参与性多部门孕产妇和新生儿干预措施对孕产妇保健服务利用及新生儿护理实践的影响：乌干达三个农村地区的一项准实验研究
Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts.
作者信息
Ekirapa-Kiracho Elizabeth, Muhumuza Kananura Rornald, Tetui Moses, Namazzi Gertrude, Mutebi Aloysius, George Asha, Paina Ligia, Waiswa Peter, Bumba Ahmed, Mulekwa Godfrey, Nakiganda-Busiku Dinah, Lyagoba Moses, Naiga Harriet, Putan Mary, Kulwenza Agatha, Ajeani Judith, Kakaire-Kirunda Ayub, Makumbi Fred, Atuyambe Lynn, Okui Olico, Namusoke Kiwanuka Suzanne
机构信息
a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.
b Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.
出版信息
Glob Health Action. 2017 Aug;10(sup4):1363506. doi: 10.1080/16549716.2017.1363506.
BACKGROUND
The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services.
OBJECTIVES
This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices.
METHODS
The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression.
RESULTS
The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.17-1.74] and saving for maternal health (aOR 2.11, 95% CI 1.39-3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care.
CONCLUSIONS
The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth.
背景
乌干达东部的“显现”研究采用了参与性多部门方法，以减少获得孕产妇和新生儿护理服务的障碍。
目的
本研究分析干预措施对孕产妇和新生儿服务利用及护理实践的影响。
方法
准实验前后比较设计有两个主要组成部分：社区动员与赋权以及卫生服务提供者能力建设。主要结局指标为产前护理（ANC）、分娩和产后护理的利用情况以及新生儿护理实践。从育龄妇女中收集了基线数据（n = 2237）和终末线数据（n = 1946）。使用差异中的差异（DiD）分析和逻辑回归对数据进行分析。
结果
DiD结果显示，早期产前检查就诊率（p < 0.01）和机构分娩率（p < 0.01）存在8%的差异。干预地区的机构分娩率从66%提高到了73%，而对照地区保持不变（64%对63%，p < 0.01）。DiD结果还表明，清洁脐带护理方面存在20%的差异（p < 0.001），延迟洗澡方面存在8%的差异（p < 0.001）。预测机构分娩的干预因素包括进行4次产前检查[调整优势比（aOR）1.42，95%置信区间（CI）1.17 - 1.74]以及为孕产妇保健储蓄（aOR 2.11，95% CI 1.39 - 3.21）。机构分娩和村卫生室（VHT）家访是清洁脐带护理和皮肤接触护理的关键预测因素。
结论
多部门方法对早期产前检查就诊率、机构分娩和新生儿护理实践产生了积极影响。村卫生室和储蓄等社区资源对孕产妇和新生儿结局至关重要，应予以支持。由村卫生室主导的健康教育应纳入切实可行的措施，使家庭能够储蓄并获得交通服务，以加强对分娩的充分准备。
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