印度比哈尔邦私营部门提供孕产妇和新生儿保健服务的情况：十年趋势

Private sector delivery of care for maternal and newborn health: trends over a decade in the Indian state of Bihar.

作者信息

Kumar G Anil, George Sibin, Majumder Moutushi, Dora S Siva Prasad, Akbar Md, Mahapatra Tanmay, Dandona Rakhi

机构信息

Public Health Foundation of India, New Delhi, India.

Piramal Swasthya Management and Research Institute, Hyderabad, India.

出版信息

BMC Med. 2025 Jan 29;23(1):50. doi: 10.1186/s12916-025-03894-6.

DOI:10.1186/s12916-025-03894-6

PMID:39875877

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11776212/

Abstract

BACKGROUND

We synthesised the current evidence in coverage and quality of delivery care, change in neonatal mortality (NMR), and causes of neonatal death in the private sector deliveries in the Indian state of Bihar from 2011 to 2021.

METHODS

Women aged 15-49 years with livebirths were interviewed in three household surveys involving state-representative samples in 2011, 2016 and 2020-2021 designed to document the coverage of maternal and newborn health services and change in NMR over time. Verbal autopsy interviews were used to assign the cause of neonatal death. The coverage of private sector facilities for livebirths in each survey and the percent change over time by 38 districts in the state and select socio-demographic characteristics, along with trends in NMR and causes of neonatal death across years are reported.

RESULTS

Private sector delivery coverage was 17.3% (95% CI = 16.6-17.9), 16.7% (95% CI = 16.2-17.2) and 26.1 (95% CI = 25.6-26.6) in 2011, 2016 and 2020-2021, respectively. A significant increase of 56.3% (95% CI = 49.3 to 63.3) in this coverage was documented between 2016 and 2020-2021 with the highest increase in the lowest wealth index quartile in urban areas. The district-wise coverage of private sector delivery ranged from 4.6% to 34.9%, 5.5% to 40.7%, and 5.9% to 62.0% in 2011, 2016 and 2020-2021, respectively. NMR was estimated at 41.3 (95% CI = 31.4-51.2), 36.6 (95% CI = 29.4-43.8), 38.6 (95% CI = 34.4-43.3) per 1000 livebirths in 2011, 2016 and 2020-2021, with no significant change over the years. Birth asphyxia was the leading cause of death in 2016 (37.8%) and 2020-2021 (33.9%) followed by preterm delivery and neonatal pneumonia; a statistically significant reduction was seen in meningitis/sepsis between 2016 and 2020-2021 (77.8%; 95% CI = - 145.4 to - 10.1).

CONCLUSIONS

This analysis contributes to a nuanced understanding of the changes in the private sector delivery in a given population over time to facilitate appropriate actions and interventions to improve newborn survival and maternal services.

摘要

背景

我们综合了2011年至2021年印度比哈尔邦私立部门分娩护理的覆盖范围、质量、新生儿死亡率（NMR）变化以及新生儿死亡原因的现有证据。

方法

在2011年、2016年以及2020 - 2021年的三项涉及该邦具有代表性样本的家庭调查中，对15 - 49岁有活产经历的女性进行了访谈，这些调查旨在记录孕产妇和新生儿健康服务的覆盖范围以及随时间推移NMR的变化。通过口头尸检访谈来确定新生儿死亡原因。报告了每次调查中私立部门活产设施的覆盖范围、该邦38个区随时间的百分比变化以及选定的社会人口特征，同时还报告了多年来NMR和新生儿死亡原因的趋势。

结果

2011年、2016年以及2020 - 2021年私立部门分娩的覆盖率分别为17.3%（95%置信区间 = 16.6 - 17.9）、16.7%（95%置信区间 = 16.2 - 17.2）和26.1%（95%置信区间 = 25.6 - 26.6）。2016年至2020 - 2021年期间，该覆盖率显著增加了56.3%（95%置信区间 = 49.3至63.3），城市地区最低财富指数四分位数的增加幅度最大。2011年、2016年以及2020 - 2021年私立部门分娩的地区覆盖率分别为4.6%至34.9%、5.5%至40.7%以及5.9%至62.0%。2011年、2016年以及2020 - 2021年每1000例活产的NMR估计分别为41.3（95%置信区间 = 31.4 - 51.2）、36.6（95%置信区间 = 29.4 - 43.8）、38.6（95%置信区间 = 34.4 - 43.3），多年来无显著变化。出生窒息是2016年（37.8%）和2020 - 2021年（33.9%）的主要死亡原因，其次是早产和新生儿肺炎；2016年至2020 - 2021年期间脑膜炎/败血症的发生率有统计学意义的显著下降（77.8%；95%置信区间 = - 145.4至 - 10.1）。