Alisjahbana A, Williams C, Dharmayanti R, Hermawan D, Kwast B E, Koblinsky M
Medical Research Unit, School of Medicine, Padjadjaran Universitym Hasan Sadikin General Hospital, Bandung, Indonesia.
Int J Gynaecol Obstet. 1995 Jun;48 Suppl:S83-94. doi: 10.1016/0020-7292(95)02323-5.
The Regionalization of Perinatal Care, an intervention study carried out in Tanjungsari, a subdistrict in rural West Java, aimed to develop a comprehensive maternal health program to improve maternal and perinatal health outcomes. The main inputs included training at all levels of the health care system (informal and formal) and the establishment of birthing homes in villages to make services more accessible. Special attention was given to referral, transportation, communication and appropriate case management, A social marketing program was conducted to inform people of the accessible birthing homes for clean delivery, located near the women, and with better transportation and communications to referral facilities should complications arise. The study design was longitudinal, following all pregnant women from early pregnancy until 42 days postpartum in an intervention and a comparison area. The population was +/- 90,000 in the intervention area and 40,000 in the comparison area. Inclusion criteria were all mother and infant units delivered between June 1st, 1992 and May 31st, 1993. Analysis showed the following results: Most women sought antenatal care (> 95%). In Tanjungsari, nearly 90% sought such care from professional providers as versus 75% in the control area of Cisalak. Most women with bleeding or bleeding and edema during pregnancy sought professional assistance in both the study and control areas. However, fever for more than 3 days received more attention in the study area versus control area (93 vs. 69%). Greater than 85% of deliveries in both areas were conducted by TBAs. However, in the study area, nearly one-third of those with intrapartum complications (17%) delivered in a health facility compared to one-tenth in the control area. This meant a hospital delivery, primarily with assistance of a doctor or doctor/midwife combination. Overall referral rates by TBAs were low -13% of women with complications in Tanjungsari and 6% in Cisalak. More women with intrapartum complications were referred in the study area than in the control, and more complied when referred. Women who suffered intrapartum complications were more likely to have a perinatal death. Perinatal deaths declined in Tanjungsari, but not significantly. However, the trend over the period of the intervention shows an improvement in the deliveries managed by TBAs with more deaths resulting in the hands of professionals. Either women were arriving too late or the quality of care could not meet the needs. There was no change in the levels or place of perinatal deaths in Cisalak.
围产期保健区域化是在西爪哇农村的一个分区丹戎萨里开展的一项干预性研究，旨在制定一项全面的孕产妇保健计划，以改善孕产妇和围产期健康结果。主要投入包括对各级卫生保健系统（非正式和正式）的培训以及在村庄建立分娩之家，以使服务更易获得。特别关注了转诊、交通、通信和适当的病例管理。开展了一项社会营销计划，告知人们在妇女附近有可提供清洁分娩服务的分娩之家，并且如果出现并发症，这些分娩之家到转诊设施的交通和通信条件更好。该研究设计为纵向研究，在一个干预区和一个对照区跟踪所有孕妇从早孕到产后42天的情况。干预区人口约为90,000人，对照区为40,000人。纳入标准为1992年6月1日至1993年5月31日期间分娩的所有母婴单元。分析结果如下：大多数妇女寻求产前护理（>95%）。在丹戎萨里，近90%的妇女从专业提供者处寻求此类护理，而在西萨拉克对照区这一比例为75%。在研究区和对照区，大多数孕期有出血或出血伴水肿的妇女都寻求了专业帮助。然而，研究区对持续发热超过3天的情况比对照区给予了更多关注（93%对69%）。两个地区超过85%的分娩由传统接生员进行。然而，在研究区，近三分之一有产时并发症的产妇（17%）在医疗机构分娩，而对照区这一比例为十分之一。这意味着主要在医生或医生/助产士组合的协助下在医院分娩。传统接生员的总体转诊率较低——丹戎萨里有并发症的妇女中13%被转诊，西萨拉克为6%。研究区有产时并发症的被转诊妇女比对照区多，而且被转诊时更多人遵从了转诊建议。患有产时并发症的妇女更有可能发生围产期死亡。丹戎萨里的围产期死亡人数有所下降，但不显著。然而，干预期间的趋势表明，由传统接生员管理的分娩情况有所改善，更多死亡发生在专业人员手中。要么是妇女到达太晚，要么是护理质量无法满足需求。西萨拉克的围产期死亡水平和地点没有变化。
