围产期护理区域化和基于特定设施的干预措施的有效性:系统回顾。

Neonatology Pub Date : 2024-11-06 DOI:10.1159/000541384
Ayesha Arshad Ali, Hamna Amir Naseem, Zoha Allahuddin, Rahima Yasin, Maha Azhar, Sawera Hanif, Jai K Das, Zulfiqar A Bhutta
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Transport-related interventions significantly decreased maternal mortality overall (OR: 0.55; 95% CI: 0.40-0.74, 1 study), neonatal mortality (RR: 0.76; 95% CI: 0.66-0.88, 1 study), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), and improved postnatal care coverage (OR: 6.89; 95% CI: 5.15-9.21, 1 study) in LMICs. Adding maternity homes/units significantly decreased stillbirth (OR: 0.75; 95% CI: 0.61-0.93, 1 study) in LMICs. Incentives for postnatal care significantly improved infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), stillbirth (OR: 0.60; 95% CI: 0.44-0.83, 1 study), and postnatal care coverage (RR: 1.13; 95% CI: 1.03-1.25, 1 study) in LMICs. Telemedicine improved postnatal care coverage significantly in LMICs (RR: 2.54; 95% CI: 1.22-5.28, 3 studies) and decreased maternal mortality (OR: 0.46; 95% CI: 0.21-0.98, 1 study) and infant mortality (OR: 0.65; 95% CI: 0.45-0.95) in LMICs. 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引用次数: 0

摘要

导言:提供和利用适当的围产期保健对于提高孕产妇和新生儿存活率以及实现可持续发展目标 3 至关重要。确保医疗保健基础设施和熟练人员的可用性可能有助于在全球范围内以及在资源有限的环境中改善孕产妇和新生儿的预后:方法:对围产期护理区域化有效性的系统综述进行了更新,并对基于设施的干预措施进行了新的综述,以提高产后护理的覆盖率和效果。这些干预措施是通过文献综述确定的,包括运输、移动医疗、远程医疗、孕产妇教育、能力建设和激励方案。我们在相关数据库中进行了搜索,并在 Review Manager 5.4 中进行了荟萃分析。我们对来自中低收入国家(LMICs)的证据进行了分组分析:区域化计划的实施大大降低了中低收入国家的孕产妇死亡率(OR:0.43;95% CI:0.34-0.55,2 项研究)、死胎率(OR:0.70;95% CI:0.54-0.89,5 项研究)、围产期死亡率(OR:0.54;95% CI:0.5-0.58,2 项研究)和中低收入国家的孕产妇死亡率(OR:0.54;95% CI:0.50-0.58,1 项研究)。在低收入国家,与交通相关的干预措施可大幅降低孕产妇死亡率(OR:0.55;95% CI:0.40-0.74,1 项研究)、新生儿死亡率(RR:0.76;95% CI:0.66-0.88,1 项研究)、围产期死亡率(RR:0.86;95% CI:0.77-0.95,1 项研究),并提高产后护理覆盖率(OR:6.89;95% CI:5.15-9.21,1 项研究)。在低收入国家,增加产科之家/单位可显著降低死胎率(OR:0.75;95% CI:0.61-0.93,1 项研究)。在低收入国家,产后护理激励措施可大幅提高婴儿死亡率(RR:0.79;95% CI:0.65-0.96,1 项研究)、死胎率(OR:0.60;95% CI:0.44-0.83,1 项研究)和产后护理覆盖率(RR:1.13;95% CI:1.03-1.25,1 项研究)。远程医疗显著提高了低收入国家的产后护理覆盖率(RR:2.54;95% CI:1.22-5.28,3 项研究),降低了低收入国家的孕产妇死亡率(OR:0.46;95% CI:0.21-0.98,1 项研究)和婴儿死亡率(OR:0.65;95% CI:0.45-0.95)。产妇教育大大降低了新生儿死亡率(RR:0.75;95% CI:0.66-0.84,2 项研究)、围产期死亡率(RR:0.86;95% CI:0.77-0.95,1 项研究)、婴儿死亡率(RR:0.79;95% CI:0.65-0.96,1 项研究)和死胎率(RR:0.61;95% CI:0.45-0.82,1 项研究)。能力建设干预措施大大降低了低收入国家的孕产妇死亡率(OR:0.37;95% CI:0.29-0.46,5 项研究)、总体新生儿死亡率(OR:0.72;95% CI:0.53-0.98,4 项研究)和低收入国家的新生儿死亡率(OR:0.63;95% CI:0.54-0.74,3 项研究;RR:0.61;95% CI:0.48-0.79,3 项研究)、围产期死亡率(OR:0.53;95% CI:0.45-0.62,2 项研究;RR:0.61;95% CI:0.48-0.79,1 项研究)。62,2 项研究;RR:0.86;95% CI:0.77-0.95,1 项研究)、婴儿死亡率(OR:0.50;95% CI:0.43-0.59,1 项研究;RR:0.79;95% CI:0.65-0.96,1 项研究)、5 岁以下儿童死亡率(RR:0.79;95% CI:0.66-0.94,1 项研究)、死产(OR:0.71;95% CI:0.62-0.82,4 项研究)以及总体早产(OR:0.39;95% CI:0.19-0.81,1 项研究):围产期区域化和基于设施的干预措施对孕产妇和新生儿的预后有积极影响,需要在高负担环境中实施,但需要通过在不同环境中进行综合试验来更好地了解最佳干预措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Effectiveness of Regionalization of Perinatal Care and Specific Facility-Based Interventions: A Systematic Review.

