An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan
An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan
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DOI：
10.1056/nejmsa042830
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发表时间：
2005-05-19
影响因子：
158.5
通讯作者：
Cheng, KK
中科院分区：
文献类型：
--
作者：
Jokhio, AH;Winter, HR;Cheng, KK
背景：全世界每年约有400万新生儿死亡和50万孕产妇死亡。有有限的证据，从临床试验，以指导发展中国家有效的孕产妇servicesinDevelopments.METHODS：我们进行了一个集群随机对照试验，涉及7个分区（talukas）在巴基斯坦的农村地区。在随机分配到干预组的三个taluka中，传统助产士接受了培训，并获得了一次性分娩包;女保健工作者将传统助产士与既定服务以及记录的过程和结果联系起来;产科小组提供产前护理外联诊所。四个对照talukas中的妇女得到了常规护理。主要结果的措施是围产期和孕产妇mortality.RESULTS：在七个talukas，10,114（84.3%）的合格妇女的估计数量被招募在三个干预talukas，和9443（78.7%）在四个控制talukas。在干预组中，9 184名妇女（90.8%）接受了训练有素的传统助产士的产前护理，1 634名妇女（16.2%）接受了产科团队至少一次的产前检查，并使用了8 172个安全分娩包。与对照talukas相比，干预talukas有一个集群调整的比值比为0.70（95%的置信区间，0.59至0.82）和孕产妇死亡率为0.74（95%的置信区间，0.45至1.23）。结论：培训传统的助产士，并将其纳入一个改进的卫生保健系统是可以实现的，有效地降低围产期死亡率。这一模式可大大改善发展中国家的围产期和孕产妇健康。
BACKGROUND:There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries.METHODS:We performed a cluster-randomized, controlled trial involving seven subdistricts (talukas) of a rural district in Pakistan. In three talukas randomly assigned to the intervention group, traditional birth attendants were trained and issued disposable delivery kits; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes; and obstetrical teams provided outreach clinics for antenatal care. Women in the four control talukas received usual care. The primary outcome measures were perinatal and maternal mortality.RESULTS:Of the estimated number of eligible women in the seven talukas, 10,114 (84.3 percent) were recruited in the three intervention talukas, and 9443 (78.7 percent) in the four control talukas. In the intervention group, 9184 women (90.8 percent) received antenatal care by trained traditional birth attendants, 1634 women (16.2 percent) were seen antenatally at least once by the obstetrical teams, and 8172 safe-delivery kits were used. As compared with the control talukas, the intervention talukas had a cluster-adjusted odds ratio for perinatal death of 0.70 (95 percent confidence interval, 0.59 to 0.82) and for maternal mortality of 0.74 (95 percent confidence interval, 0.45 to 1.23).CONCLUSIONS:Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality. This model could result in large improvements in perinatal and maternal health in developing countries.