群组产前护理与个体化产前护理对生育准备和并发症应对能力的影响：加纳东部地区孕妇的一项群组随机对照研究。

Effect of group antenatal care versus individualized antenatal care on birth preparedness and complication readiness: a cluster randomized controlled study among pregnant women in Eastern Region of Ghana.

机构信息

Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana.

University of Michigan School of Nursing, Ann Arbor, MI, USA.

出版信息

BMC Pregnancy Childbirth. 2024 Aug 16;24(1):546. doi: 10.1186/s12884-024-06743-1.

DOI:10.1186/s12884-024-06743-1

PMID:39152408

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11328422/

Abstract

BACKGROUND

As utilization of individual antenatal care (I-ANC) has increased throughout sub-Saharan Africa, questions have arisen about whether individual versus group-based care might yield better outcomes. We implemented a trial of group-based antenatal care (G-ANC) to determine its impact on birth preparedness and complication readiness (BPCR) among pregnant women in Ghana.

METHODS

We conducted a cluster randomized controlled trial comparing G-ANC to routine antenatal care in 14 health facilities in the Eastern Region of Ghana. We recruited women in their first trimester to participate in eight two-hour interactive group sessions throughout their pregnancies. Meetings were facilitated by midwives trained in G-ANC methods, and clinical assessments were conducted in addition to group discussions and activities. Data were collected at five timepoints, and results are presented comparing baseline (T0) to 34 weeks' gestation to 3 weeks post-delivery (T1) for danger sign recognition, an 11-point additive scale of BPCR, as well as individual items comprising the scale.

RESULTS

1285 participants completed T0 and T1 assessments (N = 668 I-ANC, N = 617, G-ANC). At T1, G-ANC participants were able to identify significantly more pregnancy danger signs than I-ANC participants (mean increase from 1.8 to 3.4 in G-ANC vs. 1.7 to 2.2 in I-ANC, p < 0.0001). Overall BPCR scores were significantly greater in the G-ANC group than the I-ANC group. The elements of BPCR that showed the greatest increases included arranging for emergency transport (I-ANC increased from 1.5 to 11.5% vs. G-ANC increasing from 2 to 41% (p < 0.0001)) and saving money for transportation (19-32% in the I-ANC group vs. 19-73% in the G-ANC group (p < 0.0001)). Identifying someone to accompany the woman to the facility rose from 1 to 3% in the I-ANC group vs. 2-20% in the G-ANC group (p < 0.001).

CONCLUSIONS

G-ANC significantly increased BPCR among women in rural Eastern Region of Ghana when compared to routine antenatal care. Given the success of this intervention, future efforts that prioritize the implementation of G-ANC are warranted.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04033003 (25/07/2019).

PROTOCOL AVAILABLE

Protocol Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508671/ .

摘要

背景

随着个体产前护理（I-ANC）在撒哈拉以南非洲的利用率不断提高，人们开始质疑个体护理与基于群体的护理相比是否会产生更好的结果。我们实施了一项基于群体的产前护理（G-ANC）试验，以确定其对加纳孕妇生育准备和并发症准备（BPCR）的影响。

方法

我们在加纳东部地区的 14 个卫生机构进行了一项群组随机对照试验，比较了 G-ANC 与常规产前护理。我们招募了处于妊娠第一阶段的妇女，在整个妊娠期间参加八次两小时的互动群体会议。会议由接受过 G-ANC 方法培训的助产士主持，并进行临床评估，同时开展小组讨论和活动。在五个时间点收集数据，并比较基线（T0）至 34 周妊娠至产后 3 周（T1）时的危险信号识别、BPCR 的 11 分加性量表以及量表的各个项目的结果。

结果

1285 名参与者完成了 T0 和 T1 评估（I-ANC 组 668 名，G-ANC 组 617 名）。在 T1 时，G-ANC 参与者能够识别出明显更多的妊娠危险信号，而 I-ANC 参与者则识别出明显更多的妊娠危险信号（G-ANC 参与者从 1.8 增加到 3.4，而 I-ANC 参与者从 1.7 增加到 2.2，p<0.0001）。G-ANC 组的总体 BPCR 评分明显高于 I-ANC 组。BPCR 增加幅度最大的元素包括安排紧急运输（I-ANC 组从 15%增加到 11.5%，而 G-ANC 组从 2%增加到 41%（p<0.0001））和为运输存钱（I-ANC 组从 19-32%增加到 G-ANC 组的 19-73%（p<0.0001））。在 I-ANC 组中，有 1-3%的人表示会有人陪同该妇女前往医疗机构，而在 G-ANC 组中，有 2-20%的人表示会有人陪同（p<0.001）。