Carvajal-Aguirre Liliana, Mehra Vrinda, Amouzou Agbessi, Khan Shane M, Vaz Lara, Guenther Tanya, Kalino Maggie, Zaka Nabila
Data and Analytics, Data Research and Policy, UNICEF, New York, New York, USA.
Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
J Glob Health. 2017 Dec;7(2):020508. doi: 10.7189/jogh.07.020508.
Health facility service environment is an important factor for newborns survival and well-being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn.
We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth.
Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19-1.95, = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50-2.83, < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care.
There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of health staff in facilities that offer normal delivery and newborn care services at all levels in the country.
卫生设施服务环境是影响新生儿总体生存及健康状况的重要因素，在诸如马拉维等新生儿死亡率较高的地区尤为如此，尽管基本干预措施覆盖率较高，但该国新生儿死亡率依然居高不下。本研究旨在评估出生时的卫生服务环境质量是否与新生儿所接受的护理质量相关。
我们使用了作为多指标类集调查（MICS）项目一部分开展的马拉维千年发展目标终期家庭调查以及2014年进行的服务提供评估调查的数据。分析基于过去两年间在医疗机构发生的6218例分娩。描述性统计、双变量和多变量随机效应模型用于评估正常分娩的卫生设施服务准备情况评分及新生儿护理与接受适当新生儿护理的新生儿之间的关联，本分析将适当新生儿护理定义为在出生后头两天接受六项推荐干预措施中的五项。
在调整潜在混杂因素后，与设施评分较低地区的新生儿相比，设施服务准备情况评分最高地区的新生儿接受适当新生儿护理的几率高出1.5倍（调整后的优势比（aOR）=1.52，95%置信区间CI=1.19-1.95，P=0.001）。与南部地区的新生儿相比，北部地区的新生儿接受五项新生儿护理干预措施的可能性高出两倍（aOR=2.06，95%CI=1.50-2.83，P<0.001）。生活在城市或农村地区对接受适当新生儿护理没有影响。
有必要提高所有医疗机构的服务准备水平，以便所有新生儿，无论在哪个医疗机构、哪个地区分娩，都能接受所有推荐的基本干预措施。马拉维卫生系统的投资应集中于增加对全国各级提供正常分娩和新生儿护理服务的医疗机构中卫生工作人员的培训及人员配备。
