浦东新区流动人口孕产妇保健服务利用及影响因素分析

目的:了解浦东新区流动人口孕产妇孕期保健服务利用现况及影响因素,针对影响因素制定干预措施。方法:以问卷形式对浦东新区10个流动人口较为集中的社区,对472名流动人口孕产妇在孕产期保健服务现况及影响因素进行调查。结果:浦东新区流动人口孕产妇有76%建立了"孕产妇保健手册",平均产前检查次数为(5.39±0.153)次;93.6%的流动人口孕产妇在医院中分娩;44.2%的产妇接受了产后访视。影响其保健服务利用的主要因素有:孕产妇及其配偶的文化程度、生育史。提高流动人口孕产妇及其家属的文化素质和健康意识,是提高流动人口孕产妇孕期保健服务利用的关键。     

南京地区流动孕产妇产前保健利用状况及其影响因素

目的:了解影响流动人口孕产妇产前保健服务利用现状及其影响因素,为今后制定相关卫生工作政策提供参考依据。方法:分层随机抽取409例流动产妇进行问卷调查,调查内容包括社会人口学特征、孕产史、孕早期检查及产前检查次数等情况。结果:调查结果显示,流动人口中孕产妇初次产前检查平均孕周为(21.1±9.1)周,早期检查率仅为24.9%,平均产前检查次数为(6.2±3.6)次,≥5次的产前检查率为56.2%。影响产前保健利用及时性的主要有月人均收入及是否经产;影响产前保健利用足够程度的因素主要有婚姻、文化程度、配偶有无工作、月人均收入及是否经产。结论:流动孕产妇产前保健利用率低,产前保健利用的主要影响因素为婚姻、文化程度、丈夫有无工作、是否经产及经济因素。     

社会资本对流动孕产妇保健服务利用的影响

目的探究社会资本对流动孕产妇保健服务利用的影响,为提高流动孕产妇的保健服务利用率提供依据。方法利用2014年国家卫计委全国流动人口动态监测数据,采用多因素Logistic回归方法,分析流动孕产妇的社会人口学特征、社会资本情况等对早孕建卡、产前检查和产后访视等保健服务利用的影响。结果 89.3%流动孕产妇建立孕12周《孕产妇保健手册》,66.2%流动产妇接受5次以上的产前检查,42 d产后访视率为80.3%。多因素分析结果显示,流动孕产妇的教育水平、家庭月总支出、孩子是否符合生育政策、与本地人相处是否融洽对流动孕产妇孕12周是否建立《孕产妇保健手册》有影响,流动孕产妇产前检查达标的影响因素有流动孕产妇的年龄及与本地人相处是否融洽;流动孕产妇教育水平、家庭月总支出和是否在本地接受健康教育对流动孕产妇接受42 d产后访视有显著影响。结论流动孕产妇的保健服务利用情况良好,社会资本对提高流动孕产妇保健服务有积极作用,加强流动孕产妇在流入地的社会网络构建,增加其保健信息来源渠道。     

已婚流动育龄妇女产前检查服务利用现状分析

目的了解流动人口产前检查服务利用现状,分析相关影响因素,为加强流动人口产前检查工作提供科学依据。方法从2014年全国流动人口动态监测数据中挑选年龄16~49岁已婚女性,2012和2013年有生育子女经历且孕前有流动经历、孕期在外地者4 597人的4 676次分娩的分析早孕建卡及产前检查次数。产妇相关特征和服务利用状况采用均数、百分比描述,影响作用单因素分析采用卡方检验,多因素分析采用二分类变量的Logistic回归方法。结果 85.36%的妇女在孕12周内建立孕产妇保健手册,整个孕期产前检查5次占12.87%,5~7次占20.06%,≥8次占29.70%。年龄、受教育程度、户口性质、是否符合生育政策、母亲孕期所在地、子女次序对早孕建卡的影响有统计学意义(P0.05)。结论流动妇女产前检查服务利用有所增加,但仍很大的提升空间。有针对性地加强健康教育工作及社区卫生服务建设,促进流动人口产前保健服务利用,保护流动人口健康。     

