■尽管在改善孕产妇和新生儿健康方面取得了实质性进展,印度的新生儿死亡率和死产率仍然很高。一个原因可能是许多分娩发生在缺乏先进服务的医疗机构,例如剖腹产,输血,或新生儿重症监护。基于妊娠危险因素的分层用于指导“高危”妇女进入先进设施。为了评估风险分层指导设施选择的效用,我们估计了印度被归类为"低风险"的女性中不良新生儿结局的频率.
■我们使用了2019-21第五次全国家庭健康调查(NFHS-5)-印度的人口和健康调查-其中包括针对15-49岁女性的模块。除了妊娠史和结局,调查收集了一系列风险因素,包括生物标志物。我们使用国家产科风险指南将女性分为“高风险”和“低风险”,并评估了死产的频率,新生儿死亡,和计划外的剖腹产为受访者的最后一次怀孕持续7个月或更长时间在过去的五年。我们计算了印度所有州非医院设施的分娩比例。
■使用近176,699次怀孕的数据,我们发现,根据国家指南,印度46.6%的新生儿死亡和56.3%的死胎是“低风险”女性。被归类为“低风险”的妇女的剖腹产率为8.4%(95%CI8.1-8.7%),略低于全国平均水平10.0%(95%CI9.8-10.3%)。在整个印度,32.0%(95%CI31.5-32.5%)的交付发生在可能缺乏高级服务的设施中。全国各地差异很大,旁遮普邦的非医院公共设施分娩率不到5%,喀拉拉邦,和德里相比,奥里萨邦超过40%,中央邦,还有拉贾斯坦邦.在医院分娩率最高的州,新生儿死亡率往往较低。
■基于怀孕中确定的因素的个体风险分层无法准确预测印度哪些妇女将出现分娩并发症,并经历死产和新生儿死亡。因此,“低风险”的确定不应用于指导妇女前往缺乏关键救生服务的保健设施,包括剖腹产,输血,和先进的新生儿复苏和护理。
■比尔和梅琳达·盖茨基金会和世界银行。调查结果,论文中表达的解释和结论完全是作者的解释和结论,并不代表盖茨基金会或世界银行的观点,其执行董事,或者他们所代表的国家。
UNASSIGNED: Despite substantial progress in improving maternal and newborn health, India continues to experience high rates of newborn mortality and stillbirths. One reason may be that many births happen in health facilities that lack advanced services-such as Caesarean section, blood transfusion, or newborn intensive care. Stratification based on pregnancy risk factors is used to guide \'high-risk\' women to advanced facilities. To assess the utility of risk stratification for guiding the choice of facility, we estimated the frequency of adverse newborn outcomes among women classified as \'low risk\' in India.
UNASSIGNED: We used the 2019-21 Fifth National Family Health Survey (NFHS-5)-India\'s Demographic and Health Survey-which includes modules administered to women aged 15-49 years. In addition to pregnancy history and outcomes, the survey collected a range of risk factors, including biomarkers. We used national obstetric risk guidelines to classify women as \'high risk\' versus \'low risk\' and assessed the frequency of stillbirths, newborn deaths, and unplanned Caesarean sections for the respondent\'s last pregnancy lasting 7 or more months in the past five years. We calculated the proportion of deliveries occurring at non-hospital facilities in all the Indian states.
UNASSIGNED: Using data from nearly 176,699 recent pregnancies, we found that 46.6% of India\'s newborn deaths and 56.3% of stillbirths were among women who were \'low risk\' according to national guidelines. Women classified as \'low risk\' had a Caesarean section rate of 8.4% (95% CI 8.1-8.7%), marginally lower than the national average of 10.0% (95% CI 9.8-10.3%). In India as a whole, 32.0% (95% CI 31.5-32.5%) of deliveries occurred in facilities that were likely to lack advanced services. There was substantial variation across the country, with less than 5% non-hospital public facility deliveries in Punjab, Kerala, and Delhi compared to more than 40% in Odisha, Madhya Pradesh, and Rajasthan. Newborn mortality tended to be lower in states with highest hospital delivery rates.
UNASSIGNED: Individual risk stratification based on factors identified in pregnancy fails to accurately predict which women will have delivery complications and experience stillbirth and newborn death in India. Thus a determination of \'low risk\' should not be used to guide women to health facilities lacking key life saving services, including Caesarean section, blood transfusion, and advanced newborn resuscitation and care.
UNASSIGNED: Bill and Melinda Gates Foundation and the World Bank. The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the Gates Foundation or of the World Bank, its Executive Directors, or the countries they represent.