Andargie Netsanet Belete, Debelew Gurmesa Tura
Ministry of Health, Addis Ababa Ethiopia and Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
Arch Public Health. 2022 Jan 4;80(1):5. doi: 10.1186/s13690-021-00774-2.
Previous studies have shown that there is low utilization of institutional delivery in Ethiopia, as well as various factors contributing to this low utilization. Notably, there is paucity around interventions to improve institutional delivery. Hence, this study examines the effectiveness of checklist-based box system intervention on improving institutional delivery and to investigate the association through which the intervention is linked to institutional delivery.
The study used data from a larger trial, on the effectiveness of checklist-based box system intervention on improving maternal health service utilization. In the intervention arm, mothers received regular community-level pregnancy screening and referral, service utilization monitoring boxes, drop-out tracing mechanisms, regular communication between health centers and health posts, and person-centered health education for mothers. This study used the existing government-led maternal health program as a control arm. A total of 1062 mothers who gave birth one-year before the survey were included in the final analysis. A difference-in-difference estimator was used to test the effectiveness of the intervention. Generalized structural equation modeling was used to examine the direct and/ indirect associations between the intervention and institutional delivery.
Among participants, 403 (79.5%) mothers from intervention and 323 (58.2%) mothers from control clusters gave birth at health facilities. The result of the study revealed a 19% increase in institutional delivery in the intervention arm (19, 95%CI: 11.4-27.3%). In this study the pathway from checklist-based box system intervention to institutional delivery was mainly direct - (AOR = 3.32, 95%CI: 2.36-4.66), however, 33% of the effect was partially mediated by attendance of antenatal care four visits (AOR = 1.39, 95%CI: 1.02-1.92). The influence of significant others (AOR = 0.25, 95%CI: 0.15-0.43) and age (AOR = 0.03, 95%CI: 0.01- 0.09) had an inverse relation with institutional delivery.
The implementation of a checklist-based box system significantly increased institutional delivery utilization, both directly and indirectly by improving antenatal care four attendance. A larger-scale implementation of the intervention was recommended, taking the continuum of care approach into account.
ClinicalTrials.gov , NCT03891030 , Retrospectively registered on 26 March, 2019.
先前的研究表明，埃塞俄比亚机构分娩的利用率较低，且存在多种导致利用率低下的因素。值得注意的是，改善机构分娩的干预措施较少。因此，本研究旨在探讨基于清单的箱式系统干预对提高机构分娩率的有效性，并调查该干预与机构分娩之间的关联。
本研究使用了一项更大规模试验的数据，该试验旨在研究基于清单的箱式系统干预对提高孕产妇保健服务利用率的有效性。在干预组中，母亲们接受定期的社区层面妊娠筛查和转诊、服务利用监测箱、失访追踪机制、卫生中心与卫生站之间的定期沟通，以及针对母亲的以人为本的健康教育。本研究将现有的政府主导的孕产妇保健项目作为对照组。共有1062名在调查前一年分娩的母亲被纳入最终分析。采用差异-in-差异估计器来检验干预的有效性。使用广义结构方程模型来检验干预与机构分娩之间的直接和/或间接关联。
在参与者中，干预组的403名（79.5%）母亲和对照组的323名（58.2%）母亲在医疗机构分娩。研究结果显示，干预组的机构分娩率提高了19%（19，95%CI：11.4 - 27.3%）。在本研究中，基于清单的箱式系统干预与机构分娩之间的途径主要是直接的 - （调整后比值比[AOR]=3.32，95%CI：2.36 - 4.66），然而，33%的效果部分由产前检查四次的就诊情况介导（AOR = 1.39，95%CI：1.02 - 1.92）。重要他人的影响（AOR = 0.25，9%CI：0.15 - 0.43）和年龄（AOR = 0.03，95%CI：0.01 - 0.09）与机构分娩呈负相关。
基于清单的箱式系统的实施显著提高了机构分娩的利用率，通过改善产前检查四次就诊情况直接和间接地提高了利用率。建议考虑采用连续护理方法，大规模实施该干预措施。
ClinicalTrials.gov，NCT03891030，于2019年3月26日进行回顾性注册。
