■尽管有证据表明产前护理(ANC)服务质量差,在对每次ANC访问的人口水平以及ANC服务来源的质量调整覆盖率的理解方面仍然存在显着差距,在这个覆盖范围内也是公平的。
■2020年7月至2021年6月之间的所有出生都来自比哈尔邦的261,124户家庭(91.5%的参与率)。所有死产和新生儿死亡的母亲,在新生儿期存活的25%的活产随机样本中,提供了每次ANC就诊的数据,最多可进行前4次ANC就诊,包括ANC服务的来源和接收的服务(重量测量,检查血压,腹部检查,采集尿液样本,和采集的血液样本)。如果在该访问中收到所有这些服务,则认为ANC访问是高质量的。我们报告了按ANC服务来源和财富指数(WI)分类的ANC访问1-4的质量调整后的ANC服务(Q-ANC)的覆盖率。报告加权比例以考虑取样设计。
■29,517名妇女报告了30,412例分娩,8853名合格妇女中有7270人(82.1%)参加。总的来说,来自6929名妇女的19,950次独特的ANC访问可供分析,其中41.7%,13.8%和44.5%在乡村健康和营养日(VNHD),公共设施,和一个私人提供者,分别。VHND共进行了4409次(65.3%)的第一次ANC访问,从ANC访视1到ANC访视4,私人提供者的ANC访视比例显着增加(p<0.001)。考虑到所有ANC访问,Q-ANC覆盖率为20.9%(95%CI20.7-21.2);为0.9%(95%CI0.8-1.0),VHND中ANC就诊的29.9%(95%CI29.2-30.7)和36.9%(95%CI36.5-37.4),公共设施,和私人提供者,分别。与第1至3次就诊相比,第4次ANC就诊时,公共设施中的Q-ANC覆盖率明显较低(25.1%;95%CI23.4-26.9),而与私人提供者的第1次ANC就诊时最高(50.2%;95%CI49.2-51.1),然后在第2至4次就诊时下降。无论ANC服务的来源如何,Q-ANC覆盖率随着ANC访问1和2的WI四分位数的增加而显着增加,WI四分位数3的女性与其他女性相比,ANC访问3的覆盖率明显较少,在ANC4访问的覆盖率中没有显着差异。对于公共设施和私人提供者的访问,可以看到WI对每次ANC访问的Q-ANC覆盖的不同模式。
■在10次ANC访问中只有2次被认为质量足够,无论妊娠期如何,每位孕妇都需要持续提供优质的ANC服务,ANC访问次数,和ANC服务的来源。
■资金由比尔和梅林达·盖茨基金会印度办事处提供,美国。
UNASSIGNED: Despite the evidence on the poor quality of antenatal care (ANC) services, significant gap remains in the understanding of quality-adjusted coverage at the population-level for each ANC visit and by the source of ANC services, and in equity in this coverage.
UNASSIGNED: All births between July 2020 and June 2021 were listed from 261,124 households (91.5% participation) representative of the Bihar state. Mothers of all stillbirths and neonatal deaths, and of 25% random sample of livebirths who survived the neonatal period provided data on each ANC visit up to a maximum of first 4 ANC visits, including the source of ANC services and the services received (weight measurement, blood pressure checked, abdomen checked, urine sample taken, and blood sample taken). An ANC visit was deemed of quality if all of these services were received in that visit. We report the coverage of quality-adjusted ANC services (Q-ANC) for ANC visits 1-4 disaggregated by source of ANC services and wealth index (WI). Weighted proportions are reported to take into account the sampling design.
UNASSIGNED: A total of 30,412 births were reported by 29,517 women, and 7270 (82.1%) of the 8853 eligible women participated. Overall, 19,950 unique ANC visits from 6929 women were available for analysis, of which 41.7%, 13.8% and 44.5% were at Village Health and Nutrition Day (VNHD), public facility, and with a private provider, respectively. A total of 4409 (65.3%) of the 1st ANC visits were undertaken at VHND, with the proportion of private provider ANC visits increasing significantly from ANC visit 1 to ANC visit 4 (p < 0.001). Q-ANC coverage considering all ANC visits was 20.9% (95% CI 20.7-21.2); and was 0.9% (95% CI 0.8-1.0), 29.9% (95% CI 29.2-30.7) and 36.9% (95% CI 36.5-37.4) for ANC visits in VHND, public facilities, and with private provider, respectively. Q-ANC coverage in the public facility was significantly lower in the 4th ANC visit (25.1%; 95% CI 23.4-26.9) as compared with visits 1 to 3, whereas it was the highest for 1st ANC visit with private provider (50.2%; 95% CI 49.2-51.1) and then dropped for visits 2 to 4. Irrespective of the source of ANC services, Q-ANC coverage increased significantly with increasing WI quartile for ANC visits 1 and 2, with WI quartile 3 women having significantly less coverage for ANC visit 3 compared to the rest, and no significant difference seen in the coverage of ANC 4 visit. Varied pattern of Q-ANC coverage by WI for each ANC visit was seen for public facility and private provider visits.
UNASSIGNED: With only 2 of 10 ANC visits deemed of adequate quality, sustainable delivery of quality ANC services are needed for every pregnant woman through-out the pregnancy irrespective of gestation period, number of ANC visit, and source of ANC services.
UNASSIGNED: The funding was provided by the India office of the Bill & Melinda Gates Foundation, USA.