Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Save the Children, Washington, D.C., USA.
J Glob Health. 2020 Jun;10(1):010505. doi: 10.7189/jogh.10.010505.
Postnatal care (PNC) for mothers and newborns is essential to monitor risks of morbidity and adverse conditions following delivery. Current estimates of the coverage of PNC show substantial discordance between mothers and newborns. We investigate the sources of this discordance in Demographic and Health Surveys (DHS).
We used DHS data from 48 countries collected since 2011, spanning phases 6 and 7 of the survey program with 32 and 16 surveys, respectively, analyzed. We assessed the distribution of the reported timing of PNC and conducted a sensitivity analysis that excludes/includes PNC reported within 0-1 hour or PNC in the day 2. Agreement in PNC reporting considered four groups: (1) Concordance, neither mother nor newborn received PNC; (2) Concordance, mother and newborn pair received PNC; (3) Discordance, mother received PNC and newborn did not; of (4) Discordance, mother did not receive PNC but the newborn did. We carried out logistic regressions to understand correlates of PNC discordance. All analyses distinguished phase 6 surveys from phase 7.
We found substantial differences in the PNC coverage estimated between phase 6 and phase 7 surveys. The phase 7 PNC questions for newborns were improved to increase the understanding of the questions by respondent which probably led to reducing the large PNC gap between mothers and newborns observed in phase 6 surveys. With phase 6 surveys, PNC coverage for mother was estimated on average at 62% compared to only 31% for newborns. No such gap was observed for phase 7 surveys, where for both mothers and newborns, the PNC coverage estimate was similar, at 56%. For both phases, over half of the reported PNC for mothers and newborns occurred during 0-1 hour following delivery, leading to substantial overestimation of PNC coverage, due to confusion between intrapartum care and PNC. There were 37% discordant cases between mother and newborn, largely in favor of the mother in phase 6 surveys, compared to 16% in phase 7 surveys. In phase 6 surveys, discordant PNC cases were observed largely among facility deliveries vs non-facility deliveries (44% compared to 19%).
Current estimates of coverage of PNC from DHS phase 6 surveys appears to include substantial level of measurement noises that could explain substantial part of the mother-newborn discordance in PNC. The PNC estimates appear to capture a substantial number of intrapartum care. Current measurement approaches warrant further validation to ensure accurate monitoring of the PNC programs.
母婴产后护理（PNC）对于监测分娩后发病率和不良状况的风险至关重要。目前对 PNC 覆盖范围的估计显示，母亲和新生儿之间存在很大差异。我们在人口与健康调查（DHS）中研究了这种差异的来源。
我们使用了自 2011 年以来收集的 48 个国家的 DHS 数据，涵盖了调查项目的第 6 阶段和第 7 阶段，分别分析了 32 项和 16 项调查。我们评估了报告的 PNC 时间分布，并进行了敏感性分析，排除/包括在 0-1 小时内报告的 PNC 或在第 2 天报告的 PNC。PNC 报告的一致性考虑了四个组：（1）一致，母亲和新生儿都没有接受 PNC；（2）一致，母亲和新生儿都接受了 PNC；（3）不一致，母亲接受了 PNC，但新生儿没有；（4）不一致，母亲没有接受 PNC，但新生儿接受了。我们进行了逻辑回归分析，以了解 PNC 不一致的相关因素。所有分析都区分了第 6 阶段和第 7 阶段的调查。
我们发现第 6 阶段和第 7 阶段的 PNC 覆盖率估计存在很大差异。第 7 阶段的新生儿 PNC 问题得到了改进，提高了受访者对问题的理解，这可能导致第 6 阶段调查中观察到的母亲和新生儿之间的 PNC 巨大差距缩小。在第 6 阶段调查中，母亲的 PNC 覆盖率平均估计为 62%，而新生儿仅为 31%。第 7 阶段调查没有观察到这种差距，母亲和新生儿的 PNC 覆盖率估计相似，为 56%。在两个阶段中，超过一半的母亲和新生儿报告的 PNC 发生在分娩后 0-1 小时内，由于将分娩期间的护理与 PNC 混淆，导致 PNC 覆盖率的大量高估。在母亲和新生儿之间有 37%的不一致病例，在第 6 阶段调查中，这种情况主要有利于母亲，而在第 7 阶段调查中，这种情况占 16%。在第 6 阶段调查中，不一致的 PNC 病例主要发生在设施分娩中，而非设施分娩中（44%比 19%）。
目前来自 DHS 第 6 阶段调查的 PNC 覆盖率估计似乎包括了大量的测量噪声，这可以解释 PNC 中母亲-新生儿不一致的很大一部分原因。PNC 估计似乎捕捉到了大量的分娩期间的护理。目前的测量方法需要进一步验证，以确保对 PNC 计划进行准确监测。