Introduction: Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and potentially meet Sustainable Development Goal 3. Ensuring availability of healthcare infrastructure as well as skilled personnel can potentially help improve maternal and neonatal outcomes globally as well as in resource-limited settings.

Methods: A systematic review on effectiveness of perinatal care regionalization was updated, and a new review on facility-based interventions to improve postnatal care coverage and outcomes was conducted. The interventions were identified through literature reviews and included transport, mHealth, telemedicine, maternal education, capacity building, and incentive packages. Search was conducted in relevant databases and meta-analysis conducted on Review Manager 5.4. We conducted subgroup analysis for evidence from low- and middle-income countries (LMICs).

Results: Implementation of regionalization programs significantly decreased maternal mortality in LMICs (OR: 0.43; 95% CI: 0.34-0.55, 2 studies), stillbirth overall (OR: 0.70; 95% CI: 0.54-0.89, 5 studies), perinatal mortality overall (OR: 0.54; 95% CI: 0.5-0.58, 2 studies), and LMICs (OR: 0.54; 95% CI: 0.50-0.58, 1 study). Transport-related interventions significantly decreased maternal mortality overall (OR: 0.55; 95% CI: 0.40-0.74, 1 study), neonatal mortality (RR: 0.76; 95% CI: 0.66-0.88, 1 study), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), and improved postnatal care coverage (OR: 6.89; 95% CI: 5.15-9.21, 1 study) in LMICs. Adding maternity homes/units significantly decreased stillbirth (OR: 0.75; 95% CI: 0.61-0.93, 1 study) in LMICs. Incentives for postnatal care significantly improved infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), stillbirth (OR: 0.60; 95% CI: 0.44-0.83, 1 study), and postnatal care coverage (RR: 1.13; 95% CI: 1.03-1.25, 1 study) in LMICs. Telemedicine improved postnatal care coverage significantly in LMICs (RR: 2.54; 95% CI: 1.22-5.28, 3 studies) and decreased maternal mortality (OR: 0.46; 95% CI: 0.21-0.98, 1 study) and infant mortality (OR: 0.65; 95% CI: 0.45-0.95) in LMICs. Maternal education significantly decreased neonatal mortality (RR: 0.75; 95% CI: 0.66-0.84, 2 studies), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), and stillbirth (RR: 0.61; 95% CI: 0.45-0.82, 1 study). Capacity-building interventions significantly decreased maternal mortality in LMICs (OR: 0.37; 95% CI: 0.29-0.46, 5 studies), neonatal mortality overall (OR: 0.72; 95% CI: 0.53-0.98, 4 studies) and in LMICs (OR: 0.63; 95% CI: 0.54-0.74, 3 studies, and RR: 0.61; 95% CI: 0.48-0.79, 3 studies), perinatal mortality (OR: 0.53; 95% CI: 0.45-0.62, 2 studies, and RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (OR: 0.50; 95% CI: 0.43-0.59, 1 study, and RR: 0.79; 95% CI: 0.65-0.96, 1 study), under-5 mortality (RR: 0.79; 95% CI: 0.66-0.94, 1 study), and stillbirth in LMICs (OR: 0.71; 95% CI: 0.62-0.82, 4 studies), and preterm birth overall (OR: 0.39; 95% CI: 0.19-0.81, 1 study).

Conclusion: Perinatal regionalization and facility-based interventions have a positive impact on maternal and neonatal outcomes and calls for implementation in high burden settings but a better understanding of optimal interventions is needed through comprehensive trials in diverse settings.

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