孕产妇保健服务利用现状调查

目的了解中国孕产妇保健服务需求和利用现状,探讨影响孕产妇保健服务利用的主要因素。方法应用自行设计的调查问卷对2009年7-12月间分娩的1 945名妇女进行调查,并对孕产妇保健服务利用的影响因素进行分析。结果孕早期系统保健管理卡建卡率为49.77%,产前保健指导率为82.98%,产后保健指导率为52.75%,产前检查率为99.33%,产前检查5次率为74.24%,住院分娩率为98.61%,产后访视率为42.21%,产后访视3次率为9.51%;影响孕产妇保健服务利用的因素主要有孕产妇年龄、职业、文化程度、就医距离、活产生育数、居住地以及婚姻状况等。结论孕产妇首次产前检查时间滞后,产后访视率低,孕产妇的孕期保健服务有待加强。     

19例产妇死亡原因分析

目的对湛江市1998年1月—2002年12月间19例产妇死亡原因进行回顾性分析。结果5年间死亡产妇19例,占孕产妇死亡的15!32%;在死亡的19例产妇中,孕周大于或等于28周的14例,占73.68%,半数以上的产妇未做过产前检查,有产前检查的产妇没有1例产检次数达到5次;职业为农民的产妇比例大,产妇死亡地点在基层占多数;死亡原因以妊高征居首位,其次是妊娠合并心脏病、前置胎盘大出血、宫外孕破裂大出血。提示,孕产妇孕期保健管理存在着薄弱环节;要加强孕产妇管理,大力宣传孕产期保健;提高孕产妇的自我保健意识,让每位孕产妇都能得到孕产期应有的保健服务,是不容忽略的重要措施。     

北京市大兴区流动人口妇幼保健服务现状及影响因素分析

目的:了解大兴区流动孕产妇和儿童妇幼保健服务现状与需求。方法:分层整群抽样确定4个镇,进行问卷调查与定性访谈。结果:共调查700例孕产妇,723例儿童。儿童看护人文化程度普遍低,保健知识缺乏,对卫生保健服务知晓率存在差异,计划免疫率98.9%、定期体检率59.1%、新生儿访视率19.9%,对呼吸急促、大便带血严重的疾病危险症状识别率较低为15.5%、15.2%;流动孕产妇70%以上来京后妊娠,孕期系统管理率明显低于户籍人口(P0.01),产前检查少于4次占49.44%;产前检查总费用,在正规医院78.13%500元以上,在私人诊所90.72%在200元以下;孕妇对危险因素识别能力不足,大多数人认为只有阴道出血和肚子疼的时候再找医生;91.60%的孕产妇期望接受产前检查,85.8%的儿童看护人认为需要定期体检。结论:现有妇幼保健服务利用率较低;对私人接生打击力度不够;妇幼保健服务需求依然存在,应加强宏观管理,细节管理,摸索区域管理模式。     

孕期保健影响因素及干预措施分析

目的了解内蒙古满洲里市流动人口"孕产妇"孕期保健状况及干预措施。方法采用家庭入户问卷调查法,对满洲里市18岁-42岁的3859名已婚流动人口"孕产妇"进行孕期保健状况及相关问题问卷调查分析,对审核合格的调查结果应用SPSS13.0软件包进行数据统计分析。结果 3859名流动人口"孕产妇"产前检查2267人,占58.7%,平均每个孕产妇接受产前检查(2.8±1.5)次,流动人口较常住人口明显低。产后访视2621人,占67.9%,平均每个孕产妇接受产后访视(1.1±0.2)次。流动人口孕产妇较常住人口孕产妇明显低,提示我市流动孕产妇的孕期保健工作仍不够。调查发现,文化程度低、家庭经济状况差、家庭住址不固定、孕期自我保健知识缺乏及丈夫常年外出务工等因素均是造成流动人口"孕产妇"产前检查不及时、不足够甚至不检查的原因。结论满洲里市流动人口"孕产妇’产前检查率低,检查次数少;产后访视率低,其原因与文化水平、经济条件、政策知晓、家庭环境、交通、风俗习惯、医疗卫生条件等密切相关。针对影响因素加强孕期保健工作刻不容缓。     

