Health Services Systems Project for Quality Antenatal Care and Well-Child Clinics

8/7/2019 Health Services Systems Project for Quality Antenatal Care and Well-Child Clinics

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2549


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PDG 4930211

1.

(

)

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

13.

14.

(.)( .)


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Executive Summary 1

- 3- 3- 4

8- 8- 8- 9- 11- 11- 12

12- 12- 22

22 3 30 35

- 43 43 3 51 53


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61- 61- 64

70 71

- 72- 77


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1 :

15 2:

16 3:

18 4: 19 5 :

30 20 6 :

21 7:

42 8: 53 9: 54 10: 54 11:

60


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1 : 23 2 : 25 3: () 27 4 : 29 5 : 30 6 : (Assess)

30 7 : (Assess)

31 8 : (Record) 32 9 : (Record) 33 10 : 34 11 : 34

12 :

35

13 : 35 14 : 36 15 : 36 16 : 36 17 : 37 18 : 38 19 : 38 20 : 39 21 : - 39 22 : 40 23 : 40 24 : 44


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() 25 : 46 26 : () 48 27 : 50 28 :

51 29 : 52 30 : 53 31 : 54 32 : 55 33 : 55 34 : 56 35 : 56 36 : 57 37 : 58 38 : 58 39 : 59 40 :

66 41 :

68


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ANC = Antenatal Clinic

WCC = Well Child Clinic

= = = =


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1. 2. 3. 4. 1


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6

2549


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Executive Summary

1. ANC

2.

(Quick survey Rapid survey)

2 - 2549 2 6 1 5 1 2 2

3 1 13 3

1.

2. 3 5

3


13/110

3.

3 6 ( 1 ) 11 ( 1 ) 3 10

1. 1.1 3

( Median, M) 1 12 25 1 100 8 1 4 20 4

/ 2 10

4 / 1 5 -

45 8

4 70 16

(83.3% 72.7%) (15.4%) / 30 ANC 50%

1.2 4 () 1

9 39 10 1


14/110

4 / 2 38 2 / -

6 35 4 / 4 68

3 1-6 53.8 % /

30 /

2. 2.1

Albumin Sugar

Pre-post counselling Ultrasound


15/110

2.2 3 22 36 43

101

( 18-32) ( 60) ( 80 ) 60-70 40.6 35.6

3. 3.1

/ / ( )

3.2 3 5 104

44 37 23 / ( 80 ) ( 40-75)


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( 4-23) ( 40) Plot / 30-70

Plot ( 20 13 ) ( 10) 80 52.9 29.8

1. 1 10 2. One Stop Service

3. (Flow) 4.

5. (Stand by) 6.


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ANC (Quick survey Rapid survey) 2 2549 - 2 6 1 5 1 2 2 3 1 1

3 (Median) 1 12 25 1 100 8 1 6 4 20

4 4 1 9 39 10 1 4 2


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101 ( 3 ) 104 ( 3 -) /

/


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Health Services Systems Project for Quality Antenatal Care and Well-Child ClinicsAbstract

The Health Services Systems Project for Quality Antenatal Care (ANC) and

Well-Child Clinics (WCC) had as its main purpose to assess the enhancement of antenatal

care and well-child clinics and to provide counsel regarding improved standards for the

provision of health services that are achievable in health institutions of various levels. This

study was done as a rapid survey over a two-month period (August-September) in 2006

for information regarding two basic target groups. The first group was health service

providers at the health centers/ primary care units, community hospitals, Bangkok-based

health stations and general hospitals providing services to mothers and infants. Heads of

the health service sites were interviewed. The other group was clients who were pregnant

women seeking antenatal care services and mothers of children under 6 years of age

consuming well-child health services. Data was taken from pregnant women and mothers

of infants receiving antenatal care and well-child health services on the day of data

collection, which may be a limitation for this study. Study sites were purposively chosen

from each region of Thailand, 1 province per region, totaling 5 provinces and Bangkok. In

each province, the data was collected about antenatal care and well-child health services

at one general hospital, 2 community hospitals and two health centers. In Bangkok, three

primary care units were chosen, along with 1 community hospital and 1 general hospital.

