AN INTEGRATED VILLAGE MATERNITY SERVICE TO IMPROVE REFERRAL PATTERNS IN A RURAL AREA IN WEST-JAVA
AN INTEGRATED VILLAGE MATERNITY SERVICE TO IMPROVE REFERRAL PATTERNS IN A RURAL AREA IN WEST-JAVA
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DOI：
10.1016/0020-7292(95)02323-5
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发表时间：
1995-06-01
影响因子：
3.8
通讯作者：
KOBLINSKY, M
中科院分区：
文献类型：
--
作者：
ALISJAHBANA, A;WILLIAMS, C;KOBLINSKY, M
围产期护理区域化是在西爪哇农村地区Tanjugsari进行的一项干预研究，旨在制定一项全面的孕产妇健康计划，以改善孕产妇和围产期健康结果。主要投入包括在各级保健系统(非正式和正式)进行培训，以及在村庄建立分娩之家，以使服务更容易获得。特别注意转诊、交通、通信和适当的病例管理，开展了一项社会营销方案，告知人们位于妇女附近的无障碍分娩之家，并在出现并发症时有更好的交通和与转诊设施的通信。这项研究设计是纵向的，在干预和对照区域跟踪所有孕妇从早孕到产后42天。干预区为+/-9万人，对照区为4万人。纳入标准包括1992年6月1日至1993年5月31日期间分娩的所有母婴单元。分析结果显示：大多数妇女寻求产前护理(95%)。在TanJungsari，近90%的人向专业提供者寻求此类护理，而在西萨拉克的控制区，这一比例为75%。大多数怀孕期间有出血或出血和水肿的妇女在研究区和控制区都寻求专业帮助。然而，研究区与控制区相比，发烧超过3天更受关注(93%比69%)。两个地区都有超过85%的分娩是由TBA进行的。然而，在研究区域，近三分之一(17%)的产中并发症患者在医疗机构分娩，而在对照区域，这一比例为十分之一。这意味着住院分娩，主要是在医生或医生/助产士的帮助下。TABAS的总体转诊率很低--Tanjugsari和Cisalak有并发症的妇女分别为13%和6%。与对照组相比，研究区有更多有产中并发症的妇女被转诊，并且在被转诊时更顺从。发生产中并发症的妇女更有可能发生围产期死亡。Tanjugsari的围产儿死亡率有所下降，但并不显著。然而，干预期间的趋势显示，TBA管理的分娩情况有所改善，死亡人数增加，导致专业人员死亡。要么是妇女来得太晚，要么是护理质量不能满足需求。在西沙拉克，围产儿死亡的水平或地点没有变化。
The Regionalization of Perinatal Care, an intervention study carried out in Tanjungsari, a subdistrict in rural West Java, aimed to develop a comprehensive maternal health program to improve maternal and perinatal health outcomes. The main inputs included training at all levels of the health care system (informal and formal) and the establishment of birthing homes in villages to make services more accessible. Special attention was given to referral, transportation, communication and appropriate case management, A social marketing program was conducted to inform people of the accessible birthing homes for clean delivery, located near the women, and with better transportation and communications to referral facilities should complications arise. The study design was longitudinal, following all pregnant women from early pregnancy until 42 days postpartum in an intervention and a comparison area. The population was +/- 90 000 in the intervention area and 40 000 in the comparison area. Inclusion criteria were all mother and infant units delivered between June Ist, 1992 and May 31st, 1993.Analysis showed the following results:Most women sought antenatal care (> 95%). In Tanjungsari, nearly 90% sought such care from professional providers as versus 75% in the control area of Cisalak.Most women with bleeding or bleeding and edema during pregnancy sought professional assistance in both the study and control areas. However, fever for more than 3 days received more attention in the study area versus control area (93 vs. 69%).Greater than 85% of deliveries in both areas were conducted by TBAs. However, in the study area, nearly one-third of those with intrapartum complications (17%) delivered in a health facility compared to one-tenth in the control area. This meant a hospital delivery, primarily with assistance of a doctor or doctor/midwife combination.Overall referral rates by TBAs were low - 13% of women with complications in Tanjungsari and 6% in Cisalak. More women with intrapartum complications were referred in the study area than in the control, and more complied when referred.Women who suffered intrapartum complications were more likely to have a perinatal death. Perinatal deaths declined in Tanjungsari, but not significantly. However, the trend over the period of the intervention shows an improvement in the deliveries managed by TBAs with more deaths resulting in the hands of professionals. Either women were arriving too late or the quality of care could not meet the needs. There was no change in the levels or place of perinatal deaths in Cisalak.