Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica.
Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica.
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DOI：
10.1186/s12887-021-02999-0
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发表时间：
2021-12-01
期刊：
影响因子：
2.4
通讯作者：
Hernandez B
中科院分区：
文献类型：
--
作者：
Kamath AM;Thom MG;Johanns CK;Panhorst Harris K;Schwarzbauer K;Ochoa JC;Zuniga-Brenes P;Rios-Zertuche D;Mokdad AH;Hernandez B
与产时相关的缺氧事件或出生窒息导致全球和中美洲四分之一的新生儿死亡。必须对窒息实施多维度的护理，确保新生儿及时有效的护理。 Salud Mesoamérica Initiative (SMI) 是一项基于绩效的计划，旨在改善中美洲低收入地区的孕产妇和儿童健康。我们的目标是评估 SMI 对该地区卫生中心和医院新生儿窒息护理的影响。前期设计。作为 SMI 倡议评估的一部分，从墨西哥（恰帕斯州）、洪都拉斯、尼加拉瓜和危地马拉基线（2011-2013）和第二阶段随访（2017-2018）的病历中随机抽取了 248 例窒息病例。进行了设施调查以评估医疗保健质量和窒息管理。主要结果是对窒息管理的多维护理的覆盖范围，包括出生时熟练的提供者在场、立即评估、初步稳定和适当的新生儿复苏措施。使用多变量逻辑回归分析数据。 SMI 后窒息的处理显着改善。与基线相比，干预区域对窒息的适当护理效果更好（OR = 2.4；95% CI = 1.3–4.6）。此外，洪都拉斯的多维护理（OR = 4.0；95% CI = 1.4–12.0）显着高于墨西哥。在四个多维护理组成部分中，与基线（38.7%）相比，复苏在随访中显示出最大的进展（65.7%）。 SMI 改善了所有国家各级卫生保健部门对新生儿窒息的管理。我们的研究结果表明，适当的培训和充足的供应可以改善低收入社区的健康状况。 SMI 为改善其他环境中的医疗保健提供了一个模型。
Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region. A pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011–2013) and at second-phase follow-up (2017–2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression. Management of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3–4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4–12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%). SMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.
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影响因子：
2.4
作者：
Drake, Mary;Bishanga, Dunstan R.;Nelson, Brett D.
通讯作者：
Nelson, Brett D.
影响因子：
3.3
作者：
Mokdad, Ali H.;Colson, Katherine Ellicott;Regalia, Ferdinando
通讯作者：
Regalia, Ferdinando
影响因子：
3.7
作者：
Mokdad AH;Palmisano EB;Zúñiga-Brenes P;Ríos-Zertuche D;Johanns CK;Schaefer A;Desai SS;Haakenstad A;Gagnier MC;McNellan CR;Colombara DV;López Romero S;Castillo L;Salvatierra B;Hernandez B;Betancourt-Cravioto M;Mujica-Rosales R;Regalia F;Tapia-Conyer R;Iriarte E
通讯作者：
Iriarte E
影响因子：
3.7
作者：
Trevisanuto D;Bertuola F;Lanzoni P;Cavallin F;Matediana E;Manzungu OW;Gomez E;Da Dalt L;Putoto G
通讯作者：
Putoto G
影响因子：
5.7
作者：
Mistry, Sara C.;Lin, Richard;Bould, M. Dylan
通讯作者：
Bould, M. Dylan