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首页> 外文学位 >Facteurs organisationnels associes a l'education prenatale et impact sur l'accouchement assiste dans deux contextes a risques maternels et neonatals eleves au Burkina Faso.
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Facteurs organisationnels associes a l'education prenatale et impact sur l'accouchement assiste dans deux contextes a risques maternels et neonatals eleves au Burkina Faso.

机译：在布基纳法索，母婴风险较高的两种情况下，与产前教育相关的组织因素及其对辅助分娩的影响。

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摘要

Maternal and neonatal mortality remain high in developing countries. The magnitude of these phenomena is related to a constellation of factors. But a significant proportion of adverse pregnancy and birth outcome, in poor area, are attributable to preventable and behaviourally modifiable causes. Prenatal educational interventions have been developed in order to address the factors affecting the demand for effective maternal and neonatal care. Educational strategies targeting pregnant women include individual counselling, group sessions, and the combination of both strategies. These strategies aim to improve knowledge on issues related to maternal and newborn health and to promote the appropriate use of skilled care and hygiene practices at home. The World Health Organization (WHO) released practice guidelines in developing countries related to maternal and neonatal care including birth preparedness, during routine prenatal visits. However, few data are available about the effectiveness and implementation of effective prenatal education in these countries. This thesis aims to understand the impact of prenatal education programs in two contexts in Burkina Faso where maternal and neonatal risk are high. Written in the form of articles, the thesis addresses three specific objectives namely to: 1) examine the efficacy of prenatal education programs to reduce maternal and neonatal mortality in developing countries, 2) assess the association between different organizational factors and women's exposure to birth preparedness messages during routine antenatal care, and 3) determine the impact of receiving birth preparedness advice on the likelihood of institutional delivery. For the first objective, a meta-analysis of data from randomized trials was conducted. To achieve the two other objectives, data from a retrospective cohort study were used. This observational study, designed specifically for the thesis, was conducted in two districts (Dori and Koupela) in Burkina Faso. The meta-analysis showed that educational interventions are associated with a 24% reduction in neonatal mortality. This reduction reached 30% in areas with very high neonatal mortality. In routine situations, organizational factors may limit or facilitate the transmission of educational advice to women using prenatal care. In Burkina Faso, the data indicate significant disparities between the two districts in the study. Women from Koupela district were significantly more exposed to advice than those from Dori. Beyond this regional disparity, two other organizational factors were strongly associated with exposure of women to birth preparedness counselling during routine prenatal visits. The first factor was the availability of print materials and aids (e.g., posters, pictures...), used by health professionals as communication support to provide prenatal clients with advice. The second factor was a lower volume of daily consultations (i.e., less than 20 consultations versus 20 or more) which meant lower workload for staff. Finally, advice received by women concerning signs of obstetric complications and costs of care were associated with a significantly higher likelihood of institutional deliveries but only in the district of Dori where the initial rate of institutional deliveries was relatively low. In conclusion, prenatal education is beneficial for maternal and newborn health. However, implementation and effect heterogeneities exist across contexts. Others experimental and observational studies are required to strengthen the evidence and more thoroughly investigate success factors in order to support policies. Future experiments should focus on maternal outcomes (i.e., skilled birth attendance, postpartum care, and maternal mortality). Prospective cohort studies with large and representative samples would allow for examination of events and exposures to interventions during pregnancy, childbirth, and post-partum.;Keywords : Prenatal education, Birth preparedness, maternal mortality, neonatal mortality, skilled birth attendance, prenatal care, developing countries, Burkina Faso
机译：发展中国家的孕产妇和新生儿死亡率仍然很高。这些现象的严重程度与一系列因素有关。但是，在贫困地区，很大一部分不良妊娠和分娩结果可归因于可预防和行为可改变的原因。为了解决影响有效孕产妇和新生儿护理需求的因素，已经开发了产前教育干预措施。针对孕妇的教育策略包括个人咨询，小组会议以及两种策略的结合。这些策略旨在增进对与孕产妇和新生儿健康有关的知识，并促进在家中适当使用熟练的护理和卫生习惯。世界卫生组织（世卫组织）在发展中国家进行了例行的产前检查，并在发展中国家发布了与孕产妇和新生儿保健有关的实践指南，包括生育准备。但是，在这些国家中，鲜有关于有效产前教育的有效性和实施的数据。本文旨在了解在产妇和新生儿风险较高的布基纳法索的两种情况下，产前教育计划的影响。本论文以文章的形式写成，解决了三个具体目标，即：1）检查产前教育计划在发展中国家降低孕产妇和新生儿死亡率的功效； 2）评估不同组织因素与妇女暴露于备胎之间的联系常规产前检查期间收到的信息，以及3）确定接受生育准备建议对机构分娩的可能性的影响。为了第一个目标，对来自随机试验的数据进行了荟萃分析。为了实现另外两个目标，使用了一项回顾性队列研究的数据。这项专为论文设计的观察性研究是在布基纳法索的两个地区（Dori和Koupela）进行的。荟萃分析表明，教育干预措施可使新生儿死亡率降低24％。在新生儿死亡率很高的地区，这一降低达到了30％。在常规情况下，组织因素可能会限制或促进使用产前护理向女性传播教育建议。在布基纳法索，数据表明该研究的两个地区之间存在巨大差异。来自库佩拉地区的妇女比来自多里的妇女更容易受到建议的影响。除了这一地区差异外，其他两个组织因素还与妇女在常规产前检查期间接受生育准备咨询的情况密切相关。第一个因素是印刷材料和辅助工具（例如海报，图片...）的可用性，卫生专业人员将其用作交流支持以向产前客户提供建议。第二个因素是每天的咨询量减少（即少于20次咨询，而20次或更多），这意味着工作人员的工作量减少了。最后，妇女收到的有关产科并发症迹象和护理费用的建议与机构分娩的可能性大大增加有关，但仅在最初机构分娩率相对较低的多里地区。总之，产前教育对孕产妇和新生儿健康有益。但是，实现和效果的异质性在上下文中存在。为了支持政策，还需要进行其他实验研究和观察性研究以加强证据并更彻底地调查成功因素。未来的实验应着重于产妇的结局（即熟练的出勤，产后护理和产妇死亡率）。前瞻性队列研究使用大量代表性样本进行研究，可以检查孕妇，分娩和产后的事件和干预措施的暴露;关键词：产前教育，分娩准备，孕产妇死亡率，新生儿死亡率，熟练的出勤率，产前保健，发展中国家，布基纳法索

著录项

  • 作者

    Soubeiga, Dieudonne.;

  • 作者单位

    Universite de Montreal (Canada).;

  • 授予单位 Universite de Montreal (Canada).;
  • 学科 Health Sciences Oncology.
  • 学位 Ph.D.
  • 年度 2012
  • 页码 197 p.
  • 总页数 197
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 肿瘤学;
  • 关键词

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