Dey Teesta, Ononge Sam, Weeks Andrew, Benova Lenka
Women's and Children's Health, University of Liverpool, Liverpool, UK
Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda.
BMJ Glob Health. 2021 Apr;6(4). doi: 10.1136/bmjgh-2020-004230.
Progress in reducing maternal and neonatal mortality, particularly in sub-Saharan Africa, is insufficient to achieve the Sustainable Developmental Goals by 2030. The first 24 hours following childbirth (immediate postnatal period), where the majority of morbidity and mortality occurs, is critical for mothers and babies. In Uganda,<50% of women reported receiving such care. This paper describes the coverage, changes over time and determinants of immediate postnatal care in Uganda after facility births between 2001 and 2016.
We analysed the 2006, 2011 and 2016 Ugandan Demographic and Health Surveys, including women 15-49 years with most recent live birth in a healthcare facility during the survey 5-year recall period. Immediate postnatal care coverage and changes over time were presented descriptively. Multivariable logistic regression was used to examine determinants of immediate postnatal care.
Data from 12 872 mothers were analysed. Between 2006 and 2016, births in healthcare facilities increased from 44.6% (95% CI: 41.9% to 47.3%) to 75.2% (95% CI: 73.4% to 77.0%) and coverage of immediate maternal postnatal care from 35.7% (95% CI 33.4% to 38.1%) to 65.0% (95% CI: 63.2% to 66.7%). The majority of first checks occurred between 1 and 4 hours post partum; the median time reduced from 4 hours to 1 hour. The most important factor associated with receipt of immediate postnatal care was women having a caesarean section birth adjusted OR (aOR) 2.93 (95% CI: 2.28 to 3.75). Other significant factors included exposure to mass media aOR 1.38 (95% CI: 1.15 to 1.65), baby being weighed at birth aOR 1.84 (95% CI: 1.58 to 2.14) and receipt of antenatal care with 4+Antenatal visits aOR 2.34 (95% CI: 1.50 to 3.64).
In Uganda, a large gap in coverage remains and universal immediate postnatal care has not materialised through increasing facility-based births or longer length of stay. To ensure universal coverage of high-quality care during this critical time, we recommend that maternal and newborn services should be integrated and actively involve mothers and their partners.
在降低孕产妇和新生儿死亡率方面所取得的进展，尤其是在撒哈拉以南非洲地区，仍不足以实现到2030年的可持续发展目标。分娩后的头24小时（产后即刻期），这是大多数发病和死亡发生的时段，对母亲和婴儿至关重要。在乌干达，据报告只有不到50%的妇女接受了此类护理。本文描述了2001年至2016年期间乌干达在医疗机构分娩后产后即刻护理的覆盖情况、随时间的变化以及决定因素。
我们分析了2006年、2011年和2016年的乌干达人口与健康调查，其中包括在调查的5年回忆期内在医疗机构有最近一次活产的15至49岁妇女。对产后即刻护理的覆盖情况及其随时间的变化进行了描述性呈现。使用多变量逻辑回归来研究产后即刻护理的决定因素。
分析了来自12872名母亲的数据。2006年至2016年期间，医疗机构分娩率从44.6%（95%置信区间：41.9%至47.3%）增至75.2%（95%置信区间：73.4%至77.0%），产妇产后即刻护理的覆盖率从35.7%（95%置信区间33.4%至38.1%）增至65.0%（95%置信区间：63.2%至66.7%）。大多数首次检查发生在产后1至4小时；中位时间从4小时降至1小时。与接受产后即刻护理相关的最重要因素是进行剖宫产的妇女，调整后的比值比（aOR）为2.93（95%置信区间：2.28至3.75）。其他显著因素包括接触大众媒体，aOR为1.38（95%置信区间：1.15至1.65），婴儿出生时称重，aOR为1.84（95%置信区间：1.58至2.14）以及接受4次及以上产前检查，aOR为2.34（95%置信区间：1.50至3.64）。
在乌干达，覆盖率仍存在很大差距，通过增加医疗机构分娩或延长住院时间并未实现普遍的产后即刻护理。为确保在这一关键时期实现高质量护理的普遍覆盖，我们建议应整合孕产妇和新生儿服务，并积极让母亲及其伴侣参与进来。
