Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya.
Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya.
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DOI：
10.1371/journal.pone.0171236
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Kruk ME
中科院分区：
文献类型：
--
作者：
Sharma J;Leslie HH;Kundu F;Kruk ME
保健质量是全球卫生未来进展的一个重要决定因素。然而，保健质量的分配方面没有得到足够的重视。我们评估了高质量的孕产妇保健是否公平分配：(1)绘制位于肯尼亚较贫穷地区和较富裕地区的设施的孕产妇保健质量；(2)比较贫困和非贫困肯尼亚人可获得的孕产妇保健质量。我们使用2010年肯尼亚服务提供评估（SPA）的指标评估了孕产妇护理质量的三项指标：设施基础设施和产前护理和分娩护理的临床质量，这是一项直接观察孕产妇护理提供的标准化设施调查。我们使用多维贫困指数计算了产前或分娩护理机构所服务地区的贫困程度。我们使用回归分析和非参数检验来评估位于较贫困地区和较贫困地区的设施中孕产妇保健质量的差异。我们以最低护理标准估计了对全体人口和贫困人口的有效覆盖。共有564家提供至少一项产妇保健服务的机构被纳入这项分析。产妇护理质量较低，特别是产前和分娩护理的临床质量，平均分别为0.52和0.58（满分为1），而结构性护理投入的平均水平为0.68。产妇保健质量因贫困程度而异：在设施一级，最贫困地区的所有质量指标最低，财富越高，质量指标就越高。人口获得优质孕产妇保健的最低标准（≥0.75 / 1.00）的机会既低又不公平：只有17%的妇女和8%的贫困妇女获得了最低限度的适当分娩护理。在肯尼亚，孕产妇保健的质量很低，穷人得到的保健明显不如富人得到的。为了实现降低孕产妇和新生儿死亡率的国家目标，政策举措需要解决低质量的护理问题，首先要从高度贫困地区开始。
Quality of healthcare is an important determinant of future progress in global health. However, the distributional aspects of quality of care have received inadequate attention. We assessed whether high quality maternal care is equitably distributed by (1) mapping the quality of maternal care in facilities located in poorer versus wealthier areas of Kenya; and (2) comparing the quality of maternal care available to Kenyans in and not in poverty. We assessed three measures of maternal care quality: facility infrastructure and clinical quality of antenatal care and delivery care, using indicators from the 2010 Kenya Service Provision Assessment (SPA), a standardized facility survey with direct observation of maternal care provision. We calculated poverty of the area served by antenatal or delivery care facilities using the Multidimensional Poverty Index. We used regression analyses and non-parametric tests to assess differences in maternal care quality in facilities located in more and less impoverished areas. We estimated effective coverage with a minimum standard of care for the full population and those in poverty. A total of 564 facilities offering at least one maternal care service were included in this analysis. Quality of maternal care was low, particularly clinical quality of antenatal and delivery care, which averaged 0.52 and 0.58 out of 1 respectively, compared to 0.68 for structural inputs to care. Maternal healthcare quality varied by poverty level: at the facility level, all quality metrics were lowest for the most impoverished areas and increased significantly with greater wealth. Population access to a minimum standard (≥0.75 of 1.00) of quality maternal care was both low and inequitable: only 17% of all women and 8% of impoverished women had access to minimally adequate delivery care. The quality of maternal care is low in Kenya, and care available to the impoverished is significantly worse than that for the better off. To achieve the national targets of maternal and neonatal mortality reduction, policy initiatives need to tackle low quality of care, starting with high-poverty areas.