Healthy Start Program and Feto-Infant Morbidity Outcomes: Evaluation of Program Effectiveness
Healthy Start Program and Feto-Infant Morbidity Outcomes: Evaluation of Program Effectiveness
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DOI：
10.1007/s10995-008-0400-y
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发表时间：
2009-01-01
影响因子：
2.3
通讯作者：
Berry, Lo
中科院分区：
文献类型：
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作者：
Salihu, Hamisu M.;Mbah, Alfred K.;Berry, Lo
目的评价社区健康启动干预项目对母婴发病率的影响。方法将2002年至2007年在中央希尔斯伯勒县进行的联邦政府资助的健康启动干预项目中的前瞻性数据与佛罗里达州卫生部相应的出生结果数据合并。在接受服务的人群中评估了该项目对以下胎儿-婴儿发病率指数的影响：低出生体重(LBW)、极低出生体重(VLBW)、早产、极早产、小于胎龄(SGA)和综合胎儿-婴儿发病率结果。使用Logistic回归模型的优势比和需要治疗的数量(NNT)来衡量计划的有效性和影响。结果与非接受者(N=2,815)相比，接受服务者(N=536)发生低出生体重(OR=0.7；95%CI=0.5~1.0)、早产(OR=0.7；95%CI=0.5~0.9)和胎儿-婴儿综合发病率(OR=0.8；95%CI=0.6~0.9)的风险降低。极低出生体重(OR=0.5；95%CI=0.2-1.1)和极早产(OR=0.6；95%CI=0.3-1.2)也是临床上重要的风险降低水平，尽管这些没有达到统计学意义。调整后的NNT在综合胎儿-婴儿发病率结果(18例)、早产(21例)和低出生体重(24例)方面最低，在极早产(86例)和极低出生体重(74例)事件中最高。结论在弱势社区环境中，健康开始干预计划可将极低出生体重和早产的风险降低约三分之一。
Objective We evaluate the impact of the Healthy Start intervention program on feto-infant morbidity within a community setting. Methods Prospective data from 2002 to 2007 within the ongoing Federally funded Healthy Start intervention project in Central Hillsborough County were merged with corresponding birth outcomes data from the Florida Department of Health. The impact of the project on the following feto-infant morbidity indices was assessed among service recipients: low birth weight (LBW), very low birth weight (VLBW), preterm, very preterm, small for gestational age (SGA) and a composite feto-infant morbidity outcome. Program effectiveness and impact were measured using odds ratios from logistic regression models and number needed to treat (NNT). Results The risk for low birth weight (OR = 0.7; 95% CI = 0.5-1.0), preterm (OR = 0.7; 95% CI = 0.5-0.9) and the composite feto-infant morbidity outcome (OR = 0.8; 95% CI = 0.6-0.9) was reduced among service recipients (N = 536) as compared to non-recipients (N = 2,815). A clinically important level of risk reduction was also noted for very low birth weight (OR = 0.5; 95% CI = 0.2-1.1) and very preterm (OR = 0.6; 95% CI = 0.3-1.2) although these did not reach statistical significance. The adjusted NNT was lowest for the composite feto-infant morbidity outcome (18), preterm birth (21) and low birth weight (24), and highest for very preterm (86) and very low birth weight (74) events. Conclusions In a disadvantaged community setting, the Healthy Start intervention program was found to reduce the risk for very low birth weight and preterm births by about one-third.