J Glob Health. 2024 Feb 9;14:04022. doi: 10.7189/jogh.14.04022.
Despite the existence of evidence-based interventions, substantial progress in reducing neonatal mortality is lagging, indicating that small and sick newborns (SSNs) are likely not receiving the care they require to survive and thrive. The 'three delays model' provides a framework for understanding the challenges in accessing care for SSNs. However, the extent to which each delay impacts access to care for SSNs is not well understood. To fill this evidence gap, we explored the impact of each of the three delays on access to care for SSNs in Malawi, Mozambique, and Tanzania.
Secondary analyses of data from three different surveys served as the foundation of this study. To understand the impact of delays in the decision to seek care (delay 1) and the ability to reach an appropriate point of care (delay 2), we investigated time trends in place of birth disaggregated by facility type. We also explored care-seeking behaviours for newborns who died. To understand the impact of delays in accessing high-quality care after reaching a facility (delay 3), we measured facility readiness to manage care for SSNs. We used this measure to adjust institutional delivery coverage for SSN care readiness.
Coverage of institutional deliveries was substantially lower after adjusting for facility readiness to manage SSN care, with decreases of 30 percentage points (pp) in Malawi, 14 pp in Mozambique, and 24 pp in Tanzania. While trends suggest more SSNs are born in facilities, substantial gaps remain in facilities' capacities to provide lifesaving interventions. In addition, exploration of care-seeking pathways revealed that a substantial proportion of newborn deaths occurred outside of health facilities, indicating barriers in the decision to seek care or the ability to reach an appropriate source of care may also prevent SSNs from receiving these interventions.
Investments are needed to overcome delays in accessing high-quality care for the most vulnerable newborns, those who are born small or sick. As more mothers and newborns access health services in low- and middle-income countries, ensuring that life-saving interventions for SSNs are available at the locations where newborns are born and seek care after birth is critical.
尽管存在基于证据的干预措施，但新生儿死亡率的显著降低仍存在滞后，这表明小而患病的新生儿（SSN）可能无法获得生存和茁壮成长所需的护理。“三个延迟模型”为理解获得 SSN 护理的挑战提供了框架。然而，每个延迟对获得 SSN 护理的影响程度尚不清楚。为了填补这一证据空白，我们探讨了三个延迟中的每一个对马拉维、莫桑比克和坦桑尼亚获得 SSN 护理的影响。
本研究的基础是对来自三项不同调查的二次分析数据。为了了解寻求护理的决策延迟（延迟 1）和到达适当护理点的能力延迟（延迟 2）对获得护理的影响，我们按机构类型分解了分娩地点的时间趋势。我们还探讨了新生儿死亡后的护理寻求行为。为了了解到达医疗机构后获得高质量护理的延迟（延迟 3）的影响，我们衡量了医疗机构管理 SSN 护理的准备情况。我们使用该措施来调整机构分娩覆盖范围以适应 SSN 护理准备情况。
调整机构准备情况管理 SSN 护理后，机构分娩覆盖率大大降低，马拉维降低了 30 个百分点，莫桑比克降低了 14 个百分点，坦桑尼亚降低了 24 个百分点。尽管趋势表明更多的 SSN 是在机构中出生的，但机构提供救生干预措施的能力仍存在巨大差距。此外，对护理寻求途径的探索表明，相当一部分新生儿死亡发生在医疗机构之外，这表明在寻求护理的决策或到达适当护理源的能力方面可能存在障碍，也可能阻止 SSN 获得这些干预措施。
需要投资克服最脆弱的新生儿（即出生时较小或患病的新生儿）获得高质量护理的延迟。随着越来越多的母亲和新生儿在低收入和中等收入国家获得卫生服务，确保在新生儿出生和出生后寻求护理的地点提供针对 SSN 的救生干预措施至关重要。
