Ikeda Subaru, Shibanuma Akira, Pokharel Alpha, Silwal Ram Chandra, Jimba Masamine
Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
PLOS Glob Public Health. 2023 Aug 2;3(8):e0002101. doi: 10.1371/journal.pgph.0002101. eCollection 2023.
Maternal and newborn care quality can be measured in three dimensions (Dimensions 1: care provision, 2: care experience, and 3: human and physical resources); however, little is known about which dimensions are associated with newborn and perinatal deaths. We examined the association between care quality and newborn and perinatal deaths in Nepal. This study incorporated secondary data from Nepal Service Provision Assessments (NSPA) 2015 (623 delivery facilities, facility inventory survey; 1,509 women, ANC clients interviews; 1,544 women, ANC observation) and Nepal Demographic and Health Surveys (NDHS) 2016 (5,038 women who reported having given birth in the five years preceding data collection). The outcome variables were newborn and perinatal deaths derived from the NDHS. The exposure variables were district-level maternal and newborn care quality scores calculated from the NSPA data. Covariates were women's sociodemographic, health, and obstetric characteristics. We applied the administrative boundary method to link these two surveys. We conducted binary logistic regression analyses to examine the association between care quality and newborn/perinatal deaths. In Dimension 1, higher mean and maximum quality scores at the district level were associated with a lower number of newborn deaths (mean: odds ratio [OR] = 0.04, 95% confidence interval [CI]: 0.00-0.76; max: OR = 0.09, 95% CI: 0.01-0.58), but not with perinatal deaths. In Dimensions 2 and 3, the quality score was not significantly associated with newborn deaths and perinatal. Enhancing the quality of care provision at its average and highest levels in each district may contribute to the reduction of newborn deaths, but not perinatal death. Health administrators should assess the quality of care at the administrative division level and focus on enhancing both average and maximum care quality of health facilities in each region in the care provision dimension.
孕产妇和新生儿护理质量可从三个维度进行衡量（维度1：护理提供，2：护理体验，3：人力和物力资源）；然而，对于哪些维度与新生儿和围产期死亡相关，我们知之甚少。我们研究了尼泊尔护理质量与新生儿和围产期死亡之间的关联。本研究纳入了来自2015年尼泊尔服务提供评估（NSPA）（623个分娩设施，设施清单调查；1509名妇女，产前保健服务对象访谈；1544名妇女，产前保健观察）和2016年尼泊尔人口与健康调查（NDHS）（5038名报告在数据收集前五年内分娩的妇女）的二手数据。结果变量是来自NDHS的新生儿和围产期死亡数据。暴露变量是根据NSPA数据计算得出的地区层面孕产妇和新生儿护理质量得分。协变量是妇女的社会人口统计学、健康和产科特征。我们应用行政边界方法将这两项调查联系起来。我们进行了二元逻辑回归分析，以研究护理质量与新生儿/围产期死亡之间的关联。在维度1中，地区层面较高的平均和最高质量得分与较低的新生儿死亡数量相关（平均：比值比[OR]=0.04，95%置信区间[CI]：0.00 - 0.76；最高：OR = 0.09，95% CI：0.01 - 0.58），但与围产期死亡无关。在维度2和3中，质量得分与新生儿死亡和围产期死亡均无显著关联。提高每个地区平均和最高水平的护理提供质量可能有助于减少新生儿死亡，但不能减少围产期死亡。卫生管理人员应在行政区层面评估护理质量，并在护理提供维度上专注于提高每个地区卫生设施的平均和最高护理质量。
