Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
TA Networking Corp., Tokyo, Japan.
J Glob Health. 2023 Aug 11;13:04073. doi: 10.7189/jogh.13.04073.
Many low- and middle-income countries (LMICs) prioritise minimising maternal, neonatal, and infant mortality. To improve maternal and child health, various evidence-based interventions have been introduced. Quality of care is pertinent while strengthening service utilisations. Achieving optimal-quality care is often marred with difficulties, such as inadequate skills and knowledge of health workers, poor fidelity to protocols, and poor user acceptance. Angola is a LMIC facing these problems. This study aimed to demonstrate the influence of health facilities' quality of care at antenatal care (ANC) on subsequent maternal, newborn and child health (MNCH) service utilisation in Angolan pregnant women.
Population-based cohort data from the Maternal and Child Health Handbook (MCH-HB) effectiveness study were analysed. The original study was conducted among women who became pregnant between March and April 2019 in Benguela Province, Angola. Socioeconomic and MNCH service utilisation indicators were collected through interviewer-administered structured questionnaires. The indicator of quality of care was a composite measure that assessed the implementation of the MCH-HB based on the RE-AIM framework, mostly consisted of common factors related to delivery and management of MNCH services. A multivariate logistic regression analysis was performed between quality of care, socioeconomic factors, and service utilisation indicators among the intervention group participants who had at least one ANC visit.
Of the 3351 pregnant women who visited ANC at least once, 2911 without missing values among explanatory or dependent variables were included in the analysis. Among them, 2032 (69.8%) were exposed to optimal-quality ANC, and 2058 (70.7%), 1573 (54.0%), and 941 (32.3%) achieved ANC target, facility delivery, and vaccination target for six-month-old infants, respectively. Exposure to suboptimal-quality care at ANC was associated with lower odds for facility delivery (adjusted odds ratio (AOR) = 0.60, 95% CI = 0.49-0.73) and the achievement of the vaccination target (AOR = 0.43, 95% CI = 0.33-0.55). A low socioeconomic status was inversely associated with health service utilisation indicators.
Health facilities' quality of care influences subsequent MNCH service utilisation. Therefore, simultaneous efforts to improve quality of care and the mobilisation of pregnant women and communities are essential for enhancing maternal and child health.
许多中低收入国家（LMICs）优先考虑降低孕产妇、新生儿和婴儿死亡率。为了改善母婴健康，已经引入了各种基于证据的干预措施。在加强服务利用的同时，护理质量至关重要。实现最佳质量的护理常常会遇到困难，例如卫生工作者的技能和知识不足、对方案的忠实程度差以及用户接受度低。安哥拉就是面临这些问题的一个 LMIC。本研究旨在展示安哥拉孕妇在产前护理（ANC）中卫生设施的护理质量对随后的孕产妇、新生儿和儿童健康（MNCH）服务利用的影响。
利用孕产妇和儿童保健手册（MCH-HB）效果研究的基于人群的队列数据进行分析。原始研究是在 2019 年 3 月至 4 月期间在安哥拉本格拉省怀孕的妇女中进行的。通过访谈者管理的结构化问卷收集了社会经济和 MNCH 服务利用指标。护理质量指标是一个综合措施，根据 RE-AIM 框架评估 MCH-HB 的实施情况，主要由与 MNCH 服务的分娩和管理相关的常见因素组成。对干预组中至少接受过一次 ANC 就诊的参与者进行了质量护理、社会经济因素和服务利用指标之间的多变量逻辑回归分析。
在至少接受过一次 ANC 就诊的 3351 名孕妇中，纳入分析的无缺失值的解释或因变量为 2911 名。其中，2032 名（69.8%）接受了最佳质量的 ANC，2058 名（70.7%）、1573 名（54.0%）和 941 名（32.3%）分别达到了 ANC 目标、医疗机构分娩和 6 个月龄婴儿的疫苗接种目标。在 ANC 中接受低质量护理与较低的医疗机构分娩几率相关（调整后的优势比（AOR）=0.60，95%CI=0.49-0.73）和疫苗接种目标的实现（AOR=0.43，95%CI=0.33-0.55）。较低的社会经济地位与卫生服务利用指标呈负相关。
卫生设施的护理质量影响随后的 MNCH 服务利用。因此，同时努力提高护理质量和动员孕妇和社区，对于提高母婴健康至关重要。
