印度公立医疗机构产前护理服务质量评估。
Assessment of quality of antenatal care services in public sector facilities in India.
机构信息
Public Health Foundation of India, Gurugram, Haryana, India
Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA.
出版信息
BMJ Open. 2022 Dec 1;12(12):e065200. doi: 10.1136/bmjopen-2022-065200.
OBJECTIVES
We undertook assessment of quality of antenatal care (ANC) services in public sector facilities in the Indian state of Bihar state delivered under the national ANC programme (Pradhan Mantri Surakshit Matritva Abhiyan, PMSMA).
SETTING
Three community health centres and one subdistrict hospital each in two randomly selected districts of Bihar.
PARTICIPANTS
Pregnant women who sought ANC services under PMSMA irrespective of the pregnancy trimester.
PRIMARY AND SECONDARY MEASURES
Quality ANC services were considered if a woman received all of these services in that visit-weight, blood pressure and abdomen check, urine and blood sample taken, and were given iron and folic acid and calcium tablets. The process of ANC service provision was documented.
RESULTS
Eight hundred and fourteen (94.5% participation) women participated. Coverage of quality ANC services was 30.4% (95% CI 27.3% to 33.7%) irrespective of pregnancy trimester, and was similar in both districts and ranged 3%-83.1% across the facilities. Quality ANC service coverage was significantly lower for women in the first trimester of pregnancy (6.8%, 95% CI 3.3% to 13.6%) as compared with those in the second (34.4%, 95% CI 29.9% to 39.1%) and third (32.9%, 95% CI 27.9% to 38.3%) trimester of pregnancy. Individually, the coverage of weight and blood pressure check-up, receipt of iron folic acid (IFA) and calcium tablets, and blood sample collection was >85%. The coverage of urine sample collection was 46.3% (95% CI 42.9% to 49.7%) and of abdomen check-up was 62% (95% CI 58.6% to 65.3%). Poor information sharing post check-up was done with the pregnant women. Varied implementation of ANC service provision was seen in the facilities as compared with the PMSMA guidelines, in particular with laboratory diagnostics and doctor consultation. Task shifting from doctors to ANMs was observed in all facilities.
CONCLUSIONS
Grossly inadequate quality ANC services under the PMSMA needs urgent attention to improve maternal and neonatal health outcomes.
目的
我们评估了印度比哈尔邦公共部门根据国家产前护理计划（Pradhan Mantri Surakshit Matritva Abhiyan，PMSMA）提供的产前护理（ANC）服务的质量。
设置
在比哈尔邦随机选择的两个地区的每个社区卫生中心和一个分区医院各选择三个。
参与者
在 PMSMA 下寻求 ANC 服务的孕妇，无论怀孕周期如何。
主要和次要措施
如果妇女在那次就诊中接受了所有这些服务，则认为 ANC 服务质量良好-体重，血压和腹部检查，尿液和血液样本采集，并给予铁和叶酸以及钙片。记录 ANC 服务提供的过程。
结果
814 名（94.5％的参与率）妇女参加了研究。不论怀孕周期如何，优质 ANC 服务的覆盖率为 30.4％（95％CI 27.3％至 33.7％），在两个地区均相似，设施之间的范围为 3％-83.1％。与第二孕期（34.4％，95％CI 29.9％至 39.1％）和第三孕期（32.9％，95％CI 27.9％至 38.3％）相比，第一孕期（6.8％，95％CI 3.3％至 13.6％）的妇女接受优质 ANC 服务的比例明显较低。单独来看，体重和血压检查，接受铁叶酸（IFA）和钙片以及采集血液样本的比例均> 85％。尿液样本采集的覆盖率为 46.3％（95％CI 42.9％至 49.7％），腹部检查的覆盖率为 62％（95％CI 58.6％至 65.3％）。检查后与孕妇的信息共享不佳。与 PMSMA 指南相比，各个设施提供 ANC 服务的执行情况各不相同，尤其是实验室诊断和医生咨询。观察到所有设施都从医生向 ANC 护士转移任务。
结论
在 PMSMA 下，ANC 服务的质量严重不足，需要紧急关注，以改善母婴健康结果。
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