Save the Children, Nairobi, Kenya.
Department of Global Health, Save the Children Federation Inc, Washington, DC, USA
BMJ Open. 2022 Jun 14;12(6):e058408. doi: 10.1136/bmjopen-2021-058408.
The potential of timely, quality postnatal care (PNC) to reduce maternal and newborn mortality and to advance progress toward universal health coverage (UHC) is well-documented. Yet, in many low-income and middle-income countries, coverage of PNC remains low. Risk-stratified approaches can maximise limited resources by targeting mother-baby dyads meeting the evidence-based risk criteria which predict poor postnatal outcomes.
To review evidence-based risk criteria for identification of at-risk mother-baby dyads, drawn from a literature review, and to identify key considerations for their use in a risk-stratified PNC approach.
DESIGN/SETTING/PARTICIPANTS: A virtual, semi-structured group discussion was conducted with maternal and newborn health experts on Zoom. Participants were identified through purposive sampling based on content and context expertise.
Seventeen experts, (5 men and 12 women), drawn from policymakers, implementing agencies and academia participated and surfaced several key themes. The identified risk factors are well-known, necessitating accelerated efforts to address underlying drivers of risk. Risk-stratified PNC approaches complement broader UHC efforts by providing an equity lens to identify the most vulnerable mother-baby dyads. However, these should be layered on efforts to strengthen PNC service provision for all mothers and newborns. Risk factors should comprise context-relevant, operationalisable, clinical and non-clinical factors. Even with rising coverage of facility delivery, targeted postnatal home visits still complement facility-based PNC.
Risk-stratified PNC efforts must be considered within broader health systems strengthening efforts. Implementation research at the country level is needed to understand feasibility and practicality of clinical and non-clinical risk factors and identify unintended consequences.
及时、高质量的产后护理（PNC）有潜力降低母婴死亡率，并推动实现全民健康覆盖（UHC）的进展。然而，在许多低收入和中等收入国家，PNC 的覆盖率仍然很低。风险分层方法可以通过针对符合预测不良产后结局的循证风险标准的母婴对，最大限度地利用有限的资源。
从文献综述中回顾用于识别高危母婴对的循证风险标准，并确定在风险分层 PNC 方法中使用这些标准的关键注意事项。
设计/设置/参与者：在 Zoom 上与母婴健康专家进行了一次虚拟、半结构化的小组讨论。参与者是根据内容和背景专业知识通过有目的抽样确定的。
17 名专家（5 名男性和 12 名女性），来自决策者、实施机构和学术界，参与并提出了几个关键主题。确定的风险因素是众所周知的，需要加快努力解决风险的根本驱动因素。风险分层 PNC 方法通过为确定最脆弱的母婴对提供公平视角，补充了更广泛的 UHC 努力。然而，这些方法应该与加强所有母亲和新生儿 PNC 服务提供的努力相结合。风险因素应包括与背景相关、可操作、临床和非临床因素。即使在设施分娩覆盖率上升的情况下，针对产后家庭访视的针对性访视仍然是设施基础 PNC 的补充。
风险分层 PNC 工作必须在更广泛的卫生系统加强工作中加以考虑。需要在国家一级开展实施研究，以了解临床和非临床风险因素的可行性和实用性，并确定意外后果。
