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Association between utilization and quality of antenatal care with stillbirths in four tertiary hospitals in a low-income urban setting.

低收入城市中四家三级医院产前保健利用与死胎质量之间的关联。

  • 影响因子:2.21
  • DOI:10.1111/aogs.13956
  • 作者列表:"Gwako GN","Were F","Obimbo MM","Kinuthia J","Gachuno OW","Gichangi PB
  • 发表时间:2021-04-01
Abstract

INTRODUCTION:About 2.6 million stillbirths per year occur globally with 98% occurring in low- and middle-income countries including Kenya, where an estimated 35 000 stillbirths occur annually. Most studies have focused on the direct causes of stillbirth. The aim of this study was to determine the association between antenatal care utilization and quality with stillbirth in a Kenyan set up. This information is key when planning strategies to reduce the stillbirth burden. MATERIAL AND METHODS:This was a case-control study in four urban tertiary hospitals carried out between August 2018 and April 2019. A total of 214 women with stillbirths (cases) and 428 with livebirths (controls) between 28 and 42 weeks were enrolled. Information was obtained through interviews and data abstracted from medical records. Antenatal care utilization was assessed by the proportions of women not attending antenatal care; booking first antenatal care visit in first trimester and not making the requisite four antenatal care visits. Quality of antenatal care was assessed using individual surrogate indicators (antenatal profile testing, weight/blood pressure/urinalysis testing in each antenatal visit, utilization of early obstetric ultrasound, completeness of antenatal records) and a codified indicator made up of seven parameters (attending antenatal care, booking first antenatal care in the first trimester, making four or more antenatal visits, having all antenatal profile tests, having a complete antenatal record, having blood pressure and weight measured at all visits). The association between antenatal care utilization and quality with stillbirth was assessed using univariate and multivariate analysis using logistic regression. Statistical significance was defined as a two-tailed P value ≤ .05. RESULTS:Women with stillbirth were likely to have a parity ≥4 (19.6% vs 12.6%, P = .02), have an obstetric complication (36% vs 8.6%, P = .001) and have a medical disorder (5.6% vs 1.6%, P = .01). The odds of a stillbirth were four times higher among those who did not attend antenatal care ( odds ratio [OR] 4.1, 95% confidence interval [CI] 1.6-10, P < .003). Compared with four antenatal care visits, those who had one or two visits had higher odds of a stillbirth: OR 2.96 (95% CI 1.4-6.1), P = .003, and OR 2.9 (95% CI 1.7-5), P = .003, respectively. As per the individual surrogate indicators, the likelihood of a stillbirth was lower in women who received good quality antenatal care: Hemoglobin testing (OR 0.6, 95% CI 0.4-0.8, P = .03), blood group test (OR 0.4, 95% CI 0.2-0.6, P < .001), HIV test (OR 0.3, 95% CI 0.2-0.5, P = .001), venereal disease research laboratory test (OR 0.2, 95% CI 0.1-0.4, P = .001), weight measurement (OR 0.7, 95% CI 0.5-1.0, P = .047). As per the composite indicator, the quality of antenatal care was poor across the board and there was no association between this surrogate indicator and stillbirth. CONCLUSIONS:Lack of antenatal care, attending fewer than four antenatal visits and poor quality antenatal care as measured by surrogate indicators were significantly associated with stillbirth. In addition, women with low education level, obstetric complications, multiparity and medical complications had a significantly higher likelihood of stillbirth. Improving the utilization of four or more antenatal visits and the quality of antenatal care can reduce the risk of stillbirth.

摘要

引言: 全球每年发生约260万例死胎,98% 发生在包括肯尼亚在内的低收入和中等收入国家,估计每年发生35 000例死胎。大多数研究都集中在死产的直接原因。本研究的目的是确定肯尼亚机构产前护理利用与死产质量之间的关联。这些信息是制定减少死产负担的策略时的关键。 材料和方法: 这是2018年8月至2019年4月期间在4家城市三级医院进行的病例对照研究。共有214名死产妇女 (病例) 和428名活产妇女 (对照) 参加了28至42周。通过访谈和从病历中提取的数据获得信息。产前护理利用的评估方法是: 未接受产前护理的妇女比例; 在妊娠早期预约第一次产前护理访视,未进行必要的四次产前护理访视.产前检查的质量评估采用个别替代指标 (产前检查,每次产前检查的体重/血压/尿液分析测试,早期产科超声的使用,产前记录的完整性) 和由七个参数组成的编码指标 (参加产前检查,在怀孕的前三个月预约第一次产前检查,进行四次或更多次产前检查,进行所有产前特征检查,有完整的产前记录,在所有就诊时测量血压和体重)。使用logistic回归进行单因素和多因素分析,评估产前护理利用与死产质量之间的相关性。统计学显著性定义为双尾P值 ≤ 0.05. 结果: 死产妇女的产次可能 ≥ 4次 (19.6% vs 12.6%,P = .02),有产科并发症 (36% vs 8.6%,P = .001) 和有内科疾病 (5.6% vs 1.6%,P = .01)。未参加产前保健的人死产的几率高4倍 (比值比 [OR] 4.1,95% 置信区间 [CI] 1.6-10,P <.003)。与4次产前检查相比,1次或2次检查的死产几率更高: or 2.96 (95% CI 1.4-6.1),P = .003,OR 2.9 (95% CI 1.7-5),P = .003。根据个体替代指标,接受优质产前护理的妇女发生死产的可能性较低: 血红蛋白检测 (OR 0.6,95% CI 0.4-0.8,P = .03),血型检测 (OR 0.4,95% CI 0.2-0.6,P <.001),HIV检测 (或0.3,95% CI 0.2-0.5,P = .001),性病研究实验室检查 (OR 0.2,95% CI 0.1-0.4,P = .001),体重测量 (OR 0.7,95% CI 0.5-1.0,P = .047)。根据综合指标,产前保健的质量总体较差,这一替代指标与死产之间没有关联。 结论: 缺乏产前护理、接受不到4次产前检查和按替代指标衡量的产前护理质量差与死产显著相关。此外,受教育程度低、产科并发症、多胎和内科并发症的妇女死胎的可能性明显较高。提高四次或更多次产前检查的利用率和产前护理的质量可以降低死产的风险。

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