The timing of antenatal care initiation and the content of care in Sindh, Pakistan.
The timing of antenatal care initiation and the content of care in Sindh, Pakistan.
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DOI：
10.1186/s12884-016-0979-8
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发表时间：
2016-07-27
影响因子：
3.1
通讯作者：
Tappis H
中科院分区：
文献类型：
--
作者：
Agha S;Tappis H
政策制定者和方案规划者认为产前保健覆盖率是改善孕产妇健康的主要措施。然而，来自多个国家的证据表明，产前护理的覆盖率与所提供服务的内容没有必然的关系。这项研究探讨了首次产前检查的时间（服务内容的潜在预测因素）与向怀孕妇女提供世卫组织建议的服务之间的关系。该研究使用了信德省代表性住户调查的数据，抽样调查了4 000名年龄在15至49岁之间的妇女，她们在调查前两年内有过活产。调查获得了关于怀孕期间提供的护理内容、首次产前检查的时间、上次怀孕期间产前检查的次数以及妇女的社会经济和人口特征的信息。进行了双变量分析，以检查接受世卫组织推荐的六项服务的妇女比例与首次产前检查时间之间的关系。进行多变量分析，以确定提供的护理元素的数量的预测因素。虽然信德省的大多数妇女（87%）接受产前检查，但检查时间因性别、教育和家庭财富而异。对于最富有的妇女来说，第一次产前检查的平均时间是3个月，而对于最贫穷的五分之一妇女来说，是7个月。在多变量分析中，财富、教育、生育和结婚年龄是提供护理的要素数量的重要预测因素。接受早期产前检查的妇女比其他妇女更有可能接受世卫组织推荐的服务，这与一系列社会经济和人口变量无关，也与怀孕期间产前检查的次数无关。在信德省，首次产前保健检查的时间对向孕妇提供的护理内容有独立影响。虽然提供者受到充分培训并积极提供世卫组织建议的护理标准极为重要，但这些研究结果表明，鼓励妇女尽早进行首次产前检查可能是另一种机制，通过这种机制可以提高所提供的护理质量。这种重点最有可能使最贫穷、受教育程度最低和平等程度最高的妇女受益。根据这些调查结果，我们建议在巴基斯坦卫生设施收集的常规数据应包括第一次产前检查时的怀孕月份。
Policymakers and program planners consider antenatal care (ANC) coverage to be a primary measure of improvements in maternal health. Yet, evidence from multiple countries indicates that ANC coverage has no necessary relationship with the content of services provided. This study examines the relationship between the timing of the first ANC check-up, a potential predictor of the content of services, and the provision of WHO recommended services to women during their pregnancy. The study uses data from a representative household survey of Sindh with a sample comprising of 4,000 women aged 15–49 who had had a live birth in the two years before the survey. The survey obtained information about the elements of care provided during pregnancy, the timing of the first ANC check-up, the number of ANC visits made during the last pregnancy and women’s socio-economic and demographic characteristics. Bivariate analysis was conducted to examine the relationship between the proportion of women who receive six WHO recommended services and the timing of their first ANC check-up. Multivariate analysis was conducted to identify predictors of the number of elements of care provided. While most women in Sindh (87 %) receive an ANC check-up, its timing varies by parity, education and household wealth. The median time to the first ANC check-up was 3 months for women in the richest and 7 months for women in the poorest wealth quintiles. In multivariate analysis, wealth, education, parity and age at marriage were significant predictors of the number of elements of care provided. Women who received an early ANC check-up were much more likely to receive WHO recommended services than other women, independent of a range of socio-economic and demographic variables and independent of the number of ANC visits made during pregnancy. In Sindh, the timing of the first ANC check-up has an independent effect on the content of care provided to pregnant women. While it is extremely important that providers are adequately trained and motivated to provide the WHO recommended standards of care, these findings suggest that motivating women to make an early first ANC check-up may be another mechanism through which the quality of care provided may be improved. Such a focus is most likely to benefit the poorest, least educated and highest parity women. Based on these findings, we recommend that routine data collected at health facilities in Pakistan should include the month of pregnancy at the time of the first ANC check-up.