解决医院新生儿公平覆盖和护理质量问题：中美洲窒息干预措施的前后评估。

Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica.

机构信息

Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.

Department of Anesthesiology, University of Washington, Seattle, WA, USA.

出版信息

BMC Pediatr. 2021 Dec 1;21(1):534. doi: 10.1186/s12887-021-02999-0.

DOI:10.1186/s12887-021-02999-0

PMID:34852795

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8638427/

Abstract

BACKGROUND

Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region.

METHODS

A pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011-2013) and at second-phase follow-up (2017-2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression.

RESULTS

Management of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3-4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4-12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%).

CONCLUSION

SMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.

摘要

背景

产时相关缺氧事件（即新生儿窒息）导致全球四分之一的新生儿死亡，中美洲也不例外。必须对窒息进行多维护理，以确保及时有效地为新生儿提供护理。中美洲健康倡议（SMI）是一个基于绩效的项目，旨在改善中美洲低收入地区的母婴健康。我们的目标是评估 SMI 对该地区卫生中心和医院新生儿窒息护理的影响。

方法

采用前后设计。在墨西哥（恰帕斯州）、洪都拉斯、尼加拉瓜和危地马拉，作为 SMI 倡议评估的一部分，从病历中随机选择 248 例窒息病例，分别在基线（2011-2013 年）和第二阶段随访（2017-2018 年）时进行。进行了一项设施调查，以评估医疗保健质量和窒息管理。主要结局是评估管理窒息的多维护理覆盖率，包括在分娩时由熟练提供者在场、立即评估、初步稳定和对新生儿进行适当复苏措施。使用多变量逻辑回归分析数据。

结果

在 SMI 之后，窒息管理得到了显著改善。与基线相比，干预地区对窒息的适当护理更好（OR=2.4；95%CI=1.3-4.6）。此外，与墨西哥相比，洪都拉斯的多维护理明显更高（OR=4.0；95%CI=1.4-12.0）。在四个多维护理组成部分中，复苏在随访时（65.7%）比基线时（38.7%）取得了更大的进展。