The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya
The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya
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DOI：
10.1186/s12884-015-0645-6
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发表时间：
2015-09-22
影响因子：
3.1
通讯作者：
Warren, Charlotte E.
中科院分区：
文献类型：
--
作者：
Abuya, Timothy;Ndwiga, Charity;Warren, Charlotte E.
背景资料：分娩和分娩期间的不尊重和虐待是与人权、公平和公共卫生相关的重要问题，也影响妇女在设施中分娩的决定，这些设施提供对孕产妇和新生儿并发症的适当管理。鲜为人知的是干预措施，旨在降低频率的不尊重和虐待behaviors.Methods：在2011年和2014年之间，一个前和后的研究测量D & A水平在三级干预在13个设施在肯尼亚的Heshima项目。干预措施包括与政策制定者合作，鼓励更多地关注D & A，培训提供者尊重产妇护理，并加强设施与社区之间的联系，以实现问责制和治理。在参与机构，产后妇女在出院时被要求参加研究;同意参加研究的人被管理一份关于D & A的问卷，以及六种类型，包括身体和言语虐待，侵犯机密和隐私，因不付款而被拘留和遗弃。在相同的设施中，还观察了分娩期间的医患互动。在退出访谈和观察性研究，多变量分析的危险因素D & A控制的差异，在社会人口和设施的特点之间的基线和endline surveillance.Results：总体D & A下降从20- 13%（p < 0.004）和四个的六个类型D & A下降从40- 50%。夜班分娩与更大的言语和身体虐待有关。病人和婴儿滞留显着下降，从8.0- 0.8%，虽然这是部分归因于2013年国家免费分娩护理policy.Conclusion：虽然一些背景因素可能会影响这些结果，所观察到的下降幅度和一致性表明，多组分干预可能有可能减少D & A的频率。需要作出更大的努力，制定更有力的评价方法，以评估其他环境中的D & A。
Background: Disrespect and abuse (D & A) during labor and delivery are important issues correlated with human rights, equity, and public health that also affect women's decisions to deliver in facilities, which provide appropriate management of maternal and neonatal complications. Little is known about interventions aimed at lowering the frequency of disrespectful and abusive behaviors.Methods: Between 2011 and 2014, a pre- and-post study measured D & A levels in a three-tiered intervention at 13 facilities in Kenya under the Heshima project. The intervention involved working with policymakers to encourage greater focus on D & A, training providers on respectful maternity care, and strengthening linkages between the facility and community for accountability and governance. At participating facilities, postpartum women were approached at discharge and asked to participate in the study; those who consented were administered a questionnaire on D & A in general as well as six typologies, including physical and verbal abuse, violations of confidentiality and privacy, detainment for non-payment, and abandonment. Observation of provider-patient interaction during labor was also conducted in the same facilities. In both exit interview and observational studies, multivariate analyses of risk factors for D & A controlled for differences in socio-demographic and facility characteristics between baseline and endline surveys.Results: Overall D & A decreased from 20-13 % (p < 0.004) and among four of the six typologies D & A decreased from 40-50 %. Night shift deliveries were associated with greater verbal and physical abuse. Patient and infant detainment declined dramatically from 8.0-0.8 %, though this was partially attributable to the 2013 national free delivery care policy.Conclusion: Although a number of contextual factors may have influenced these findings, the magnitude and consistency of the observed decreases suggest that the multi-component intervention may have the potential to reduce the frequency of D & A. Greater efforts are needed to develop stronger evaluation methods for assessing D & A in other settings.