Department of Korea, Korea Foundation for International Healthcare, Seoul, Republic of Korea
Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, Massachusetts, USA.
BMJ Open. 2022 Sep 7;12(9):e062028. doi: 10.1136/bmjopen-2022-062028.
To investigate effective, quality-adjusted, coverage and inequality of maternal and child health (MCH) services to assess progress in improving quality of care in Cambodia.
A retrospective secondary analysis using the three most recent (2005, 2010 and 2014) Demographic and Health Surveys.
Cambodia.
53 155 women aged 15-49 years old and 23 242 children under 5 years old across the three surveys.
We estimated crude coverage, effective coverage and inequality in effective coverage for five MCH services over time: antenatal care (ANC), facility delivery and sick childcare for diarrhoea, pneumonia and fever. Quality was defined by the proportion of care seekers who received a set of interventions during healthcare visits. Effective coverage was estimated by combining crude coverage and quality. We used equiplots and risk ratios, to assess patterns in inequality in MCH effective coverage across wealth quintile, urban-rural and women's education levels and over time.
In 2014, crude and effective coverage was 80.1% and 56.4%, respectively, for maternal health services (ANC and facility delivery) and 59.1% and 26.9%, respectively, for sick childcare (diarrhoea, pneumonia and fever). Between 2005 and 2014, effective coverage improved for all services, but improvements were larger for maternal healthcare than for sick child care. In 2014, poorer children were more likely to receive oral rehydration solution for diarrhoea than children from richer households. Meanwhile, women from urban areas were more likely to receive a postnatal check before getting discharged.
Effective coverage has generally improved in Cambodia but efforts remain to improve quality for all MCH services. Our results point to substantial gaps in curative sick child care, a large share of which is provided by unregulated private providers in Cambodia. Policymakers should focus on improving effective coverage, and not only crude coverage, to achieve the health-related Sustainable Development Goals by 2030.
调查产妇和儿童健康（MCH）服务的有效性、质量调整后覆盖率和不平等性，以评估柬埔寨提高护理质量的进展。
使用最近三次（2005 年、2010 年和 2014 年）人口与健康调查进行回顾性二次分析。
柬埔寨。
三次调查共 53155 名 15-49 岁的妇女和 23242 名 5 岁以下的儿童。
我们随时间估算了五项 MCH 服务的粗覆盖率、有效覆盖率和有效覆盖率的不平等性：产前护理（ANC）、分娩和腹泻、肺炎和发热时的儿童护理。质量由在医疗保健访问中接受一系列干预措施的护理寻求者的比例定义。有效覆盖率是通过将粗覆盖率和质量结合起来估算的。我们使用等距图和风险比评估了在财富五分位数、城乡和妇女教育水平以及随时间推移的 MCH 有效覆盖率不平等模式。
2014 年，产妇保健服务（ANC 和分娩）的粗覆盖率和有效覆盖率分别为 80.1%和 56.4%，而儿童腹泻、肺炎和发热时的护理（腹泻、肺炎和发热）的粗覆盖率和有效覆盖率分别为 59.1%和 26.9%。2005 年至 2014 年间，所有服务的有效覆盖率都有所提高，但孕产妇保健服务的提高幅度大于儿童保健服务。2014 年，较贫穷的儿童比来自较富裕家庭的儿童更有可能获得口服补液盐治疗腹泻。与此同时，来自城市地区的妇女更有可能在出院前接受产后检查。
柬埔寨的有效覆盖率总体上有所提高，但仍需努力提高所有 MCH 服务的质量。我们的研究结果表明，在治疗性儿童保健方面存在巨大差距，其中很大一部分是由柬埔寨不受监管的私人提供者提供的。政策制定者应注重提高有效覆盖率，而不仅仅是粗覆盖率，以实现到 2030 年与健康相关的可持续发展目标。
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