Wickramasinghe Nuwan Darshana, Horton Jennifer, Darshika Ishani, Galgamuwa Kaushila Dinithi, Ranasinghe Wasantha Pradeep, Agampodi Thilini Chanchala, Agampodi Suneth Buddhika
Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
PLoS One. 2017 Oct 11;12(10):e0185883. doi: 10.1371/journal.pone.0185883. eCollection 2017.
Even though postpartum morbidity continues to cause high disease burden in maternal morbidity and mortality across the globe, the literature pertaining to resultant productivity loss is scarce. Hence, the present study aimed at determining the productivity loss and associated cost of episodes of postpartum ill health.
A cross sectional study was conducted in two Medical Officer of Heath areas in the Anuradhapura district, Sri Lanka in 2011, among 407 women residing in Anuradhapura district with an infant aged between 8 to 24 weeks. Validated interviewer administered questionnaires, including the IMMPACT productivity cost tool, were used to collect data on self-reported episodes of postpartum ill health. The productivity loss was calculated as the sum of days lost due to partial and total incapacitation. The adjusted productivity loss for coping strategies was calculated. Productivity cost, both total and adjusted, were calculated based on the mean daily per capita income of the study sample.
Of the 407 participants, 161(39.6%) reported at least one episode of postpartum illness. Hospitalisations were reported by 27 (16.8%) of all symptomatic postpartum women. Common symptoms of postpartum ill health were pain/infection at either episiotomy or surgical site (n = 44, 27.3%), lower abdominal pain (n = 40, 24.8%) and backache (n = 27, 16.8%). The mean productivity loss per episode of ill health was 15 days (SD = 7.8 days) and the mean productivity loss per episode after adjusting for coping strategies was 7.9 days (SD = 4.4 days). The mean productivity cost per an episode was US$ 34.2(95%CI US$ 26.7-41.6) and the mean productivity cost per an episode after adjusting for coping strategies was US$ 18.0 (95%CI US$ 14.1-22.0).
The prevalence of self-reported postpartum ill health, associated productivity loss and cost were high in the study sample and the main contributors were preventable conditions including pain and infection. Thus, effective pain management and proper infection prevention and control measures are important in reducing the burden of postpartum illness and resultant productivity cost.
尽管产后发病在全球孕产妇发病和死亡中持续造成高疾病负担，但关于由此导致的生产力损失的文献却很匮乏。因此，本研究旨在确定产后健康不良事件的生产力损失及相关成本。
2011年在斯里兰卡阿努拉德普勒区的两个卫生医疗官辖区进行了一项横断面研究，研究对象为居住在阿努拉德普勒区、婴儿年龄在8至24周之间的407名妇女。使用经过验证的由访谈员管理的问卷，包括IMMPACT生产力成本工具，收集关于自我报告的产后健康不良事件的数据。生产力损失计算为因部分和完全丧失工作能力而损失的天数总和。计算了应对策略调整后的生产力损失。基于研究样本的人均日收入计算了总生产力成本和调整后的生产力成本。
在407名参与者中，161人（39.6%）报告至少有一次产后疾病发作。所有有症状的产后妇女中有27人（16.8%）报告住院治疗。产后健康不良的常见症状是会阴切开术或手术部位的疼痛/感染（n = 44，27.3%）、下腹部疼痛（n = 40，24.8%）和背痛（n = 27，16.8%）。每次健康不良事件的平均生产力损失为15天（标准差 = 7.8天），调整应对策略后每次事件的平均生产力损失为7.9天（标准差 = 4.4天）。每次事件的平均生产力成本为34.2美元（95%置信区间为26.7 - 41.6美元），调整应对策略后每次事件的平均生产力成本为18.0美元（95%置信区间为14.1 - 22.0美元）。
在研究样本中，自我报告的产后健康不良的患病率、相关生产力损失和成本都很高，主要促成因素是包括疼痛和感染在内的可预防状况。因此，有效的疼痛管理以及适当的感染预防和控制措施对于减轻产后疾病负担和由此产生的生产力成本很重要。
