Ransjö-Arvidson A B, Chintu K, Ng'andu N, Eriksson B, Susu B, Christensson K, Diwan V K
Department of Obstetrics and Gynaecology, University Teaching Hospital, School of Nursing, University of Zambia.
J Epidemiol Community Health. 1998 Jun;52(6):385-91. doi: 10.1136/jech.52.6.385.
The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies, during a period of 42 days after delivery. Another aim was to compare the mothers', the midwife's, and the doctor's findings of prevalence of health problems at the end of the puerperium period.
A randomised controlled trial was carried out. One group of mothers and their infants were randomly allocated to a home visiting group (Group A); the other group (Group B) was only visited at day 42.
The study was carried out at the University Teaching Hospital (UTH) in Lusaka, the capital city of Zambia.
A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant, as assessed by the attending midwife, were randomised to two groups. Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3, 7, 28, and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42.
At day 42 an equal proportion (30%) of mothers in both groups perceived that they had health problems. The prevalence of infant health problems in Group B was significantly higher (p < 0.01) as perceived by mothers. There were more mothers in Group B (p < 0.01) perceiving insufficient milk production and giving supplementary feeding. At day 42, mothers in Group A (56%) took more actions than mothers in Group B (41%) to solve infant health problems (p < 0.03). In both groups the mothers' perceived own health problems, were significantly higher (p < 0.01) than those observed by the obstetrician and those observed by the midwife. The midwife found more infant health problems in Group B (p < 0.01) than in Group A and more infants with health problems in both groups compared with the paediatrician's findings (p < 0.01).
There was a significant difference between the mothers' reported health problems and the health problems identified by the midwife and the doctors. The study shows that a midwife home visit and individual health education to mothers, reduce the prevalence of infant health problems, and enables the mother to more often take action when an infant health problem is identified. There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care.
本研究的主要目的是探究在产后42天内，助产士家访计划对顺产母亲及其健康足月儿的健康问题患病率和母乳喂养行为是否有显著影响。另一个目的是比较产褥期末母亲、助产士和医生对健康问题患病率的调查结果。
开展了一项随机对照试验。一组母亲及其婴儿被随机分配到家访组（A组）；另一组（B组）仅在第42天接受访视。
该研究在赞比亚首都卢萨卡的大学教学医院（UTH）进行。
共有408名经助产士评估顺产并生下健康足月儿的母亲被随机分为两组。A组由208对母婴组成，助产士在产后第3天、第7天、第28天和第42天到她们家中进行访视；B组由200对母婴组成，仅在第42天接受访视。
在第42天，两组中认为自己有健康问题的母亲比例相同（30%）。母亲们认为，B组婴儿健康问题的患病率显著更高（p<0.01）。B组中认为乳汁分泌不足并进行补充喂养的母亲更多（p<0.01）。在第42天，A组母亲（56%）比B组母亲（41%）采取更多行动来解决婴儿健康问题（p<0.03）。在两组中，母亲们认为自己存在的健康问题，显著高于产科医生和助产士观察到的问题（p<0.01）。助产士发现B组的婴儿健康问题比A组多（p<0.01），且与儿科医生的调查结果相比，两组中存在健康问题的婴儿都更多（p<0.01）。
母亲报告的健康问题与助产士和医生确定的健康问题之间存在显著差异。该研究表明，助产士家访和对母亲进行个体健康教育，可降低婴儿健康问题的患病率，并使母亲在发现婴儿健康问题时更常采取行动。有必要重新评估助产士培训课程，以便纳入更多婴儿管理护理内容。
