Measuring the quality of antenatal care in a context of high utilisation: evidence from Telangana, India.
Measuring the quality of antenatal care in a context of high utilisation: evidence from Telangana, India.
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DOI：
10.1186/s12884-022-05200-1
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发表时间：
2022-11-25
影响因子：
3.1
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中科院分区：
文献类型：
--
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在许多低收入和中等收入地区，包括印度的特兰加纳州，孕产妇保健覆盖率大幅增加。然而，越来越多的证据表明，妇女在怀孕期间获得的护理质量不足。本研究旨在探讨产前保健质量的尺寸在特兰加纳，印度使用四个主要和次要的数据来源。对来自两个二级全州数据源（全国家庭健康调查（NFHS-5），2019-21;健康管理信息系统（HMIS），2019-20）和两个主要数据源（特兰加纳选定地区的19个初级卫生中心和分中心的设施调查;以及这些设施的36次产前保健咨询的观察结果）的数据进行了连续分析。NFHS-5数据显示，特兰加纳约73%的妇女在怀孕期间接受了所有六项评估的产前护理。卫生和医疗保险信息系统的数据显示，产前检查覆盖率高，但筛查水平不同，贫血血红蛋白检测覆盖率高，但妊娠糖尿病和梅毒检测覆盖率低。设施调查发现，几个关键的产前保健服务缺少设备。产前护理观察发现，血压测量和体格检查的覆盖率很高，而且通常都是正确的。在症状检查和妇女与提供者之间的沟通方面存在重大缺陷。在22%的咨询中，妇女被问及是否有任何问题。只有一名妇女被问及她的心理健康状况。在咨询中，分别有58%和36%的妇女就与生育准备有关的十个项目中的至少一个和六个危险信号中的至少一个进行咨询。尽管产前保健服务和一些基本的孕产妇和胎儿评估的覆盖率很高，但质量差距仍然很大，特别是在保健提供者与孕妇之间的沟通以及关键服务的提供方面。要在产前保健的内容和经验方面取得高质量的进展，就需要解决服务差距，制定更好的措施，以掌握和改善妇女的保健经验。 在线版本包含补充材料，可通过10.1186/s12884-022-05200-1获得。
Antenatal care coverage has dramatically increased in many low-and middle-income settings, including in the state of Telangana, India. However, there is increasing evidence of shortfalls in the quality of care women receive during their pregnancies. This study aims to examine dimensions of antenatal care quality in Telangana, India using four primary and secondary data sources. Data from two secondary statewide data sources (National Family Health Survey (NFHS-5), 2019–21; Health Management Information System (HMIS), 2019–20) and two primary data sources (a facility survey in 19 primary health centres and sub-centres in selected districts of Telangana; and observations of 36 antenatal care consultations at these facilities) were descriptively analysed. NFHS-5 data showed about 73% of women in Telangana received all six assessed antenatal care components during pregnancy. HMIS data showed high coverage of antenatal care visits but differences in levels of screening, with high coverage of haemoglobin tests for anaemia but low coverage of testing for gestational diabetes and syphilis. The facility survey found missing equipment for several key antenatal care services. Antenatal care observations found blood pressure measurement and physical examinations had high coverage and were generally performed correctly. There were substantial deficiencies in symptom checking and communication between the woman and provider. Women were asked if they had any questions in 22% of consultations. Only one woman was asked about her mental health. Counselling of women on at least one of the ten items relating to birth preparedness and on at least one of six danger signs occurred in 58% and 36% of consultations, respectively. Despite high coverage of antenatal care services and some essential maternal and foetal assessments, substantial quality gaps remained, particularly in communication between healthcare providers and pregnant women and in availability of key services. Progress towards achieving high quality in both content and experience of antenatal care requires addressing service gaps and developing better measures to capture and improve women’s experiences of care. The online version contains supplementary material available at 10.1186/s12884-022-05200-1.
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