ネパールにおける出生結果に対する女性グループによる参加型介入の効果:クラスターランダム化対照試験
Dharma S Manandhar1, David Osrin, Bhim Prasad Shrestha
1Mother and Infant Research Activities (MIRA), PO Box 921, Kathmandu, Nepal.
Lancet (London, England)
|September 15, 2004
まとめ
コミュニティベースの参加型介入により,ネパールにおける新生児死亡率が大幅に低下し,女性のグループに,現地における新生児に関する課題に取り組む権限を与えられた. この低コストのアプローチは,脆弱な集団における出産結果と母親の健康を改善しました.
科学分野:
- グローバル・ヘルス グローバル・ヘルス
- 母親と子供の健康について
- コミュニティベースの介入
背景:
- 新生児死亡は,開発途上国における5歳未満の死亡率に大きく寄与しています.
- 家庭出産は,最も貧しい人口の中で一般的であり,新生児のリスクを高めています.
- 新生児死亡率を減らすために,コミュニティベースの参加型アプローチが検討されています.
研究 の 目的:
- 新生児死亡率の低下におけるコミュニティベースの参加型介入の有効性を評価する.
- 女性のグループが産前問題や健康上の結果に与える影響を評価する.
- 介入のスケーラビリティと持続可能性を決定する.
主な方法:
- ペアマッチングクラスターランダム化対照試験は,ネパールのマクワンプール地区で行われました.
- 女性のグループは,地元の女性によって促進され,妊婦の問題を特定し,対処するためにアクション・ラーニング・サイクルに参加しました.
- 出産の結果は,28,931人の女性のコホートで監視され,治療意図による分析が行われました.
主要な成果:
- 新生児死亡率は,コントロールクラスター (36.9/1000) と比較して,介入クラスター (26.2/1000) で著しく低かった.
- 妊産婦死亡率は,対照群 (341/100,000) と対照群 (69/100,000) の間で著しく減少した.
- 介入参加者は,産前ケア,施設での出産,衛生的な出産の慣行の利用が増えたことを示しました.
結論:
- 女性のグループを利用した低コストの参加型介入は,資源の限られた環境での出産結果を大幅に改善することができます.
- この介入は,母親と新生児の健康を改善するための持続可能性とスケーラビリティの可能性を実証しました.
- 地域社会を参加型アプローチを通じて力づくることは,重大な健康上の課題に対処する上で効果的です.
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