Maternal survival 2 - Strategies for reducing maternal mortality: getting on with what works
Maternal survival 2 - Strategies for reducing maternal mortality: getting on with what works
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DOI：
10.1016/s0140-6736(06)69381-1
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发表时间：
2006-10-07
期刊：
影响因子：
168.9
通讯作者：
Graham, Wendy J.
中科院分区：
文献类型：
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作者：
Campbell, Oona M. R.;Graham, Wendy J.
由于各国国情和孕产妇健康的决定因素千差万别，了解哪些措施在降低孕产妇死亡率方面有效的概念变得复杂。在此，我们的目的是表明，尽管存在这种复杂性，但降低孕产妇死亡率只需要做出几个战略选择。我们开始提出的逻辑，告知我们的战略选择。这一逻辑表明，实施有效的产时护理策略是压倒一切的优先事项。我们还讨论了这种战略的替代配置，并利用现有的最佳证据，优先考虑一种基于在初级机构（保健中心）提供服务的战略，并得到医院一级设施的支持。然后，我们继续讨论补充产时护理的策略。最后，我们讨论了近20年的安全孕产规划之后决策中令人费解的犹豫：如果要实现第五个千年发展目标，那么需要优先考虑的是显而易见的。在采取有效措施方面的进一步拖延使人们对决策者对这一目标的承诺产生了疑问。
The concept of knowing what works in terms of reducing maternal mortality is complicated by a huge diversity of country contexts and of determinants of maternal health. Here we aim to show that, despite this complexity, only a few strategic choices need to be made to reduce maternal mortality. We begin by presenting the logic that informs our strategic choices. This logic suggests that implementation of an effective intrapartum-care strategy is an overwhelming priority. We also discuss the alternative configurations of such a strategy and, using the best available evidence, prioritise one strategy based on delivery in primary-level institutions (health centres), backed up by access to referral-level facilities. We then go on to discuss strategies that complement intrapartum care. We conclude by discussing the inexplicable hesitation in decision-making after nearly 20 years of safe motherhood programming: if the fifth Millennium Development Goal is to be achieved, then what needs to be prioritised is obvious. Further delays in getting on with what works begs questions about the commitment of decision-makers to this goal.