云南藏区安全分娩项目效果评估研究

发布时间：2018-06-07 09:11

本文选题：一主二辅 + 安全分娩项目　；参考：《昆明医科大学》2017年硕士论文

【摘要】：目的本研究主要评价云南藏区试点“一主二辅”的安全分娩服务模式对改善项目地区孕产期保健服务利用的效果,总结项目实施过程中的经验与问题,为在更多的同类地区推广和实施提供科学依据。方法本研究以健康促进的生态学模型作为理论框架,采用定性与定量相结合的方法开展调查。本研究为准试验设计中设有对照组的前后对比设计,维西县白济汛乡和康普乡接受项目干预作为干预组,选取与干预组地理位置靠近的中路乡和攀天阁乡为对照组,不接受项目干预措施。以分层整群抽样的方法选取4个乡的育龄妇女作为研究对象。基线调查于2011年开展,2015年以基本相同的调查工具在项目地区开展终末调查。使用双重差分法评估干预措施的净效应。结果(1)孕产期保健知识水平提高。在反映研究对象孕产期保健知识的题目中,干预组和对照组在终末调查中均有不同程度的改善,且干预组在干预后对于孕产期保健知识的掌握普遍优于对照组。其中干预组认为需要5次以上产前检查的由干预前的60%上升至87.2%,双重差分法对研究对象孕产期保健知识的评估结果也显示,孕期需做产检数干预和时间的交互项系数为1.338,OR=3.811,P0.01,是否知道住院分娩好的交互系数为1.222,OR=3.395,P=0.025,说明干预措施对提升育龄妇女孕期需做产检次数的知识水平以及住院分娩的知晓情况具有明显效果。(2)在孕产期保健态度方面,干预组和对照组终末调查孕期7项危险情况需要就医的态度明显提升,干预组干预后选择视情况而定和在家生的明显减少,其中选择在家生的由9.1%下降为2.1%,而对照组选择在家生的情况终末比基线略有增加。回归结果显示,孕期什么情况会就医、如果怀孕会选择哪里分娩的净效应项系数分别为(P=1.565,1.239),且P0.05,说明干预措施对于改善育龄妇女孕产期保健的态度有显著效果。(3)干预组终末调查显示孕产期保健服务利用有明显改善,对照组虽也有进步,但其提升远不及干预组明显。干预组研究对象在干预前的早检率为81.8%,干预后95.8%,提升近14个百分点,对照组早检率基线和终末分别为84.8%,89.3%。5次以上产检率干预组由66.0%上升为81.6%,对照组由69.0%提升为71.4%。干预组的住院分娩率在干预前后有一定改善,分别为91.9%,98.3%,而对照组的住院分娩率两次调查均在94.0%左右。双重差分法结果显示,怀孕早期是否做产检、是否5次及以上产检、是否住院分娩干预和时间交互项的系数分别为β=1.243,0.761,2.117;OR=3.466,2.139,8.305;P 值均小于 0.05。这说明干预措施对于改善早检、5次及以上产检和住院分娩等孕产期保健行为具有明显的促进作用。结论研究结果表明,“一主二辅”安全分娩模式的干预措施能够使育龄妇女掌握更多的孕产期保健知识,对孕产期保健积极态度的形成具有促进作用,并在很大程度上改善了育龄妇女孕产期保健的行为,其中早检率、5次及以上产检率和住院分娩率等重要指标均有明显提升,并且双重差分法结果显示干预措施有意义。以上说明“一主二辅”的安全分娩服务模式在云南藏区有效可行,对该地区育龄妇女孕产期保健服务的利用能产生积极作用。建议(1)促进项目各利益相关方,特别是社区力量参与到项目的设计、执行与评估中,是项目顺利实施的关键。(2)基层妇幼卫生服务提供方也是“弱势人群”,需要充分尊重和理解。(3)基层的妇女组织,特别是自然村级的妇女小组长是可以依靠的力量。(4)可考虑在偏远行政村建待产室。(5)孕产期保健服务与移动健康的展望。
[Abstract]:Objective the purpose of this study was to evaluate the effect of the safe delivery service model of "one main two auxiliary" in Yunnan Tibetan area to improve the utilization of pregnancy and maternity care service in the project area, summarize the experience and problems in the process of project implementation, and provide scientific basis for the promotion and Implementation of more similar areas. As a theoretical framework, the model is investigated by the combination of qualitative and quantitative methods. In this study, the comparative design of the control group is designed in the quasi experimental design. The intervention group is taken as the intervention group in the Bai Ji flood Township and komp Township in Wei Xi county, and the control group is selected as the control group, which is close to the geographical position of the intervention group, and does not accept the item. Target intervention measures were selected by stratified cluster sampling in 4 rural women of childbearing age. The baseline survey was carried out in 2011. In 2015, the final survey was carried out in the project area with the same basic survey tools. The net effect of the intervention measures was evaluated using the double difference method. Results (1) the health knowledge level of pregnancy and maternity was improved. Among the subjects of prenatal health care, the intervention group and the control group had different degrees of improvement in the final survey, and the intervention group was generally superior to the control group in the mastery of pregnancy and maternity health knowledge in the intervention group. The intervention group believed that 5 more prenatal examinations were increased to 87.2% from 60% before the intervention, and the dual difference method was used in the intervention group. The results of the health care knowledge of the pregnant women also showed that the interaction coefficient of intervention and time needed to be done during pregnancy was 1.338, OR=3.811, P0.01, and whether the interaction coefficient of good hospital delivery was 1.222, OR=3.395, P=0.025, indicating the level of knowledge and hospitalization of the