Madaj Barbara, Gopalakrishnan Somasundari, Quach Alexandre, Filiaci Simone, Traore Adama, Bakusa Dankom, Mdegela Mselenge, Yousofzai Abdul Wali, Rahmanzai Ahmed Javed, Kodindo Grace, Gami Jean-Pierre, Rostand Njiki Dounou, Kessely Hamit, Addo Stephen Ayisi, Abbey Mercy, Sapali Mary, Omar Ali, Ernest Alex, Mtandu Rugola, Agossou Abram, Ketoh Guillaume K, Furtado Nicholas, Mangiaterra Viviana, van den Broek Nynke
Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Centre for Maternal and Newborn Health, Lome, Togo.
BJOG. 2022 Aug;129(9):1546-1557. doi: 10.1111/1471-0528.17106. Epub 2022 Feb 17.
Antenatal (ANC) and postnatal care (PNC) are logical entry points for prevention and treatment of pregnancy-related illness and to reduce perinatal mortality. We developed signal functions and assessed availability of the essential components of care.
Cross-sectional survey.
Afghanistan, Chad, Ghana, Tanzania, Togo.
Three hundred and twenty-one healthcare facilities.
Fifteen essential components or signal functions of ANC and PNC were identified. Healthcare facility assessment for availability of each component, human resources, equipment, drugs and consumables required to provide each component.
Availability of ANC PNC components.
Across all countries, healthcare providers are available (median number per facility: 8; interquartile range [IQR] 3-17) with a ratio of 3:1 for secondary versus primary care. Significantly more women attend for ANC than PNC (1668 versus 300 per facility/year). None of the healthcare facilities was able to provide all 15 essential components of ANC and PNC. The majority (>75%) could provide five components: diagnosis and management of syphilis, vaccination to prevent tetanus, BMI assessment, gestational diabetes screening, monitoring newborn growth. In Sub-Saharan countries, interventions for malaria and HIV (including prevention of mother to child transmission [PMTCT]) were available in 11.7-86.5% of facilities. Prevention and management of TB; assessment of pre- or post-term birth, fetal wellbeing, detection of multiple pregnancy, abnormal lie and presentation; screening and support for mental health and domestic abuse were provided in <25% of facilities.
Essential components of ANC and PNC are not in place. Focused attention on content is required if perinatal mortality and maternal morbidity during and after pregnancy are to be reduced.
ANC and PNC are essential care bundles. We identified 15 core components. These are not in place in the majority of LMIC settings.
产前保健（ANC）和产后保健（PNC）是预防和治疗妊娠相关疾病以及降低围产期死亡率的合理切入点。我们开发了信号功能并评估了基本保健要素的可及性。
横断面调查。
阿富汗、乍得、加纳、坦桑尼亚、多哥。
321家医疗机构。
确定了15项产前保健和产后保健的基本要素或信号功能。对每家医疗机构的各要素可及性、提供各要素所需的人力资源、设备、药品和耗材进行评估。
产前保健和产后保健要素的可及性。
在所有国家，均有医疗服务提供者（每家机构的中位数人数：8人；四分位间距[IQR]为3 - 17），二级保健与一级保健的比例为3:1。参加产前保健的女性明显多于产后保健（每家机构/每年分别为1668人和300人）。没有一家医疗机构能够提供产前保健和产后保健的所有15项基本要素。大多数（>75%）能够提供五项要素：梅毒的诊断和管理、预防破伤风的疫苗接种、体重指数评估、妊娠期糖尿病筛查、监测新生儿生长。在撒哈拉以南国家，11.7% - 86.5%的机构提供疟疾和艾滋病毒干预措施（包括预防母婴传播[PMTCT]）。不到25%的机构提供结核病的预防和管理；评估早产或过期产、胎儿健康状况、多胎妊娠的检测、胎位异常和先露异常；心理健康和家庭虐待的筛查及支持。
产前保健和产后保健的基本要素尚未落实到位。如果要降低围产期死亡率和孕期及产后的孕产妇发病率，就需要重点关注相关内容。
产前保健和产后保健是基本保健包。我们确定了15项核心要素。在大多数低收入和中等收入国家环境中这些要素尚未落实到位。
