Hajra Mukasa Comfort, Nankanja Maureen, Mugisa Margaret, Valentine Ojoro, Kagurusi Patrick
Programmes, Amref Health Africa in Uganda, Kampala, Uganda.
Health Psychol Behav Med. 2023 Mar 13;11(1):2185245. doi: 10.1080/21642850.2023.2185245. eCollection 2023.
Evidence on the impact of Maternal Newborn and child health (MNCH) and Water, Sanitation and Hygiene (WASH) interventions on skilled birth attendance (SBA) and neonatal sepsis remains unclear. We conducted this study in Amuru district to generate evidence.
A before-and-after study design was conducted. Interventions implemented included; training of HCWs, construction of WASH facilities, and health education of communities. A digitized structured questionnaire was used to obtain data on ANC and SBA, WASH practices and prevalence of pneumonia and diarrhea among 466 expectant mothers and caretakers of under-fives at baseline, midterm and endline. Data on sepsis incidence, ANC, SBA and WASH status was obtained from six healthcare facilities. A total of 12 KIIs and 12 FGDs were conducted. Data were analyzed using STATA 15. Two sample tests of proportions were used to compare findings at baseline and endline. Qualitative data were analyzed using thematic content analysis.
The number of women delivering at HCFs significantly increased from 41.4% to 63.0% ( < .0001). Incidence of neonatal sepsis reduced from 0.6% to 0.2% ( = .0687), although the difference was not significant. Community-level findings also indicated a decline in cases of water-borne illnesses; cases of dysentery decreased from 10.0% to 0.6%, cases of cholera decreased from 8.9% to 1.9% at endline, cases of typhoid decreased from 26.5% to 12.7% at endline.
This study revealed that integrated WASH/MNCH interventions can significantly increase ANC and SBA, reduce incidences of neonatal sepsis, diarrhea, pneumonia, and other related diseases and improve WASH practices in communities. Significant improvements in WASH/IPC and the capacity of HCWs to deliver safe MNCH services are realized.
关于孕产妇、新生儿和儿童健康（MNCH）及水、环境卫生与个人卫生（WASH）干预措施对熟练接生服务（SBA）和新生儿败血症的影响，相关证据仍不明确。我们在阿穆鲁区开展了这项研究以获取证据。
采用前后对照研究设计。实施的干预措施包括：对医护人员进行培训、建设水、环境卫生与个人卫生设施以及对社区进行健康教育。使用数字化结构化问卷在基线期、中期和终末期获取466名孕妇和五岁以下儿童看护人的产前护理（ANC）和熟练接生服务、水、环境卫生与个人卫生习惯以及肺炎和腹泻患病率的数据。败血症发病率、产前护理、熟练接生服务和水、环境卫生与个人卫生状况的数据来自六个医疗机构。共进行了12次关键信息访谈（KIIs）和12次焦点小组讨论（FGDs）。使用STATA 15对数据进行分析。采用双样本比例检验比较基线期和终末期的结果。定性数据采用主题内容分析法进行分析。
在医疗机构分娩的妇女数量从41.4%显著增加到63.0%（P <.0001）。新生儿败血症的发病率从0.6%降至0.2%（P =.0687），尽管差异不显著。社区层面的结果还表明水传播疾病的病例有所减少；痢疾病例从10.0%降至0.6%，霍乱病例在终末期从8.9%降至1.9%，伤寒病例在终末期从26.5%降至12.7%。
本研究表明，水、环境卫生与个人卫生/孕产妇、新生儿和儿童健康综合干预措施可显著增加产前护理和熟练接生服务，降低新生儿败血症、腹泻、肺炎及其他相关疾病的发病率，并改善社区的水、环境卫生与个人卫生习惯。水、环境卫生与个人卫生/感染预防与控制（IPC）以及医护人员提供安全的孕产妇、新生儿和儿童健康服务的能力有显著提高。
