产前保健质量与孕妇风险检测:埃塞俄比亚、印度、肯尼亚和南非的观察研究。

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2024-08-27 eCollection Date: 2024-08-01 DOI:10.1371/journal.pmed.1004446
Catherine Arsenault, Nompumelelo Gloria Mfeka-Nkabinde, Monica Chaudhry, Prashant Jarhyan, Tefera Taddele, Irene Mugenya, Shalom Sabwa, Katherine Wright, Beatrice Amboko, Laura Baensch, Gebeyaw Molla Wondim, Londiwe Mthethwa, Emma Clarke-Deelder, Wen-Chien Yang, Rose J Kosgei, Priyanka Purohit, Nokuzola Cynthia Mzolo, Anagaw Derseh Mebratie, Subhojit Shaw, Adiam Nega, Boikhutso Tlou, Günther Fink, Mosa Moshabela, Dorairaj Prabhakaran, Sailesh Mohan, Damen Haile Mariam, Jacinta Nzinga, Theodros Getachew, Margaret E Kruk
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引用次数: 0

摘要

背景:产前保健(ANC)是改善孕产妇和新生儿健康(MNH)的重要平台。虽然有多篇文章介绍了中低收入国家(LMICs)的产前护理内容,但很少有文章调查产前护理期间妊娠风险因素的检测和管理质量。目前仍不清楚存在妊娠风险因素的妇女是否得到了有针对性的管理和额外的产前保健:这项观察性研究使用了埃塞俄比亚、印度、肯尼亚和南非的 8 个地点在 2023 年 4 月至 2024 年 1 月期间开展的 MNH eCohort 研究的基线数据。共调查了 4068 名首次接受产前护理的孕妇。我们建立了针对特定国家的产前护理完整性指数,衡量了在以下 5 个领域中提供 16 到 22 项建议临床行动的情况:体格检查、诊断检测、病史采集和筛查、咨询以及治疗和预防。我们调查了有妊娠风险的妇女是否倾向于接受更高质量的护理,并评估了 7 种并发疾病和妊娠风险因素(贫血、营养不良、肥胖、慢性病、抑郁、产科并发症和危险征兆)的检测和管理质量。埃塞俄比亚的产前保健完成率为 43%,肯尼亚为 66%,印度为 73%,南非为 76%,在病史采集、筛查和咨询方面存在很大差距。埃塞俄比亚、肯尼亚和南非的大多数妇女在怀孕的第二个或第三个月开始接受产前保健。我们使用了针对特定国家的多变量混合效应线性回归模型来研究与产前保健完整性相关的因素。模型包括个人人口统计学特征、健康状况、是否存在风险因素、医疗机构特征以及研究地点的固定效应。我们发现,一些医疗机构的特征(人员配备、病人数量、结构准备情况)与产前检查完成率的变化有关。相比之下,仅在肯尼亚,妊娠风险因素只与产前护理完成率增加 1.7 个百分点有关(95% 置信区间为 0.3 - 3.0,P 值为 0.014)。在印度和南非,自我报告健康状况差与产前检查完成率较高有关,而在埃塞俄比亚与产前检查完成率较低有关。一些并发症和风险因素在产前检查中被忽视。营养不良的妇女中只有 0% 到 6% 得到了食物补充,抑郁症妇女中只有 1% 到 3% 被转介给心理健康提供者或得到了抗抑郁药物。曾经历过产科并发症(流产、早产、死胎或新生儿死亡)的妇女中,只有 36% 至 73% 的人在首次产前检查时与医疗服务提供者讨论了她们的产科病史。虽然我们的目的是通过健康卡中的数据验证自我报告的健康状况和护理内容,但我们的研究结果可能会受到回忆或其他信息偏差的影响:在这项研究中,我们发现在遵守产前保健标准方面存在差距,尤其是对于需要专业管理的妇女。为最大限度地发挥产前保健的潜在健康益处,应针对有可能出现不良妊娠结局的妇女制定相关策略,并改善在妊娠头三个月及早开始产前保健的情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Antenatal care quality and detection of risk among pregnant women: An observational study in Ethiopia, India, Kenya, and South Africa.

Background: Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC.

Methods and findings: This observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases.

Conclusions: In this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester.

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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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