The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal.
The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal.
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DOI：
10.7189/jogh.11.05010
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发表时间：
2021-05-11
影响因子：
7.2
通讯作者：
Kinney M
中科院分区：
文献类型：
--
作者：
Ashish KC;Peterson SS;Gurung R;Skalkidou A;Gautam J;Malla H;Paudel P;Bhattarai K;Joshi N;Tinkari BS;Adhikari S;Shrestha D;Ghimire B;Sharma S;Khanal L;Shrestha S;Graham WJ;Kinney M
新冠肺炎大流行已导致全球医疗服务全系统中断。我们评估了大流行对尼泊尔机构提供护理中断的影响。我们在9家医院的52名 356名女性中进行了一项前瞻性队列研究，以评估大流行期间机构分娩护理的中断(将2019年3月至8月与2020年同期进行比较)。我们还对大流行期间的2022名妇女进行了嵌套跟踪队列研究，以评估她们提供尊重护理的情况和经历。我们使用线性回归模型来评估提供和护理经验与新冠肺炎热点地区的住院分娩量和女性居住地之间的关联。在大流行期间，9家医院的平均住院分娩人数为24 563人，与2019年同期相比，平均下降11.6%(P <； 0.0001)。疫情期间，中、高流量医院的住院分娩平均下降了20.8%(P <； 0.0001)，而低流量医院的住院分娩平均增加了7.9%(P = 0.001)。在大流行期间，产科服务平均停止了4.3天，工作人员被重新部署到新冠肺炎专职护理。与中高产量型医院相比，低产量型医院(β = 0.446，P <； 0.0001)提供的尊重护理更好。女性居住在新冠肺炎热点地区与受到尊重的护理经历之间存在正相关关系(β = 0.076，P = 0.001)。新冠肺炎疫情对产科服务产生了不同的影响，每家医院的产生量变化不同，产量越小的设施效果越好。需要进行更多的研究，以调查大流行对妇女在哪里分娩的影响，以及她们提供尊重产妇保健的情况和经验，以便在大流行后时期采取“重建-重建-更好”的方法。
The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal. We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women’s residence in a COVID-19 hotspot area. The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% (P < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals declined on average by 20.8% (P < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% (P = 0.001). Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care. Respectful provision of care was better in hospitals with low-volume birth (β = 0.446, P < 0.0001) in comparison to high-medium-volume hospitals. There was a positive association between women’s residence in a COVID-19 hotspot area and respectful experience of care (β = 0.076, P = 0.001). The COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a “building-back-better” approach in post-pandemic period.
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影响因子：
2.7
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