Kassie Ayelign Mengesha, Eakin Elizabeth, Endalamaw Aklilu, Zewdie Anteneh, Wolka Eskinder, Assefa Yibeltal
School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia.
BMC Health Serv Res. 2024 Dec 18;24(1):1601. doi: 10.1186/s12913-024-12085-7.
There is no consistent operationalization of effective coverage (EC) across studies. Therefore, this scoping review synthesized evidence on the definitions and measurement approaches, outcomes reported, and the factors that are associated with variations in quality-adjusted EC estimates of maternal and neonatal healthcare services in low- and middle-income countries.
Article search was conducted using PubMed, Embase, Google Scholar, and other databases. Then, title, abstract, and full text screenings for inclusion were performed by two authors independently and disagreements were resolved through discussion. In case of duplication, the full-text published articles were retained, and the results are presented using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist as a guide.
Overall, 36 articles were included in this scoping review. In most articles, EC has been defined from the perspectives of people in need utilizing healthcare services in well-equipped health facilities and from actual receipt of quality services. In addition, usage, instead of need, has been used as a domain in estimating EC in some instances. Effective coverage ranged from 0% for different services including for post-partum care, to 84% for antenatal care. Moreover, different socio-demographic factors including wealth index, education, and residence are found to have an association with variations in EC of maternal and neonatal healthcare services with the wealthiest, most educated, and those living in urban areas having higher estimates. From the supply side, numerous factors, particularly health facility capacity-related constraints, have been reported to be associated with low EC of those services.
The variability in the definition and measurement approaches of EC across studies emphasizes the need for standardization for better comparison in future research. We recommend that quality-adjusted EC be defined in two ways: intervention-specific service delivery EC and general service delivery EC. In addition, disparities in EC are observed among women with different socioeconomic status including educational level and wealth index. Organizational capacity constraints and other health system and societal factors also contributed to variations in EC.
不同研究中有效覆盖率（EC）的操作化定义并不一致。因此，本范围综述综合了关于低收入和中等收入国家孕产妇和新生儿保健服务质量调整后有效覆盖率估计值的定义、测量方法、报告的结果以及与之相关的因素的证据。
通过PubMed、Embase、谷歌学术和其他数据库进行文献检索。然后，由两位作者独立进行标题、摘要和全文筛选以确定纳入文献，如有分歧则通过讨论解决。如有重复，保留全文发表的文章，并以《系统评价与Meta分析扩展版范围综述清单》为指南呈现结果。
总体而言，本范围综述纳入了36篇文章。在大多数文章中，有效覆盖率是从有需求者在配备完善的医疗机构中使用医疗服务的角度以及实际获得优质服务的角度来定义的。此外，在某些情况下，使用情况而非需求被用作估计有效覆盖率的一个领域。不同服务的有效覆盖率范围从产后护理等不同服务的0%到产前护理的84%不等。此外，发现不同的社会人口学因素，包括财富指数、教育程度和居住地区，与孕产妇和新生儿保健服务有效覆盖率的差异有关，最富裕、受教育程度最高以及居住在城市地区的人群的有效覆盖率估计值更高。从供应方来看，据报道有许多因素，特别是与卫生设施能力相关的限制因素，与这些服务的低有效覆盖率有关。
不同研究中有效覆盖率定义和测量方法的差异强调了在未来研究中进行标准化以实现更好比较的必要性。我们建议以两种方式定义质量调整后的有效覆盖率：特定干预服务提供有效覆盖率和一般服务提供有效覆盖率。此外，在不同社会经济地位（包括教育水平和财富指数）的女性中观察到了有效覆盖率的差异。组织能力限制以及其他卫生系统和社会因素也导致了有效覆盖率的差异。