The result of the study found that the burden for provision of antenatal care and well-

child health services for children based on information obtained from the heads of the

health service sites above fell on a median of three staff persons, minimally one and a

maximum of 12 staff persons. The median of pregnant women who came for services at

the various sites was 25, with a minimum of 1 pregnant woman and maximum of 100. The

ratio of clients to health staff was 8:1. The overall distribution of burden among health

service providers in 6 regions of Thailand for antenatal care services was a minimum of 4

days per month because in some locations the services are provided only once per week.

The largest number of days for the services per month was 20, due to provision of daily

services. The median of service provision was equal to 4 times per month. The well-child


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service staff numbered between 1 and 9 staff persons with a median of 4. A median of 39

mothers received well-child services per service period, resulting in an average client-

staff ratio of 10:1. These services were provided anywhere from once per month to twice

per week.

The procedure used for providing antenatal care and well-child services was

obtained by interviewing heads of each health service site. Their information showed

commonality in procedures among all health service-providing sites. Variation was found

among the health services providers in this study in terms of the amount of counsel

provided to the client, due to the heavy client load of some of the staff. In other cases,

records concerning assessments were taken less meticulously in heavy load locations.

Health service sites at the secondary care and tertiary care level had a larger variety of

medical staff who were often engaged in providing a variety of other additional services as

part of the cause of heavy case load.

After observing 101 pregnant women (at least 3 clients per site) and 104 mothers

with children (at least 3 per site), the study found that the staff used the antenatal care

services information on Sen Tang Luk Rak [Pregnancy Pathway] and the Pregnant

Womans Nutritional Chart at a very low level. For Child health care, meanwhile, little use

was made of the patients medical history or information regarding drug/food allergies.

In addition the use of the maternal and child health handbooks was at a very low

level, according to interviews with the pregnant women and mothers and checking the

handbooks for records made in them. For maternal health, Pregnancy Pathway, Pregnant

Womens Nutritional Chart, and pregnancy risk assessment were used minimally. As for

the childs health, least use was made of the medical history of the child, drug and food

allergies, child development as well as the growth charts.


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1

(CIDA, UNICEF 1997; 2542)

(CIDA, UNICEF 1997)

(WHO, 1994) ( 2549)

6


22/110

2

( 2546) Moyer VA (2004)

1.

2.

3.

( 2546)1.

/

2.

3.

- 1(2505-2509) 8 (2540-2545) 80 90

90 ( 2547)


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3

1. ANC

2.

(Antenatal care - ANC)

(Check list)

(Well Child Clinic - WCC) ()

WCC

3 1-6

1-6 3 (.) .

6

WCC


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4

ANC WCC 30 30 ANC WCC

6 MCH Board ( 2549)

11 3

1. //

20

2.

3. Hct., CBC, VDRL, Albumin, Sugar4.5.6.7. 1 8. 2

4

..1994 Mother-babyPackage: Implementing safe motherhood in countries


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5

Mother-Baby Package - 4

(WHO 1994.)1.2.3.4.5.6.7.8. -

Mother-Baby Package

1.

2.

3. Mother-Baby Package

4.

40


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6

28 28-36 2

12 6.. 2530-2534 4 () 1 29 2 29-32 3 33-36 4 37-40 1 1

.. 2001 7 pre-eclampsia, UTI, postpartum anemia maternalmortality, LBW perinatal mortality (WHO 2002)

- 2 20 ( 2549)

12

2535 26 2535 1 6(2) 24(1) ( 2542)

American Academy of Pediatrics ( 2546)


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7

7 1, 2, 4, 6, 9, 12 15, 18 2, 3, 4 5

6, 8, 10-11 11-14 , 15-17 18-21

1.

2.

3.

4.

( 2546)1.-

2.

3.

