Independent Researcher, Streithausen, Germany.
Independent Researcher, Bad Krozingen, Germany.
Prim Health Care Res Dev. 2024 May 9;25:e27. doi: 10.1017/S146342362400015X.
The study assessed mothers, children and adolescents' health (MCAH) outcomes in the context of a Primary Health Care (PHC) project and associated costs in two protracted long-term refugee camps, along the Thai-Myanmar border.
Myanmar refugees settled in Thailand nearly 40 years ago, in a string of camps along the border, where they fully depend on external support for health and social services. Between 2000 and 2018, a single international NGO has been implementing an integrated PHC project.
This retrospective study looked at the trends of MCAH indicators of mortality and morbidity and compared them to the sustainable development goals (SDGs) indicators. A review of programme documents explored and triangulated the evolution and changing context of the PHC services, and associated project costs were analysed. To verify changes over time, interviews with 12 key informants were conducted.
While maternal mortality (SDG3.1) remained high at 126.5/100,000 live births, child mortality (SDG 3.2) and infectious diseases in children under 5 (SDG 3.3) fell by 69% and by up to 92%, respectively. Maternal anaemia decreased by 30%; and more than 90% of pregnant women attended four or more antenatal care visits, whereas 80% delivered by a skilled birth attendant; caesarean section rates rose but remained low at an average of 3.7%; the adolescent (15-19 years) birth rate peaked at 188 per 1000 in 2015 but declined to 89/1000 in 2018 (SDG 3.7).
Comprehensive PHC delivery, with improved health provider competence in MCAH care, together with secured funding is an appropriate strategy to bring MCAH indicators to acceptable levels. However, inequities due to confinement in camps, fragmentation of specific health services, prevent fulfilment of the 2030 SDG Agenda to 'Leave no one behind'. Costs per birth was 115 EURO in 2018; however, MCAH expenditure requires further exploration over a longer period.
本研究评估了在泰缅边境两个长期难民营中，初级卫生保健（PHC）项目背景下母婴和儿童青少年健康（MCAH）的结果及其相关成本。
40 年前，缅甸难民在泰国边境的一系列难民营中定居，他们完全依赖外部支持来获得医疗和社会服务。2000 年至 2018 年期间，一家国际非政府组织一直在实施一项综合 PHC 项目。
这项回顾性研究观察了 MCAH 死亡率和发病率的趋势，并将其与可持续发展目标（SDG）指标进行了比较。对项目文件的审查探讨并三角剖分了 PHC 服务的演变和变化背景，并分析了相关项目成本。为了验证随时间的变化，对 12 名关键知情人进行了访谈。
尽管孕产妇死亡率（SDG3.1）仍高达每 10 万活产 126.5 例，但儿童死亡率（SDG 3.2）和 5 岁以下儿童传染病（SDG 3.3）分别下降了 69%和高达 92%。孕产妇贫血减少了 30%；超过 90%的孕妇接受了 4 次或更多次产前保健，而 80%的孕妇由熟练的接生员接生；剖腹产率上升，但仍保持在低水平，平均为 3.7%；青少年（15-19 岁）出生率在 2015 年达到每 1000 人 188 人，但在 2018 年降至 89/1000（SDG 3.7）。
全面提供 PHC，提高 MCAH 护理方面的卫生保健提供者能力，并确保资金安全，是将 MCAH 指标提高到可接受水平的适当策略。然而，由于被困在难民营中以及特定卫生服务碎片化导致的不平等，使 2030 年实现“不让任何人掉队”的可持续发展目标议程的目标无法实现。2018 年每例分娩的成本为 115 欧元；然而，MCAH 支出需要在更长的时间内进一步探讨。
