Department of Global Public Health-Health Systems and Policy (HSP): Medicines Focusing Antibiotics, Karolinska Institutet, 17177, Stockholm, Sweden.
Department of Pediatrics, RD Gardi Medical College, Ujjain, MP, 456010, India.
BMC Health Serv Res. 2020 Oct 21;20(1):966. doi: 10.1186/s12913-020-05805-2.
More than a quarter of global neonatal deaths are reported from India, and a large proportion of these deaths are preventable. However, in the absence of robust public health care systems in several states in India, informal health care providers (IHCPs) with no formal medical education are the first contact service providers. The aim of this study was to assess the knowledge of IHCPs in basic evidence-based practices in neonatal care in Ujjain district and investigated factors associated with differences in levels of knowledge.
A cross-sectional survey was conducted using a questionnaire with multiple-choice questions covering the basic elements of neonatal care. The total score of the IHCPs was calculated. Multivariate quantile regression model was used to look for association of IHCPs knowledge score with: the practitioners' age, years of experience, number of patients treated per day, and whether they attended children in their practice.
Of the 945 IHCPs approached, 830 (88%) participated in the study. The mean ± SD score achieved was 22.3 ± 7.7, with a median score of 21 out of maximum score of 48. Although IHCPs could identify key tenets of enhancing survival chances of neonates, they scored low on the specifics of cord care, breastfeeding, vitamin K use to prevent neonatal hemorrhage, and identification and care of low-birth-weight babies. The practitioners particularly lacked knowledge about neonatal resuscitation, and only a small proportion reported following up on immunizations. Results of quantile regression analysis showed that more than 5 years of practice experience and treating more than 20 patients per day had a statistically significant positive association with the knowledge score at higher quantiles (q75 and q90th) only. IHCPs treating children had significantly better scores across quantiles accept at the highest quantile (90).
The present study highlighted that know-do gap exists in evidence-based practices for all key areas of neonatal care tested among the IHCPs. The study provides the evidence that some IHCPs do possess knowledge in basic evidence-based practices in neonatal care, which could be built upon by future educational interventions. Targeting IHCPs can be an innovative way to reach a large rural population in the study setting and to improve neonatal care services.
全球超过四分之一的新生儿死亡发生在印度，其中很大一部分是可以预防的。然而，在印度的一些邦缺乏健全的公共卫生保健系统的情况下，没有接受过正规医学教育的非正式卫生保健提供者（IHCP）是第一个接触服务提供者。本研究的目的是评估乌贾因区 IHCP 对基本循证新生儿护理实践的知识，并研究与知识水平差异相关的因素。
采用包含新生儿护理基本要素的多项选择题问卷进行横断面调查。计算 IHCP 的总分。使用多元分位数回归模型来寻找 IHCP 知识得分与以下因素的关联：从业者的年龄、从业年限、每天治疗的患者人数以及他们是否在实践中治疗儿童。
在 945 名接触的 IHCP 中，有 830 名（88%）参与了研究。平均得分为 22.3±7.7，中位数得分为 21，满分 48。尽管 IHCP 能够识别提高新生儿生存机会的关键原则，但他们在脐带护理、母乳喂养、维生素 K 预防新生儿出血、识别和护理低出生体重婴儿等方面的具体细节得分较低。从业者特别缺乏新生儿复苏方面的知识，只有一小部分人报告说对免疫接种进行了随访。分位数回归分析的结果表明，超过 5 年的从业经验和每天治疗超过 20 名患者与较高分位数（q75 和 q90）的知识得分呈统计学上显著正相关，仅在 q90 分位数上。治疗儿童的 IHCP 在所有分位数上的得分都明显更好，但在最高分位数（90）上除外。
本研究强调，在接受测试的所有新生儿护理关键领域中，IHCP 都存在知识与实践之间的差距。研究结果表明，一些 IHCP 确实具备基本循证新生儿护理实践方面的知识，未来的教育干预可以在此基础上进行。针对 IHCP 是一种创新的方法，可以在研究环境中覆盖大量农村人口，并改善新生儿护理服务。
