Perinatal interventions and survival in resource-poor settings: which work, which don't, which have the jury out?
Perinatal interventions and survival in resource-poor settings: which work, which don't, which have the jury out?
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DOI：
10.1136/adc.2009.179366
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发表时间：
2010-12
影响因子：
5.2
通讯作者：
Prost A
中科院分区：
文献类型：
--
作者：
Osrin D;Prost A
围产期状况对低收入国家的疾病负担影响最大。尽管新生儿后死亡率有所下降，但非洲和亚洲许多国家的死产和早期新生儿死亡率仍然很高，而且死亡率集中在出生前后。我们的文章首先考虑了对改善围产期生存的“干预”解释的差异。我们确定了三种类型的干预：单一行动、一揽子行动的集合以及更广泛的社会或系统方法。我们使用这种分类来总结最近的系统评价和荟萃分析的结果。在描述了基于社区的围产期护理有效性的不断增长的证据基础之后，我们讨论了当前对整合的担忧：妇女和儿童健康计划、基于社区和机构的护理以及正规和非正规部门人力资源的整合。最后，我们对低收入国家妇女及其家庭面临的选择的复杂性进行了一些思考，特别是考虑到非政府和私营部门医疗保健的增长。
Perinatal conditions make the largest contribution to the burden of disease in low-income countries. Although postneonatal mortality rates have declined, stillbirth and early neonatal mortality rates remain high in many countries in Africa and Asia, and there is a concentration of mortality around the time of birth. Our article begins by considering differences in the interpretation of ‘intervention’ to improve perinatal survival. We identify three types of intervention: a single action, a collection of actions delivered in a package and a broader social or system approach. We use this classification to summarise the findings of recent systematic reviews and meta-analyses. After describing the growing evidence base for the effectiveness of community-based perinatal care, we discuss current concerns about integration: of women’s and children’s health programmes, of community-based and institutional care, and of formal and informal sector human resources. We end with some thoughts on the complexity of choices confronting women and their families in low-income countries, particularly in view of the growth in non-government and private sector healthcare.
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