In Low- And Middle -Income Countries, Is Delivery In High-Geographically Feasible?
In Low- And Middle -Income Countries, Is Delivery In High-Geographically Feasible?
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DOI：
10.1377/hlthaff.2018.05397
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发表时间：
2019-09-01
期刊：
影响因子：
9.7
通讯作者：
Kruk, Margaret E.
中科院分区：
文献类型：
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作者：
Gage, Anna D.;Carnes, Fei;Kruk, Margaret E.
在保健设施中分娩是降低孕产妇和新生儿死亡率的一项关键战略，但在中低收入国家，越来越多地使用保健设施并没有持续降低死亡率。在这些国家，许多分娩是在初级保健机构进行的，那里的护理质量很差。我们对服务交付重新设计的地理可行性进行了建模，将交付从初级保健诊所转移到六个国家的医院：海地，肯尼亚，马拉维，纳米比亚，尼泊尔和坦桑尼亚。我们估计了目前和正在重新设计的最近分娩设施的两小时内的妇女比例。今天，研究国家中83%-100%的孕妇可以在两小时内到达分娩设施。重新设计的政策将减少两小时的访问最多10%，从马拉维的0.6%到坦桑尼亚的9.9%不等。将分娩服务转移到医院不会不适当地阻碍研究国家获得护理的地理机会。低收入和中等收入国家应考虑这一政策，因为这可能是减少孕产妇和新生儿死亡的有效办法。
Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and middle-income countries. In such countries, many deliveries occur at primary care facilities, where the quality of care is poor. We modeled the geographic feasibility of service delivery redesign that shifted deliveries from primary care clinics to hospitals in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. We estimated the proportion of women within two hours of the nearest delivery facility, both currently and under redesign. Today, 83-100 percent of pregnant women in the study countries have two-hour access to a delivery facility. A policy of redesign would reduce two-hour access by at most 10 percent, ranging from 0.6 percent in Malawi to 9.9 percent in Tanzania. Relocating delivery services to hospitals would not unduly impede geographic access to care in the study countries. This policy should be considered in low- and middle-income countries, as it may be an effective approach to reducing maternal and newborn deaths.