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2018年公共卫生大会:剖腹产的趋势在埃及及其相关因素:证据来自全国调查,2005 - 2014支H Al-Rifai——阿拉伯联合酋长国大学

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问题的声明:剖腹产(剖腹产)交付的继续增长,引发了世界范围的一个主要公共健康问题。

方法和理论取向:剖腹产分娩的趋势从2005年到2014年的折磨,与剖腹产增加交付相关的因素在埃及的母亲,从2005年到2014年被交货地点检查。总样本超过29000埃及母亲们调查了2005年,2008年和2014年。

发现:Institutional-based剖腹产增加了40.7分从EDHS2005电火花强化- 2014(优势比,3.46,95%置信区间CI: 3.15 - 3所示。80年,P-trend < 0.001)。母亲相比,较低的社会经济地位(SES),母亲高SES有更高几率(优势比,1.78,95%置信区间CI: 1.25 - -2.54, P = 0.001)剖腹产,但只在电火花强化- 2005。的调整趋势Csections被发现4.19倍(95%置信区间:3.73—-4.70,P < 0.001)高于私营部门,公共部门是2.67倍(95%置信区间CI: 2.27 - 3.13, P = 0.001)高,EDHS2014相对于电火花强化- 2005。这个增加私营部门的解释中显著增加剖腹产的母亲可能在低风险;19到24岁母亲和? ? ?35年(优势比:0.31;95%置信区间:0.21—-0.45;在电火花强化- 2005和0.43,95%置信区间CI: 0.330.56,在电火花强化- 2014,P < 0.001);初孕妇母亲和母亲? ? ?4个孩子(优势比:1.62;95%置信区间:1.12—-2.34,在电火花强化- 2005和3.76,95%置信区间:2.94—-4.80在电火花强化- 2014)和正常相比高危婴儿出生体重(优势比:0.79,95% CI: 0.62—-0.99在电火花强化- 2005 P < 0.05和0.83; 95% CI: 0.65-1.04 in EDHS-2014, P>0.05).

结论:稳步上升剖腹产在埃及近年来已经达到了惊人的水平。这种增长似乎被关联到一个转向私人卫生保健设施交付。剖腹产分娩的更加警惕,尤其是在私人部门,是十分必要的。讨论:剖腹产的研究估计趋势在2005年埃及母亲样本中,2008年和2014年。有大幅上涨的趋势institutional-based剖腹产三倍以上,在研究期间。私营部门似乎csections上升的司机在埃及,大幅增加也观察到在公共部门使用这种手术。超过4倍增加剖腹产在私营部门是由大幅增加在csections母亲剖腹产分娩的风险可能较低。在埃及,csections执行2014年的近60%人口比例远远超过阈值世卫组织推荐的10 - 15%。populationbased剖腹产的比例> 10%并没有导致健康改善母亲和新生儿。虽然观察到随着时间的增加剖腹产率在埃及是符合已经在许多国家和国际研究指出,随着时间的增加地方埃及作为一个国家最高的剖腹产在世界范围内,执行后巴西(45.9%)。 The institutional-based proportion (67.3%) of c-sections recorded in Egypt in 2014 is 2.2-time and 2.7-time higher than that recently recorded in Jordan (30.3%) and in Saudi Arabia (25%), respectively. The decline in homebased deliveries by over 60% merely reflects an improvement in provided health care services in Egypt. Over the past decade, per capita total expenditure on health increased from US$75.8 in 2000 to US$123.2 in 2010. However, improving administered health care services should not justify the massive increase in csections. This exponential rise in csections indicates an overuse for this surgical procedure that might be due to many c-sections may increasingly be performed without any medical indication. This rise in c-sections would pose further economic burden in a resource limited-setting such as Egypt, which is already burdened with different economic difficulties where 26.3% of Egyptians live below the poverty line In 2008, the WHO estimated that 253,890 unnecessary c-sections had been performed with a total cost of US$ 41,085,585 per year. Referring to the obtained results, the discernible increase in c-sections in Egypt in 2014, this study assumes that the unnecessary csections and its associated spending at least would double the ones estimated in 2008. Furthermore, the increased c-sections would pose further unfavorable health outcomes as a result of adverse outcomes associated with c-sections in a country already burdened with a relatively high MMR and NMR in addition to other infectious diseases mainly hepatitis C virus that infect nearly 15% of the 15 to 59 years old Egyptian people. This disease alone consumes about 20% of the Ministry of Health and Population total annual budget to treat infected individuals. Rigorous institutional-based study is needed to assess the impact of this high proportion of csections and identify the exact medical and non-medical needs for csection deliveries for future planning and effective policy interventions. In the three surveys, childbearing at ≤18 years or ≥35 years, living in high SES, maternal overweight/obesity, pregnancy with high-risk birth weight or multiple babies, delivery in a private sector were found as significant factors associated with c-section delivery in Egypt except for SES in EDHS-2014.

结论:结果表明,proportion埃及csections近年来稳步增加,已经达到了惊人的水平。剖腹产的比例记录在过去的电火花强化进行了推荐的最大阈值在2014年翻了两番。数量的增加分娩发生在私营部门似乎转向私人设施交付。增加私营部门,尤其是母亲的低风险的潜在csections需要迫切需要采用关键政策和策略能够阻止稳步上升剖腹产在埃及和改善生殖健康,母亲和婴儿的健康结果。同时,深入institutionalbased研究收集数据的确切适应症与剖腹产在埃及也是必要的。

rrifai@uaeu.ac.ae

Rami H Al-Rifai

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