Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis.
Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis.
复制标题
DOI：
10.1371/journal.pone.0139288
复制
发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Ghana EMBRACE Implementation Research Project Team
中科院分区：
文献类型：
--
作者：
Kikuchi K;Ansah EK;Okawa S;Enuameh Y;Yasuoka J;Nanishi K;Shibanuma A;Gyapong M;Owusu-Agyei S;Oduro AR;Asare GQ;Hodgson A;Jimba M;Ghana EMBRACE Implementation Research Project Team
持续护理通过确保对母亲和儿童的护理，有可能改善孕产妇、新生儿和儿童健康。人们普遍认为，孕产妇和新生儿保健的连续性护理包括连续的时间（从孕前到母亲和儿童）和空间（从社区-家庭护理到临床护理）。然而，目前还不清楚的护理联系可能有更大的影响MNCH的结果。本研究的目的是评估不同的连续护理联系在降低低收入和中等收入国家新生儿、围产期和孕产妇死亡率方面的有效性。我们搜索了随机和半随机对照试验，这些试验涉及两个或多个连续护理的联系，并试图增加母亲对产前护理、熟练助产和产后护理的接受。结果变量为新生儿、围产期和孕产妇死亡率。在检索到的7，142篇文章中，我们选择了19篇作为最终分析的合格文章。在这些研究中，有13项采用了将产前护理、熟练助产和产后护理联系起来的一揽子干预措施。每项研究都使用了将产前护理与熟练助产护理或熟练助产护理与产后护理联系起来的一揽子措施。四项研究使用了一套干预措施，将产前护理和产后护理联系起来。在产前护理、熟练助产和产后护理相联系的一揽子措施中，观察到新生儿、围产期和孕产妇死亡风险显著降低（RR 0.83; 95% CI 0.77 - 0.89，I2 79%）。此外，这种联系降低了合并新生儿，围产期和孕产妇死亡率时，整合连续的护理空间的尺寸（RR 0.85; 95%CI 0.77至0.93，I2 81%）。我们的回顾表明，持续的产前保健，熟练的助产和产后护理是必要的，以改善低收入和中等收入国家的MNCH结果。该审查对减少新生儿和围产期死亡率得出了结论。虽然产妇死亡率没有显著下降，但所有死亡率的综合衡量标准却有所下降。因此，有足够的证据来扩大这一干预方案，以改善MNCH的结果。
Continuum of care has the potential to improve maternal, newborn, and child health (MNCH) by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood) and space dimensions (from community-family care to clinical care). However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries. We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers’ uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality. Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%). Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%). Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the reduction of neonatal and perinatal deaths. Although maternal deaths were not significantly reduced, composite measures of all mortality were. Thus, the evidence is sufficient to scale up this intervention package for the improvement of MNCH outcomes.