Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?
Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?
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DOI：
10.1016/s0140-6736(14)60792-3
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发表时间：
2014-07-26
期刊：
影响因子：
168.9
通讯作者：
Walker, Neff
中科院分区：
文献类型：
--
作者：
Bhutta, Zulfiqar A.;Das, Jai K.;Walker, Neff
新生儿存活率方面的进展缓慢，减少死产的进展更是如此。为了实现到2035年每个国家每千名新生儿死亡10人或更少、死产10人或更少的目标，必须加速扩大针对新生儿死亡主要原因的最有效护理。我们系统地审查了整个护理过程和各种交付平台的干预措施，然后模拟了75个高负担倒计时国家扩大规模的效果和成本。通过为所有在设施中分娩的妇女和新生儿提供有效护理来弥合质量差距，到2020年，每年可防止约11.3万例孕产妇死亡、53.1万例死产和132.5万例新生儿死亡，估计每年的运营成本为45亿美元（每人0.9美元）。到2025年，提高孕前、产前、产时和产后干预的覆盖率和质量，每年可避免71%的新生儿死亡（190万[范围160 - 210万]）、33%的死产（82万[60 - 93万]）和54%的孕产妇死亡（16万[14 - 17万]）。这些减少可以在每年56.5亿美元（每人1.15美元）的增量运行成本下实现，这相当于每挽救一个生命（包括死产、新生儿和孕产妇死亡）1，928美元。这种效果的大部分（82%）是由于基于设施的护理，虽然比基于社区的战略更昂贵，但提高了生存的可能性。大部分运营成本也用于基于设施的护理（36.6亿美元或64%），即使没有考虑新医院和国家特定资本投入的成本。对新生儿死亡影响最大的是通过分娩和分娩期间提供的干预措施，包括产科并发症（41%），其次是对小婴儿和生病新生儿的护理（30%）。使用现代避孕药具来满足未满足的计划生育需求将产生协同作用，并将有助于将出生率和死亡率减少一半左右。我们的分析还表明，现有的干预措施可以减少新生儿死亡的三个最常见的原因-早产，产时和感染相关的死亡-分别为58%，79%和84%。
Progress in newborn survival has been slow, and even more so for reductions in stillbirths. To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths per 1000 births in every country by 2035 will necessitate accelerated scale-up of the most effective care targeting major causes of newborn deaths. We have systematically reviewed interventions across the continuum of care and various delivery platforms, and then modelled the effect and cost of scale-up in the 75 high-burden Countdown countries. Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113 000 maternal deaths, 531 000 stillbirths, and 1.325 million neonatal deaths annually by 2020 at an estimated running cost of US$4.5 billion per year (US$0.9 per person). Increased coverage and quality of preconception, antenatal, intrapartum, and postnatal interventions by 2025 could avert 71% of neonatal deaths (1.9 million [range 1.6-2.1 million]), 33% of stillbirths (0.82 million [0.60-0.93 million]), and 54% of maternal deaths (0.16 million [0.14-0.17 million]) per year. These reductions can be achieved at an annual incremental running cost of US$5.65 billion (US$1.15 per person), which amounts to US$ 1928 for each life saved, including stillbirths, neonatal, and maternal deaths. Most (82%) of this effect is attributable to facility-based care which, although more expensive than community-based strategies, improves the likelihood of survival. Most of the running costs are also for facility-based care (US$3.66 billion or 64%), even without the cost of new hospitals and country-specific capital inputs being factored in. The maximum effect on neonatal deaths is through interventions delivered during labour and birth, including for obstetric complications (41%), followed by care of small and ill newborn babies (30%). To meet the unmet need for family planning with modern contraceptives would be synergistic, and would contribute to around a halving of births and therefore deaths. Our analysis also indicates that available interventions can reduce the three most common cause of neonatal mortality-preterm, intrapartum, and infection-related deaths-by 58%, 79%, and 84%, respectively.