Increasing access to care for sick newborns: evidence from the Ghana Newhints cluster-randomised controlled trial.
Increasing access to care for sick newborns: evidence from the Ghana Newhints cluster-randomised controlled trial.
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DOI：
10.1136/bmjopen-2015-008107
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发表时间：
2016-06-13
期刊：
影响因子：
2.9
通讯作者：
Kirkwood BR
中科院分区：
文献类型：
--
作者：
Manu A;Hill Z;Ten Asbroek AH;Soremekun S;Weobong B;Gyan T;Tawiah-Agyemang C;Danso S;Amenga-Etego S;Owusu-Agyei S;Kirkwood BR
评价纽因茨社区监测志愿者（CBSV）评估和转诊对患病新生儿获得护理的影响以及对现有不平等的影响。我们评估了一个嵌套在纽因茨随机分组对照试验中的前瞻性队列。在加纳布龙-阿哈福地区七个相邻地区的750 000多人（主要是农村人口）中开展了以社区为基础的干预活动。 参与者是最近分娩的妇女（来自超过120 000名受监测的妇女）及其16 168名活产婴儿。 定性深入访谈转诊叙述（IDIs）进行了92母亲，CBSV和卫生设施前台和产科/儿科病房的工作人员。2008年11月至2009年12月期间，Newhints培训并有效监督了98个监督区（集群）中49个区的475名社区卫生服务人员（加纳卫生服务局现有人员），以评估新生儿，并在出生后第一周内将其转介到卫生设施;促进为患病新生儿寻求独立护理，并围绕障碍解决问题。主要评价结果是新生儿疾病转诊和独立护理寻求的依从率。在4006例抽样中，2795例（69.8%）近期分娩的妇女接受了CBSV评估访视，279例（10.0%）新生儿出现危险体征。转诊的依从性前所未有地高（86.0%），最贫穷的五分之一妇女（Q1）的依从性好于最不贫穷的妇女（Q5）：87.5%（Q1）对69.7%（Q5）; p=0.038。四分之三的人去医院; 18%的人住院，58%的人接受门诊治疗。一些（24%）母亲被拒之门外，后续的IDIs显示，这些未经治疗的婴儿中有一些随后死亡。在纽辛斯区，重症新生儿疾病的独立护理寻求从对照组的55.4%增加到77.3%，特别是在Q1，寻求护理几乎翻了一番（95.0%对48.6%; RR=1.94（1.32，2.84）; p=0.001）。农村居民的比例最高，但城市居民的遵守速度更快。家访是可行的，也是将患病新生儿与设施联系起来的一种潜在的扶贫办法。它在提高生存率方面的有效性取决于设施护理质量的相应改善。NCT 00623337。
To evaluate the impact of Newhints community-based surveillance volunteer (CBSV) assessments and referrals on access to care for sick newborns and on existing inequities in access. We evaluated a prospective cohort nested within the Newhints cluster-randomised controlled trial. Community-based intervention involving more than 750 000, predominantly rural, population in seven contiguous districts in the Brong-Ahafo Region, Ghana. Participants were recently delivered women (from more than 120 000 women under surveillance) and their 16 168 liveborn babies. Qualitative in-depth interviews with referral narratives (IDIs) were conducted with 92 mothers, CBSVs and health facility front-desk and maternity/paediatrics ward staff. Newhints trained and effectively supervised 475 CBSVs (existing within the Ghana Health Service) in 49 of 98 supervisory zones (clusters) to assess and refer newborns with any of the 10-key-danger signs to health facilities within the first week after birth; promote independent care seeking for sick newborns and problem-solve around barriers between November 2008 and December 2009. The main evaluation outcomes were rates of compliance with referrals and independent care seeking for newborn illnesses. Of 4006 sampled, 2795 (69.8%) recently delivered women received CBSV assessment visits and 279 (10.0%) newborns were referred with danger signs. Compliance with referrals was unprecedentedly high (86.0%) with women in the poorest quintile (Q1) complying better than the least poor (Q5):87.5%(Q1) vs 69.7%(Q5); p=0.038. Three-quarters went to hospitals; 18% were admitted and 58% received outpatient treatment. Some (24%) mothers were turned away at facilities and follow-on IDIs showed that some of these untreated babies subsequently died. Independent care seeking for severe newborn illness increased from 55.4% in control to 77.3% in Newhints zones, especially among Q1 where care seeking almost doubled (95.0% vs 48.6%; RR=1.94 (1.32, 2.84); p=0.001). Rates were the highest among rural residents but urban residents complied quicker. Home visits are feasible and a potentially pro-poor approach to link sick newborns to facilities. Its effectiveness in improving survival hinges on matched improvement in facility quality of care. NCT00623337.