Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
PLoS One. 2021 Aug 5;16(8):e0251706. doi: 10.1371/journal.pone.0251706. eCollection 2021.
Access to health services across the continuum of care improves maternal and newborn health outcomes. Ethiopia launched the Community-Based Newborn Care programme in 2013 to increase the coverage of antenatal care, institutional delivery, postnatal care and newborn care. The programme also introduced gentamicin and amoxicillin treatment by health extension workers for young infants with possible serious bacterial infection when referral was not possible. This study aimed to assess the extent to which the coverage of health services for mothers and their young infants increased after the initiation of the programme.
A baseline survey was conducted in October-December 2013 and a follow-up survey four years later in November-December 2017. At baseline, 10,224 households and 1,016 women who had a live birth in the 3-15 months prior to the survey were included. In the follow-up survey, 10,270 households and 1,057 women with a recent live birth were included. Women were asked about their experience of care during pregnancy, delivery and postpartum periods, as well as the treatment provided for their child's illness in the first 59 days of life.
Between baseline and follow-up surveys the proportion of women reporting at least one antenatal care visit increased by 15 percentage points (95% CI: 10,19), four or more antenatal care visits increased by 17 percentage points (95%CI: 13,22), and institutional delivery increased by 40 percentage points (95% CI: 35,44). In contrast, the proportion of newborns with a postnatal care visit within 48 hours of birth decreased by 6 percentage points (95% CI: -10, -3) for home deliveries and by 14 percentage points (95% CI: -21, -7) for facility deliveries. The proportion of mothers reporting that their young infant with possible serious bacterial infection received amoxicillin for seven days increased by 50 percentage points (95% CI: 37,62) and gentamicin for seven days increased by 15 percentage points (95% CI: 5,25). Concurrent use of both antibiotics increased by 12 percentage points (95% CI: 4,19).
The Community-Based Newborn Care programme was an ambitious initiative to enhance the access to services for pregnant women and newborns. Major improvements were seen for the number of antenatal care visits and institutional delivery, while postnatal care remained alarmingly low. Antibiotic treatment for young infants with possible serious bacterial infection increased, although most treatment did not follow national guidelines. Improving postnatal care coverage and using a simplified antibiotic regimen following recent World Health Organization guidelines could address gaps in the care provided for sick young infants.
在整个护理连续体中获得卫生服务可改善母婴健康结果。埃塞俄比亚于 2013 年启动了社区新生儿护理方案，以提高产前护理、机构分娩、产后护理和新生儿护理的覆盖率。该方案还为可能患有严重细菌感染的婴儿提供了庆大霉素和阿莫西林治疗，当无法转介时由卫生推广人员进行。本研究旨在评估该方案启动后母亲及其婴儿的卫生服务覆盖率增加的程度。
2013 年 10 月至 12 月进行了基线调查，四年后的 2017 年 11 月至 12 月进行了随访调查。基线调查时，包括了 10224 户家庭和 1016 名在调查前 3-15 个月内分娩的妇女。在随访调查中，包括了 10270 户家庭和 1057 名最近分娩的妇女。妇女被问及她们在怀孕期间、分娩期间和产后期间的护理经历，以及她们的孩子在生命的头 59 天内患病的治疗情况。
在基线和随访调查之间，报告至少一次产前护理就诊的妇女比例增加了 15 个百分点（95%CI：10，19），四次或更多次产前护理就诊的比例增加了 17 个百分点（95%CI：13，22），机构分娩的比例增加了 40 个百分点（95%CI：35，44）。相比之下，在家分娩的新生儿在出生后 48 小时内接受产后护理的比例下降了 6 个百分点（95%CI：-10，-3），在机构分娩的比例下降了 14 个百分点（95%CI：-21，-7）。报告其可能患有严重细菌感染的婴儿接受阿莫西林治疗七天的母亲比例增加了 50 个百分点（95%CI：37，62），接受庆大霉素治疗七天的比例增加了 15 个百分点（95%CI：5，25）。同时使用两种抗生素的比例增加了 12 个百分点（95%CI：4，19）。
社区新生儿护理方案是一项雄心勃勃的举措，旨在增强孕妇和新生儿获得服务的机会。在产前护理就诊次数和机构分娩方面取得了重大进展，而产后护理仍然低得令人震惊。可能患有严重细菌感染的婴儿的抗生素治疗有所增加，尽管大多数治疗并未遵循国家指南。改善产后护理覆盖率，并按照最近的世界卫生组织指南使用简化的抗生素方案，可能会解决为患病婴儿提供护理方面的差距。
