Reducing one million child deaths from birth asphyxia--a survey of health systems gaps and priorities.
Reducing one million child deaths from birth asphyxia--a survey of health systems gaps and priorities.
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DOI：
10.1186/1478-4505-5-4
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发表时间：
2007-05-16
影响因子：
4
通讯作者：
Darmstadt, Gary L
中科院分区：
文献类型：
--
作者：
Lawn, Joy E;Manandhar, Ananta;Darmstadt, Gary L
背景技术背景：数以百万计的儿童死亡和死产可归因于出生窒息，但可用于指导政策和做法的信息有限，特别是在社区一级。我们调查了选定的政策制定者，方案实施者和研究人员编制的见解，政策，方案和研究，以减少窒息相关的deaths.METHOD：一份调查问卷的开发和预先测试的基础上，广泛的文献综述，然后通过电子邮件（或航空邮件或传真，必要时）发送到453政策制定者，方案实施者和研究人员积极参与儿童健康，特别是在社区一级。该调查有法文和英文版，采用5分制，供答卷人评定干预措施和指标的有效性和可行性。开放式问题允许答复者根据其经验提供更多细节。显着性检验进行卡方，F-检验和Fisher的精确概率testsappropriates.Results：来自32个国家的173个人（44%）。据报告，在所代表的27个发展中国家中，有20个国家（74%）制定了国家新生儿生存政策，但答复者的回答有时相互矛盾，并显示出对政策内容的不确定性，这可能妨碍政策的执行。答复者强调，在社区一级，术语混乱和缺乏有效的衡量指标是获得决策所需准确数据的障碍。在干预措施方面，分娩准备和基本新生儿护理被认为是有效和可行的，而社区一级的复苏被认为不太可行。答复者强调，从供需两方面加强卫生系统是方案的优先事项，特别是确保广泛提供熟练助产士，促进做好分娩准备，以及促进基本新生儿护理。研究重点包括实施分娩准备，有效评估社区的妊娠风险，确保传统助产士（TBA）与卫生系统的联系，测试各种社区干部复苏的成本效益，以及为病例管理和人口监测制定明确的病例定义。结论：如果不更多地关注改善护理和推进出生窒息研究，200万例与窒息有关的死亡以及相关的孕产妇死亡将在未来许多年内仍然无法获得有效的护理，无论是熟练的还是社区一级的护理。
BACKGROUND: Millions of child deaths and stillbirths are attributable to birth asphyxia, yet limited information is available to guide policy and practice, particularly at the community level. We surveyed selected policymakers, programme implementers and researchers to compile insights on policies, programmes, and research to reduce asphyxia-related deaths.METHOD: A questionnaire was developed and pretested based on an extensive literature review, then sent by email (or airmail or fax, when necessary) to 453 policymakers, programme implementers, and researchers active in child health, particularly at the community level. The survey was available in French and English and employed 5-point scales for respondents to rate effectiveness and feasibility of interventions and indicators. Open-ended questions permitted respondents to furnish additional details based on their experience. Significance testing was carried out using chi-square, F-test and Fisher's exact probability tests as appropriate.RESULTS: 173 individuals from 32 countries responded (44%). National newborn survival policies were reported to exist in 20 of 27 (74%) developing countries represented, but respondents' answers were occasionally contradictory and revealed uncertainty about policy content, which may hinder policy implementation. Respondents emphasized confusing terminology and a lack of valid measurement indicators at community level as barriers to obtaining accurate data for decision making. Regarding interventions, birth preparedness and essential newborn care were considered both effective and feasible, while resuscitation at community level was considered less feasible. Respondents emphasized health systems strengthening for both supply and demand factors as programme priorities, particularly ensuring wide availability of skilled birth attendants, promotion of birth preparedness, and promotion of essential newborn care. Research priorities included operationalising birth preparedness, effectively evaluating pregnancy risk in the community, ensuring roles for traditional birth attendants (TBAs) that link them with the health system, testing the cost-effectiveness of various community cadres for resuscitation, and developing a clear case definition for case management and population monitoring.CONCLUSION: Without more attention to improve care and advance birth asphyxia research, the 2 million deaths related to asphyxia, plus associated maternal deaths, will remain out of reach of effective care, either skilled or community level, for many years to come.