Alma-Ata: Rebirth and revision 6 - Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?
Alma-Ata: Rebirth and revision 6 - Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?
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DOI：
10.1016/s0140-6736(08)61407-5
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发表时间：
2008-09-13
期刊：
影响因子：
168.9
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Bhutta, Zulfiqar A.;Ali, Samana;Black, Robert E.
最近对孕产妇、新生儿和儿童健康（MNCH）和死亡率的几次审查强调，有大量的干预措施可以减少死亡和残疾。孕产妇和保健的重点各不相同，建议在设施一级提供熟练护理，以挽救孕产妇生命，并扩大社区和家庭护理，以提高新生儿和儿童的存活率。对潜在有用的干预措施和提供战略的新证据进行系统审查，确定了37项关键的促进、预防和治疗干预措施和初级卫生保健提供战略。有些特别适合通过社区支助团体和保健工作者提供，而另一些则只能通过将基于社区的战略与第一级转诊设施相联系来提供。对巴基斯坦和乌干达孕产妇和新生儿保健指标的个案研究显示了如何有效地利用初级保健干预措施。在这两个国家，将循证干预措施纳入初级卫生保健方案的实际覆盖范围，可以预防20-30%的孕产妇死亡（在一级设施中有能力进行剖腹产的可达32%）、20-21%的新生儿死亡和29-40%的5岁以下儿童新生儿死亡。加强初级保健一级的孕产妇和保健应是各国实现千年发展目标中降低孕产妇和儿童死亡率的具体目标的优先事项。
Several recent reviews of maternal, newborn, and child health (MNCH) and mortality have emphasised that a large range of interventions are available with the potential to reduce deaths and disability. The emphasis within MNCH varies, with skilled care at facility levels recommended for saving maternal lives and scale-up of community and household care for improving newborn and child survival. Systematic review of new evidence on potentially useful interventions and delivery strategies identifies 37 key promotional, preventive, and treatment interventions and strategies for delivery in primary health care. Some are especially suitable for delivery through community support groups and health workers, whereas others can only be delivered by linking community-based strategies with functional first-level referral facilities. Case studies of MNCH indicators in Pakistan and Uganda show how primary health-care interventions can be used effectively. Inclusion of evidence-based interventions in MNCH programmes in primary health care at pragmatic coverage in these two countries could prevent 20-30% of all maternal deaths (up to 32% with capability for caesarean section at first-level facilities), 20-21% of newborn deaths, and 29-40% of all postneonatal deaths in children aged less than 5 years. Strengthening MNCH at the primary health-care level should be a priority for countries to reach their Millennium Development Goal targets for reducing maternal and child mortality.