒息导致的新生儿死亡。同样，减少所有三种延误可减少因下呼吸道感染导致的新生儿死亡。
