Pati Sanghamitra, Puri Parul, Sinha Rajeshwari, Panda Meely, Pati Sandipana
Department of Health Research, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India.
International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India.
J Family Med Prim Care. 2022 May;11(5):1980-1988. doi: 10.4103/jfmpc.jfmpc_1855_21. Epub 2022 May 14.
Multimorbidity is being recognized as a crucial maternal health challenge in India. However, pregnancy remains an exclusion criterion in most multimorbidity estimation studies resulting in a deficient understanding of the problem in this population. The present study aims to estimate the prevalence of multimorbidity, identify its correlates, and assess healthcare utilization and expenditure outcomes among women availing of antenatal care clinics.
An exploratory cross-sectional study was conducted among 127 pregnant women attending three antenatal clinics of Bhubaneswar, Odisha, from February to July 2016. Data were collected using a "multimorbidity assessment questionnaire for primary care," contextualized for antenatal settings. The prevalence and correlates were determined using descriptive analysis, and the outcomes were measured by the number of healthcare visits, medications, and healthcare expenditure. About 15% of antenatal women were multimorbid.
Anemia (52.6%), hypertension (31.6%), acid-peptic diseases (26.3%), and thyroid (26.3%) were the leading chronic conditions. Statistically, significant association was found between multimorbidity and medical consultation, the medicines consumed, and functional limitation. The healthcare expenditure was significantly higher among the multimorbidity groups.
Our findings suggest the inclusion of comprehensive multimorbidity assessment in routine antenatal screening. Preconception care should establish linkages between maternal and reproductive health with chronic disease prevention, and identify ways to reduce healthcare utilization and expenditure. Longitudinal studies to assess the trajectory and impact of multimorbidity on maternal and infant health are warranted.
在印度，多种疾病并存正被视为一项严峻的孕产妇健康挑战。然而，在大多数多种疾病并存情况的评估研究中，怀孕仍是排除标准，这导致对该人群中这一问题的认识不足。本研究旨在评估多种疾病并存的患病率，确定其相关因素，并评估在产前保健诊所就诊的女性的医疗服务利用情况和支出结果。
2016年2月至7月，在奥里萨邦布巴内斯瓦尔的三家产前诊所对127名孕妇进行了一项探索性横断面研究。使用一份针对初级保健的“多种疾病并存评估问卷”收集数据，并根据产前情况进行了调整。通过描述性分析确定患病率和相关因素，并通过医疗就诊次数、药物使用情况和医疗支出衡量结果。约15%的产前女性患有多种疾病。
贫血（52.6%）、高血压（31.6%）、酸相关性疾病（26.3%）和甲状腺疾病（26.3%）是主要的慢性病。在统计学上，发现多种疾病并存与医疗咨询、所服用药物以及功能受限之间存在显著关联。多种疾病并存组的医疗支出显著更高。
我们的研究结果表明，应将全面的多种疾病并存评估纳入常规产前筛查。孕前保健应在孕产妇和生殖健康与慢性病预防之间建立联系，并确定减少医疗服务利用和支出的方法。有必要开展纵向研究，以评估多种疾病并存对孕产妇和婴儿健康的发展轨迹及影响。
