北京市朝阳区825例流动孕产妇产前检查现状及影响因素分析

目的了解北京市朝阳区流动孕产妇产前检查的基本现状及相关影响因素,为制定流动孕产妇孕期保健服务的相关卫生政策提供参考依据。方法采用分层整群抽样,选取朝阳区流动人口相对密集的7个街道/乡镇随机抽取825例流动产妇(对象为1岁以下儿童母亲)进行回顾性问卷调查。结果流动产妇中认为妊娠期间需要进行产前检查的为93.0%,而实际孕期建立《母子健康档案》的只占35.5%;21.2%的流动产妇在私人诊所做过产前检查。在对医院服务的综合评价中最不满意的是就诊等候时间。结论私人诊所为流动孕产妇提供廉价和不健全的产前检查服务这一因素不容忽视。通过取缔非法行医诊所,改善医疗管理体制,制定合理的收费标准,以满足不同层次流动孕产妇的孕期保健需求;加大宣传力度是增强孕产妇主动寻求孕期保健服务的有效手段。     

The use of formal and informal services for antenatal care and malaria treatment in rural Uganda

The study aimed to analyze reasons for the use or non-use of antenatal care services and malaria treatment among pregnant women living in rural areas in Uganda. Focus group discussions with pregnant women, in-depth interviews with key informants (Traditional Birth Attendants (TBAs) and health workers) and a structured questionnaire administered to pregnant women were used to collect the relevant information. Antenatal care attendance was irregular and few women knew that the purpose of attending antenatal care was to monitor both the growth of the baby and the health status of the woman. Parity significantly influenced antenatal care attendance, but level of education, religion and marital status did not. Fifty-five per cent of the women stated that they had delivered outside the formal health delivery system despite antenatal care attendance. All women in their second pregnancy had delivered their first child in the village, despite TBA training to the contrary.Malaria as perceived by pregnant women is common and multiple health service providers are used for its treatment. About 66% of the mothers reported having suffered from malaria during the current pregnancy; of these more than half had received treatment outside the formal health delivery system. Self-treatment with drugs bought from ordinary shops was commonly reported. Nearly all women (93.3%) knew about the antimalarial drug chloroquine and 83% thought that it was used for the treatment of malaria, not for its prevention. Some women believed that the drug could cause abortion.Health seeking behaviour was influenced by several factors, including the perceived high cost of antenatal care services, or conducting a delivery and treatment, and perceived inadequacy of services provided by the formal health system. Inadequacy of formal health services was perceived by users to be partly due to understaffing and to irregular supply of essential drugs.Intensive health education to pregnant women on the safety of chloroquine use in pregnancy, the importance and the need for regular antenatal care attendance are recommended. In addition, training of more TBAs and continued educational efforts to upgrade their knowledge, regular and adequate supply of essential drugs, and free health services for high-risk groups such as pregnant women are recommended to improve antenatal care services and drug prophylaxis use in pregnancy.      

农民工孕妇产前保健影响因素

目的了解分析农民工孕妇产前保健情况、存在问题和影响因素,为进一步采取措施改善农民工孕妇产前保健提供信息。方法于2006年7月至2007年11月期间,对在本院产科住院的203名农民工产妇作问卷调查,对早孕检查方法、建立孕产妇联系手册、产前检查次数等产前保健状况进行了描述,并分析影响因素。结果农民工孕妇的产前保健还存在比较大的问题。调查对象中,有30．5％不在医院作早孕确定,有38．4％没有建立孕产妇联系卡,有77．3％没作产前保健或者不足3次。丈夫是否上海户籍、丈夫的经济收入及是否有准生证是影响产前保健的重要因素。结论农民工孕妇产前保健还存在较大问题,其影响因素也是多方面的,包括丈夫是否上海户籍、经济收入及是否有准生证。这些问题都迫切需要政府有专门的措施来解决。     

