目标:审查12个低收入和中等收入国家(LMICs)国家以下一级的妇幼保健(MCH)服务的能力和质量及其与中间卫生产出(如覆盖率和获得护理的机会)的关系。
方法:使用2007年至2019年服务提供评估调查和人口健康调查的匹配国家以下数据进行观察性横断面研究。
方法:在12个低收入国家/地区提供调查数据的138个国家以下地区(阿富汗,孟加拉国,刚果民主共和国,海地,肯尼亚,马拉维,纳米比亚,尼泊尔,卢旺达,塞内加尔,坦桑尼亚和乌干达)。
结果:探讨了八个中间的妇幼保健结果/产出:(1)通过现代方法满足计划生育的需要;(2)参加四次或更多次的产前护理;(3)感知到的护理财务障碍;(4)感知到的护理地理障碍;(5)白喉-百日咳-破伤风(DPT)第三剂量覆盖率;(6)DPT-寻求补水治疗的
结果:总体而言,在12个国家/地区观察到中等至较差的PHC表现,在能力和质量子领域中,同一国家的不同国家以下地区之间以及同一国家以下地区之间存在很大的异质性。对PHC服务提供与儿童健康结果之间关系的分析显示,最近的监督(b=0.34,p<0.01)和监督者的反馈(b=0.28,p<0.05)均与寻求治疗的增加有关肺炎。我们还观察到能力和质量的几种测量与DPT免疫的关联。对孕产妇健康结果的分析仅在p<0.05水平上产生了一些具有统计学意义的结果,然而,在调整其他协变量后,没有一个仍然显著。
结论:该分析的结果说明了LMIC内PHC服务提供能力和质量的异质性。寻求加强其PHC系统的国家可以改善国家以下一级的PHC监测,以更好地了解国家以下各级服务提供方面的瓶颈。
To examine the capacity and quality of maternal and child health (MCH) services at the subnational primary healthcare (PHC) level in 12 low-income and middle-income countries (LMICs) and its association with intermediate health outputs such as coverage and access to care.
Observational cross-sectional
study using matched subnational data from service provision assessment surveys and demographic health surveys from 2007 to 2019.
138 subnational areas with available survey data in 12 LMICs (Afghanistan, Bangladesh, Democratic Republic of Congo, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania and Uganda).
Eight intermediate MCH outcomes/outputs were explored: (1) met need for family planning by modern methods; (2) attendance of four or more antenatal care visits; (3) perceived financial barriers to care; (4) perceived geographical barriers to care; (5) diphtheria-pertussis-tetanus (DPT) third dose coverage; (6) DPT dropout-rate; (7) care-seeking for pneumonia; and (8) oral rehydration solutions coverage.
Overall, moderate-to-poor PHC performance was observed across the 12 countries, with substantial heterogeneity between the different subnational areas in the same country as well as within the same subnational area across both capacity and quality subdomains. The analysis of the relationship between PHC service delivery and child health outcomes revealed that recent supervision (b=0.34, p<0.01) and supervisors\' feedback (b=0.28, p<0.05) were each associated with increased care-seeking for pneumonia. We also observed the associations of several measures of capacity and quality with DPT immunisation. The analysis of maternal health outcomes yielded only a few statistically significant results at p<0.05 level, however, none remained significant after adjusting for other covariates.
The results of this analysis illustrate the heterogeneity in the capacity and quality of PHC service delivery within LMICs. Countries seeking to strengthen their PHC systems could improve PHC monitoring at the subnational level to better understand subnational bottlenecks in service delivery.