Paschal Mdoe研究小组揭示坦桑尼亚降低与出生有关的死亡率项目的结果。这一研究成果于2025年2月26日发表在国际顶尖学术期刊《新英格兰医学杂志》上。

背景:与出生有关的死亡率是造成全世界死亡负担的一个主要因素，特别是在低收入国家。安全分娩一揽子护理方案是一项综合干预措施，旨在提高母婴护理质量，目标是降低与分娩有关的死亡率。

方法:研究小组在坦桑尼亚5个地区的30家高负担医疗机构开展了一项为期3年的楔形聚类随机研究。该计划中的一系列干预措施旨在通过定期的现场模拟培训、收集和使用当地临床数据、训练有素的当地辅导员的协助以及使用创新的围产期护理工具来持续提高质量。主要结局是围产期死亡，包括产时死产（疑似分娩死亡）和出生后24小时内新生儿死亡。

结果:共有281,165名母亲和277,734名婴儿被纳入最终分析。围产期死亡的估计发生率从计划基线期的每千名新生儿15.3例死亡下降到实施后的每千名新生儿12.5例死亡(调整后的相对危险度为0.82；95%置信区间为0.73 ~ 0.92；P=0.001)，区域间存在显著异质性。在基线期，产时死产的发生率为每1000个新生儿8.6例死亡，实施后为每1000个新生儿8.7例死亡(调整后的相对危险度为1.01；95% CI, 0.87 - 1.17)，出生后24小时内新生儿死亡率分别为每1000例6.4例和3.9例(调整后相对危险度，0.61；95% CI, 0.49 ~ 0.77)。无严重不良事件报告。

研究结果表明，安全分娩一揽子护理方案的实施表明，在资源有限的情况下，针对与分娩有关的紧急情况，整合质量改进工作是可行的，并与围产期死亡率的显著降低有关。

附：英文原文

Title: Outcomes of a Program to Reduce Birth-Related Mortality in Tanzania

Author: Benjamin A. Kamala, Hege L. Ersdal, Robert D. Moshiro, Godfrey Guga, Ingvild Dalen, Jan T. Kvaly, Felix A. Bundala, Ahmad Makuwani, Ntuli A. Kapologwe, Rashid S. Mfaume, Esto R. Mduma, Paschal Mdoe

Issue&Volume: 2025-02-26

Abstract: BACKGROUND

Birth-related mortality is a major contributor to the burden of deaths worldwide, especially in low-income countries. The Safer Births Bundle of Care program is a combination of interventions developed to improve the quality of care for mother and baby with the goal of reducing birth-related mortality.

METHODS

We performed a 3-year stepped-wedge cluster-randomized study of the Safer Births program at 30 high-burden facilities in five regions in Tanzania. The bundle of interventions in the program was aimed at continuous quality improvement through regular onsite simulation-based training, the collection and use of local clinical data, the assistance of trained local facilitators, and the use of innovative tools for perinatal care. The primary outcome was perinatal death, which included intrapartum stillbirth (suspected death during labor) and neonatal death within the first 24 hours after birth.

RESULTS

A total of 281,165 mothers and 277,734 babies were included in the final analysis. The estimated incidence of perinatal death decreased from 15.3 deaths per 1000 births in the baseline period of the program to 12.5 deaths per 1000 births after implementation (adjusted relative risk, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P=0.001), with substantial heterogeneity among regions. The incidence of intrapartum stillbirths was 8.6 deaths per 1000 births in the baseline period and 8.7 deaths per 1000 births after implementation (adjusted relative risk, 1.01; 95% CI, 0.87 to 1.17), and the incidence of neonatal deaths within the first 24 hours after birth was 6.4 and 3.9 deaths per 1000 births, respectively (adjusted relative risk, 0.61; 95% CI, 0.49 to 0.77). No serious adverse events were reported.

CONCLUSIONS

Implementation of the Safer Births Bundle of Care program showed the feasibility of integrating quality-improvement efforts targeting birth-related emergencies in resource-limited settings and was associated with a significant reduction in perinatal mortality.

DOI: NJ202502260000001

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2406295