The effects of centering pregnancy on maternal and fetal outcomes in northern Nigeria; a prospective cohort analysis
The effects of centering pregnancy on maternal and fetal outcomes in northern Nigeria; a prospective cohort analysis
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DOI：
10.1186/s12884-018-1805-2
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发表时间：
2018-05-11
影响因子：
3.1
通讯作者：
Chiegli, Robert
中科院分区：
文献类型：
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作者：
Eluwa, George, I;Adebajo, Sylvia B.;Chiegli, Robert
背景：尼日利亚的孕产妇和婴儿死亡率居高不下，主要原因是熟练助产士的使用率较低。尼日利亚南部和北部在使用熟练助产士方面存在巨大差异，南部明显高于北部。方法：对2012年12月至2014年5月间社会人口学特征和产科病史相近的孕妇分为干预组(CPG)和对照组，进行前瞻性随访。采用卡方检验比较干预组和对照组在背景特征和干预结果方面的差异。结果：共有517名孕妇(对照组260名，CPG组257名)登记并参与研究。对照组中36%的妇女在怀孕第二和第三个三个月至少参加一次ANC，而在CPG中这一比例为49%(p<；0.01)。CPG提供医疗设施的比例较高(13%vs.8%；p<；0.01)。在控制了年龄、以前怀孕的次数、足月分娩次数、活着的孩子数量和被调查者或其配偶的职业后，与没有参加CPG的受访者相比，参加CPG的受访者更有可能在妊娠晚期至少参加一次产前护理(ANC)会议[调整后的风险比(ARR)：1.52；95%可信区间：1.36-1.69]，更有可能在6周[ARR：2.23；95%CI：1.16-4.29]和14周[ARR：3.46；95%CI：1.19~10.01]，更倾向于使用医疗服务[ARR：1.50；95%CI：1.06~2.13]。结论：中心妊娠或集体妊娠对产前服务、设施分娩和产后服务的使用有积极影响，是提高尼日利亚北部孕产妇保健服务接受度的一种有前景的干预措施。设施交付率低仍然令人震惊，需要进一步调查，以改善尼日利亚北部的设施交付率。
Background: Maternal and infant mortality remains high in Nigeria primarily due to low use of skilled birth attendants. Huge disparities exist between southern and northen Nigeria on use of skilled birth attendants with south significantly higher than the north. We assessed the effect of centering pregnancy group (CPG) antenatal care on the uptake of antenatal care (ANC), facility delivery and immunization rates for infants in Kano state.Methods: Between December 2012 and May 2014, pregnant women with similar sociodemographics and obstetric history were enrolled into intervention (CPG) and control groups and followed up prospectively. Chi-square tests were conducted to compare the differences between the intervention and the control groups with respect to background characteristics and intervention outcomes. Logistic regression was used to measure the associations between CPG and uptake of services for mother-baby pairs in care.Results: A total of 517 (260 in the control group and 257 in the CPG) pregnant women enrolled and participated in the study. Thirty-six percent of women in the control group attended ANC at least once in 2nd and 3nd trimester compared to 49% of respondents in the CPG (p < 0.01). Health facility delivery was higher among CPG (13% vs. 8%; p < 0.01). When controlled for age, number of previous pregnancies, number of term deliveries, number of children alive and occupation of respondent or their spouses, respondents who participated in the CPGs compared to those who did not, were more likely to attend at least one antenatal care (ANC) session in the third trimester [adjusted risk ratio (ARR): 1.52; 95% CI: 1.36-1.69], more likely to immunize their babies at six weeks [ARR: 2.23; 95% CI: 1.16-4.29] and fourteen weeks [ARR: 3.46; 95% CI: 1.19-10.01] and more likely to use health services [ARR: 1.50; 95% CI: 1.06-2.13].Conclusion: Centering or group pregnancy showed a positive effect on the use of antenatal services, facility delivery and postnatal services and thus is a promising intervention to increase uptake of maternal health care services in northern Nigeria. The low facility delivery remains a cause for alarm and requires further investigation to improve facility delivery in northern Nigeria.