家庭访问与社区卫生工作者和儿童生存的固定场所护理:一个集群随机试验,马里
Jenny Liu1, Emily Treleaven2, Caroline Whidden3
1Institute for Health and Aging, University of California, San Francisco, United States of America (USA).
Bulletin of the World Health Organization
|September 2, 2024
概括
社区卫生工作者主动访问家庭并没有减少马里农村的儿童死亡率. 然而,初级医疗保健的整体系统改进可能有助于在两组研究中减少五岁以下儿童死亡.
科学领域:
- 全球健康 全球健康
- 儿科死亡率 儿科死亡率
- 社区卫生干预措施 社区卫生干预
背景情况:
- 五岁以下儿童死亡率仍然是一个重大的全球卫生挑战,特别是在资源较低的环境中.
- 社区卫生工作者 (CHW) 在农村地区提供初级医疗保健服务方面发挥着至关重要的作用.
- 评估针对性的干预措施,如家庭访问,对于改善儿童存活率至关重要.
研究的目的:
- 评估受过培训的医疗保健工作者主动访问家庭对减少马里农村五岁以下儿童死亡率的影响.
- 为了比较基于家庭访问的初级保健的有效性与由CHWs提供的基于设施的护理.
主要方法:
- 一个集群随机试验,涉及马里农村的137个村庄集群.
- 从2017年2月到2020年1月,有31,761名儿童被录取.
- 干预组:医疗保健医生提供定期的家庭访问;控制组:医疗保健医生提供基于设施的护理. 两支手臂都获得了改善的初级保健服务,并取消了用户费用.
主要成果:
- 在干预组和控制组,五岁以下儿童死亡率在三年内显著下降.
- 对治疗意图的分析显示,在家庭访问 (IRR:1.02) 和机构护理臂 (IRR:1.02) 之间,在五岁以下儿童死亡率上没有显著差异.
- 每个方案的估计也表明研究组之间没有统计学上显著的差异 (IRR: 1.01).
结论:
- 医疗保健工作者主动进行家庭访问并没有表明,与设施医疗照顾相比,五岁以下儿童死亡率显著降低.
- 系统加强措施,包括改善初级医疗保健服务和取消用户费,可能有助于观察到的儿童死亡率下降.
- 可能需要进一步的研究来优化CHW主导的干预措施,以改善类似环境中的儿童存活率.
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