Villalobos Aremis, Allen-Leigh Betania, Salazar-Alberto Javier, De Castro Filipa, Barrientos-Gutiérrez Tonatiuh, Leyva-López Ahideé, Rojas-Martínez Rosalba
Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico.
Colectivo Sol, A.C., Mexico City, Mexico.
PLoS One. 2017 Mar 8;12(3):e0173342. doi: 10.1371/journal.pone.0173342. eCollection 2017.
Adolescents need sexual and reproductive health services but little is known about quality-of-care in lower- and middle-income countries where most of the world's adolescents reside. Quality-of-care has important implications as lower quality may be linked to higher unplanned pregnancy and sexually transmitted infection rates. This study sought to generate evidence about quality-of-care in public sexual and reproductive health services for adolescents.
This cross-sectional study had a complex, probabilistic, stratified sampling design, representative at the national, regional and rural/urban level in Mexico, collecting provider questionnaires at 505 primary care units in 2012. A sexual and reproductive quality-of-healthcare index was defined and multinomial logistic regression was utilized in 2015.
At the national level 13.9% (95%CI: 6.9-26.0) of healthcare units provide low quality, 68.6% (95%CI: 58.4-77.3) medium quality and 17.5% (95%CI: 11.9-25.0) high quality reproductive healthcare services to adolescents. Urban or metropolitan primary care units were at least 10 times more likely to provide high quality care than those in rural areas. Units with a space specifically for counseling adolescents were at least 8 times more likely to provide high quality care. Ministry of Health clinics provided the lowest quality of service, while those from Social Security for the Underserved provided the best.
The study indicates higher quality sexual and reproductive healthcare services are needed. In Mexico and other middle- to low-income countries where quality-of-care has been shown to be a problem, incorporating adolescent-friendly, gender-equity and rights-based perspectives could contribute to improvement. Setting and disseminating standards for care in guidelines and providing tools such as algorithms could help healthcare personnel provide higher quality care.
青少年需要性与生殖健康服务，但对于世界上大多数青少年所居住的低收入和中等收入国家的医疗服务质量却知之甚少。医疗服务质量具有重要意义，因为较低的质量可能与较高的意外怀孕率和性传播感染率相关。本研究旨在获取有关青少年公共性与生殖健康服务质量的证据。
这项横断面研究采用了复杂的概率分层抽样设计，在墨西哥全国、区域以及农村/城市层面均具有代表性，于2012年在505个初级保健单位收集提供者问卷。2015年定义了性与生殖健康医疗质量指数并采用了多项逻辑回归分析。
在国家层面，13.9%（95%置信区间：6.9 - 26.0）的医疗单位为青少年提供低质量的生殖健康服务，68.6%（95%置信区间：58.4 - 77.3）提供中等质量的服务，17.5%（95%置信区间：11.9 - 25.0）提供高质量的服务。城市或大都市的初级保健单位提供高质量服务的可能性至少是农村地区的10倍。设有专门为青少年提供咨询空间的单位提供高质量服务的可能性至少是其他单位的8倍。卫生部诊所提供的服务质量最低，而面向弱势群体的社会保障诊所提供的服务质量最佳。
该研究表明需要更高质量的性与生殖健康医疗服务。在墨西哥以及其他已表明存在医疗服务质量问题的中低收入国家，纳入青少年友好、性别平等和基于权利的观点可能有助于改善情况。在指南中设定并传播护理标准以及提供算法等工具可以帮助医护人员提供更高质量的护理。
