Missed Opportunities in Neonatal Deaths in Rwanda: Applying the Three Delays Model in a Cross-Sectional Analysis of Neonatal Death
Missed Opportunities in Neonatal Deaths in Rwanda: Applying the Three Delays Model in a Cross-Sectional Analysis of Neonatal Death
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DOI：
10.1007/s10995-016-2210-y
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发表时间：
2017-05-01
影响因子：
2.3
通讯作者：
Ngabo, Fidele
中科院分区：
文献类型：
--
作者：
Wilmot, Efua;Yotebieng, Marcel;Ngabo, Fidele
目的及时实施循证干预措施，减少早产儿感染、产时损伤及并发症等新生儿死亡。用于了解孕产妇死亡情况的“三延误”模式（寻求护理延误、到达保健设施延误和获得适当护理延误）可能有助于了解新生儿死亡情况。我们评估卢旺达新生儿死亡的主要原因及其相关的延误。方法采用横断面研究设计，我们评估了2012年40家分娩婴儿的机构的数据。每个设施的审计委员会审查了该设施的每例新生儿死亡，并使用结构化问卷向卫生部报告了调查结果。调查表中的信息集中在一个电子数据库中。截至2012年底，数据库中有卢旺达5个省40个卫生设施（主要是地区医院）的记录，并用于这项分析。结果1324例新生儿死亡原因依次为窒息及其并发症（36.7%）、下呼吸道感染（22.5%）、早产（22.4%）。近四分之三的新生儿至少经历了一次延迟：孕产妇寻求护理延迟22.1%，孕产妇到达护理延迟11.2%，孕产妇适当护理延迟14.2%，新生儿寻求护理延迟8.1%，新生儿到达护理延迟9.3%，新生儿适当护理延迟29.1%。每一个主要死因的新生儿在统计学上显着增加的几率经历产妇延迟寻求照顾。窒息死亡增加了经历所有三种产妇延迟的几率。LRTI死亡增加了所有三种新生儿延迟的几率。结论：在卢旺达，妇女在寻求产科护理方面的延误是与新生儿死亡的主要原因相关的一个关键因素。提高产科护理质量可以减少新生儿窒息死亡。同样，减少所有三种延迟可以减少由于LRTI导致的新生儿死亡。
Objective Administered in a timely manner, current evidence-based interventions could reduce neonatal deaths from infections, intrapartum injuries and complications due to prematurity. The three delays model (delay in seeking care, in arriving at a health facility, and in receiving adequate care), which has been applied to understanding maternal deaths, may be useful for understanding neonatal deaths. We assess the main causes of neonatal deaths in Rwanda and their associated delays. Methods Using a cross-sectional study design, we evaluated data from 2012 from 40 facilities in which babies were delivered. Audit committees in each facility reviewed each neonatal death in the facility and reported finding to the Ministry of Health using structured questionnaires. Information from questionnaires were centralized in an electronic database. At the end of 2012, records from 40 health facilities across Rwanda's five provinces (mainly district hospitals) were available in the database and were used for this analysis. Results Of the 1324 neonates, the major causes of death were: asphyxia and its complications (36.7%), lower respiratory tract infections (LRTI) (22.5%), and prematurity (22.4%). At least one delay was experienced by nearly three-quarters of neonates: Maternal Delay in Seeking Care 22.1%, Maternal Delay in Arrival to Care 11.2%, Maternal Delay in Adequate Care 14.2%, Neonatal Delay in Seeking Care 8.1%, Neonatal Delay in Arrival to Care 9.3%, and Neonatal Delay in Adequate Care 29.1%. Neonates with each of the main causes of death had statistically significantly increased odds of experiencing Maternal Delay in Seeking Care. Asphyxia deaths had increased odds of experiencing all three Maternal Delays. LRTI deaths had increased odds of all three Neonatal Delays. Conclusion Delays for women in seeking obstetrical care is a critical factor associated with the main causes of neonatal death in Rwanda. Improving obstetrical care quality could reduce neonatal deaths due to asphyxia. Likewise, reducing all three delays could reduce neonatal deaths due to LRTI.