Increasing Awareness of Danger Signs in Pregnancy Through Community- and Clinic-Based Education in Guatemala

Objective: This study evaluates the effectiveness of a set of information, education, and communication (IEC) strategies designed to increase the awareness of danger signs in pregnancy, delivery, or the postpartum period among pregnant or recently pregnant women. Methods: Three IEC programs were implemented in 4 regions of southwestern Guatemala between April 1997 and May 1998: (1) a clinic-based program involving the training of health providers in prenatal counseling and the provision of educational media to clients; (2) a community-based strategy consisting of radio messages regarding obstetric complications; and (3) educational sessions conducted through women's groups. Three surveys were conducted. In 1997, 637 pregnant women were interviewed at clinics where the interventions had been implemented. In 1998, 163 pregnant women using a subset of the same health clinics were interviewed. In 1999, a population-based survey of 638 pregnant and postpartum women was conducted. Using logistic regression, we model awareness of danger signs as a function of sociodemographic characteristics, prenatal care utilization, and IEC interventions. Results: Among women using health clinics, the likelihood of having heard of danger signs nearly tripled between 1997 and 1998, when the clinic interventions were fully implemented. In 1999, those who had heard radio messages or participated in women's groups were, respectively, 3 times and 5 times more likely to have heard of danger signs in pregnancy. Conclusions: Safe motherhood programs can effectively increase knowledge of danger signs through clinic- and community-based educational strategies.     

A survey of teenage pregnant women and their male partners in the Grampian region

This paper describes an exploratory pilot study of the male partners of teenagers presenting for either termination of pregnancy (TOP) or antenatal care (ANC). Seventy-five teenage pregnant women were recruited into the study and were asked to complete a questionnaire. The results suggest that the male partners tended to be older than their teenage partners. Teenage pregnant women presenting for termination of pregnancy had statistically significant higher levels of education, compared to those presenting for antenatal care. An association was found between the women's decision to continue or not with the pregnancy and her chosen form of contraception. In the antenatal group, women tended to state that their male partner's indication of support had influenced their decision to continue with the pregnancy. In-depth research should be conducted on the male partners of teenage pregnant women if effective sex education interventions are to be developed.     

Knowledge about Obstetric Danger Signs among Pregnant Women in Aleta Wondo District, Sidama Zone, Southern Ethiopia

Background

Raising awareness of women on danger signs of pregnancy, childbirth and the postpartum period is crucial for safe motherhood. In Ethiopia, a country where maternal morbidity and mortality is high little is known about knowledge level of pregnant women on obstetric danger signs. The objective of this study was to assess pregnant women''s knowledge about obstetric danger signs in Aleta Wondo district, Sidama Zone, South Ethiopia.

Methods

A community based cross-sectional study was conducted from January 18 – February 20, 2007, on a sample of 812 pregnant women selected from, 8 rural and 2 urban Kebeles. A structured pre-tested questionnaire was used to collect quantitative data on socio-demographic characteristics, obstetric history, and knowledge about danger signs of pregnancy, childbirth and post partum period. Qualitative data was collected through focus group discussion with pregnant women and in-depth interview with traditional birth attendants. The collected data were analyzed using SPSS for Windows version 12.0.1.

Results

Seven hundred forty three pregnant women participated in the study making a response rate of 92%. Out of the 743 pregnant women who participated in this study 226 (30.4%), 305(41.3%) and 279(37.7%) knew at least two danger signs during pregnancy, childbirth and postpartum period, respectively. Being urban resident was consistently found to be strongly associated with mentioning at least two danger signs of pregnancy (OR=4.1; 95% CI: 2.4, 7.0), child birth (OR=3.3; 95% CI: 1.8, 6.1), and postpartum period (OR=8.4; 95% CI: 4.5, 15.4).

