Vasconcelos Alexandra, Sousa Swasilanne, Bandeira Nelson, Alves Marta, Papoila Ana Luísa, Pereira Filomena, Machado Maria Céu
Unidade de Clínica Tropical-Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal.
Hospital Dr. Ayres de Menezes, São Tomé, Sao Tome and Principe.
PLOS Glob Public Health. 2022 Dec 29;2(12):e0001444. doi: 10.1371/journal.pgph.0001444. eCollection 2022.
Newborn mortality and adverse birth outcomes (ABOs) in Sao Tome & Príncipe (STP) are overwhelmingly high, and access to quality-antenatal care (ANC) is one of the strategies to tackle it. This study aimed to fill the gaps in ANC screenings with a focus on how to improve neonatal outcomes. We conducted a retrospective hospital-based study in which ANC pregnancy cards were reviewed. Screenings were described and compared according to the total number of ANC contacts: 1-3 (inadequate), 4-7 (adequate), and ≥8 (complete). The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Statistical significance was considered at a p-value ≤0.05. A total of 511 ANC pregnancy cards were reviewed. Mothers' mean age was 26.6 (SD = 7.1), 51.7% had a first trimester early booking, 14.9% (76) had 1-3 ANC contacts, 46.4% (237) had 4-7 and 38.7% (198) ≥8. Screening absence was found in 24%-41%, lack of money was registered in 36%. Pregnant women had no screening performed for HIV in 4.5%, syphilis in 8.8%, HBV 39.3%, malaria 25.8%, hemoglobin 24.5%, blood glucose 45.4%, urine 29.7%, stool exams 27.8% and 41.1% had no ultrasound. Screening completion for blood group, HIV, malaria, urine, hemoglobin, and coproparasitological exam were found to have a statistically significant difference (p<0.001) for the complete ANC group when compared to other groups. Antenatal problems identified were: 1) bacteriuria (43.2%); 2) maternal anemia (37%); 3) intestinal parasitic infections (59.2%); 4) sickle cell solubility test positive (13%); and 5) a RhD-negative phenotype (5.8%). Missed-ANC treatments were up to 50%. This study reveals a coverage-quality gap in STP since no pregnant woman is left without ANC contact, although most still miss evidence-based screenings with an impact on neonatal outcomes. Strategies such as implementing a total free ANC screening package in STP would enhance maternal diagnosis and prompt treatments.
圣多美和普林西比（STP）的新生儿死亡率和不良出生结局（ABO）极高，而获得高质量的产前护理（ANC）是解决这一问题的策略之一。本研究旨在填补ANC筛查方面的空白，重点关注如何改善新生儿结局。我们开展了一项基于医院的回顾性研究，对ANC妊娠卡进行了审查。根据ANC接触的总数对筛查进行了描述和比较：1 - 3次（不足）、4 - 7次（足够）和≥8次（完整）。收集的数据录入QuickTapSurvey并导出到SPSS 25版进行分析。当p值≤0.05时认为具有统计学意义。共审查了511张ANC妊娠卡。母亲的平均年龄为26.6岁（标准差 = 7.1），51.7%的孕妇在孕早期进行了早期预约，14.9%（76人）有1 - 3次ANC接触，46.4%（237人）有4 - 7次接触，38.7%（198人）≥8次。发现24% - 41%的孕妇未进行筛查，36%的孕妇登记缺钱。4.5%的孕妇未进行HIV筛查，8.8%未进行梅毒筛查，39.3%未进行乙肝筛查，25.8%未进行疟疾筛查，24.5%未进行血红蛋白筛查，45.4%未进行血糖筛查，29.7%未进行尿液筛查，27.8%未进行粪便检查，41.1%未进行超声检查。与其他组相比，完整ANC组在血型、HIV、疟疾、尿液、血红蛋白和粪便寄生虫学检查的筛查完成情况方面存在统计学显著差异（p<0.001）。识别出的产前问题有：1）菌尿（43.2%）；2）孕产妇贫血（37%）；3）肠道寄生虫感染（59.2%）；4）镰状细胞溶解度试验阳性（13%）；5）RhD阴性表型（5.8%）。错过的ANC治疗高达50%。本研究揭示了STP在覆盖质量方面的差距，因为没有孕妇未进行ANC接触，尽管大多数孕妇仍错过对新生儿结局有影响的循证筛查。在STP实施全面免费的ANC筛查套餐等策略将加强孕产妇诊断并促进治疗。
