群随机设计的农村地区产前保健项目评价

目的:评价产前保健是否能改善围产儿健康水平。方法:运用群随机设计方法,选取定远县55个乡镇中具备实施干预基础条件的20个乡镇,按照社会经济发展、孕产期保健服务的提供和利用等指标进行匹配,随机将乡镇分入干预组和对照组。干预内容包括:①对乡镇医疗机构的产科医生进行培训,使其能够提供系统的产前保健服务;②通过发放宣传单,张贴海报等形式,告知产前保健的重要性;③为乡镇医院提供基本的产前检查设备。通过应用观察、小组讨论、问卷调查等方法对所获得的资料进行评价。结果:过程评价发现,干预措施未能完全按照计划实施。主要的制约因素有:卫生部门与计划生育部门的工作协调有障碍;项目实施期间有关政策发生改变;政府对母婴保健工作的投入不足。结果评价显示干预组和对照组的围产儿死亡率差别无统计学意义。结论:由于项目受到政策改变等因素的影响而未能完全按计划实施,因此,该研究未能回答产前保健是否能改善妊娠结局这一问题;在开展社区卫生项目评价中,为真正了解项目是否能够取得预期效果,过程评价和结果评价都是必需的。

Evaluation of a cluster randomized designed prenatal care object in rural areas

Objective:To evaluate whether prenatal care can improve the level of perinatal health.Methods:A cluster randomized designed method was used to select 20 townships with the fundamental conditions for intervention from 55 townships in Dingyuan county and then paired according to social-economic development,supply and utilization of health service during pregnancy,then the townships were divided into intervention group and control group.The intervention contents included: ①training obstetricians in township hospitals,in order to make them supply systematical prenatal care;②informing the women of the importance of prenatal care by means of distributing leaflets and putting up posters;③providing basic prenatal care instruments for township hospitals.Application observation,group discussion,questionnaire survey were used to evaluate the data.Results:The intervention measures didn't carry out completely according to plan.The main conditioned factors included the barrier of work coordination between department of health and family planning department,the change of related policies in the course of project implementation and the lack of government funding in maternal and infant health care.The results of evaluation showed that there was no significant difference in perinatal mortality between intervention group and control group.Conclusion:The project doesn't carry out completely according to plan because of the change of related policies,thus,the study can't answer the question about weather prenatal care can improve pregnancy outcomes;in the course of evaluation of community based health project,process evaluation and outcome evaluation are necessary in order to understand weather the project can achieve desired effect.