社区卫生工作者家访能否改善脆弱国家（如阿富汗）的寻求医疗服务和母婴护理行为？一项基于人群的干预研究。
Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study.
机构信息
UNICEF Afghanistan, UNOCA, Jalalabad Road, Kabul, Afghanistan.
Ministry of Public Health, Reproductive, Maternal, Newborn, Child and Adolescent Directorate, Kabul, Afghanistan.
出版信息
BMC Med. 2018 Jul 9;16(1):106. doi: 10.1186/s12916-018-1092-9.
BACKGROUND
The effects of community health worker (CHW) home visiting during the antenatal and postnatal periods in fragile- and conflicted-affected countries such as Afghanistan are not known.
METHODS
We conducted a non-randomised population-based intervention study from March 2015 to February 2016. Two intervention and two control districts were selected. All female CHWs in the intervention districts were trained to provide eight home visits and behaviour change communication messages from pregnancy to 28 days postpartum. The primary outcome was the proportion of women who reported delivering in a health facility. Secondary outcomes were the proportion of women who reported attending a health facility for at least one antenatal and one postnatal visit. Outcomes were analysed at 12 months using multivariable difference-in-difference linear regression models adjusted for clustering.
RESULTS
Overall, 289 female CHWs in the intervention districts performed home visits and 1407 eligible women (less than 12 months postpartum) at baseline and 1320 endline women provided outcome data (94% response rate). Facility delivery increased in intervention villages by 8.2% and decreased in the control villages by 6.3% (adjusted mean difference (AMD) 11.0%, 95% confidence interval (CI) 4.0-18.0%, p = 0.002). Attendance for at least one antenatal care visit (AMD 10.5%, 95% CI 4.2-16.9%, p = 0.001) and postnatal care visit (AMD 7.2%, 95% CI 0.2-14.2%, p = 0.040) increased in the intervention compared to the control districts.
CONCLUSIONS
CHW home visiting during the antenatal and postnatal periods can improve health service use in fragile- and conflict-affected countries. Commitment to scale-up from Ministries and donors is now needed.
TRIAL REGISTRATION
This trial was retrospectively registered at the Australian and New Zealand Clinical Trial Registry ( ACTRN12618000609257 ).
背景
在阿富汗等脆弱和冲突国家，社区卫生工作者（CHW）在产前和产后进行家访的效果尚不清楚。
方法
我们进行了一项非随机人群干预研究，时间为 2015 年 3 月至 2016 年 2 月。选择了两个干预区和两个对照区。干预区的所有女性 CHW 都接受了培训，以便在怀孕至产后 28 天期间进行八次家访和行为改变沟通信息。主要结局是报告在医疗机构分娩的妇女比例。次要结局是报告至少接受一次产前和一次产后就诊的妇女比例。在 12 个月时使用多变量差异-差异线性回归模型进行分析，调整了聚类的影响。
结果
共有 289 名干预区的女性 CHW 进行了家访，1407 名符合条件的妇女（产后不到 12 个月）在基线和 1320 名期末妇女提供了结局数据（响应率为 94%）。干预村的住院分娩率增加了 8.2%，对照组下降了 6.3%（调整后的平均差异（AMD）为 11.0%，95%置信区间（CI）为 4.0-18.0%，p=0.002）。至少接受一次产前护理就诊（AMD 为 10.5%，95%CI 为 4.2-16.9%，p=0.001）和产后护理就诊（AMD 为 7.2%，95%CI 为 0.2-14.2%，p=0.040）在干预区比对照组增加。
结论
在产前和产后期间，CHW 家访可以改善脆弱和冲突国家的卫生服务利用情况。现在需要来自部委和捐助者的扩大规模的承诺。
试验注册
该试验在澳大利亚和新西兰临床试验注册中心（ACTRN12618000609257）进行了回顾性注册。
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