Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
PLoS One. 2019 Feb 22;14(2):e0212635. doi: 10.1371/journal.pone.0212635. eCollection 2019.
The proportion of women attending four or more antenatal care (ANC) visits is widely used for monitoring, but provides limited information on quality of care. Effective coverage metrics, assessing if ANC interventions are completely delivered, can identify critical gaps in healthcare service delivery. We aimed to measure coverage of at least one screening and effective coverage of ANC interventions in the public health system in the West Bank, Palestine, and to explore associations between infrastructure-related and maternal sociodemographic variables and effective coverage.
We used data from paper-based clinical records of 1369 pregnant women attending ANC in 17 primary healthcare clinics. Infrastructure-related variables were derived from a 2014 national inventory assessment of clinics. Sample size calculations were made to detect effective coverage ranging 40-60% with a 2-3% margin of error, clinics were selected by probability sampling. We calculated inverse probability weighted percentages of: effective coverage of appropriate number and timing of screenings of ANC interventions; and coverage of at least one screening.
Coverage of one screening and effective coverage of ANC interventions were notably different for screening for: hypertension (98% vs. 10%); fetal growth abnormalities (66% vs. 6%); anemia (93% vs. 14%); gestational diabetes (93% vs. 34%), and antenatal ultrasound (74% vs. 24%). Clinics with a laboratory and ultrasound generally performed better in terms of effective coverage, and maternal sociodemographic factors had no associations with effective coverage estimates. Only 13% of the women attended ANC visits according to the recommended national schedule, driving effective coverage down.
Indicators for ANC monitoring and their definitions can have important consequences for quantifying health system performance and identifying issues with care provision. To achieve more effective coverage in public primary care clinics in the West Bank, efforts should be made to improve care provision according to prescribed guidelines.
妇女接受四次或更多次产前保健（ANC）就诊的比例被广泛用于监测，但提供的护理质量信息有限。有效的覆盖指标评估 ANC 干预措施是否完全提供，可以发现医疗保健服务提供中的关键差距。我们旨在衡量西岸公共卫生系统中至少一次筛查的覆盖率和 ANC 干预措施的有效覆盖率，并探讨基础设施相关和产妇社会人口统计学变量与有效覆盖率之间的关系。
我们使用了在 17 个初级保健诊所接受 ANC 的 1369 名孕妇的纸质临床记录中的数据。基础设施相关变量源自 2014 年对诊所的国家库存评估。进行了样本量计算，以检测有效覆盖率在 40-60%之间，误差幅度为 2-3%，诊所通过概率抽样选择。我们计算了以下指标的逆概率加权百分比：ANC 干预措施的适当数量和时间进行筛查的有效覆盖率；以及至少一次筛查的覆盖率。
在筛查高血压（98%对 10%）、胎儿生长异常（66%对 6%）、贫血（93%对 14%）、妊娠期糖尿病（93%对 34%）和产前超声（74%对 24%）方面，一次筛查和 ANC 干预措施的有效覆盖率有明显差异。有实验室和超声的诊所通常在有效覆盖率方面表现更好，而产妇社会人口统计学因素与有效覆盖率估计值没有关联。只有 13%的妇女按照国家推荐的时间表接受 ANC 就诊，这导致有效覆盖率下降。
ANC 监测指标及其定义可能对量化卫生系统绩效和识别护理提供问题具有重要影响。为了在西岸的公共初级保健诊所实现更有效的覆盖率，应努力根据规定的指南改善护理提供。
