Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Accra, Ghana.
BMC Pregnancy Childbirth. 2022 Oct 29;22(1):800. doi: 10.1186/s12884-022-05138-4.
Globally, postnatal care (PNC) is fraught with challenges. Despite high PNC coverages in Ghana's Greater Accra Region (GAR), maternal and newborn health outcomes are of great concern. In 2017, neonatal and post-neonatal mortality rates in GAR were 19 and 13 per 1000 live births respectively despite PNC coverages of 93% for at least one PNC and 87.5% for PNC within 48 hours post-delivery. Telephone follow-up has been used to improve health outcomes in some settings, however, its usefulness in improving maternal and infant health during the postnatal period is not well known in Ghana. We assessed effectiveness of telephone-based PNC on infant and maternal illness in selected hospitals in GAR.
An open-label, assessor-blinded, parallel-group, two-arm superiority randomized controlled trial with 1:1 allocation ratio was conducted from September 2020 to March 2021. Mother-baby pairs in intervention arm, in addition to usual PNC, received midwife-led telephone counselling within 48 hours post-discharge plus telephone access to midwife during postnatal period. In control arm, only usual PNC was provided. Descriptive and inferential data analyses were conducted to generate frequencies, relative frequencies, risk ratios and 95% confidence intervals. Primary analysis was by intention-to-treat (ITT), complemented by per-protocol (PP) analysis.
Of 608 mother-baby pairs assessed for eligibility, 400 (65.8%) were enrolled. During 3 months follow-up, proportion of infants who fell ill was 62.5% in intervention arm and 77.5% in control arm (p = 0.001). Maternal illness occurred in 27.5% of intervention and 38.5% of control participants (p = 0.02). Risk of infant illness was 20% less in intervention than control arm in both ITT analysis [RR = 0.8 (95%CI = 0.71-0.92] and PP analysis [RR = 0.8 (95%CI = 0.67-0.89)]. Compared to controls, risk of maternal illness in intervention arm was 30% lower in both ITT [RR = 0.7 (95%CI = 0.54-95.00)] and PP analysis [RR = 0.7 (95%CI = 0.51-0.94)].
Telephone-based PNC significantly reduced risk of maternal and infant illness within first 3 months after delivery. This intervention merits consideration as a tool for adoption and scale up to improve infant and maternal health.
This trial was retrospectively registered with the International Standard Randomized Controlled Trial Number (ISRCTN) Registry with number ISRCTN46905855 on 09/04/2021.
在全球范围内，产后护理（PNC）充满挑战。尽管加纳大阿克拉地区（GAR）的 PNC 覆盖率很高，但产妇和新生儿的健康状况仍令人担忧。2017 年，GAR 的新生儿和产后新生儿死亡率分别为每 1000 例活产 19 例和 13 例，尽管至少有一次 PNC 的覆盖率为 93%，48 小时内 PNC 的覆盖率为 87.5%。电话随访已被用于改善一些环境中的健康结果，但在加纳，其在产后期间改善母婴健康的有效性尚不清楚。我们评估了基于电话的 PNC 在 GAR 选定医院对婴儿和产妇疾病的有效性。
这是一项开放标签、评估者盲法、平行组、2 臂优效性随机对照试验，分配比例为 1:1。干预组的母婴对除了常规 PNC 外，还在出院后 48 小时内接受助产士主导的电话咨询，并在产后期间可通过电话联系助产士。在对照组中，仅提供常规 PNC。进行描述性和推断性数据分析以生成频率、相对频率、风险比和 95%置信区间。主要分析采用意向治疗（ITT），补充方案（PP）分析。
在评估合格性的 608 对母婴中，有 400 对（65.8%）入组。在 3 个月的随访期间，干预组中生病的婴儿比例为 62.5%，对照组为 77.5%（p=0.001）。干预组中有 27.5%的产妇生病，对照组中有 38.5%的产妇生病（p=0.02）。在 ITT 分析[RR=0.8（95%CI=0.71-0.92）]和 PP 分析[RR=0.8（95%CI=0.67-0.89）]中，干预组婴儿患病的风险比对照组分别低 20%和 30%。在 ITT 分析[RR=0.7（95%CI=0.54-95.00）]和 PP 分析[RR=0.7（95%CI=0.51-0.94）]中，与对照组相比，干预组产妇患病的风险分别低 30%和 70%。
基于电话的 PNC 显著降低了产后 3 个月内母婴患病的风险。该干预措施值得考虑采用和推广，以改善母婴健康。
该试验于 2021 年 9 月 9 日在国际标准随机对照试验注册（ISRCTN）登记处（登记号：ISRCTN46905855）进行了回顾性登记。