Mayer VA Butler M (2004) North American organizations 7 3 42 2 (intensive)


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8

Osborn LM (1994)

1.2. 3. 4. 5.6. 7. 8.9.

(Quick survey Rapid survey)

2 - 2549

2 6


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9

1

1

1 2 2 3 1 1

2 2549

6-28 2549

22-26 2549 6-11 2549 21-24 2549 6-11 2549 7, 10, 15 16 2549 8, 9, 11, 21, 22 28 2549


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10

1

:* 3 / ANC Antenatal Clinic

WCC Well Child Clinic

1 1 1 1 1

ANC

15 WCC

15 ANC

15 WCC

15

/

1

1

3

1 *

2 *

2 *


31/110

11

1.

30 ()

2. 3 5 3

()3.

()

3


32/110

12

2

ANC WCC

3 6 ( 1 ) 11 ( 1 ) 3 10

3 1.2.

2.1 2.2 3 2.3

3.3.1 3.2 3 3.3

1.

1.1 1

3 ( Median, M) 1 12


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13

25 1 100 8 1 6 4 20

4

35 () 2 18 1 3 1 18 1

/ 2 (7 )

10 (25 ) 4 / 1 ( 2 3)

5 4 6 2 45 (50 ) 8 ( 2 3)

4 8 70 (100 ) 16 ( 2 3)

( 4) (83.3% 72.7%) (15.4%)/-

30 ANC 50% / 5

( 6)

/


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14

1.2 ( 1) 4 ()

1 9 39 10 1 4 ( 2 3) / 2 (5 ) 38 (65 ) 2 / 8 / 6 35 4 / (4 /

) 4 68

( 4) - 3 1-6 3 / 53.8 % /

- -

30 /- ( 5)

( 6) /


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15


36/110

16


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17


38/110

18


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19


40/110

20


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21


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1

M * Q.D. ** M Q.D. M Q.D. M Q.D. M Q.D. M

ANC

3 1.25 4 2 2 2 2 2.3 5 2.5 6.0 8 7.5 25 26 35 28 17 21 50 25 50 ANC (/) 4 4 8.0 4.0 8 2 4 5 4 2 4 3:1 6:1 18:1 9:1 10:1

(n=5) (n=5) (n=5) (n=5) (n=5)

WCC

5 2 4 1.5 1 2 3 3 2 2 7 20 12 70 16 30 20 25 17 38 13 60 WCC (/) 1 1.5 4 1.5 4 0.5 4 0.8 4 0.8 8 4:1 18:1 30:1 8:1 19:1

(n=5) (n=5) (n=5) (n=5) (n=5)

* M Median** Q.D. Quartile Deviation


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2

M Q.D. M Q.D. M Q.D. M Q.D. M Q.D. M Q.D.

ANC

1.5 0.5 4.0 1 3 - 3 1 4 1 8 - 1 7.0 1 12.

5

5.5 25 - 11 1 35 10 80 - 1

ANC (/) 4.0 .0 4.5 0.5 20 - 4 .0 10 2 12 - 4 5:1 3:1 8:1 4:1 9:1 10:1

(n=2) (n=2) (n=1) (n=2) (n=2) (n=1)

WCC

2.5 0.5 5.5 0.5 7 - 3.5 0.5 4.5 .5 5 - 1 19.

0

9 35.

0

15 20 - 65.

0

15 57.

5

12.

5

80 - 2

WCC (/) 1.0 .0 2.5 1.5 4 - 1.0 .0 4.0 .0 4 - 3 8:1 6:1 3:1 19:1 13:1 16:1

(n=2) (n=2) (n=1) (n=2) (n=2) (n=1)


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2

M Q.D. M Q.D. M Q.D. M Q.D. M Q.D. M Q.D.

