评估群组产前护理对卢旺达妊娠时长的影响：一项整群随机试验。
Assessing the impact of group antenatal care on gestational length in Rwanda: A cluster-randomized trial.
机构信息
Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, Rwanda.
Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America.
出版信息
PLoS One. 2021 Feb 2;16(2):e0246442. doi: 10.1371/journal.pone.0246442. eCollection 2021.
BACKGROUND
Research on group antenatal care in low- and middle-income contexts suggests high acceptability and preliminary implementation success.
METHODS
We studied the effect of group antenatal care on gestational age at birth among women in Rwanda, hypothesizing that participation would increase mean gestational length. For this unblinded cluster randomized trial, 36 health centers were pair-matched and randomized; half continued individual antenatal care (control), half implemented group antenatal care (intervention). Women who initiated antenatal care between May 2017 and December 2018 were invited to participate, and included in analyses if they presented before 24 weeks gestation, attended at least two visits, and their birth outcome was obtained. We used a generalized estimating equations model for analysis.
FINDINGS
In total, 4091 women in 18 control clusters and 4752 women in 18 intervention clusters were included in the analysis. On average, women attended three total antenatal care visits. Gestational length was equivalent in the intervention and control groups (39.3 weeks (SD 1.6) and 39.3 weeks (SD 1.5)). There were no significant differences between groups in secondary outcomes except that more women in control sites attended postnatal care visits (40.1% versus 29.7%, p = 0.003) and more women in intervention sites attended at least three total antenatal care visits (80.7% versus 71.7%, p = 0.003). No harms were observed.
INTERPRETATION
Group antenatal care did not result in a difference in gestational length between groups. This may be due to the low intervention dose. We suggest studies of both the effectiveness and costs of higher doses of group antenatal care among women at higher risk of preterm birth. We observed threats to group care due to facility staff shortages; we recommend studies in which antenatal care providers are exclusively allocated to group antenatal care during visits.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03154177.
背景
在中低收入国家进行的群体产前护理研究表明，这种模式具有较高的可接受性和初步实施成功。
方法
我们研究了群体产前护理对卢旺达妇女分娩时胎龄的影响，假设参与该模式会增加平均妊娠周期。本项非盲、集群随机试验将 36 个保健中心进行配对和随机分组；一半继续提供个体产前护理（对照组），一半实施群体产前护理（干预组）。2017 年 5 月至 2018 年 12 月间开始接受产前护理的妇女受邀参与研究，且只有在妊娠 24 周前就诊、至少接受过两次产前护理访视且获得分娩结局的妇女被纳入分析。我们使用广义估计方程模型进行分析。
结果
共有 18 个对照组和 18 个干预组的 4091 名妇女和 4752 名妇女纳入分析。平均而言，妇女总共接受了三次产前护理访视。干预组和对照组的妊娠周期相当（39.3 周（SD 1.6）和 39.3 周（SD 1.5））。除对照组的产后护理就诊率更高（40.1%对 29.7%，p=0.003）和干预组的更多妇女接受至少三次完整的产前护理就诊（80.7%对 71.7%，p=0.003）外，两组间的次要结局无显著差异。未观察到任何不良事件。
解释
群体产前护理并未导致两组间妊娠周期存在差异。这可能是由于干预剂量较低所致。我们建议开展针对更高剂量的群体产前护理在有早产风险的妇女中的有效性和成本的研究。我们观察到群体护理因机构工作人员短缺而受到威胁；我们建议在研究中，在就诊期间仅将产前护理提供者分配给群体产前护理。
试验注册
ClinicalTrials.gov NCT03154177。
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