Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Box 1410, Mbarara, Uganda.
Doctors without Borders (CUAMM), Western Equatorial State, South Sudan.
Midwifery. 2019 Nov;78:78-84. doi: 10.1016/j.midw.2019.08.003. Epub 2019 Aug 5.
At 789 maternal deaths per 100,000 live births, South Sudan has one of the worst maternal mortality indicators in the world. Utilization of maternal health services namely antenatal care (ANC), skilled birth attendance (SBA), and early postnatal care (EPNC) is critical in reducing these deaths. We evaluated whether health education on birth preparedness and complication readiness (BPCR) has an impact on the utilization of skilled birth attendance and early postnatal care in Mundri East County, South Sudan.
We used observational data collected from antenatal clinics in South Sudan to perform a propensity score matched analysis. Treatment effects in both unmatched and matched cohorts were estimated using modified Poisson regression analysis with robust standard errors in prevalence risk ratios (PR) and 95% confidence intervals.
13 primary healthcare facilities.
385 postpartum mothers.
Health education on BPCR.
Two outcomes were evaluated: (1) SBA measured as delivery in a health facility, and (2) EPNC use measured as use of postnatal care within 2-7 days of delivery.
Data on 243 (67.9%) mothers who attended antenatal care were analyzed. 92 participants who received BPCR health education were matched with 92 who had never. In unmatched adjusted analysis, health education on BPCR significantly increased SBA (Adjusted PR (APR), 1.99; 95% confidence interval (CI), 1.99-3.65) but not EPNC use (APR, 1.78; 95% CI, 0.73-4.35). In propensity score-matched analysis, SBA significantly improved (PR, 2.64; 95% CI, 1.91-3.66) while the increase in EPNC use was insignificant (PR, 1.14; 95% CI, 0.43-3.03).
Health education on BPCR improves SBA but not EPNC use among mothers in Mundri East County, South Sudan.
South Sudan's health systems should design new strategies to enhance EPNC use in order to significantly reduce maternal and newborn deaths in the earlier days of the postpartum period. In addition, a qualitative study is needed to identify barriers to EPNC use.
南苏丹每 10 万名活产儿中就有 789 名产妇死亡，其孕产妇死亡率是世界上最严重的国家之一。利用孕产妇保健服务，即产前护理（ANC）、熟练接生（SBA）和产后早期护理（EPNC），对于降低这些死亡率至关重要。我们评估了在南苏丹东芒迪县开展生育准备和并发症准备（BPCR）健康教育是否会对熟练接生和产后早期护理的利用产生影响。
我们使用了从南苏丹产前诊所收集的观察性数据，进行了倾向评分匹配分析。在未匹配和匹配队列中，使用校正后的泊松回归分析，以患病率风险比（PR）和 95%置信区间（CI）表示治疗效果。
13 个初级保健设施。
385 名产后母亲。
BPCR 健康教育。
评估了两个结果：（1）SBA 衡量为在医疗机构分娩，（2）EPNC 使用衡量为分娩后 2-7 天内使用产后护理。
分析了接受过产前护理的 243 名（67.9%）母亲的数据。92 名接受 BPCR 健康教育的参与者与从未接受过的 92 名参与者进行了匹配。在未调整的匹配分析中，BPCR 健康教育显著增加了 SBA（调整后的 PR（APR），1.99；95%置信区间（CI），1.99-3.65），但不增加 EPNC 使用（APR，1.78；95%CI，0.73-4.35）。在倾向评分匹配分析中，SBA 显著改善（PR，2.64；95%CI，1.91-3.66），而 EPNC 使用的增加则不显著（PR，1.14；95%CI，0.43-3.03）。
在南苏丹东芒迪县，BPCR 健康教育可提高 SBA，但不能提高 EPNC 的使用。
南苏丹的卫生系统应设计新策略，以提高 EPNC 的使用，从而在产后早期显著降低母婴死亡。此外，需要进行定性研究，以确定阻碍 EPNC 使用的因素。