ANC

1 .0 4.0 2 5.0 - 1.0 .0 6.0 1 5.0 - 10 .0 33.5 16.5 55.0 - 5.5 4.5 50.0 .0 60.0 - ANC (/) 4 .0 6.0 2 20 - 4.0 .0 4.0 .0 12.0 - 10:1 8:1 11:1 6:1 8:1 12:1

(n=2) (n=2) (n=1) (n=2) (n=2) (n=1)

WCC

1.0 .0 6.5 .5 3.0 - 1.0 .0 5.0 2 2.0 - 37.5 12.5 19.0 1 55.0 - 39.0 2 40.0 20 28.0 - WCC 2.5 1.5 4.0 .0 4.0 - 2.5 1.5 4.0 .0 4.0 - 38:1 3:1 18:1 39:1 8:1 14:1

(n=2) (n=2) (n=1) (n=2) (n=2) (n=1)


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3

/

M Q.D. Min Max M Q.D. Min Max

ANC

2 2 1 12 5 2 1 7 10 3 1 55 45 16 7 55 ANC (/) 4.0 .0 4 4 8 2 4 20 5:1 9:1

(n=13) (n=11) WCC

2 1.5 1 7 6 1.5 1 9 38 12.5 10 85 35 20 18 70 WCC (/) 2 2.5 1 8 4 .0 1 8 15:1 7:1

(n=13) (n=11)


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4

./. . .

(ANC)

11 84.6 2 15.4 3 27.3 8 72.7 1 16.7 5

3 23.1 10 76.9 - - 11 100 - - 6

2 15.4 11 84.6 - - 11 100 - - 6

(ANC) 10 76.9 3 23.1 5 50.0 5 50.0 4 66.7 2 (n=13) (n=11) (n=6)

(WCC)

9 69.2 4 30.8 5 45.5 6 54.5 3 50.0 3

3 1-6

6 46.2 7 53.8 4 36.4 7 63.6 4 66.7 2

7 53.8 6 46.2 4 36.4 7 63.6 5 83.3 1

5 38.5 8 61.5 3 27.3 8 62.7 1 16.7 5

(WCC) 9 69.2 4 30.8 8 72.7 3 27.3 6 100 - (n=13) (n=11) (n=6)


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5

30

1. 600 2. 3. 4. 5. 30 6. 7.. . 2

8. 30

1. 2. 3. 4.

5. 6.


48/110

6

./. . .

(ANC)

8 61.5 5 38.5 2 18.2 9 81.8 3 50.0 3 50 8 61.5 5 38.5 6 54.5 5 45.5 6 100.0 - 9 69.2 4 30.8 5 45.5 6 54.5 2 33.3 4 66 7 53.8 6 46.2 1 9.1 10 90.9 2 33.3 4 13 100 - - 9 81.8 2 18.2 6 100 -

(n=13) (n=11) (n=6)

(WCC)

8 61.5 5 38.5 6 54.5 5 45.5 3 50.0 3 50 13 100.0 - - 8 72.7 3 27.3 5 83.3 1 5 38.5 8 61.5 4 36.4 7 63.6 - - 6 4 30.8 9 69.2 1 9.1 10 90.9 2 33.3 4 13 100.0 - - 11 100.0 - - 6 100.0 -

(n=13) (n=11) (n=6)


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(ANC)

1. ( ) 1. ( ) 2. ./. ( )2.

.

3. -..

1. / (P2) ( ) ( ) H 2. / (P2) ( ) ( ) H 3. (P2) ( ) ( ) H 4. (P2) ( ) ( ) H 5. (P3) ( ) ( ) A R E 6. (P4) ( ) ( ) A R E 7. (P5) ( ) ( ) A R E 8. (P6) ( ) ( ) E 9. (P7-8) ( ) ( ) A R E 10. (P10) (P12) ( ) ( ) ( ) A R E 11. (P10) ( ) ( ) ( ) A R E : H = History taking A = Assessment R = Record E = Explain


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12. (P10) ( ) ( ) ( ) A R E 13. (P10) ( ) ( ) ( ) A R E 14. (P10) ( ) ( ) ( ) A R E 15. (P10) ( ) ( ) ( ) A R E 16. (P10) ( ) ( ) ( ) A R E 17. (P10) ( ) ( ) ( ) R E 18. (P10) ( ) ( ) ( ) R E 19. (P11) (P13) ( ) ( ) A R E 20. (P11) (P13) ( ) ( ) A R E 21. .

