OBJECTIVE:Scale-up of prevention of mother-to-child transmission (PMTCT) of HIV programmes in sub-Saharan Africa has stimulated interest to assess whether these programmes can indirectly affect other health priorities. This study assesses whether PMTCT programmes, or components of these programmes, are associated with better obstetrical quality of care and how PMTCT may reinforce existing maternal health programmes. DESIGN:Cross-sectional analysis of data from a cluster-randomized trial called QUARITE. SETTING:Mali and Senegal, West Africa. PARTICIPANTS:Thirty-one referral hospitals and 612 obstetrical patients. INTERVENTION:The exposure of interest was PMTCT measured with a scale containing 10 components describing different prongs of a hospital PMTCT programme. Other variables of interest included: presence of a quality of care improvement programme, hospital resources and patient demographic characteristics. MAIN OUTCOME MEASURE:Obstetrical quality of care measured through a validated chart abstraction tool. RESULTS:Of 45 points, the mean hospital PMTCT score was 26.1 (SD: 6.7). Total PMTCT score was not significantly associated with quality of care, but programme component scores were. After adjustment for known predictors of quality of care, staff training in PMTCT (P = 0.03) and complementary nutritional services (P = 0.03) were significantly associated with better quality obstetrical care. A point increase in scores for either of these components was associated with 40% greater odds of good obstetrical care. CONCLUSIONS:PMTCT training and nutritional components are significantly associated with better quality intrapartum care. Health professionals' training in maternal healthcare and PMTCT could be combined to improve the quality of obstetric care in the region.

译文

目的:在撒哈拉以南非洲扩大艾滋病毒预防计划的母婴传播(PMTCT)预防已经引起了人们对评估这些计划是否可以间接影响其他卫生优先事项的兴趣。这项研究评估了PMTCT计划或这些计划的组成部分是否与更好的产科护理质量相关,以及PMTCT如何加强现有的孕产妇保健计划。
设计:对来自名为QUARITE的聚类随机试验的数据进行横断面分析。
地点:西非马里和塞内加尔。
参加者:31所转诊医院和612例产科患者。
干预:感兴趣的暴露是用PMTCT测量的,该量表包含10种成分,描述了医院PMTCT计划的不同分支。其他感兴趣的变量包括:护理质量改善计划的存在,医院资源和患者人口统计学特征。
主要观察指标:通过经过验证的图表提取工具来评估产科护理质量。
结果:在45分中,医院PMTCT平均得分为26.1(标准差:6.7)。 PMTCT总分与护理质量没有显着相关,但计划组成分却与之相关。在调整了已知的护理质量预测因素后,对PMTCT进行的员工培训(P = 0.03)和补充营养服务(P = 0.03)与更好的产科护理质量显着相关。这些成分中任一个的得分增加与良好产科护理的机会增加40%相关。
结论:PMTCT培训和营养成分与更好的产期护理质量显着相关。可以将卫生专业人员在孕产妇保健和PMTCT方面的培训结合起来,以提高该地区的产科护理质量。

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