intervention measures to improve the number of childbirth women during pregnancy. The awareness of childbirth has obvious effects. (2) in the attitude of pregnancy and maternity health care, the attitude of the intervention group and the control group at the end of the investigation of the 7 dangerous conditions of the pregnancy is obviously improved, the intervention group's choice of prognosis and the decrease of the family life are obviously reduced, among which the selection in the family from 9.1% is 2.1%, while the control group is selected at home. The end of the situation was slightly higher than that of the base line. The regression results showed that the net effect factor of pregnancy would be (P=1.565,1.239), and P0.05, indicating that the intervention measures had significant effect on improving the maternal health care of women of childbearing age. (3) the final survey of the intervention group showed the pregnancy health care. The use of service was obviously improved, although the control group was also progresses, but the improvement was far less than that in the intervention group. The early detection rate of the intervention group was 81.8% before intervention, 95.8% after intervention, 14 percentage points in the control group, the baseline and end of the control group was 84.8%, the intervention group increased from 66% to 81.6% in the control group, and the control group was 81.6%, and the control group was 66%. The rate of inpatient delivery in the 71.4%. intervention group was improved to a certain extent before and after the intervention, 91.9% and 98.3%, respectively, while the two investigation of the hospitalization rate in the control group was around 94%. The double difference method showed that whether the early pregnancy was done, whether or not 5 times and above were tested, whether the intervention of inpatient delivery and the coefficient of time interaction were divided. Not for beta =1.243,0.761,2.117; OR=3.466,2.139,8.305; P values are less than 0.05., indicating that intervention measures have a significant effect on improving early detection, 5 times and above production and hospitalization and childbirth. Conclusion the results show that the intervention measures of "one main two auxiliary" safe delivery mode can make women of childbearing age master. More pregnant and maternity health care knowledge can promote the formation of positive attitude of pregnancy and maternity care, and to a great extent improve the behavior of pregnant women of childbearing age. The early detection rate, 5 times and above and the rate of inpatient delivery have obviously improved, and the result of double difference method shows that the intervention measures are intentional. It shows that the safe delivery service mode of "one main two auxiliary" is effective and feasible in Yunnan Tibetan area, and has a positive effect on the utilization of pregnant and maternity care service for women of childbearing age in this area. (1) promote the project of all stakeholders, especially the community strength to participate in the project planning, implementation and evaluation, which is the successful implementation of the project. Key. (2) the grass-roots maternal and child health service provider is also a "vulnerable group", which needs to be fully respected and understood. (3) the women's organizations at the grass-roots level, especially the women's group at the natural village level, are the power to rely on. (4) the labour room can be considered in the remote administrative village. (5) the outlook of health care service and mobile health in the maternity period.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R715.3

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