1. ( ) ( ) 4. 2.

( )

( )

5.

3. ( ) ( ) 6.

( ) ( )


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(WCC)

1. ( ) 1. ( ) 2. ./. ( ) 3. .4. . .5. - . ( ) 1. ( ) 2.

.

1. (P42) (P52) ( ) ( ) ( ) A R E

2. Plot (P31-33) (P34-36) ( ) ( ) ( ) R E

3. / (P42) (P52) ( ) ( ) ( ) A R E

4. (P42) (P52) ( ) ( ) ( ) A R E

5. (P35, 36) (P45-46) ( ) ( ) E

6. (P35) (P45) ( ) ( ) ( ) E

7. (P22-30) (P24-32) (P24-32)

( )

( )

( ) ( )

( )

A R E

8. (P37) (P47) ( ) ( ) A E

9. (P39, 40) (P49-50) ( ) ( ) A E

: A = Assessment R = Record E = Explain


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10. (P41, 43) (P51, 53) ( ) ( ) A R E

11. (P44) (P54) ( ) ( ) R E

12. (P45) (P55) ( ) ( ) A R E

13. (P45) (P55) ( ) ( ) A R E

14. ..

1. ( ) ( ) 2. ( 2 ) ( ) ( )

3. () ( ) ( )

4. () ( ) ( )

5. ( ) ( ) ( )


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22

2. 2.1

2.1.1

1

1 2

2 1 3 1 1

24-28

()

1 2

1 1 -


54/110

23

1 1 1

1

1

2

1

2

1 3

/

24-28

1

1

/

1 1

/

. 1 . 1

:


55/110

24

2.1.2 1

() 1 2 24

2

38 32

2 1 4

3 1

()

1

2

1

4

2


56/110

25

2

2

1

1

- - - -

2

24

3

1 12 1 1

38 1

4

1

2

1

1 ()

:


57/110

26

2.1.3 () 1

2

1

2

()

1 2

(Treatment)

3


58/110

27

3 ()

2

1

/

/

2

Treatment

2

1

:


59/110


60/110

29

4

1

4

2

1

28-32

38 3

. 1

1

1

28

( 1 ) 1

:


61/110

30

2.2 3 - 101

2.2.1 (History Taking)

5

/ / 40-50 /

2.2.2 (Assess) 6 (Assess)

55.8

44.450.0 51.2

41.7

36.4

0

20

40

60

80

100

/ /

./. (n = 43) . (n = 36) . (n = 22)

67.469.4

59.1

69.863.9

59.1

30.2 27.8

13.6

30.2

22.2

31.8

97.7

100.0100.0

86.097.2

100.0100.0

97.2

100.0

0

20

40

60

80

100

./. (n = 43) . (n = 36) . (n = 22)


62/110

31

100.

0

97.

2

100.

0

97.

7

88.

9

86.

4

90.

7

88.

9

86.

4

88.

491.

7

90.

9 97.

7

97.

2

95.

5

90.

797.

2

95.

5

0

2 0

4 0

6 0

8 0

1 0 0

. / . ( n = 4 3 ) . (n = 3 6 ) . (n = 2 2 )

( 44-51 25-46 ) 2 / 2

7 (Assess)

6 86 2


63/110

32

2.2.3 (Record) 8 (Record)

/

42-49 /

53.550.0

40.9

60.555.6

40.9

20.922.2

9.1

18.619.4

13.6

93.0

100.0 100.0

83.7

100.0 100.0100.0

100.0 100.0

0

20

40

60

80

100

./ . (n = 43) . (n = 36) . (n = 22)


64/110

33

9 (Record)

/ /

2.2.4 (Explain)

/

/ / 10

95.

3

94.

4100.

0

97.

7

97.

2

86.

49

5.

3

94.

4

8

1.

89

0.

7 97.

2

86.

4

97.

7

97.

2

95.