Conclusion

This study indicated that the knowledge level of pregnant women about obstetric danger signs (during pregnancy, childbirth and postpartum period) was low and affected by residential area. Therefore, the identified deficiencies in awareness should be addressed through maternal and child health services by designing an appropriate strategies including provision of targeted information, education and communication.     

Prenatal care in Kinshasa: Knowledge, beliefs, and barriers to timely care

According to the international medical community, adequate antenatal care, beginning by the end of the fourth month of pregnancy, is beneficial to maternal and perinatal outcomes. However, there is little research on timing of antenatal care and factors that influence it, including external barriers and women's beliefs. This research was conducted at antenatal clinics in the Democratic Republic of Congo where rates of infant and maternal mortality are among the highest in sub-Saharan Africa and where antenatal care begins later than in other countries in the region; the goal was to assess knowledge, beliefs and barriers to timely antenatal care. In this paper we present data collected in structured interviews at the women's first antenatal visit (N = 206). Although 75% of women believed antenatal care should start before the end of the fourth month, as recommended by WHO, only 22% presented by this time. Important barriers were financial (37%) and lack of knowledge about appropriate timing (35%). Gravidity was associated with gestational age at first visit (p < 0.001). Average gestational age at first visit was 4.7 months in primigravidae and 5.9 months in women with > or = 2 previous pregnancies. Most women in Kinshasa begin antenatal care later than recommended by WHO. Educating women on the importance of timely antenatal care and improving its financial accessibility should be priorities for maternal and child health programs in the DRC.     

A Qualitative Study of Women’s Experiences of Communication in Antenatal Care: Identifying Areas for Action

To identify key features of communication across antenatal (prenatal) care that are evaluated positively or negatively by service users. Focus groups and semi-structured interviews were used to explore communication experiences of thirty pregnant women from diverse social and ethnic backgrounds affiliated to a large London hospital. Data were analysed using thematic analysis. Women reported a wide diversity of experiences. From the users’ perspective, constructive communication on the part of health care providers was characterised by an empathic conversational style, openness to questions, allowing sufficient time to talk through any concerns, and pro-active contact by providers (e.g. text message appointment reminders). These features created reassurance, facilitated information exchange, improved appointment attendance and fostered tolerance in stressful situations. Salient features of poor communication were a lack of information provision, especially about the overall arrangement and the purpose of antenatal care, insufficient discussion about possible problems with the pregnancy and discourteous styles of interaction. Poor communication led some women to become assertive to address their needs; others became reluctant to actively engage with providers. General Practitioners need to be better integrated into antenatal care, more information should be provided about the pattern and purpose of the care women receive during pregnancy, and new technologies should be used to facilitate interactions between women and their healthcare providers. Providers require communications training to encourage empathic interactions that promote constructive provider–user relationships and encourage women to engage effectively and access the care they need.     

Quality assessment of the antenatal program for anaemia in rural Tanzania.

OBJECTIVE: To assess the quality of antenatal care with respect to anaemia, a common health problem, in a developing country. DESIGN: Cross-sectional study. SETTING: Rufiji rural district, coastal Tanzania. STUDY PARTICIPANTS: Three hundred and seventy-nine consecutively enrolled pregnant women from 16 randomly selected antenatal clinics, including 10 dispensaries, four rural health centres and two hospitals. METHODS: We noted availability of infrastructure for management of anaemia, observed provider-client interaction, and interviewed women who attended antenatal clinics. An observer and health workers measured haemoglobin levels and their measurements were compared. MAIN OUTCOME MEASURES: Quality of antenatal care, anaemia in pregnancy, and maternal satisfaction. RESULTS: Half of the rural health clinics had no instrument to measure haemoglobin. The majority (58%) of pregnant women were not checked for anaemia at all, 10% were clinically examined, and 37% had haemoglobin assessed. The agreement between health workers' (using Tallqvist) and the observers' (using HemoCue) measurements of haemoglobin was poor to fair. The prevalence of anaemia (Hb < 10.5 g/dl) and severe anaemia (< 7.0 g/dl) was 58% and 6.2%, respectively, but overall only 4% of the anaemic pregnant women had specific action taken within the antenatal care program. CONCLUSION: Deficiencies in quality of screening, diagnostic information, and individual counselling need to be addressed before any impact of the antenatal care programme on anaemia can be expected.     

