Quality of antenatal care service provision in health facilities across sub-Saharan Africa: Evidence from nationally representative health facility assessments
Quality of antenatal care service provision in health facilities across sub-Saharan Africa: Evidence from nationally representative health facility assessments
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DOI：
10.7189/jogh.07.021101
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发表时间：
2017-12-01
影响因子：
7.2
通讯作者：
Walker, Neff
中科院分区：
文献类型：
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作者：
Kanyangarara, Mufaro;Munos, Melinda K.;Walker, Neff
背景在过去的二十年中，产前护理(ANC)服务的利用率有所提高。产妇和新生儿健康方面的持续进展将需要了解非国大服务的获得和质量。我们将卫生机构和家庭调查数据联系起来，检查撒哈拉以南非洲卫生机构五项ANC干预措施的服务质量。方法使用来自20个国家具有代表性的卫生设施评估-服务提供评估(SPA)和服务可用性和准备情况评估(SARA)的数据，我们估计设施级别准备好提供五项ANC干预措施：孕妇破伤风类毒素疫苗、孕期疟疾间歇预防性治疗(IPTp)、孕期梅毒检测和治疗、补铁和高血压疾病病例管理。设施水平指标按卫生设施类型、管理机构和地点进行分层，然后与相应的人口和健康调查(DHS)中对该阶层ANC利用率的估计相联系，以生成人口水平对“适当护理的可能性”的估计。结果在20个医疗机构评估中共调查了10534家医疗机构，其中8742家报告提供ANC服务，并被纳入分析。卫生机构准备提供IPTp、铁剂补充剂和破伤风类毒素疫苗(中位数分别为84.1%、84.9%和82.8%)高于提供高血压疾病病例管理和梅毒检测和治疗的准备(中位数分别为23.0%和19.9%)。至少4次非国大就诊覆盖率从24.8%到75.8%不等。通过将卫生设施和家庭调查数据联系起来，对适当护理可能性的估计显示，所有干预措施，特别是高血压疾病病例管理和梅毒检测和治疗，都存在明显差距。我们对适当护理的高可能性的估计与国土安全部对铁剂补充剂、IPTp和破伤风类毒素疫苗覆盖率的估计之间有相当好的一致性。结论将家庭调查与卫生设施评估联系起来，揭示了人口水平对高质量ANC干预措施覆盖率的显著差距，并强调了需要双管齐下的方法来提高ANC利用率和改善ANC服务质量。
Background Utilization of antenatal care (ANC) services has increased over the past two decades. Continued gains in maternal and newborn health will require an understanding of both access and quality of ANC services. We linked health facility and household survey data to examine the quality of service provision for five ANC interventions across health facilities in sub-Saharan Africa.Methods Using data from 20 nationally representative health facility assessments - the Service Provision Assessment (SPA) and the Service Availability and Readiness Assessment (SARA), we estimated facility level readiness to deliver five ANC interventions: tetanus toxoid vaccine for pregnant women, intermittent preventive treatment for malaria in pregnancy (IPTp), syphilis detection and treatment in pregnancy, iron supplementation and hypertensive disease case management. Facility level indicators were stratified by health facility type, managing authority and location, then linked to estimates of ANC utilization in that stratum from the corresponding Demographic and Health Surveys (DHS) to generate population level estimates of the 'likelihood of appropriate care'. Finally, the association between estimates of the 'likelihood of appropriate care' from the linking approach and estimates of coverage levels from the DHS were assessed.Findings A total of 10 534 health facilities were surveyed in the 20 health facility assessments, of which 8742 reported offering ANC services and were included in the analysis. Health facility readiness to deliver IPTp, iron supplementation, and tetanus toxoid vaccination was higher (median: 84.1%, 84.9% and 82.8% respectively) than readiness to deliver hypertensive disease case management and syphilis detection and treatment (median: 23.0% and 19.9% respectively). Coverage of at least 4 ANC visits ranged from 24.8% to 75.8%. Estimates of the likelihood of appropriate care derived from linking health facility and household survey data showed marked gaps for all interventions, particularly hypertensive disease case management and syphilis detection and treatment. There was fairly good concordance between our estimates of high likelihood of appropriate care and DHS estimates of coverage for iron supplementation, IPTp, and tetanus toxoid vaccination.Conclusion Linking household surveys to health facility assessments revealed marked gaps in population-level coverage of quality ANC interventions and underscored the need for a double-pronged approach to increase ANC utilization and improve the quality of ANC services.