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首页> 外文期刊>The New England journal of medicine >An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan.
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An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan.

机译：一项涉及传统接生员以及巴基斯坦围产期和产妇死亡率的干预措施。

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BACKGROUND: There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries. METHODS: We performed a cluster-randomized, controlled trial involving seven subdistricts (talukas) of a rural district in Pakistan. In three talukas randomly assigned to the intervention group, traditional birth attendants were trained and issued disposable delivery kits; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes; and obstetrical teams provided outreach clinics for antenatal care. Women in the four control talukas received usual care. The primary outcome measures were perinatal and maternal mortality. RESULTS: Of the estimated number of eligible women in the seven talukas, 10,114 (84.3 percent) were recruited in the three intervention talukas, and 9443 (78.7 percent) in the four control talukas. In the intervention group, 9184 women (90.8 percent) received antenatal care by trained traditional birth attendants, 1634 women (16.2 percent) were seen antenatally at least once by the obstetrical teams, and 8172 safe-delivery kits were used. As compared with the control talukas, the intervention talukas had a cluster-adjusted odds ratio for perinatal death of 0.70 (95 percent confidence interval, 0.59 to 0.82) and for maternal mortality of 0.74 (95 percent confidence interval, 0.45 to 1.23). CONCLUSIONS: Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality. This model could result in large improvements in perinatal and maternal health in developing countries.
机译：背景：全世界每年大约有400万新生儿死亡和50万孕产妇死亡。来自临床试验的证据不足以指导发展中国家有效产妇服务的发展。方法：我们进行了一项涉及巴基斯坦农村地区的七个街道（塔卢卡斯）的整群随机对照试验。在随机分配给干预组的三只taluka中，对传统的接生员进行了培训并发放了一次性分娩工具包; Lady Health Workers将传统接生员与已建立的服务联系在一起，并记录了流程和结果;产科团队提供了外展诊所进行产前护理。四个对照组的距骨中的妇女得到了常规护理。主要结果指标是围产期和孕产妇死亡率。结果：在七名taluka中，估计合格的女性人数中，三名干预taluka中招募了10,114名女性（84.3％），在四名对照taluka中招募了9443名（78.7％）。在干预组中，有9184名妇女（90.8％）由训练有素的传统接生员接受了产前护理，产科团队至少一次产前检查过1634名妇女（16.2％），并使用了8172个安全分娩工具包。与对照组相比，干预围产儿围产儿死亡的簇校正比值比为0.70（95％置信区间为0.59至0.82），孕产妇死亡率为0.74（95％置信区间为0.45至1.23）。结论：对传统的接生员进行培训并将其纳入改善的卫生保健系统是可以实现的，并且可以有效降低围产期死亡率。这种模式可能会大大改善发展中国家的围产期和孕产妇保健。

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