Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
BMJ Open. 2021 May 4;11(5):e042058. doi: 10.1136/bmjopen-2020-042058.
To measure the length of stay at a health facility after childbirth, identify factors associated with the length of stay and measure the gap between the timings of the last check-up and discharge.
A cross-sectional study.
Five public health facilities in Dhading, Nepal.
351 randomly selected mothers who gave birth at selected health facilities within 1 year of data collection between 10 and 31 August 2018.
Length of stay (hours) at a health facility after childbirth. Adequate length was defined as 24 hours or longer based on the WHO guidelines.
Among 350 mothers (99.7%) out of 351 recruited, 61.7% were discharged within 24 hours after childbirth. Factors associated with shorter length of stay were as follows: travel time less than 30 min to a health facility (incidence rate ratio (IRR)=0.69, 95% CI 0.61 to 0.78); delivery attended by auxiliary staff (IRR=0.86, 95% CI 0.75 to 0.98); and delivery in a primary healthcare centre (IRR=0.67, 95% CI 0.58 to 0.79). Factors associated with longer length of stay were as follows: aged 22 years or above at the first pregnancy (IRR=1.25, 95% CI 1.13 to 1.40); having maternal complications (IRR=2.41, 95% CI 2.16 to 2.70); accompanied by her own family (IRR=1.17, 95% CI 1.03 to 1.34), accompanied by her husband (IRR=1.16, 95% CI 1.04 to 1.29); and delivered at a facility with a physical space where mother and newborn could stay overnight (IRR=1.20, 95% CI 1.07 to 1.34). Among mothers without complications, 32% received the last check-up 3 hours or less before discharge.
Multiple factors, such as mothers' conditions, health facility characteristics and external support, were associated with the length of stay after childbirth. However, even if mothers stayed long, they might have not necessarily received timely and proper assessment before discharge.
测量分娩后在医疗机构的停留时间，确定与停留时间相关的因素，并测量最后一次检查和出院之间的时间差距。
一项横断面研究。
尼泊尔达丁的 5 家公立医疗机构。
2018 年 8 月 10 日至 31 日期间在选定的医疗机构分娩的 351 名随机选择的母亲。
分娩后在医疗机构的停留时间（小时）。根据世卫组织的指南，足够的时间被定义为 24 小时或更长时间。
在招募的 351 名母亲（350 名）中，61.7%在分娩后 24 小时内出院。与较短的停留时间相关的因素如下：到医疗机构的旅行时间少于 30 分钟（发病率比（IRR）=0.69，95%CI 0.61 至 0.78）；由辅助人员接生（IRR=0.86，95%CI 0.75 至 0.98）；以及在初级保健中心分娩（IRR=0.67，95%CI 0.58 至 0.79）。与较长的停留时间相关的因素如下：第一次怀孕年龄为 22 岁或以上（IRR=1.25，95%CI 1.13 至 1.40）；有产妇并发症（IRR=2.41，95%CI 2.16 至 2.70）；有自己的家人陪伴（IRR=1.17，95%CI 1.03 至 1.34），有丈夫陪伴（IRR=1.16，95%CI 1.04 至 1.29）；以及在有母婴过夜物理空间的机构分娩（IRR=1.20，95%CI 1.07 至 1.34）。在没有并发症的母亲中，32%在出院前 3 小时或更短时间接受最后一次检查。
母亲的状况、医疗机构的特点和外部支持等多种因素与分娩后的停留时间有关。然而，即使母亲停留时间较长，她们在出院前也不一定得到了及时和适当的评估。
