School of Public Health, Chinese Academy of Medical Science & Peking Union Medical College, No.5 Dongdansantiao, 100730, Beijing, People's Republic of China.
BMC Public Health. 2019 Jun 26;19(1):824. doi: 10.1186/s12889-019-7207-1.
Reducing maternal mortality remains a global priority. In 2000, the United Nations Member States pledged to work towards a series of Millennium Development Goals (MDGs), in which the fifth target was to reduce maternal mortality ratio by 75% from 1990 to 2015. The Chinese government introduced Basic Public Health Service project in 2009 to the further improvement of maternal health services and reduction in maternal mortality. China had achieved the goal of MDG5 1 year ahead of the schedule in 2014, but the effects of the project on reducing maternal mortality were rarely evaluated with robust methods.
We conducted a longitudinal study on maternal mortality ratio by extracting mortality data from the National Maternal Mortality Surveillance System (1991-2016) and maternal health services measures from the China health statistic yearbook (2001-2016). We utilized the segmented linear regression model to assess changes and trends of maternal mortality ratio and maternal health services before and after the introduction of Basic Public Health Service project. Pearson correlation analysis was conducted to measure the strength of association between the maternal mortality ratio and maternal health services.
The yearly trend change of national maternal mortality ratio was - 1.76 (p < 0.01) after the introduction of Basic Public Health Service project in 2009, while the yearly trend change of maternal health record establish rate, prenatal examination rate, postpartum visit rate was 0.77 (p < 0.01), 0.61 (p < 0.01) and 0.83 (p < 0.01) separately. The negative correlations were also found between national maternal mortality ratio and prenatal examination rate (r = - 0.95, p < 0.01), maternal health record establish rate (r = - 0.93, p < 0.01) and postpartum visit rate (r = - 0.92, p < 0.01).
The Basic Public Health Service project was found to be associated with the improvements in the maternal health services and reduction in maternal mortality. The design and implementation of the project may serve as a positive example for other developing countries. Continued monitoring and assessment of project effects should be stressed.
降低孕产妇死亡率仍然是全球重点。2000 年，联合国成员国承诺努力实现一系列千年发展目标（MDGs），其中第五个目标是到 2015 年将孕产妇死亡率降低 75%。中国政府于 2009 年推出了基本公共卫生服务项目，以进一步改善孕产妇保健服务，降低孕产妇死亡率。中国在 2014 年提前一年实现了千年发展目标 5 的目标，但该项目对降低孕产妇死亡率的影响很少用强有力的方法进行评估。
我们从国家孕产妇死亡率监测系统（1991-2016 年）中提取死亡率数据，从《中国卫生统计年鉴》（2001-2016 年）中提取孕产妇保健服务措施，采用分段线性回归模型评估基本公共卫生服务项目实施前后孕产妇死亡率和孕产妇保健服务的变化和趋势。采用 Pearson 相关分析测量孕产妇死亡率与孕产妇保健服务之间的关联强度。
2009 年基本公共卫生服务项目实施后，全国孕产妇死亡率的年趋势变化为-1.76（p<0.01），而孕产妇健康记录建立率、产前检查率、产后访视率的年趋势变化分别为 0.77（p<0.01）、0.61（p<0.01）和 0.83（p<0.01）。全国孕产妇死亡率与产前检查率（r=-0.95，p<0.01）、孕产妇健康记录建立率（r=-0.93，p<0.01）和产后访视率（r=-0.92，p<0.01）呈负相关。
基本公共卫生服务项目与孕产妇保健服务的改善和孕产妇死亡率的降低有关。该项目的设计和实施可为其他发展中国家提供一个积极的范例。应强调继续监测和评估项目效果。
