Quality of facility-based family planning services for adolescents in Malawi: Findings from a national census of health facilities
Quality of facility-based family planning services for adolescents in Malawi: Findings from a national census of health facilities
复制标题
DOI：
10.4314/mmj.v28i2.4
复制
发表时间：
2016-06-01
影响因子：
0.8
通讯作者：
Stones, William
中科院分区：
文献类型：
--
作者：
Jayachandran, Vinitha;Chapotera, Gertrude;Stones, William
本研究的主要目的是描述在提供和护理经验方面，以设施为基础的计划生育服务的质量，与马拉维的老年客户相比。方法对2013- 2014年服务提供评估调查数据进行二次数据分析，该调查是对全国所有正规卫生机构的普查。对于本研究，纳入标准是客户的年龄被记录在数据集中，它给出了1388次咨询观察的加权总数，反映了护理的提供，以及客户退出访谈，反映了护理的经验。结果与26岁及以上的患者相比，最年轻的患者（13至19岁）报告更好的护理体验的几率是其两倍（优势比[OR] 2.03, 95%可信区间[CI] 1.15至3.54,P = 0.013）。观察到的提供标准很低，通常有一半或更多的规定的护理要素被省略。与25岁以上的客户相比，青少年提供的护理略好，百分比系数为4.56 (95% CI 0.90至8.23,P = 0.015)， 20-25岁的系数为2.33 （95% CI 0.21至4.44,P = 0.032）。与政府机构相比，在非政府机构管理的机构中看到的病人提供了更好的护理，系数为12.35 (95% CI 6.70至18.01,P < 0.001)；在诊所就诊的患者比在医院就诊的患者得到的护理更差（系数-6.88,95% CI -11.41至-2.35,P = 0.003），由健康监测助理就诊的患者比由临床医生就诊的患者得到的护理更差（系数-9.41,95% CI -15.53至-3.29,P = 0.003）。结论：参加机构计划生育服务的青少年的护理质量略好于老年人，但这被整体护理标准较低的发现所掩盖。加强卫生系统，特别是在诊所一级，是一项政策和规划优先事项，将有助于马拉维的青少年生殖健康。
BackgroundThe main objective of this study was to describe the quality, in terms of provision and experience of care, of facility-based family planning services for adolescents compared to older clients in Malawi.MethodsSecondary data analysis was performed on data obtained from the Service Provision Assessment survey 2013-14, a census of all formal health facilities in the country. For the present study the inclusion criterion was that the client's age was recorded in the data set, which gave a weighted total of 1388 observations of consultations, reflecting provision of care, and client exit interviews, reflecting experience of care.ResultsThe youngest clients (age group 13 to 19 years) had twice the odds of reporting a better experience of care compared to clients aged 26 and older (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.15 to 3.54, P = 0.013). The standard of observed provision was low, typically with half or more of the mandated elements of care omitted. Compared with clients aged over 25, provision of care was slightly better for adolescents, with a coefficient of 4.56 on a percentage scale (95% CI 0.90 to 8.23, P = 0.015) and a coefficient of 2.33 for those aged 20-25 (95% CI 0.21 to 4.44, P = 0.032). Clients seen in facilities under nongovernmental management had better provision of care compared to government facilities, with a coefficient of 12.35 (95% CI 6.70 to 18.01, P < 0.001); care was worse for clients seen in clinics compared to hospitals (coefficient -6.88, 95% CI -11.41 to -2.35, P = 0.003) and also for clients seen by health surveillance assistants compared to those seen by a clinician (coefficient -9.41, 95% CI -15.53 to -3.29, P = 0.003).ConclusionsQuality of care for adolescents attending facility-based family planning services was slightly better than for older clients, but this is overshadowed by the finding of a low standard of care overall. Health system strengthening, especially at the clinic level, is a policy and programming priority that will contribute to adolescent reproductive health in Malawi.