From research to practice: the example of antenatal care in Thailand

The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. However, in developing countries there is wide variation in the proportion of women who receive antenatal care. The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. This new model of antenatal care is being implemented in Thailand. Action has been required at all levels of the health-care system, from consumers through to health professionals, the Ministry of Public Health and international organizations. The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems.     

城市流动与户籍孕产妇产前保健利用状况比较分析

目的:了解流动孕产妇与户籍孕产妇产前保健服务的利用情况,发现两人群的差异,探讨影响因素并为制定干预措施提供依据。方法:采用对比研究,在广州、浙江、福建、北京对379名流动孕产妇和381名户籍孕产妇进行问卷调查,了解其社会人口学因素及产前保健利用情况,包括初检孕周、产检次数及早、中、晚孕期的产检项目等。结果:流动与户籍孕产妇孕早期初检率分别为40.5%和57.1%,产检5次及以上的比率分别为60.4%和80.6%;流动孕产妇孕早、中期各基本项目检查率低于户籍孕产妇,孕晚期差异不大。流动人口、文化程度低、经济收入低、未婚或离异、无保险、经产妇、计划外生育、怀孕后无人通知产检等会影响孕产妇的产检利用情况。结论:城市中流动孕产妇产前保健服务的利用情况与户籍孕产妇相比存在较大差异,孕产妇保健应注重提供普惠性的服务项目及加大服务宣教力度。     

Promoting safer sexual practices among expectant fathers in the Lao People's Democratic Republic

Men's decisions and behaviours influence the sexual, reproductive and maternal health of women and the health of their families, but men are rarely included in reproductive and maternal health care services. Men's attendance at antenatal care has the potential to prevent women from becoming infected with HIV during pregnancy and post-partum, when they are more vulnerable to infection and have a high risk of transmission to the infant. Greater involvement of men requires an understanding of social, cultural and organisational barriers in different contexts. In 2006, the Burnet Institute undertook fieldwork to inform a pilot project to encourage expectant fathers to attend antenatal care. A local Lao team conducted focus group discussions and interviews in Vientiane with expectant fathers, pregnant women, older women and health care providers. It was found that myths about the dangers of sex during pregnancy and women's decreased desire resulted in periods of sexual abstinence. Participants reported that unprotected extramarital sex was common but difficult for couples to discuss. Men lacked knowledge about sexually transmitted infections, including HIV. Men wanted information so they could better protect the health of their partners and babies during and after pregnancy, and reported being willing to attend antenatal care when invited. Our findings have useful implications for policy and implementation.     

Operational problems of an iron supplementation programme for pregnant women: an assessment of UNRWA experience.

Assessed is a large-scale iron supplementation programme for the 70 000 pregnant refugee women cared for by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). For this purpose, a retrospective survey of 1267 antenatal records was conducted in health centres located in the West Bank, Gaza, Syrian Arab Republic, Jordan, and Lebanon. The following operational problems were identified: late entry to antenatal care; high drop-out rate from antenatal care; low compliance in follow-up haemoglobin examinations; and misdirected continued testing of women who were not anaemic at registration. Routine iron supplementation of all pregnant women should be considered only in those countries where severe anaemia is prevalent and should always be coupled with additional interventions that are effective at improving iron deficiency anaemia in a given population. In most countries attention should be directed towards changing dietary habits to enhance the availability of local foodstuffs that are rich in iron. One initial haemoglobin test may help in focusing on the relatively few initially anaemic subjects who need further attention. Repeated testing during pregnancy is unwarranted.     

Opportunities to improve maternal health literacy through antenatal education: an exploratory study.

