背景:在社会经济上处于不利地位的妇女的孕产妇健康状况较差。产妇保健干预措施往往无法惠及最需要的人,并可能加剧不平等。在包奇州,尼日利亚,最近的一项整群随机对照试验(CRCT)显示,对孕妇及其配偶进行普遍家访对孕产妇健康结局有显著影响.家庭访客分享了有关家庭本身可采取的当地风险因素的证据,该计划包括确保干预地区的所有家庭都能接受访问的具体努力。
目的:检查干预实施的公平性及其对公平性的影响。
■总体研究是阶梯式楔形设计的CRCT,检查15,912名孕妇的结局。
方法:我们根据社区的公平因素,检查了家庭访视(三次或更多次访视)的覆盖率及其对产妇健康结果的影响。家庭,和个人水平。
结果:处境不利的孕妇(生活在农村社区,来自最贫穷的家庭,和没有受过教育的人)和那些不太弱势的人一样有可能接受三次或更多的访问。改善母亲对危险迹象和配偶交流的知识,减少繁重的工作,妊娠并发症,根据相同的公平因素,弱势女性的产后败血症明显更大。
结论:普遍家访具有公平的覆盖面,所有孕妇,包括那些不访问基于设施的服务的人,并对孕产妇健康产生了重要的公平影响。
BACKGROUND: Socio-economically disadvantaged women have poor maternal health outcomes. Maternal health interventions often fail to reach those who need them most and may exacerbate inequalities. In Bauchi State, Nigeria, a recent cluster randomised controlled trial (CRCT) showed an impressive impact on maternal health outcomes of universal home visits to pregnant women and their spouses. The home visitors shared evidence about local risk factors actionable by households themselves and the program included specific efforts to ensure all households in the intervention areas received visits.
OBJECTIVE: To examine equity of the intervention implementation and its pro-equity impact.
UNASSIGNED: The overall study was a CRCT in a stepped wedge design, examining outcomes among 15,912 pregnant women.
METHODS: We examined coverage of the home visits (three or more visits) and their impact on maternal health outcomes according to equity factors at community, household, and individual levels.
RESULTS: Disadvantaged pregnant women (living in rural communities, from the poorest households, and without education) were as likely as those less disadvantaged to receive three or more visits. Improvements in maternal knowledge of danger signs and spousal communication, and reductions in heavy work, pregnancy complications, and post-natal sepsis were significantly greater among disadvantaged women according to the same equity factors.
CONCLUSIONS: The universal home visits had equitable coverage, reaching all pregnant women, including those who do not access facility-based services, and had an important pro-equity impact on maternal health.