Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India
Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India
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DOI：
10.1093/heapol/14.1.38
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发表时间：
1999-03-01
影响因子：
3.2
通讯作者：
Wypij, D
中科院分区：
文献类型：
--
作者：
Bloom, SS;Lippeveld, T;Wypij, D
支持产前筛查和干预措施对降低孕产妇死亡率有效的证据很少，研究结果相互矛盾。此外，在研究中，产前保健利用的特征很差。作为一项正在调查的暴露，产前保健应明确界定。然而，这些措施通常只考虑访问的频率和时间，而不考虑护理内容。我们介绍了一个新的措施产前保健利用，包括20个输入组成部分，涵盖护理内容和访问频率。每个组成部分的权重反映了其对改善孕产妇和儿童健康的相对重要性，这些权重来自对国际研究人员的调查。在印度北方邦瓦拉纳西的300名低收入至中等收入妇女的概率样本中研究了产前保健利用的综合措施。结果表明，根据一个简单的指标（两次或两次以上的检查与更少的检查）来划分妇女的产前护理状况，掩盖了所接受护理的大量差异。进行了逻辑回归分析，以检查产前保健利用对使用安全分娩护理的可能性的影响，这是一个已知的降低孕产妇死亡率的因素。在控制了相关的社会人口统计学和生育史因素后，护理水平相对较高（评分第75（th）百分位）的妇女在分娩时使用经过培训的辅助的估计几率几乎是护理水平较低（评分第25（th）百分位）的妇女的四倍（OR = 3.97, 95% CI = 1.96, 8.10）。在保健机构分娩的妇女与在家中分娩的妇女获得了类似的结果。怀孕期间获得的护理水平与使用安全分娩护理之间的这种强烈的正相关关系可能有助于解释为什么产前护理也可能与降低孕产妇死亡率有关。
Evidence to support that antenatal screenings and interventions are effective in reducing maternal mortality has been scanty and studies have presented contradictory findings. In addition, antenatal care utilization is poorly characterized in studies. As an exposure under investigation, antenatal care should be well defined. However, measures typically only account for the frequency and timing of visits and not for care content. We introduce a new measure for antenatal care utilization, comprised of 20 input components covering care content and visit frequency. Weights for each component reflect its relative importance to better maternal and child health, and were derived from a survey of international researchers.This composite measure for antenatal care utilization was studied in a probability sample of 300 low to middle income women who had given birth within the last three years in Varanasi, Uttar Pradesh, India. Results showed that demarcating women's antenatal care status based on a simple indicator - two or more visits versus less - masked a large amount of variation in care received. Logistic regression analyses were conducted to examine the effect of antenatal care utilization on the likelihood of using safe delivery care, a factor known to decrease maternal mortality. After controlling for relevant socio-demographic and maternity history factors, women with a relatively high level of care (at the 75(th) percentile of the score) had an estimated odds of using trained assistance at delivery that was almost four times higher than women with a low level of care (at the 25(th) percentile of the score) (OR = 3.97, 95% CI = 1.96, 8.10). Similar results were obtained for women delivering in a health facility versus at home. This strong positive association between level of care obtained during pregnancy and the use of safe delivery care may help explain why antenatal care could also be associated with reduced maternal mortality.