Cronk Ryan, Guo Amy, Folz Caroline, Hynes Peter, Labat Ashley, Liang Kaida, Bartram Jamie
The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC, 27599, USA; ICF, 2635 Meridian Pkwy Suite 200, Durham, NC, 27713, USA.
The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC, 27599, USA.
Int J Hyg Environ Health. 2021 Mar;232:113681. doi: 10.1016/j.ijheh.2020.113681. Epub 2020 Dec 24.
Adequate environmental conditions, comprising sufficient environmental hygiene items (e.g. gloves, soap, and disinfectant), adequate infrastructure (e.g. sanitation facilities, water supply), a clean environment, and hygienic behaviors in healthcare facilities (HCFs) are necessary for safe care in maternity wards. Few data are available describing environmental conditions in maternity wards in rural areas of low- and middle-income countries (LMICs). We collected data on these conditions from 1547 HCFs with maternity wards in 14 countries (Ethiopia, Ghana, Honduras, India, Kenya, Malawi, Mali, Mozambique, Niger, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe). We described patterns and availability of essential environmental conditions, and a regression model was developed to explore predictive factors. 73% of HCFs offering maternal and neonatal health (MNH) services did not meet the guidelines for the World Health Organization 'six cleans' (clean perineum, clean bed surface, clean hands, clean blade, clean cord tie, and clean towels to wrap the baby and mother). The items with the lowest availability were clean towels (40%). In a multivariable logistic regression model, HCFs that provided maternity services were more likely to have all 'six cleans' available if they: had at least an improved water source; had an infection prevention and control (IPC) protocol; had a budget considered sufficient that included funding for water, sanitation, hygiene, and IPC; and emphasized the importance of IPC within the nearby community. Our results demonstrate substantial differences between countries in the availability of environmental hygiene items, facility cleanliness, and quality of environmental health infrastructure in HCF maternity wards. There are several low-cost, high-impact, context-relevant opportunities to enhance essential environmental conditions that would improve the quality of neonatal and maternal care in maternity wards in HCFs in LMICs.
充足的环境条件，包括足够的环境卫生用品（如手套、肥皂和消毒剂）、适当的基础设施（如卫生设施、供水）、清洁的环境以及医疗机构（HCFs）中的卫生行为，对于产科病房的安全护理至关重要。关于低收入和中等收入国家（LMICs）农村地区产科病房环境条件的数据很少。我们从14个国家（埃塞俄比亚、加纳、洪都拉斯、印度、肯尼亚、马拉维、马里、莫桑比克、尼日尔、卢旺达、坦桑尼亚、乌干达、赞比亚和津巴布韦）的1547家设有产科病房的HCFs收集了这些条件的数据。我们描述了基本环境条件的模式和可用性，并建立了回归模型来探索预测因素。提供孕产妇和新生儿健康（MNH）服务的HCFs中，73%未达到世界卫生组织“六洁”（清洁会阴、清洁床面、清洁双手、清洁刀片、清洁脐带结扎处以及清洁包裹婴儿和母亲的毛巾）的指南。可用性最低的物品是清洁毛巾（40%）。在多变量逻辑回归模型中，提供产科服务的HCFs如果具备以下条件，则更有可能具备所有“六洁”：至少有一个改善的水源；有感染预防与控制（IPC）方案；有一个被认为足够的预算，包括用于水、卫生、清洁和IPC的资金；并且在附近社区强调IPC的重要性。我们的结果表明，各国在HCFs产科病房环境卫生用品的可用性、设施清洁度以及环境卫生基础设施质量方面存在很大差异。有几个低成本、高影响且与实际情况相关的机会来改善基本环境条件，这将提高LMICs中HCFs产科病房新生儿和孕产妇护理的质量。
