Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries.
Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries.
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DOI：
10.1136/bmjopen-2017-017122
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发表时间：
2017-11-15
期刊：
影响因子：
2.9
通讯作者：
Vollmer S
中科院分区：
文献类型：
--
作者：
Kuhnt J;Vollmer S
产前保健是初级卫生保健的重要组成部分，其提供范围已在世界范围内扩大。关于向孕妇提供ANC对儿童健康结果影响的大规模跨国研究证据有限。我们调查了低收入和中等收入国家的ANC与短期和长期死亡率以及儿童营养结局的关系。我们使用了具有全国代表性的健康和福利数据，这些数据来自1990年至2013年在69个低收入和中等收入国家对育龄妇女（15-49岁）、她们的子女及其各自家庭进行的193次人口和健康调查。分析样本包括752 635项新生儿死亡率观察，574 675项婴儿死亡率观察，400 426项低出生体重观察，501 484项发育迟缓观察和512 424项体重不足观察。结果变量为新生儿和婴儿死亡率、低出生体重、发育迟缓和体重不足。至少一次ANC访问与新生儿死亡率降低1.04%和婴儿死亡率降低1.07%相关。至少有四次ANC就诊和至少有一次熟练的医疗服务提供者就诊，分别将概率降低了0.56%和0.42%。至少一次ANC访问与分娩低出生体重婴儿的概率降低3.82%有关，并与发育迟缓和体重不足的概率降低4.11和3.26%有关。至少有四次ANC就诊和至少一次见过熟练的医疗服务提供者，分别将成功率降低了2.83%、1.41%和1.90%。低收入和中等收入国家目前现有的和可获得的产前保健服务与改善出生结果和长期减少儿童死亡率和营养不良直接相关。
Antenatal care (ANC) is an essential part of primary healthcare and its provision has expanded worldwide. There is limited evidence of large-scale cross-country studies on the impact of ANC offered to pregnant women on child health outcomes. We investigate the association of ANC in low-income and middle-income countries with short- and long-term mortality and nutritional child outcomes. We used nationally representative health and welfare data from 193 Demographic and Health Surveys conducted between 1990 and 2013 from 69 low-income and middle-income countries for women of reproductive age (15–49 years), their children and their respective household. The analytical sample consisted of 752 635 observations for neonatal mortality, 574 675 observations for infant mortality, 400 426 observations for low birth weight, 501 484 observations for stunting and 512 424 observations for underweight. Outcome variables are neonatal and infant mortality, low birth weight, stunting and underweight. At least one ANC visit was associated with a 1.04% points reduced probability of neonatal mortality and a 1.07% points lower probability of infant mortality. Having at least four ANC visits and having at least once seen a skilled provider reduced the probability by an additional 0.56% and 0.42% points, respectively. At least one ANC visit is associated with a 3.82% points reduced probability of giving birth to a low birth weight baby and a 4.11 and 3.26% points reduced stunting and underweight probability. Having at least four ANC visits and at least once seen a skilled provider reduced the probability by an additional 2.83%, 1.41% and 1.90% points, respectively. The currently existing and accessed ANC services in low-income and middle-income countries are directly associated with improved birth outcomes and longer-term reductions of child mortality and malnourishment.
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