上海市徐汇区外来孕产妇系统保健项目使用情况的潜在类别模型分析

目的探讨上海市徐汇区外来孕产妇系统保健项目使用情况的潜在类别模型,为全覆盖管理模式提供参考依据。方法对上海市徐汇区13家社区卫生服务中心儿保门诊参加首次婴儿体检的非上海市户籍的外来儿童母亲(产妇)进行关于参加孕产妇系统保健的回顾性调查。选取建立孕妇保健手册,产前检查各项目、产后访视各项目共23个变量作为显变量,进行潜在类别分析(LCA),识别潜在类别,进而对外来妇女参与孕产妇系统保健的特征进行分类。结果当潜在类别数目为6时模型拟合最佳。依据各因素潜在类别条件概率的分布特征,1 248例研究对象参与孕产妇系统检查项目的行为方式可分类为:参与各项服务积极性高组;产前检查参与度中等、产后访视积极性高组;参与各项服务积极性低组;忽视产前检查、重视产后访视组;产前检查一般、重视产后访视组;参与各项服务积极性低组,分别占调查对象的37.50%、33.57%、10.66%、7.93%、7.45%、2.88%。结论不同流动特征人群对孕产妇系统保健服务利用行为特征分类不一致。潜在类别分析可以应用于不同特征对象的识别。通过依据各项目的参与行为的潜在类别特征进行人群的分型,识别母婴保健服务项目参与度不足的人群,以便制定有针对性的保健干预措施。     

山东省日照市东港区孕期保健综合服务模式效果分析

目的：通过实施孕期保健综合服务模式项目，提升孕期保健服务覆盖率，保障母婴安全，降低孕期死亡率，提高孕期保健服务水平。方法：2019年在日照市在东港区试点开展孕期保健综合服务模式，比较2017-2020年孕期保健服务模式实施前后情况，分析相关考察指标。结果：孕期保健综合服务模式实施后，接受孕期保健综合服务并完成妊娠的孕产妇共7778例，产前检查7586例。30～34岁孕产妇逐年增加，25～29岁孕产妇逐年减少；一胎比例逐年增加，二胎、三胎比例逐年减少(均P<0.05)。项目实施后孕期保健覆盖率明显提高，其中产前检查参检率(97.5%)高于项目实施前(93.4%、93,1%),产前检查≥5次(94.3%)以及早期产前检查率(95.6%)提高；孕期住院分娩率保持100%,剖宫产率波动在35.1%,产后访视率(93.3%)提升，2019年项目实施以来孕产妇死亡率为零。结论：本次调查的孕产妇年龄逐年增加，2胎、3胎占比逐年下降，高龄产妇占比增加，应加强孕产期管理。通过孕期保健综合服务模式实施，使本地区孕期保健服务水平明显提升，各项保健服务指标得到提升，母婴安全水平得到提高。     

上海市两区流动人口孕产妇利用保健服务的障碍因素

目的:分析上海市闵行区和松江区流动孕产妇利用保健服务的障碍因素。方法:定量调查:以上海市闵行区和松江区各1个计划免疫门诊作为研究现场,调查当天3岁以下外来儿童的母亲共195名作为研究对象,通过自编问卷调查其孕产期保健状况。定性访谈:对流动人口特约分娩点4名医护人员、4名流动妇女和2名行政管理人员进行访谈。结果:56.4%的调查对象文化程度在初中及以下,家庭人均月收入在上海市最低工资水平以下的占40.0%,61.0%的调查对象参加了不同形式的国家基本医疗保障计划。产前建卡率为74.9%,产前检查率为97.9%,产前检查9次完成率为42.1%;孕期并发贫血的患病率为36.4%;住院分娩率为98.5%,但剖宫产率高达44.6%,低出生体重儿发生率为2.6%;合格产后访视率仅为18.5%。政府对流动人口孕产妇保健提出一系列优惠政策,但73.3%的调查对象对所有优惠政策都不知晓。结论:流动人口孕产妇接受保健服务的障碍因素:①流动人口孕产妇相对较低的文化水平导致保健意识较弱;②社会保障不足,政策宣传和实施不到位;③基层卫生人员缺乏,无法满足流动人口日益增高的卫生保健需求。     

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.      

流动人口特约分娩点孕产妇保健状况调查

目的:了解流动人口特约分娩点孕产妇保健状况,为进一步完善流动人口孕产妇保健管理提供依据。方法:以2005年1~12月在上海市南汇区新场社区卫生服务中心分娩的所有流动人口孕产妇为研究对象,收集病史资料和流动人口分娩登记表信息,对1152例流动孕产妇构成、产前检查次数、分娩方式及分娩费用等进行分析。结果:没有做过产前检查或只有1次产前检查的流动孕产妇占60%,产前检查次数与产次有关(P<0.0001),流动孕产妇剖宫产组平均住院费用为3 387元,阴道分娩组平均住院费用为1105元,结论:流动人口妇女孕产期保健服务利用率低,住院分娩费用相对其收入仍偏高,需要加强对流动人口孕产期保健知识的宣传,降低经济负担,为更多的孕产妇提供限价服务。     

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。     

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.     

