Adherence to standards of first-visit antenatal care among providers: A stratified analysis of Tanzanian facility-based survey for improving quality of antenatal care
Adherence to standards of first-visit antenatal care among providers: A stratified analysis of Tanzanian facility-based survey for improving quality of antenatal care
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DOI：
10.1371/journal.pone.0216520
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发表时间：
2019-05-13
期刊：
影响因子：
3.7
通讯作者：
Mpondo, Bonaventura C. T.
中科院分区：
文献类型：
--
作者：
Bintabara, Deogratius;Nakamura, Keiko;Mpondo, Bonaventura C. T.
尽管早期产前保健访视有利于早期预防、发现和治疗妊娠期潜在并发症，但需要高水平的提供者遵守首次产前保健标准。然而，关于坦桑尼亚提供者坚持产前护理的信息很少。进行这项研究，以评估供应商坚持首次访问产前保健标准，并应用分层分析，以确定相关因素在Tanzania.MethodsData从2014-2015年坦桑尼亚服务提供评估调查在这项研究中使用。使用10个领域来衡量提供者对首次产前护理标准的遵守情况：客户病史;之前怀孕的方面;当前怀孕的危险迹象;体检;常规检测;艾滋病毒检测和咨询;维持健康怀孕;铁/叶酸补充剂;破伤风类毒素疫苗接种和分娩准备。然后创建一个综合分数，其中最高分位数（对应于。60.5%）被认为是遵守产前保健首诊标准的提供者。最初，根据设施类型和管理权限，在每个级别分别进行一系列未经调整的logistic回归分析（即，提供者、服务提供者和客户）。此后，P < 0.2的所有变量被安装到各自的分层多变量logistic回归分析使用5%的显着性level.ResultsA共1756首次访问产前保健咨询822供应商在648个卫生设施进行了分析。首次产前检查依从性的总体中位数[四分位距，IQR]相对较低，为47.1% [35.7%-60.5%]。在对特定分层中每个级别的选定变量进行调整后，在药房;在卫生中心的女性提供者[AOR = 5.5; 95%CI，1.8-16.4];在医院的质量保证绩效[AOR = 2.2; 95%CI，1.3-3.9];常规检查的可用性[AOR = 2.5; 95%CI，1.3-3.9]。公共机构的药物供应[AOR = 1.8; 95%CI，1.1-3.2]和接受进修培训[AOR = 1.8; 95%CI，1.1 - 3.1]以及私人机构;接受外部资金从政府[AOR = 3.0; 95%CI，1.1-8.4]显着相关，更好地坚持首诊产前保健standards.ConclusionsThe研究强调的重要因素，包括提供进修培训，定期分发基本药物，和诊断设备，可能会影响供应商坚持首诊ANC标准。
IntroductionDespite the benefits of early antenatal care visits for early prevention, detection, and treatment of potential complications in pregnancy, a high level of provider adherence to first-visit antenatal care standards is needed. However, little information is available regarding provider adherence to antenatal care in Tanzania. This study was performed to assess provider adherence to first-visit antenatal care standards and to apply stratified analysis to identify associated factors in Tanzania.MethodsData from the 2014-2015 Tanzania Service Provision Assessment Survey were used in this study. Provider adherence to first-visit antenatal care standards was measured using 10 domains: client history; aspects of prior pregnancies; danger signs of the current pregnancy; physical examination; routine tests; HIV testing and counseling; maintaining a healthy pregnancy; iron/folate supplements; tetanus toxoid vaccination, and preparation for delivery. A composite score was then created in which the highest quantile (corresponding to. 60.5%) considered to provider adhering to first-visit antenatal care standards. Initially, a series of unadjusted logistic regression analyses according to the type of facility and managing authority were performed separately at each level (i.e., facility, provider, and client). Thereafter, all variables with P < 0.2 were fitted into the respective stratified multivariable logistic regression analysis using a 5% significance level.ResultsA total of 1756 first-visit antenatal care consultations performed by 822 providers in 648 health facilities were analyzed. The overall median [Interquartile range, IQR] adherence to first-visit antenatal care was relatively low at 47.1% [35.7%-60.5%]. After adjusting for selected variables from each level in specific strata, at dispensary; female providers [AOR = 5.5; 95% CI, 1.8-16.4], at health centre; performance of quality assurance [AOR = 2.2; 95% CI, 1.3-3.9], at hospital; availability of routine tests [AOR = 2.5; 95% CI, 1.3-4.8] and basic medicine [AOR = 2.8; 95% CI, 1.4-5.7], at public facilities; availability of medicine [AOR = 1.8; 95% CI, 1.1-3.2] and receiving refresher training [AOR = 1.8; 95% CI, 1.1-3.1], and at private facility; receiving external fund from government [AOR = 3.0; 95% CI, 1.1-8.4] were significantly associated with better adherence to first-visit antenatal care standards.ConclusionsThe study highlighted the important factors, including the provision of refresher training, regular distribution of basic medicines, and diagnostics equipment which may influence provider adherence to first-visit ANC standards.