Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys
Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys
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DOI：
10.1016/s2214-109x(16)30180-2
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发表时间：
2016-11-01
影响因子：
34.3
通讯作者：
Langer, Ana
中科院分区：
文献类型：
--
作者：
Kruk, Margaret E.;Leslie, Hannah H.;Langer, Ana
如果医疗质量不足，全球为增加卫生保健机构的出生率所做的努力可能不会降低孕产妇或新生儿死亡率。然而，在低收入国家，几乎没有系统的证据表明为妇女和新生儿提供护理的保健设施的质量。我们分析了基本孕产妇保健功能的质量及其与五个撒哈拉以南非洲国家卫生保健设施的分娩量和手术能力的关系。（人口与健康调查方案提供的服务评估），提供肯尼亚、纳米比亚、卢旺达、坦桑尼亚、和乌干达的我们使用12个护理结构和流程指标的指数来衡量分娩设施中基本孕产妇护理功能的质量，包括基础设施和基于证据的常规和紧急护理干预措施的使用。我们回归了出生数量和混杂因素（公共或私人管理，抗逆转录病毒治疗服务的可用性，熟练工作人员的可用性和国家）的质量指数，按设施类型分层：初级（无剖腹产能力）或二级（有剖腹产能力）护理设施。哈佛大学人类研究保护计划批准了这项分析豁免人类subjects review.Findings-全国性的调查，2006年4月和2010年5月之间完成。我们的样本包括1715（93%）的1842个医疗机构提供正常的分娩服务，排除设施缺失（n=126）或无效（n=1）的数据。1511家（88%）研究机构（622864例机构分娩中的276965例[ 44%]）不具备剖腹产能力（初级保健机构）。初级保健设施的基本产妇保健职能质量（指数得分为0.38）大大低于二级保健设施（0.77）。低输送量始终与低质量相关，最低与最高容量设施之间的质量差异为-0.22（95% CI -0.26至-0.19），初级保健机构和-0.17（-0.21至-0.11）在二级医疗机构。在这五个非洲国家中，设施分娩发生在初级保健设施，这些设施在产妇护理质量的基本措施中得分很低。具有剖腹产能力的设施，特别是每年出生人数超过500人的设施，在孕产妇护理质量方面得分较高。低收入和中等收入国家应系统地评估和改善卫生设施的分娩护理质量，以加速减少孕产妇和新生儿死亡。版权所有（C）作者。爱思唯尔有限公司出版
Background Global efforts to increase births at health-care facilities might not reduce maternal or newborn mortality if quality of care is insufficient. However, little systematic evidence exists for the quality at health facilities caring for women and newborn babies in low-income countries. We analysed the quality of basic maternal care functions and its association with volume of deliveries and surgical capacity in health-care facilities in five sub-Saharan African countries.Methods In this analysis, we combined nationally representative health system surveys (Service Provision Assessments by the Demographic and Health Survery Programme) with data for volume of deliveries and quality of delivery care from Kenya, Namibia, Rwanda, Tanzania, and Uganda. We measured the quality of basic maternal care functions in delivery facilities using an index of 12 indicators of structure and processes of care, including infrastructure and use of evidence-based routine and emergency care interventions. We regressed the quality index on volume of births and confounders (public or privately managed, availability of antiretroviral therapy services, availability of skilled staffing, and country) stratified by facility type: primary (no caesarean capacity) or secondary (has caesarean capacity) care facilities. The Harvard University Human Research Protection Program approved this analysis as exempt from human subjects review.Findings The national surveys were completed between April, 2006, and May, 2010. Our sample consisted of 1715 (93%) of 1842 health-care facilities that provided normal delivery service, after exclusion of facilities with missing (n=126) or invalid (n=1) data. 1511 (88%) study facilities (site of 276 965 [ 44%] of 622 864 facility births) did not have caesarean section capacity (primary care facilities). Quality of basic maternal care functions was substantially lower in primary (index score 0.38) than secondary care facilities (0.77). Low delivery volume was consistently associated with poor quality, with differences in quality between the lowest versus highest volume facilities of -0.22 (95% CI -0.26 to -0.19) in primary care facilities and -0.17 (-0.21 to -0.11) in secondary care facilities.Interpretation More than 40% of facility deliveries in these five African countries occurred in primary care facilities, which scored poorly on basic measures of maternal care quality. Facilities with caesarean section capacity, particularly those with birth volumes higher than 500 per year, had higher scores for maternal care quality. Low-income and middle-income countries should systematically assess and improve the quality of delivery care in health facilities to accelerate reduction of maternal and newborn deaths. Copyright (C) The Author(s). Published by Elsevier Ltd.