Feasibility and preliminary effectiveness of group antenatal care in Senegalese health posts: a pilot implementation trial
Feasibility and preliminary effectiveness of group antenatal care in Senegalese health posts: a pilot implementation trial
复制标题
DOI：
10.1093/heapol/czz178
复制
发表时间：
2020-06-01
影响因子：
3.2
通讯作者：
Bassani, Diego
中科院分区：
文献类型：
--
作者：
McKinnon, Britt;Sall, Mohamadou;Bassani, Diego
塞内加尔几乎所有孕妇都接受过一些产前护理（ANC），但只有大约一半的孕妇接受过四次或四次以上的产前检查，而且产前护理期间提供的教育和咨询往往不足，在某些情况下甚至不存在。这导致错过了在怀孕期间和整个护理过程中就适当的寻求护理的做法和健康行为向妇女提供支持和咨询的机会。这项试验性的有效性实施随机对照试验探讨了ANC组（G-ANC），一种将标准的个人妊娠护理与促进参与性团体教育活动和同伴支持相结合的模式，是否可能解决其中的一些挑战。为塞内加尔调整的G-ANC模式建立在当地保健服务系统的基础上，并与世界卫生组织关于转向以妇女为中心的孕产服务模式的建议保持一致。在卫生站一级实施，共有330名孕妇参加了研究，其中85%在产后6-10周接受了随访。我们评估了实施结果（如可接受性，成本），以建立在塞内加尔的模型的可行性，并探讨了有效性的结果与孕产妇和婴儿健康的规划一个大规模的试验。结果表明，妇女和ANC提供者对G-ANC模式非常热情，探索性分析表明，纯母乳喂养，计划生育，分娩准备和孕产妇和新生儿危险信号知识的使用意愿有所改善。本文提供了及时和相关的证据，G-ANC作为一种替代模式的照顾在怀孕期间的可行性和坚实的基础，建议进行大规模的实施研究G-ANC在塞内加尔。
Almost all pregnant women in Senegal receive some antenatal care (ANC), yet only around half receive four or more visits and provision of education and counselling during ANC is often inadequate and, in some cases, non-existent. This results in missed opportunities to provide support and to counsel women regarding appropriate care-seeking practices and health behaviours during pregnancy and across the continuum of care. This pilot effectiveness-implementation randomized controlled trial explored whether group ANC (G-ANC), a model that integrates standard individual pregnancy care with facilitated participatory group education activities and peer support, could potentially address some of these challenges. The G-ANC model adapted for Senegal builds on local healthcare delivery systems and aligns with World Health Organization recommendations for a shift towards women-centred models of maternity services. It was implemented at the health post level, and a total of 330 pregnant women participated in the study, of whom 85% were followed up at 6-10 weeks post-delivery. We assessed implementation outcomes (e.g. acceptability, cost) to establish the feasibility of the model in Senegal and explored effectiveness outcomes related to maternal and infant health for the planning of a large-scale trial. Results indicate that women and ANC providers were overwhelmingly enthusiastic about the G-ANC model, and exploratory analyses suggested improvements in exclusive breastfeeding, intention to use family planning, birth preparations and knowledge around maternal and newborn danger signs. This article provides timely and relevant evidence on the feasibility of G-ANC as an alternative model of care during pregnancy and a solid basis for recommending the conduct of a large-scale implementation study of G-ANC in Senegal.