This paper examines the concept of maternal health literacy, defined as the cognitive and social skills that determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and that of their children. Specifically, it investigates the feasibility of using the concept of health literacy to guide the content and process of antenatal classes. The paper reports on the results of focus groups and interviews conducted with a range of health care providers, pregnant women and new mothers to obtain different perspectives on the issues surrounding antenatal education and parenting. The results give us a realistic look at what women are learning from existing antenatal education and how it can be improved. Comparing the results from the educators and the women, the same basic issues surface. Both recognize that there are serious time limitations in antenatal classes. These limitations, combined with natural anxiety and curiosity about childbirth, generally ensure that the content of classes is confined to pregnancy and childbirth. The limitations of time are also cited as a reason for the teaching methods being heavily weighted towards the transfer of factual information, as distinct from the development of decision-making skills, and practical skills for childbirth and parenting The results indicate clearly that antenatal classes cannot possibly cover all there is to know about pregnancy, childbirth and parenting. If the purpose of antenatal classes is to improve maternal health literacy, then women need to leave a class with the skills and confidence to take a range of actions that contribute to a successful pregnancy, childbirth and early parenting. This includes knowing where to go for further information, and the ability to analyse information critically. The authors conclude that this would represent a very challenging change in orientation for both the educators and pregnant women included in this study. Work continues on the development of the tools that will be needed to support this change.     

2005年潍坊市部分孕妇利用卫生服务状况调查

[目的]了解孕妇利用卫生服务状况,以便为提高卫生服务利用水平提供理论参考,为妇幼保健组织确定工作重点和开展针对性的健康教育提供科学依据。[方法]2005年,对到潍坊市3家医院就诊或定期检查的227名孕妇进行调查。[结果]调查227名孕妇,＂孕期发现异常后进一步检查＂、＂注重孕期卫生和自我护理＂、＂产前检查1～4次＂等的利用率均达到90%以上。城区孕妇＂怀孕后12周内做首次检查＂和＂B超或胎儿彩超检查＂的利用率高于农村孕妇 ＂B超或胎儿彩超检查＂和＂体重、血压、腹围、宫高、胎位等检查＂的利用率郊区孕妇高于城区和农村孕妇。[结论]潍坊市孕妇对卫生服务的利用较高,但应进一步加强对农村孕妇的服务。     

西藏农牧区妇女孕产期保健现状分析

目的 了解西藏自治区农牧区妇女孕产期保健现状.方法 采用横断面调查方法,分层随机抽样,入户访问了1512名3岁以下儿童的母亲.结果 妇女产前检查覆盖率为77.6%,平均产前检查次数为3.89次,5次以上产前检查率为26.3%,住院分娩率为40 4%,83.9%的妇女接受过孕期卫生保健宣传教育,产后访视的比例为66.2%.家庭有无副业收入、是否牧区、个人卫生状况、产前保健宣传教育、动员住院分娩、孕期保健知识等是影响是否进行产前检查的主要因素.结论 该地区妇女孕产期保健状况有显著改善,但目前产前检查次数仍然偏低,住院分娩率偏低,缺乏孕产期保健常识是影响孕产期保健利用的主要因素之一.建议加强健康教育,普及孕期卫生保健知识,促进产前保健和住院分娩.     

Promoting safer sexual practices among expectant fathers in the Lao People's Democratic Republic

Men's decisions and behaviours influence the sexual, reproductive and maternal health of women and the health of their families, but men are rarely included in reproductive and maternal health care services. Men's attendance at antenatal care has the potential to prevent women from becoming infected with HIV during pregnancy and post-partum, when they are more vulnerable to infection and have a high risk of transmission to the infant. Greater involvement of men requires an understanding of social, cultural and organisational barriers in different contexts. In 2006, the Burnet Institute undertook fieldwork to inform a pilot project to encourage expectant fathers to attend antenatal care. A local Lao team conducted focus group discussions and interviews in Vientiane with expectant fathers, pregnant women, older women and health care providers. It was found that myths about the dangers of sex during pregnancy and women's decreased desire resulted in periods of sexual abstinence. Participants reported that unprotected extramarital sex was common but difficult for couples to discuss. Men lacked knowledge about sexually transmitted infections, including HIV. Men wanted information so they could better protect the health of their partners and babies during and after pregnancy, and reported being willing to attend antenatal care when invited. Our findings have useful implications for policy and implementation.     