5

8

1.

4

83.

3

86.

4

97.

7

86.

1

90.

9 97.

7

100.

0

95.

5

0

20

40

60

80

100

/

./. (n = 43) . (n = 36) . (n = 22)


65/110

34

69.

8

50.

0

59.

1

48.

8

61.1

36.

4

25.

6

33.

3

13.

6

58.

1

66.

7

68.

2

32.

6

27.

8

22.

7

69.

8

72.

2

81.

8

62.

8

86.

1

81.

8

79.

1

77.

88

6.

4

55.

8

41.

7 50.

0

39.

5

25.

0

45.

5

0

2 0

4 0

6 0

8 0

1 0 0

. / . ( n = 4 3 ) . ( n = 3 6 ) . ( n = 2 2 )

10

/ 65 / / / ( 11)

11

69.

8

69.

4

86.

4

67.

4

69.

4

68.

272.

1

66.

7

81.

88

8.

4

86.

190.

9

79.

1

75.

0

86.

4

76.

780.

686.

4

79.

1

88.

9

77.

3

90.

7

86.

19

5.

5

0

20

40

60

80

100

/

./. (n = 43) . (n = 36) . (n = 22)


66/110

35

2.3

2.3.1

101 25 6.46 14 42 20 34 9

12

() ( 43) 40 2 2 6

13

25 6 9.26 5 40 25 36 13-24 14 1-12 6 37

14-19

20.8%

20-24

26.7%25-29

26.7%

30-34

16.8%

34

8.9%

1

42.6%

2

39.6%

3

13.9%

6

1.0%

5

1.0%

4

2.0%


67/110

36

41.6%

37.6%

10.9%

4.0%

2.0%.

2.0%

.

2.0%

14

4

15

2.3.2 16

25-36 47.5%

13-24 32.7%

1-12 13.9%

37 5.9%

88.488.9

72.783.7

88.9

68.2

90.794.4

63.658.1

52.845.5 51.2

63.9

45.5

97.794.4

100.0

88.4

97.2

86.4

44.2

80.6

59.1

0

20

40

60

80

100

/ / /

./. (n = 43) . (n = 36) . (n = 22)


68/110

37

53.5

77.8

54.5

69.8

80.6

68.2

51.2

66.7

54.5

0

20

40

60

80

100

./ . (n = 43) . (n = 36) ./ . (n = 22)

/ /

/ / /

17

//


69/110


70/110

39

2.3.3 20

-

21 -

- 24 - -

- - 28 /-

86.0

77.8

81.8 83.7

88.9

95.5

81.4

88.9

100.0

72.1

86.1

90.9

0.0

27.8

63.6

0

20

40

60

80

100

./. (n = 43) . (n = 36) . (n = 22)

0

27.8

63.6

23.8

0

20

40

60

80

10 0

./. . .


71/110

40

22

89 (S.D. = 55.501) 10 253 1 1 30 1 14 2

/ (X = 76.21 , S.D. = 45.802) (X = 87 , S.D. = 53.666) (X = 115.09 , S.D. = 67.964)

23

(ANC) 23 1

54-97 / (P2) (P6) 60

1 0 - 3 0

1 7 . 8 %

3 5 - 6 0

2 0 . 8 %

6 5 - 9 0

2 5 . 7 %

9 5 - 1 2 0

1 1 . 9 %

1 6 0 - 1 8 0

6 . 9 %

1 2 5 - 1 5 0 9 . 9 %

1 8 0

6 . 9 %

4 0 . 6 %

3 5 . 6 %

2 2 . 8 %

1 . 0 %


72/110

41

, ,

70-80

/ 80-90 /, /,

, , ,

90 , , , , , ,

42-51

(Assess) 26-99

(Record) 18-100

(Explain) 26-90


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42

2.3.4 7

History

Assess

Record

Explain

/ 85.1 50.5 na na na/ 82.2 44.6 na na na 86.1 47.5 na na na

53.5 41.6 na na na

54.5 na 66.3 49.5 60.4 97.0 na 65.3 54.5 50.5 62.4 na 25.7 18.8 25.7 73.3 na na na 63.4 57.4 na 27.7 17.8 28.7 94.1 na 99.0 97.0 73.3 87.1 na 93.1 93.1 75.2 96.0 na 99.0 100.0 80.2 92.1 na 99.0 96.0 73.3 83.2 na 92.1 95.0 68.3 85.1 na 89.1 92.1 72.3 84.2 na 90.1 92.1 88.1 93.1 na 97.0 97.0 79.2 71.3 na 94.1 83.2 80.2

