Bypassing birth centres for childbirth: an analysis of data from a community-based prospective cohort study in Nepal
Bypassing birth centres for childbirth: an analysis of data from a community-based prospective cohort study in Nepal
复制标题
DOI：
10.1093/heapol/czt090
复制
发表时间：
2015-02-01
影响因子：
3.2
通讯作者：
Binns, Colin W.
中科院分区：
文献类型：
--
作者：
Karkee, Rajendra;Lee, Andy H.;Binns, Colin W.
背景在尼泊尔，居住在农村地区的妇女往往绕过当地的生育中心而在城市医院分娩，尽管这些中心提供产科护理。本研究调查了分流的发生率，分流者的特点和分流的原因。方法在尼泊尔中部卡斯基地区进行前瞻性队列研究。从社区招募的353名怀孕5个月或以上的孕妇可以前往当地的分娩中心。他们在基线时使用结构化问卷进行访谈，并在产后45天内进行随访。在生育中心分娩的妇女和在医院分娩的妇女之间进行了比较。采用Logistic回归分析确定影响搭桥风险的因素。结果在卫生机构分娩的258名参与者的最后样本中，181名妇女（70.2%）绕过最近的分娩中心到医院分娩。旁路患者往往是富有的，并有产时并发症，但旁路的可能性明显降低胎次高和频繁（四次或以上）产前保健访问。营运设施的可用性、医疗用品和设备的充足性以及设施中称职的保健工作人员是他们作出绕过决定的主要原因。结论尼泊尔中部地区旁路分娩风险较高。建议提供优质和可靠的紧急产科服务，并在生育中心提供训练有素和称职的工作人员，以减少绕道和对公立医院系统的压力。
Background In Nepal, women residing in rural areas tend to bypass local birth centres and deliver at urban hospitals, despite the availability of obstetric care in these centres. This study investigated the incidence of bypassing, characteristics of bypassers and their reasons for bypassing the birth centres.Methods A prospective cohort study was undertaken in the Kaski district of central Nepal. The 353 pregnant women of 5 months or more gestation recruited from the community had access to local birth centres. They were interviewed at baseline using a structured questionnaire, and were followed up within 45 days post-partum. Comparisons were made between women who delivered at birth centres and those who gave birth at hospital. Logistic regression analysis was performed to determine the factors affecting the risk of bypassing.Results Of the final sample of 258 participants who delivered in a health facility, 181 women (70.2%) bypassed their nearest birth centres to deliver at hospitals. Bypassers tended to be wealthy and have intrapartum complications, but the likelihood of bypassing apparently decreased by higher parity and frequent (four or more) antenatal care visits. Availability of operating facility, adequacy of medical supplies and equipment and competent health staff at the facility were the main reasons for their bypassing decision.Conclusions The risk of bypassing for childbirth was high in central Nepal. Provision of quality and reliable emergency obstetric services together with well trained and competent staff at birth centres are recommended to reduce bypassing and pressure on the public hospital system.