Adequate environmental conditions, comprising sufficient environmental hygiene items (e.g. gloves, soap, and disinfectant), adequate infrastructure (e.g. sanitation facilities, water supply), a clean environment, and hygienic behaviors in healthcare facilities (HCFs) are necessary for safe care in maternity wards. Few data are available describing environmental conditions in maternity wards in rural areas of low- and middle-income countries (LMICs). We collected data on these conditions from 1547 HCFs with maternity wards in 14 countries (Ethiopia, Ghana, Honduras, India, Kenya, Malawi, Mali, Mozambique, Niger, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe). We described patterns and availability of essential environmental conditions, and a regression model was developed to explore predictive factors. 73% of HCFs offering maternal and neonatal health (MNH) services did not meet the guidelines for the World Health Organization 'six cleans' (clean perineum, clean bed surface, clean hands, clean blade, clean cord tie, and clean towels to wrap the baby and mother). The items with the lowest availability were clean towels (40%). In a multivariable logistic regression model, HCFs that provided maternity services were more likely to have all 'six cleans' available if they: had at least an improved water source; had an infection prevention and control (IPC) protocol; had a budget considered sufficient that included funding for water, sanitation, hygiene, and IPC; and emphasized the importance of IPC within the nearby community. Our results demonstrate substantial differences between countries in the availability of environmental hygiene items, facility cleanliness, and quality of environmental health infrastructure in HCF maternity wards. There are several low-cost, high-impact, context-relevant opportunities to enhance essential environmental conditions that would improve the quality of neonatal and maternal care in maternity wards in HCFs in LMICs.

译文

适当的环境条件,包括足够的环境卫生物品 (例如手套,肥皂和消毒剂),足够的基础设施 (例如卫生设施,供水),清洁的环境以及医疗保健设施 (HCFs) 的卫生行为是必要的在产科病房中进行安全护理。描述中低收入国家农村地区产科病房环境状况的数据很少。我们从14个国家 (埃塞俄比亚,加纳,洪都拉斯,印度,肯尼亚,马拉维,马里,莫桑比克,尼日尔,卢旺达,坦桑尼亚,乌干达,赞比亚和津巴布韦) 的1547个HCFs中收集了有关这些情况的数据。我们描述了基本环境条件的模式和可用性,并开发了一个回归模型来探索预测因素。提供孕产妇和新生儿健康 (MNH) 服务的HCFs 73% 不符合世界卫生组织 “六种清洁” (清洁会阴,清洁床面,清洁手,清洁刀片,清洁绳带和清洁毛巾包裹婴儿和母亲) 的指南。可用性最低的项目是干净的毛巾 (40%)。在多变量逻辑回归模型中,提供产妇服务的HCFs更有可能获得所有 “六种清洁”,如果它们: 至少有改善的水源; 有感染预防和控制 (IPC) 协议; 有足够的预算,包括水,卫生,和IPC; 并强调了IPC在附近社区中的重要性。我们的结果表明,各国在HCF产科病房的环境卫生用品,设施清洁度和环境卫生基础设施质量方面存在重大差异。在lmic中,有一些低成本,高影响力,与背景相关的机会可以改善基本环境条件,从而提高HCFs产科病房的新生儿和产妇护理质量。

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