运用生命挽救工具预测降低广西农村孕产妇死亡率的干预措施健康效果的适用性

Applicability of lives saved tool in projecting effects of scaling up interventions on reducing maternal mortality rates in the rural area of Guangxi province in China

目的:运用生命挽救工具(lives saved tool,LiST)预测在广西农村地区扩大相关干预措施覆盖率对降低孕产妇死亡率的效果,分析LiST在当地的适用性,并遴选适合该地区的优先干预措施,为该模型在中国的推广提供依据。方法:通过文献检索、入户调查和专家咨询收集孕产妇死亡和妇幼干预覆盖率数据,以2008年为基线,运用LiST模型预测2009年和2010年孕产妇死亡率和死因构成,将预测结果与实测值进行对比分析;以2010年为基线,进一步预测在2015年所有相关干预实现全覆盖的健康效果,筛选优先干预措施。结果:2011年,广西农村孕期补钙率、硫酸镁治疗先兆子痫率和住院分娩率分别达到51.9%、99.0%和98.4%。LiST模型准确预测出2008年至2010年广西农村孕产妇死亡率先升后降的趋势,2009年孕产妇死亡率预测值比实测值低4.71%,2010年预测值比实测值高10.43%。当2015年所有相关干预措施实现全覆盖时,广西农村孕产妇死亡率降至18/10万,其中分娩期管理对降低孕产妇死亡的贡献最大,为90%。结论:LiST可用于预测降低广西农村孕产妇死亡率的干预措施健康效果。但是,由于当地一些重要的孕产妇死因(如羊水栓塞)未纳入LiST模型,模型预测的准确性受到影响。提高乡镇卫生院产科服务质量,促进高危孕产妇转诊是广西农村地区进一步降低孕产妇死亡的优先策略。

Objective：To evaluate applicability of lives saved tool （LIST） in projecting effects of maternal health interventions on reducing maternal mortality in the rural area of Guangxi Zhuang Autonomous Region in China, and provide evidence for promoting LiST in China. Methods： By using maternal intervention coverage and other information collected through the cross-sectional household survey, literature review and expert consultation, LiST projection was performed and modeled. The maternal mortality reduction and causes of death were measured and compared, and the differences were analyzed. SPSS 19.0 was used in the household survey data analysis. Results： Coverage of calcium supplementation, MgSO4- management of pre-eclampsia and institutional delivery reached 51.9%, 99.0% and 98.4% respectively in rural Guangxi in 2011. The LiST captured the general trend of maternal mortality in rural Guangxi. The modeled maternal mortality rate was 4.71% , lower than the measured in 2009 and 10.43% higher in 2010. Maternal mortality rate would decreased to 18/100 000 in 2015 assuming all relevant interven- tions reached full coverage, and 90% of the maternal morality reduction was attributed to the labor and delivery management. Conclusion： LiST can be applied to project effects of maternal health interventions on reducing the maternal mortality in rural Guangxi, but its accuracy was limited by the fact that the effect of relevant interventions on some major causes of maternal death, such as amniotic embolism, was not calculated in LiST and maternal deaths caused by those causes varied by the year in the area. Based on the LiST projection, labor and delivery management was found to be the priority intervention in improving maternal health in rural Guangxi. Improving the quality of obstetric care in township hospitals and facilitating referral of high-risk pregnant women were highly recommended.