山东省济宁地区农村妇女孕产期卫生服务利用及其影响因素分析

为了解农村妇女孕产期对卫生服务的利用及其影响因素,对４２７１名０～１岁孩子母亲的孕产期保健情况作了调查。分析结果为：早孕检查率为８８．０２％。产前检查率为９８．４８％,前产检查次数≥５次占５７．９５％,住院分娩率为％,产后访视≥３次占２３１．６８％。同时对影响产前检查次数的因素进行了分析。结果表明：距乡镇卫生院的距离、孕妇的卫生知识得分和是否参加保偿制等是影响产前检查粢九的主要因素。建议应加强健康     

九江市农村育龄妇女孕产期保健服务需求状况分析

目的:了解九江市农村育龄妇女孕产期保健服务需求的现状,探讨农村育龄妇女孕产期保健服务需求的差异。方法:采用分层-整群抽样方法随机抽取九江市3476例农村育龄妇女作为调查对象进行结构式访谈问卷调查。结果:农村育龄妇女普遍存在孕产期保健意识缺乏现象,孕期保健和住院分娩地点主要选择县、乡两级,农村育龄妇女孕期保健的目的主要是为了了解胎儿的发育情况;半数以上不愿意接受医生指导的孕期常规筛查项目,调查对象认为"没必要"筛查;尚有17.3%的农村育龄妇女在停经4个月后才进行初次产检;1.4%的农村育龄妇女选择家庭、村级卫生所为分娩地点。结论:建议给予县、乡两级孕产期保健服务能力建设以持续和重点支持。建议采用进村入户发放传单、张贴标语、讲解典型事例、与家庭成员商谈等更深入细致的健康教育形式,消除农村育龄期妇女孕产期保健知识的盲点。     

Factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal

BackgroundVaccination during pregnancy can protect pregnant women and their babies from infectious diseases. Tetanus vaccine, also known as tetanus toxoid, is the only vaccine given to pregnant women in The Gambia and Senegal, where it is given by antenatal care providers as part of the Expanded Programme on Immunization. A qualitative study was undertaken to explore factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal.MethodsFocus group discussions and in-depth interviews were conducted across urban and rural settlements of The Gambia and Senegal. We explored the knowledge, attitudes, and perceptions of 152 women who were either pregnant or with an infant. NVivo 11 Qualitative Data Analysis Software was used for management and thematic analysis of the data.ResultsWomen had sufficient knowledge of the need for tetanus vaccine from different information sources but insufficient knowledge of tetanus causes, signs and symptoms. Tetanus vaccine was perceived to be safe and side effects such as pain and swelling at site of injection did not deter uptake of future doses. Women overall had confidence in their sources of vaccine information and the health care workers who administered maternal vaccinations. Their willingness to accept vaccination during pregnancy was particularly influenced by their husbands and trusted healthcare workers. Women across all sites mentioned they would accept new maternal vaccines if they are sensitized beforehand about any potential risks and benefits to them and their babies.ConclusionVaccine acceptance can be influenced by several factors including contextual, individual or group influences and vaccine or vaccination-specific issues. Women across The Gambia and Senegal are generally vaccine acceptors with confidence in the health care workers who vaccinate them and few concerns about maternal vaccines. Women’s acceptance of vaccination during pregnancy is based on previous vaccination experiences and individual weighing of risks and benefits.