The Rajarata Pregnancy Cohort (RaPCo): study protocol
The Rajarata Pregnancy Cohort (RaPCo): study protocol
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DOI：
10.1186/s12884-020-03056-x
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发表时间：
2020-06-26
影响因子：
3.1
通讯作者：
Agampodi, Suneth Buddhika
中科院分区：
文献类型：
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作者：
Agampodi, Thilini Chanchala;Wickramasinghe, Nuwan Darshana;Agampodi, Suneth Buddhika
消除可预防的孕产妇死亡仍然是全球优先事项，在产科过渡的后期阶段，确定孕产妇健康结果的社会决定因素对于解决孕产妇死亡率停滞不前的问题至关重要。除非确定与孕产妇心理健康和自杀有关的复杂和具体情况的社会经济病因，否则各国很难实现可持续发展目标中关于孕产妇健康的具体目标。拉贾拉塔妊娠队列（RaPCo）是一项前瞻性队列研究，旨在探索社会决定因素与孕产妇心理健康在决定妊娠和新生儿结局方面的相互作用。方法本研究将于2019年7月至9月招募斯里兰卡阿努拉德普勒地区孕产妇保健项目中所有符合条件的孕妇。估计样本量为2400人。我们将评估社会人口和经济状况、社会资本、基于性别的暴力和心理健康，包括在妊娠头三个月进行临床检查和生化调查。参与者将在第二和第三孕期，分娩和产后早期进行四次随访。新生儿将在出生时、新生儿期、6个月时和1岁时进行随访。妊娠和儿童结局数据将通过直接接触收集。将进行定性研究，以了解与堕胎、产前抑郁、产妇死亡和未遂有关的复杂社会因素和行为层面。这是斯里兰卡报道的第一个以社会决定因素和心理健康为重点的产妇队列。作为一个处于产科过渡第四阶段的国家，这些发现将为低收入和中等收入国家实现《可持续发展目标》提供可概括的证据。研究将在一个具有多文化、多民族和多元社区特色的地区进行；因此，将使所产生的证据能够应用于许多不同的情况。该研究还具有使用直接参与者接触，数据收集，测量，检查和生化测试的优势，以尽量减少常规收集数据的错误。RaPCo的研究将能够产生证据，以加强政策，在地方、区域和全球范围内进一步减少孕产妇死亡，特别注重全球议程中没有最佳处理的社会因素和心理健康。
Background Ending preventable maternal deaths remains a global priority and in the later stages of obstetric transition, identifying the social determinants of maternal health outcomes is essential to address stagnating maternal mortality rates. Countries would hardly achieve the Sustainable Development Goal (SGD) targets on maternal health, unless the complex and context-specific socio-economic aetiologies associated with maternal mental health and suicide are identified. The Rajarata Pregnancy Cohort (RaPCo) is a prospective cohort study, designed to explore the interactions between social determinants and maternal mental health in determining pregnancy and new-born outcomes. Methods The study will recruit all eligible pregnant women in the maternal care programme of Anuradhapura district, Sri Lanka from July to September 2019. The estimated sample size is 2400. We will assess the socio-demographic and economic status, social capital, gender-based violence and mental health, including a clinical examination and biochemical investigations during the first trimester. Participants will undergo four follow-ups at 2nd and 3rd trimesters, at delivery and in early postpartum. The new-borns will be followed up at birth, neonatal period, at 6 six months and at 1 year. Pregnancy and child outcome data will be collected using direct contact. Qualitative studies will be carried out to understand the complex social factors and behavioural dimensions related to abortion, antenatal depression, maternal deaths and near misses. Discussion This is the first reported maternal cohort in Sri Lanka focusing on social determinants and mental health. As a country in stage four of obstetric transition, these findings will provide generalizable evidence on achieving SGD targets in low- and middle-income countries. The study will be conducted in a district with multi-cultural, multi-ethnic and diverse community characteristics; thus, will enable the evidence generated to be applied in many different contexts. The study also possesses the strength of using direct participant contact, data collection, measurement, examination and biochemical testing to minimise errors in routinely collected data. The RaPCo study will be able to generate evidence to strengthen policies to further reduce maternal deaths in the local, regional and global contexts particularly focusing on social factors and mental health, which are not optimally addressed in the global agenda.