津巴布韦农村地区有机构和无机构分娩的产妇的产前和分娩实践与新生儿死亡率：一项整群随机试验的观察数据。

Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial.

机构信息

Blizard Institute, Queen Mary University of London, London, UK.

Northern Ireland Medical and Dental Training Agency (NIMDTA), Beechill House, 42 Beechill Rd, Belfast, BT8 7RL, UK.

出版信息

BMC Pregnancy Childbirth. 2022 Dec 30;22(1):981. doi: 10.1186/s12884-022-05282-x.

DOI:10.1186/s12884-022-05282-x

PMID:36585673

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9805263/

Abstract

BACKGROUND

Despite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions.

METHODS

This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes.

RESULTS

Among 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference.

CONCLUSIONS

Preterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe.

TRIAL REGISTRATION

The trial is registered with ClinicalTrials.gov, number NCT01824940.

摘要

背景

尽管津巴布韦在孕妇产前护理、机构分娩和 HIV 抗逆转录病毒治疗方面取得了相对较高的覆盖率，但新生儿死亡率仍然居高不下。为了制定有效的干预措施，需要更清楚地了解因果途径。

方法

本研究是对 Sanitation Hygiene Infant Nutrition Efficacy (SHINE) 试验数据的二次分析，这是一项针对孕妇及其婴儿的以社区为基础的集群随机试验，旨在检查津巴布韦农村地区机构分娩和非机构分娩期间的护理情况及其与出生结局的关系。

结果

在 4423 名孕妇中，有 529 名（11.9%）在医疗机构外分娩；与机构分娩相比，这些分娩的卫生实践较差，减少新生儿低体温的干预措施也较少使用。在 3441 名在机构出生的婴儿中，有 592 名（17.2%）早产（<37 周妊娠），而在 462 名非在卫生机构出生的婴儿中，有 175 名（37.9%）早产（RR：2.20（1.92，2.53））。同样，在非医疗机构出生的婴儿中，死产率[1.2%比 3.0%（RR：2.38，1.36，4.15）]和新生儿死亡率[2.4%比 4.8%（RR：2.01，1.31，3.10）]也更高。在因急产而在家分娩的 293 名母亲中，有 221 名（75%）表示未在医疗机构分娩的主要原因是急产，而 32 名（11%）、34 名（12%）和 9 名（3%）分别表示距离诊所远、经济拮据和宗教/个人偏好。

结论

早产在津巴布韦农村所有婴儿中都很常见，在非医疗机构出生的婴儿中极其常见。我们的研究结果表明，分娩过早，而不是产妇的选择，可能是许多资源匮乏环境中非医疗机构分娩的原因，从而引发一系列事件，导致在医疗机构外出生的儿童的死产和新生儿死亡率增加一倍。预防早产的初级干预措施对于降低津巴布韦的新生儿死亡率至关重要。