孟加拉国农村地区产前干预对新生儿高胆红素血症管理的效果：分组随机试验的结果。

IF 3.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health Pub Date : 2025-01-01 DOI:10.1016/j.puhe.2024.12.018

Supta Sarker , Farjana Jahan , Sarker Masud Parvez , A.K.M. Shoab , Rezaul Hasan , Shams El Arifeen , Sk Masum Billah , Md Mahbubul Hoque , Mahbubur Rahman

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引用次数: 0

摘要

目标：在中低收入国家，近80%的严重新生儿高胆红素血症病例被发现得太晚，无法进行医疗治疗。家长对新生儿黄疸的了解对早期发现和有效治疗至关重要。本研究评估了产前敏化在提高孟加拉国产妇对新生儿高胆红素血症管理的知识和态度方面的有效性。研究设计：集群随机试验。方法：2019年9月至2021年3月，通过社区卫生工作者（CHW）在20个干预和比较集群中对新生儿高胆红素血症进行前瞻性家庭干预试验。参与者都是处于妊娠中期或晚期的孕妇。计算基于比例的差异（DID）来确定母亲对新生儿黄疸的知识和态度的变化。结果：共纳入539名孕妇，干预组273名，对照组266名。干预后，参与者对新生儿高胆红素血症的总体知识水平从基线（33.2%）到终点（70.5%）显著增加（DID: 24.9, 95%CI: 19.2, 30.7）。新生儿黄疸管理知识改善最大（DID: 60），其次是危险信号检测（DID: 40.0）。干预还增强了参与者对新生儿高胆红素血症的积极态度（DID: 13.1, 95%CI: 8.1, 18.0）。提高了对新生儿高胆红素血症的认识的母亲对新生儿高胆红素血症的好感度几乎是其他母亲的五倍。结论：chw主导的以家庭为基础的产前敏感化干预措施显著提高了母亲对新生儿高胆红素血症检测和管理的认识和态度。将这种增敏纳入现有卫生系统的产前护理可能是改善孟加拉国新生儿健康结果的一种切实可行的方法。

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Effectiveness of prenatal intervention on neonatal hyperbilirubinemia management in rural Bangladesh: Results from a cluster-randomized trial

Objectives

Nearly 80 % of severe neonatal hyperbilirubinemia cases are identified too late for medical treatment in lower-middle-income countries. Parents’ understanding of neonatal jaundice is crucial for early detection and effective treatment. This study evaluated the effectiveness of prenatal sensitization in improving maternal knowledge and attitude toward neonatal hyperbilirubinemia management in Bangladesh.

Study design

Cluster-randomized trial.

Methods

Between September 2019 and March 2021, a prospective home-based intervention trial on neonatal hyperbilirubinemia was conducted in 20 interventions and comparison clusters through community health workers (CHW). Participants were pregnant women in their second or third trimester of pregnancy. Proportion-based difference-in-difference (DID) was calculated to determine changes in the mother's knowledge and attitude towards newborn jaundice.

Results

A total of 539 pregnant women were enrolled, 273 in the intervention, and 266 in the comparison arm. Following the intervention, participant's overall knowledge level about neonatal hyperbilirubinemia increased significantly (DID: 24.9, 95%CI: 19.2, 30.7) from baseline (33.2 %) to endline (70.5 %). Knowledge of newborn jaundice management showed the most improvement (DID: 60), followed by danger signs detection (DID: 40.0). The intervention also enhanced participants' positive attitudes regarding neonatal hyperbilirubinemia (DID: 13.1, 95%CI: 8.1, 18.0). Mothers with improved knowledge of neonatal hyperbilirubinemia were nearly five times more likely to have a favorable attitude toward it than those with counterparts.

Conclusions

CHW-led home-based prenatal sensitization interventions substantially improved mothers' awareness and attitudes toward neonatal hyperbilirubinemia detection and management. Integrating such sensitization into prenatal care of the existing health system could be a practical approach to improve neonatal health outcomes in Bangladesh.

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来源期刊

Public Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

0.00%

发文量

280

审稿时长

37 days

期刊介绍： Public Health is an international, multidisciplinary peer-reviewed journal. It publishes original papers, reviews and short reports on all aspects of the science, philosophy, and practice of public health.