Mistreatment of newborns after childbirth in health facilities in Nepal: Results from a prospective cohort observational study.
Mistreatment of newborns after childbirth in health facilities in Nepal: Results from a prospective cohort observational study.
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DOI：
10.1371/journal.pone.0246352
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Målqvist M
中科院分区：
文献类型：
--
作者：
K C A;Moinuddin M;Kinney M;Sacks E;Gurung R;Sunny AK;Bhattarai P;Sharma S;Målqvist M
病人的护理经验反映了卫生机构的卫生保健质量。虽然有多项研究记录了分娩期间对妇女的虐待和不尊重，但关于分娩后立即虐待新生儿的证据有限。本文基于一项大规模的观察性研究，通过评估与尼泊尔分娩后新生儿虐待相关的患病率和风险因素，解决了证据缺口问题。这是一项在尼泊尔4家公立转诊医院进行的为期18个月的前瞻性观察性队列研究。纳入了研究期间在这些机构出生的所有新生儿，他们自主呼吸并接受观察。分析了一套衡量虐待新生儿情况的指标。主成分分析被用来构建一个单一的新生儿虐待指数。单变量、多变量和多水平分析用于测量新生儿虐待指数与人口统计学、产科和新生儿特征之间的关联。共有31，804名新生儿自发呼吸。在纳入的新生儿中，63.0%（95%CI，62.5-63.5）在未经父母同意的情况下接受了医疗干预，25.0%（95%CI，24.5-25.5）未得到善意和尊重（粗暴处理），21.4%（95%CI，20.9-21.8）的新生儿在无医疗需要的情况下进行了吸痰。在新生儿中，71.7%（95% CI，71.2-72.3）在出生后1分钟内进行了脐带夹紧，77.6%（95% CI，77.1-78.1）在出生后1小时内未进行母乳喂养。仅3.5%（95%CI，3.2-3.8）的婴儿出生后在产房保持皮肤接触。虐待指数显示，相对弱势族裔群体妇女所生婴儿和有两胎或两胎以上妇女所生婴儿的虐待差异最大。在调整医院异质性后，30-34岁女性所生婴儿（β，-0.041; p值，0.01）和35岁或以上女性所生婴儿（β，-0.064; p值，与18岁或18岁以下妇女所生婴儿相比，（β，0.077; p值，0.000）比出生于相对较低（婆罗门）种族群体的婴儿更容易受到虐待。女性新生儿（β，0.016; p值，0.015）比男性新生儿更容易受到虐待。尼泊尔公立医院虐待自主呼吸新生儿的情况很严重。不同的医院，产妇种族，产妇年龄和新生儿性别的虐待。减少新生儿虐待需要在政策、卫生系统和个人层面进行干预。此外，还需要进行执行研究，以确定有效的干预措施，减少新生儿出生时的不平等和虐待。
Patient experience of care reflects the quality of health care in health facilities. While there are multiple studies documenting abuse and disrespect to women during childbirth, there is limited evidence on the mistreatment of newborns immediately after childbirth. This paper addresses the evidence gap by assessing the prevalence and risk factors associated with mistreatment of newborns after childbirth in Nepal, based on a large-scale observational study. This is a prospective observational cohort study conducted over a period of 18 months in 4 public referral hospitals in Nepal. All newborns born at the facilities during the study period, who breathed spontaneously and were observed, were included. A set of indicators to measure mistreatment for newborns was analysed. Principal component analysis was used to construct a single newborn mistreatment index. Uni-variate, multi-variate, and multi-level analysis was done to measure the association between the newborn mistreatment index and demographic, obstetric, and neonatal characteristics. A total of 31,804 births of newborns who spontaneously breathed were included. Among the included newborns, 63.0% (95% CI, 62.5–63.5) received medical interventions without taking consent from the parents, 25.0% (95% CI, 24.5–25.5) were not treated with kindness and respect (roughly handled), and 21.4% (95% CI, 20.9–21.8) of them were suctioned with no medical need. Among the newborns, 71.7% (95% CI, 71.2–72.3) had the cord clamped within 1 minute and 77.6% (95% CI, 77.1–78.1) were not breast fed within 1 hour of birth. Only 3.5% (95% CI, 3.2–3.8) were kept in skin to skin contact in the delivery room after birth. The mistreatment index showed maximum variation in mistreatment among those infants born to women of relatively disadvantaged ethnic groups and infants born to women with 2 or previous births. After adjusting for hospital heterogeneity, infants born to women aged 30–34 years (β, -0.041; p value, 0.01) and infants born to women aged 35 years or more (β, -0.064; p value, 0.029) were less mistreated in reference to infants born to women aged 18 years or less. Infants born to women from the relatively disadvantaged (chhetri) ethnic groups (β, 0.077; p value, 0.000) were more likely to be mistreated than the infants born to relatively advantaged (brahmin) ethnic groups. Female newborns (β, 0.016; p value, 0.015) were more likely to be mistreated than male newborns. The mistreatment of spontaneously breathing newborns is high in public hospitals in Nepal. Mistreatment varied by hospital, maternal ethnicity, maternal age, and sex of the newborn. Reducing mistreatment of newborns will require interventions at policy, health system, and individual level. Further, implementation studies will be required to identify effective interventions to reduce inequity and mistreatment of newborns at birth.
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DOI：
10.1016/s0140-6736(18)31668-4
发表时间：
2018-11-17
期刊：
Lancet (London, England)
影响因子：
--
作者：
Kruk ME;Gage AD;Joseph NT;Danaei G;García-Saisó S;Salomon JA
通讯作者：
Salomon JA
影响因子：
8
作者：
Ashish, K. C.;Lawn, Joy E.;Singhal, Nalini
通讯作者：
Singhal, Nalini
影响因子：
3.4
作者：
Asefa, Anteneh;Bekele, Delayehu
通讯作者：
Bekele, Delayehu
影响因子：
4.6
作者：
Langer, Julia A.;Ramos, Julia V.;Burkey, Matthew D.
通讯作者：
Burkey, Matthew D.
影响因子：
2.6
作者：
Sagili, Haritha;Pramya, N.;Rani, P. Reddi
通讯作者：
Rani, P. Reddi