Integrated maternal and child health services in Mozambique: structural health system limitations overshadow its effect on follow-up of HIV-exposed infants.
Integrated maternal and child health services in Mozambique: structural health system limitations overshadow its effect on follow-up of HIV-exposed infants.
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DOI：
10.1186/1472-6963-13-207
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发表时间：
2013-06-07
影响因子：
2.8
通讯作者：
Degomme O
中科院分区：
文献类型：
--
作者：
Geelhoed D;Lafort Y;Chissale É;Candrinho B;Degomme O
在许多撒哈拉以南非洲国家，对感染艾滋病毒的婴儿进行随访仍然是一项公共卫生挑战。正如综合产前和孕产服务有助于改善对艾滋病毒呈阳性孕妇的护理一样，对母亲和婴儿出生后的综合护理也可以改善对艾滋病毒暴露婴儿的随访。我们介绍了一项研究结果，该研究测试了莫桑比克太特省这种综合护理的可行性及其对艾滋病毒暴露婴儿随访的影响。 2009年4月至2010年9月期间，我们在六个农村公立初级卫生保健机构中进行了一项混合方法干预对照研究，根据规模和可及性进行有目的地选择，并随机分配三个机构作为干预组和对照组。干预措施包括重组服务，为母亲及其五岁以下的孩子提供一站式综合护理。我们收集了干预前 6 个月（2009 年 1 月至 6 月）和开始干预后 13 个月（2009 年 7 月至 2010 年 7 月）有关预防艾滋病毒母婴传播（PMTCT）、艾滋病毒暴露婴儿的随访以及其他母婴健康（MCH）活动的月度常规设施统计数据。工作人员在研究开始、六个月后和研究结束时接受了采访。使用准泊松模型对定量数据进行分析，以了解干预前后的时期、干预组和对照组的医疗机构之间的显着差异以及时间趋势。周期效应和干预交互效应的系数用它们的 p 值计算。定性数据的主题分析是手动完成的。所有参与的医疗机构都可以为母婴提供一站式综合护理，工作人员对该服务机构给予了积极评价。我们在两个研究组中观察到艾滋病毒暴露婴儿的随访（登记、随访、血清学检测）有所改善，但工作人员频繁缺勤和消耗品供应不规律干扰了干预组和对照组的医疗机构绩效。尽管艾滋病毒暴露婴儿的随访在各个方面都有所改善，但我们观察到一站式、综合妇幼保健服务并没有取得任何改善。医疗保健系统的结构性限制，例如人员缺勤和基本商品供应不规律，似乎掩盖了其潜在影响。定期的技术支持和充足的基本工作条件对于提高莫桑比克周边公共医疗机构感染艾滋病毒的婴儿的随访绩效至关重要。
The follow-up of HIV-exposed infants remains a public health challenge in many Sub-Saharan countries. Just as integrated antenatal and maternity services have contributed to improved care for HIV-positive pregnant women, so too could integrated care for mother and infant after birth improve follow-up of HIV-exposed infants. We present results of a study testing the viability of such integrated care, and its effects on follow-up of HIV-exposed infants, in Tete Province, Mozambique. Between April 2009 and September 2010, we conducted a mixed-method, intervention-control study in six rural public primary healthcare facilities, selected purposively for size and accessibility, with random allocation of three facilities each for intervention and control groups. The intervention consisted of a reorganization of services to provide one-stop, integrated care for mothers and their children under five years of age. We collected monthly routine facility statistics on prevention of mother-to-child HIV transmission (PMTCT), follow-up of HIV-exposed infants, and other mother and child health (MCH) activities for the six months before (January-June 2009) and 13 months after starting the intervention (July 2009-July 2010). Staff were interviewed at the start, after six months, and at the end of the study. Quantitative data were analysed using quasi-Poisson models for significant differences between the periods before and after intervention, between healthcare facilities in intervention and control groups, and for time trends. The coefficients for the effect of the period and the interaction effect of the intervention were calculated with their p-values. Thematic analysis of qualitative data was done manually. One-stop, integrated care for mother and child was feasible in all participating healthcare facilities, and staff evaluated this service organisation positively. We observed in both study groups an improvement in follow-up of HIV-exposed infants (registration, follow-up visits, serological testing), but frequent absenteeism of staff and irregular supply of consumables interfered with healthcare facility performance for both intervention and control groups. Despite improvement in various aspects of the follow-up of HIV-exposed infants, we observed no improvement attributable to one-stop, integrated MCH care. Structural healthcare system limitations, such as staff absences and irregular supply of essential commodities, appear to overshadow its potential effects. Regular technical support and adequate basic working conditions are essential for improved performance in the follow-up of HIV-exposed infants in peripheral public healthcare facilities in Mozambique.
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DOI：
10.1097/qai.0b013e318207a535
发表时间：
2011-04-01
影响因子：
3.6
作者：
Cook, Rebecca E.;Ciampa, Philip J.;Moon, Troy D.
通讯作者：
Moon, Troy D.
影响因子：
3.3
作者：
Delvaux, Therese;Konan, Jean-Paul Diby;Ronsmans, Carine
通讯作者：
Ronsmans, Carine
错过的机会防止母亲到孩子交流：系统的审查和荟萃分析。
DOI：
10.1097/qad.0b013e328359ab0c
发表时间：
2012-11-28
期刊：
AIDS (London, England)
影响因子：
--
作者：
Wettstein C;Mugglin C;Egger M;Blaser N;Vizcaya LS;Estill J;Bender N;Davies MA;Wandeler G;Keiser O;IeDEA Southern Africa Collaboration
通讯作者：
IeDEA Southern Africa Collaboration
肯尼亚农村艾滋病毒感染的早期婴儿诊断的动力和约束。
影响因子：
4.4
作者：
Hassan, Amin S.;Sakwa, Erick M.;Nabwera, Helen M.;Taegtmeyer, Miriam M.;Kimutai, Robert M.;Sanders, Eduard J.;Awuondo, Ken K.;Mutinda, Maureen N.;Molyneux, Catherine S.;Berkley, James A.
通讯作者：
Berkley, James A.
DOI：
10.1097/qai.0b013e31815d2f71
发表时间：
2008-01-01
影响因子：
3.6
作者：
Potter, Dara;Goldenberg, Robert L.;Vermund, Sten H.
通讯作者：
Vermund, Sten H.