协议驱动的初级保健和社区联系,以减少赞比亚农村的全因死亡率:一个阶梯集群随机试验
Wilbroad Mutale1, Helen Ayles2, James Lewis3
1Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
这项研究评估了赞比亚的BHOMA干预. 虽然总体死亡率下降,但复杂的卫生系统干预措施并没有显著降低目标人群中所有原因死亡率.
科学领域:
- 全球健康 全球健康
- 卫生系统研究 卫生系统研究
- 公共卫生干预 公共卫生干预
背景情况:
- 低收入和中等收入国家 (LMICs) 面临着影响人口健康的持续卫生系统挑战.
- 对密集卫生系统干预措施的严格比较研究很少,结果不确定.
- 设备不足的卫生系统阻碍了对LMIC中普遍存在的健康挑战的有效应对.
研究的目的:
- 评估复杂卫生系统干预 (BHOMA) 对赞比亚死亡率的影响.
- 评估密集的临床培训,质量改善和管理支持对健康结果的有效性.
- 确定多方面加强卫生系统的方法是否能在资源较少的环境中改善人口健康.
主要方法:
- 一个阶梯集群随机试验,涉及赞比亚卢萨卡省42个农村卫生中心.
- BHOMA的干预包括临床培训,质量改善,商品支持,社区宣传和管理支持.
- 主要结局:全因死亡率 (28天至60岁);次要结局:新生儿后5岁以下死亡率和服务覆盖率得分.
主要成果:
- 死亡率显示,从干预前期到干预后期的死亡率大幅下降.
- BHOMA干预没有显示出统计学上显著的任何原因死亡率降低 (调整HR:1.12;p=0.443).
- 在特定的服务覆盖率得分中观察到改善,包括用杀虫剂处理的床使用,疟疾治疗和高血压管理.
结论:
- 观察到死亡率的总体降低,但不能直接归因于BHOMA干预.
- 虽然一些服务覆盖率指标有所改善,但复杂的卫生系统干预措施并没有对所有原因死亡率的首要结果产生重大影响.
- 需要进一步的研究,以了解影响卫生系统加强和人口健康结果的因素在LMICs.
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