Piecing together the crazy quilt of prenatal care

The failure to provide adequate prenatal care for low-income pregnant women in the United States and the effects of this failure on infant mortality are well known. Many studies have identified institutional barriers against access to care as a major cause. To overcome these barriers, Public Health District V, South Central Idaho, has created a comprehensive prenatal health care model that has almost tripled participation in its program during the first year of implementation and increased it again significantly during the second year. This decentralized pregnancy program has succeeded in getting all of the physicians offering obstetrical care in the district to serve low-income pregnant clients on a rotating basis. The new program provides pregnancy testing as well as financial screening services. Also, it has combined support services into one-stop-shopping clinics that include an innovative expansion of the Women, Infants and Children (WIC) Program of the U. S. Department of Agriculture. WIC food vouchers help attract clients into the prenatal care system and keep them coming. Enrichment of the duties of the public health nurse provides case coordination that pulls together the patchwork of medical and support services for the pregnant client.     

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。     

上海市普陀区孕产期卫生服务利用研究

目的了解普陀区本市产妇和外来产妇孕产期卫生服务利用情况,分析孕产期卫生服务利用的影响因素。方法通过对产妇的问卷调查,了解产妇及家庭一般情况、孕产期卫生服务利用情况。数据由Epidata2.1软件建立数据库,使用SPSS11.0软件对录入资料进行统计分析。结果 1、本市、外来产妇在孕产期卫生服务利用方面差异有统计学意义。2、本市、外来产妇在产时、产后卫生服务利用方面差异有统计学意义。3、产妇年龄、丈夫户籍、丈夫文化程度、家庭经济状况是孕产期卫生服务利用的影响因素。结论 1、本市产妇孕产期卫生服务利用情况优于全国其他地区,且近几年有所提高。2、外来产妇孕产期卫生服务利用情况有所改善,但与本市产妇比较仍有明显差距。3、外来、本市产妇在产时卫生服务利用方面存在差异。4、调整卫生服务策略,提高孕产期卫生服务利用。     

Seroprevalence and risk factors of Toxoplasma gondii infection among pregnant women in Trinidad and Tobago.

OBJECTIVE: To determine the seroprevalence of toxoplasmosis and the frequency of risk factors for the disease in women attending antenatal clinics in hospitals and local health centers in Trinidad and Tobago. METHODS: From November 2002-September 2003, 232 pregnant women at the antenatal clinics of two large hospitals were sampled during their first trimesters. From October 2003-February 2005, 218 pregnant women at five health care centers were followed through three trimesters, wherever possible, and blood samples collected. Sera were screened for Toxoplasma gondii IgG and IgM immunoglobulins using an enzyme immunoassay. Data on demographics, as well as practices considered to be risk factors for toxoplasmosis, were obtained. RESULTS: Of the 232 women sampled at the two hospital clinics, 83 (35.8%) and 8 (3.4%) were seropositive for immunoglobulins of T. gondii IgG and IgM, respectively. Of the 218 women at the health centers, 76 (34.9%) had evidence of past infection (IgG), while 26 (11.9%) were seropositive for IgM immunoglobulin, suggesting new infections during pregnancy. Only having "3 or more" children was significantly associated with infection by T. gondii. CONCLUSION: In Trinidad and Tobago, the seroprevalence of past infection by T. gondii in pregnant women is relatively low (39.3%) for patients in both hospital and health center clinics. Consequently, there is an elevated risk of primary infection during pregnancy and the potential for congenital infection.     

外来孕妇保健服务利用及影响因素调研

目的:了解上海市外来孕妇对保健服务的利用情况和影响因素。方法:2009年6～7月对上海市19个区县的450名外来孕妇进行现状调查。结果:被调查孕妇中,86.00%已经建册,91.11%进行了产检,75.56%将来准备在二、三级医院分娩,72.89%准备在上海分娩。从影响因素看,影响孕期保健服务利用的主要有丈夫户籍、收入和医保,丈夫为上海户籍、家庭月收入高和享有医保的孕妇更愿意选择在上海和二、三级医院分娩;外来孕妇选择医院时首先考虑医疗质量(占68.56%),但"规范产检"受到经济收入的影响。研究显示,孕期保健服务的利用与孕妇年龄、妊娠史、孕妇本人及丈夫的文化程度无相关性。结论:目前上海市通过多种形式的健康教育和平价优惠政策推广,使得不同年龄、不同文化程度和生育经历的孕妇之间对孕产期服务利用差距逐渐缩小,但仍需进一步提高医疗质量,并加大保健服务的宣传力度,为外来人口提供更加安全、高质量、公平的保健服务。