60 Million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths?
60 Million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths?
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DOI：
10.1016/j.ijgo.2009.07.010
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发表时间：
2009-10
影响因子：
3.8
通讯作者：
Lawn, Joy E.
中科院分区：
文献类型：
--
作者：
Darmstadt, Gary L.;Lee, Anne C. C.;Cousens, Simon;Sibley, Lynn;Bhutta, Zulfiqar A.;Donnay, France;Osrin, Dave;Bang, Abhay;Kumar, Vishwajeet;Wall, Steven N.;Baqui, Abdullah;Lawn, Joy E.
关键词：
对于世界上6000万的非设施分娩来说，解决目前由谁来助产以及他们对分娩结果的影响是改善分娩期间护理的关键起点。我们对社区干部——社区技术助产士（SBAs）、训练有素的传统助产士（TBAs）和社区卫生工作者（CHWs）——在改善围产期和分娩相关结局方面的影响进行了系统的证据回顾。在社区提供熟练助产服务的证据质量较低，主要由前后和准实验研究组成，合并后的全因围产期死亡率（PMR）降低了12%，分娩相关新生儿死亡率（IPR-NMR）降低了22%-47%。低/中等质量的证据表明，TBA培训可以改善与设施的联系，改善围产期结局。TBA训练的随机对照试验（RCT）显示PMR降低30%，荟萃分析显示IPR-NMR降低11%。有适度的证据表明，卫生保健对围产儿结局有积极的影响。CHW包装的荟萃分析（2个集群随机对照试验，2个准实验研究）显示，PMR降低28%，早期新生儿死亡率降低36%；一项准实验研究显示，IPR-NMR降低了42%。建议为所有孕妇提供熟练的分娩护理，并将社区战略与及时、高质量的产科急诊联系起来。卫生保健中心在提供妊娠和分娩护理、动员社区和改善低收入环境的围产期结局方面可能发挥着有希望的作用。虽然TBA的作用仍有争议，但应进一步考虑强调与卫生系统伙伴关系的战略。以社区为基础的创新战略与加强卫生系统相结合，可改善农村贫困人口的分娩护理，有助于减少孕产妇和新生儿存活率及死产率方面的严重不平等现象，并为提高设施分娩覆盖率提供有效过渡。
For the world’s 60 million non-facility births, addressing who is currently attending these births and what effect they have on birth outcomes is a key starting point toward improving care during childbirth. We present a systematic review of evidence for the effect of community-based cadres–community-based skilled birth attendants (SBAs), trained traditional birth attendants (TBAs), and community health workers (CHWs)–in improving perinatal and intrapartum-related outcomes. The evidence for providing skilled birth attendance in the community is low quality, consisting of primarily before-and-after and quasi-experimental studies, with a pooled 12% reduction in all cause perinatal mortality (PMR) and a 22%–47% reduction in intrapartum-related neonatal mortality (IPR-NMR). Low/moderate quality evidence suggests that TBA training may improve linkages with facilities and improve perinatal outcomes. A randomized controlled trial (RCT) of TBA training showed a 30% reduction in PMR, and a meta-analysis demonstrated an 11% reduction in IPR-NMR. There is moderate evidence that CHWs have a positive impact on perinatal-neonatal outcomes. Meta-analysis of CHW packages (2 cluster randomized controlled trials, 2 quasi-experimental studies) showed a 28% reduction in PMR and a 36% reduction in early neonatal mortality rate; one quasi-experimental study showed a 42% reduction in IPR-NMR. Skilled childbirth care is recommended for all pregnant women, and community strategies need to be linked to prompt, high-quality emergency obstetric care. CHWs may play a promising role in providing pregnancy and childbirth care, mobilizing communities, and improving perinatal outcomes in low-income settings. While the role of the TBA is still controversial, strategies emphasizing partnerships with the health system should be further considered. Innovative community-based strategies combined with health systems strengthening may improve childbirth care for the rural poor, help reduce gross inequities in maternal and newborn survival and stillbirth rates, and provide an effective transition to higher coverage for facility births.
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DOI：
10.1016/0020-7292(95)02323-5
发表时间：
1995-06-01
影响因子：
3.8
作者：
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发表时间：
2009-01-01
期刊：
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影响因子：
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作者：
Darmstadt, Gary L;Baqui, Abdullah H;El Arifeen, Shams
通讯作者：
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影响因子：
168.9
作者：
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