Decentralizing and task sharing within the primary health system improved access and quality of ANC services in Amhara and Oromia regions: pre-post health facility data.

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Solomon Abebe, Shoa Girma, Abeba Ayele, Tarik Taye, Melissa Morrison, Dedefo Teno, Gebeyehu Asire, Addisie Worku, Della Berhanu
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引用次数: 0

Abstract

Background: Improved access to quality antenatal care (ANC) promotes healthy behaviors and early complication management, enhancing maternal and newborn outcomes. The Enhancing Nutrition and Antenatal Infection Treatment for Maternal and Child Health (ENAT) intervention in Ethiopia aimed to increase newborn birth weight by improving ANC utilization and quality. ENAT task shared and decentralized ANC services to facilitate early contact and point of care (POC) testing and management of maternal infections and anemia. This study assessed if task sharing and decentralization improved utilization and quality of ANC services at primary health care facilities.

Methods: The study assessed changes in ANC coverage and quality before and after the ENAT intervention, in 65 health centers and 303 health posts across Amhara and Oromia regions of Ethiopia. The intervention task shared ANC services at health centers (Augst 2018-January 2021) and then decentralized services to health posts (February 2021-February 2022). Using descriptive analyses, this study assessed, between baseline and endline, changes in coverage in the proportion of women who: enrolled early into ANC; had at least one ANC contact; and had four or more ANC contacts. Similarly, the study separately assessed each quality indicator through changes in the proportion of iron and folic acid supplementation, and deworming tablets, and POC testing and treatment for anemia, syphilis, and asymptomatic bacteriuria at baseline, phase I and phase II.

Results: ANC utilization and quality improved in the 368 sites. Between baseline and endline the proportion of women having an ANC contact before 16 weeks of gestational age increased from 6 to 37%, while those receiving at least one ANC contact and four or more ANC contacts increased from 74 to 91% and 45-57%, respectively. Iron and folic acid supplementation and deworming increased from 44 to 97% and from 44 to 79%, respectively. In the final 12 months of the intervention, 87%, 80%, and 87% of pregnant women attending ANC received POC testing for anemia, syphilis, and asymptomatic bacteriuria, respectively.

Conclusions: Our findings suggest that bringing ANC services closer to communities can increase early ANC contact and enhance the coverage and quality of services, leading to better maternal and newborn health outcomes.

初级卫生系统内的权力下放和任务分担改善了阿姆哈拉和奥罗米亚地区非国大服务的可及性和质量:卫生设施前后数据。
背景:改善获得优质产前保健(ANC)的机会可促进健康行为和早期并发症管理,提高孕产妇和新生儿结局。埃塞俄比亚的“加强营养和产前感染治疗,促进母婴健康”(ENAT)干预措施旨在通过提高ANC的利用率和质量来增加新生儿体重。ENAT的任务是共享和分散母婴护理服务,以促进早期接触和护理点检测以及孕产妇感染和贫血的管理。这项研究评估了任务分担和权力下放是否能改善初级卫生保健设施的非国大服务的利用和质量。方法:该研究评估了埃塞俄比亚阿姆哈拉和奥罗米亚地区65个卫生中心和303个卫生站在ENAT干预前后ANC覆盖率和质量的变化。干预任务在保健中心共享ANC服务(2018年8月至2021年1月),然后将服务分散到保健站(2021年2月至2022年2月)。使用描述性分析,本研究评估了基线和终点之间妇女覆盖率的变化:早期加入ANC;至少有一个ANC联系人;有四个或更多ANC联系人同样,该研究通过铁和叶酸补充比例的变化,以及驱虫片的变化,以及基线、I期和II期贫血、梅毒和无症状菌尿的POC检测和治疗,分别评估了每个质量指标。结果:368个站点的ANC利用率和质量均有提高。在基线和终点之间,孕龄16周前接触过ANC的妇女比例从6%增加到37%,而至少接触过一次ANC和四次以上接触过ANC的妇女比例分别从74%增加到91%和45% -57%。铁和叶酸的补充量和驱虫率分别从44%提高到97%和44%提高到79%。在干预的最后12个月,87%、80%和87%参加ANC的孕妇分别接受了贫血、梅毒和无症状细菌性尿症的POC检测。结论:我们的研究结果表明,使ANC服务更接近社区,可以增加ANC的早期接触,提高服务的覆盖面和质量,从而改善孕产妇和新生儿的健康结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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