Facility Delivery, Postnatal Care and Neonatal Deaths in India: Nationally-Representative Case-Control Studies.
Facility Delivery, Postnatal Care and Neonatal Deaths in India: Nationally-Representative Case-Control Studies.
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DOI：
10.1371/journal.pone.0140448
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Jha P
中科院分区：
文献类型：
--
作者：
Fadel SA;Ram U;Morris SK;Begum R;Shet A;Jotkar R;Jha P
临床研究证明了干预措施在减少新生儿死亡方面的有效性，但对其实际有效性的研究较少。在印度，妇女往往在出现并发症后寻求设施分娩，而不是为了避免并发症。我们的目标是量化设施交付和产后检查与新生儿死亡率的关联，同时检查"反向因果关系"，其中母亲在卫生设施交付由于不良围产期事件。我们对约300，000例活产和4，000例新生儿死亡进行了全国代表性病例对照研究，以检查分娩地点和产后检查对新生儿死亡率的影响。我们将新生儿死亡与所有活产婴儿以及报告出血过多或难产的活产婴儿子集进行了比较，这些新生儿死亡与寻求护理的病例更具可比性。在2004 - 8例出生的较大研究中，无产后检查的设施分娩与新生儿死亡几率增加相关（比值比= 2.5; 99%CI 2.2 - 2.9），尤其是早期与晚期新生儿死亡。然而，使用更具可比性的对照显示出显著的衰减（比值比= 0.5; 0.4 - 0.5）。设施分娩和产后检查与新生儿死亡几率降低有关。在2001 - 4出生的早期研究中，过度风险有所减弱。设施分娩与产后检查的综合效果大大高于设施分娩本身。评估减少儿童和孕产妇死亡的干预措施在现实生活中的有效性需要考虑反向因果关系。如果这些关联是因果关系，那么在产后检查的设施分娩可以避免印度约1/3的新生儿死亡（约100，000/年）。
Clinical studies demonstrate the efficacy of interventions to reduce neonatal deaths, but there are fewer studies of their real-life effectiveness. In India, women often seek facility delivery after complications arise, rather than to avoid complications. Our objective was to quantify the association of facility delivery and postnatal checkups with neonatal mortality while examining the “reverse causality” in which the mothers deliver at a health facility due to adverse perinatal events. We conducted nationally representative case-control studies of about 300,000 live births and 4,000 neonatal deaths to examine the effect of, place of delivery and postnatal checkup on neonatal mortality. We compared neonatal deaths to all live births and to a subset of live births reporting excessive bleeding or obstructed labour that were more comparable to cases in seeking care. In the larger study of 2004–8 births, facility delivery without postnatal checkup was associated with an increased odds of neonatal death (Odds ratio = 2.5; 99% CI 2.2–2.9), especially for early versus late neonatal deaths. However, use of more comparable controls showed marked attenuation (Odds ratio = 0.5; 0.4–0.5). Facility delivery with postnatal checkup was associated with reduced odds of neonatal death. Excess risks were attenuated in the earlier study of 2001–4 births. The combined effect of facility deliveries with postnatal checks ups is substantially higher than just facility delivery alone. Evaluation of the real-life effectiveness of interventions to reduce child and maternal deaths need to consider reverse causality. If these associations are causal, facility delivery with postnatal check up could avoid about 1/3 of all neonatal deaths in India (~100,000/year).