Quality of antenatal care in Zambia a national assessment 英文参考文献.docVIP

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Quality of antenatal care in Zambia a national assessment 英文参考文献.doc

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Quality of antenatal care in Zambia a national assessment 英文参考文献

Kyeietal.BMCPregnancyandChildbirth2012,12:151 /1471-2393/12/151 RESEARCH ARTICLE OpenAccess QualityofantenatalcareinZambia:anational assessment NicholasNAKyei1,3*,CollinsChansa2andSabineGabrysch1 Abstract Background:Antenatalcare(ANC)isoneoftherecommendedinterventionstoreducematernalandneonatal mortality.YetinmostSub-SaharanAfricancountries,highratesofANCcoveragecoexistwithhighmaternaland neonatalmortality.ThisdisconnecthasfueledcallstofocusonthequalityofANCservices.However,little conceptualorempiricalworkexistsonthemeasurementofANCqualityathealthfacilitiesinlow-incomecountries. WedevelopedaclassificationtoolandassessedthelevelofANCserviceprovisionathealthfacilitiesinZambiaona nationalscaleandcomparedthistothequalityofANCreceivedbyexpectantmothers. Methods:Weanalysedtwonationaldatasetswithdetailedantenatalprovideranduserinformation,the2005 ZambiaHealthFacilityCensusandthe2007ZambiaDemographicandHealthSurvey(DHS),todescribethelevelof ANCserviceprovisionat1,299antenatalfacilitiesin2005andthequalityofANCreceivedby4,148mothers between2002and2007. Results:Wefoundthatonly45antenatalfacilities(3%)fulfilledourdevelopedcriteriaforoptimumANCservice, while47%offacilitiesprovidedadequateservice,andtheremaining50%offeredinadequateservice.Although94% ofmothersreportedatleastoneANCvisitwithaskilledhealthworkerand60%attendedatleastfourvisits,only 29%ofmothersreceivedgoodqualityANC,andonly8%ofmothersreceivedgoodqualityANCandattendedin thefirsttrimester. Conclusions:DHSdatacanbeusedtomonitor“effectiveANCcoverage”whichcanbefarbelowANCcoverageas estimatedbycurrentindicators.This“qualitygap”indicatesmissedopportunitiesatANCfordeliveringeffective interventions.EvaluatingthelevelofANCprovisionathealthfacilitiesisanefficientwaytodetectwhere deficienciesarelocatedinthesystemandcouldserveasamonitoringtooltoevaluatecountryprogress. Keywords:Maternalhealthservices,Prenatalcare,Healthcarequality,AfricaSouthoftheSahara Background have adopted a focused ANC strategy promoted by Every day, appr