Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child HIV transmission programme in Cote d'Ivoire
Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child HIV transmission programme in Cote d'Ivoire
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DOI：
10.1111/j.1365-3156.2008.02105.x
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发表时间：
2008-08-01
影响因子：
3.3
通讯作者：
Ronsmans, Carine
中科院分区：
文献类型：
--
作者：
Delvaux, Therese;Konan, Jean-Paul Diby;Ronsmans, Carine
目的评估在科特迪瓦实施预防母婴艾滋病传播（PMTCT）计划是否提高了产前和分娩保健服务的质量。方法在实施前对5个城市卫生机构的产前和分娩保健服务质量进行评估。（2002-2003年）和之后（2005年）通过审查设施数据实施预防母婴传播方案;观察产前咨询（n = 606前; n = 591后）和分娩（n = 229前; n = 231后）和妇女的退出访谈;和卫生设施的工作人员访谈。结果艾滋病毒检测从未提出在基线，并提出了63%的妇女在第一次ANC访问后PMTCT实施。总体检测率为42%，83%的受检艾滋病毒感染孕妇接受了奈韦拉平治疗。此外，在所有保健设施中，人际交流和保密情况都有显著改善。在产科病房，在方案实施后，所有设施的入院、分娩和产后护理的产科护理质量在全球范围内都有所改善，尽管有些指标仍然很差，例如在分娩期间直接填写分娩记录。实施PMTCT后，初产妇的会阴切开率从64%下降到25%（P < 0.001）。产前和分娩护理质量的全球分数显着改善后，在所有设施的programme.CONCLUSIONS引入全面的PMTCT服务，可以提高产前和分娩护理的质量一般。
OBJECTIVE To assess whether implementation of a prevention of mother-to-child HIV transmission (PMTCT) programme in Cote d'Ivoire improved the quality of antenatal and delivery care services.METHODS Quality of antenatal and delivery care services was assessed in five urban health facilities before (2002-2003) and after (2005) the implementation of a PMTCT programme through review of facility data; observation of antenatal consultations (n = 606 before; n = 591 after) and deliveries (n = 229 before; n = 231 after) and exit interviews of women; and interviews of health facility staff.RESULTS HIV testing was never proposed at baseline and was proposed to 63% of women at the first ANC visit after PMTCT implementation. The overall testing rate was 42% and 83% of tested HIV-infected pregnant women received nevirapine. In addition, inter-personal communication and confidentiality significantly improved in all health facilities. In the maternity ward, quality of obstetrical care at admission, delivery and post-partum care globally improved in all facilities after the implementation of the programme although some indicators remained poor, such as filling in the partograph directly during labour. Episiotomy rates among primiparous women dropped from 64% to 25% (P < 0.001) after PMTCT implementation. Global scores for quality of antenatal and delivery care significantly improved in all facilities after the implementation of the programme.CONCLUSIONS Introducing comprehensive PMTCT services can improve the quality of antenatal and delivery care in general.