Silvestre Maria Asuncion A, Mannava Priya, Corsino Marie Ann, Capili Donna S, Calibo Anthony P, Tan Cynthia Fernandez, Murray John C S, Kitong Jacqueline, Sobel Howard L
Kalusugan ng Mag-Ina, Inc. (KMI; Health of Mother and Child), Quezon City, Philippines.
Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, World Health Organization Western Pacific Regional Office, Manila, Philippines.
Int J Qual Health Care. 2018 Aug 1;30(7):537-544. doi: 10.1093/intqhc/mzy049.
To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015.
Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015.
Eleven large government hospitals from five regions in the Philippines.
One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery.
A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication.
Sixteen intrapartum and newborn care practices.
Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted.
Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.
确定2008年至2015年间11家大型医院的产时及新生儿护理实践是否有所改善。
对2008年和2015年在11家医院进行的观察性评估进行二次数据分析。
菲律宾五个地区的11家大型政府医院。
2008年随机抽取的107对产后母婴对，以及2015年随机抽取的106名产后出院前的母亲。
2009年开始的一项全国性倡议，旨在通过制定产时及新生儿护理服务标准套餐、基于实践的培训、组建多学科医院工作组以及在医院定期评估和召开会议以确定改进实践、政策和环境的行动来提高新生儿护理质量。通过政策制定、卫生筹资套餐、卫生设施标准、能力建设和卫生宣传来支持质量改进。
16项产时及新生儿护理实践。
2008年至2015年间，出生后5秒内开始擦干、延迟脐带结扎、脐带干燥护理、不间断皮肤接触、首次母乳喂养的时间和持续时间以及推迟至出生后6小时洗澡等方面均有显著改善（P<0.001）。接受卫生脐带处理和乙肝首剂疫苗接种的新生儿比例下降了11-12%。除引产减少外，不适当的产妇护理实践依然存在。
通过专注于改善医院政策、环境和卫生工作者实践的方法，新生儿护理实践有了显著改善。产妇护理实践仍然过时，主要是因为采用了无效的产妇护理教学培训方法。