94.1 na na 92.1 82.2 96.0 na na 98.0 90.1 91.1 na 48.5 45.5 49.5 60.4 na 33.7 31.7 35.6

: na = not applicable


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44

1 1 24

24

1

/ 1


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45

3.1.2

OPD 1 30 1

/ 2

/ >2

Plot

2

/ 9 1 9 >9 9

/1 Check List

3


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46

25

2 1

3

1

2

9

>9 1 9 1

1 1

1 9

1 1 Check List

1

1

1


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3.1.3 ( -)

1

2

2 2

3

3

1

9 / 26


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3.1.4 1

/

Bathroom Scale 1 1 1 /

2

3 2

Plot 1

3 9 4

27


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50

27

4

1

1

2

1

3

2 Plot 1

/

1 /

3 9

Bathroom Scale

1

1

1

:


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52

29

3.2.3 (Explain)

Plot

50 / 20 10 ( 8 )

18.220.5

100.0

97.8

61.4

84.186.4

43.2

97.7

5.48.1

100.0100.0

62.2

94.6100.0

67.6

100.0

8.78.7

100.0

100.0

60.9

100.0100.0

78.3

100.0

0

20

40

60

80

100

plot

/

./. (n= 44) . (n=37) . (n=23)


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53

44%

56%

8

./.(n= 45)

.(n=36)

.(n=23)

n % n % n %

29 65.9 26 70.3 13 56.5plot 24 54.5 23 62.2 14 60.9/ 26 59.1 16 43.2 10 43.5 23 52.3 11 29.7 9 39.1 25 56.8 21 56.8 15 65.2 27 61.4 24 64.9 13 56.5 30 68.2 26 70.3 18 78.3 16 43.2 16 43.2 12 52.2 21 47.7 17 45.9 8 34.8 36 81.8 33 89.2 21 91.3 40 90.9 22 83.8 93 95.7 10 22.7 6 16.2 5 21.7 8 18.2 3 8.1 2 8.7

3.3 3.3.1

104

30

1 48 4 8 7.82 4-6 2-3 7-9


85/110

54

7-9

15%

10-12

9%

13- 18

10%

18

13%

1

10% 2-3 15%

4-6

28%

31

30 2 2

9

1 58 55.8

2 31 29.8

3 11 10.6

4 3 2.9

5 1 1.0

1,700 4,110 3,045 412.94

9.6 2,500 77.9 2,500 3,499

10

2,500 10 9.62,500 3,499 81 77.9

3,500 13 12.5


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55

12.1

82.8

5.26.5

71.7

21.7

0

20

40

60

80

100

2,500 2,500 3,499 3,500 4,110

2,500 3,500

32

33

1.9

16.3

41.0

24.0

2.9 2.9

10.6

0

5

10

15

20

25

30

35

40

45

.

.

.

.

.


87/110

56

63.

6

20.

5

56.

8

56.

8

13.

6

100.

0

6.

8

32.

4

43.

2

37.

8

40.

5

10.

8

60.

96

9.

6

69.

6

30.

4

100.

0

0.

0

6.

8

10.

8

40.

5

94.

4

4.

3

69.6

0

10

20

30

40

50

60

7080

90

100

plot

/

./. (n= 44) . (n=37) . (n=23)

3.3.2

Plot

40-60 ( 34)

34

35

86.790.9

75.086.488.6

91.794.6

86.591.9

94.6

82.691.3

65.2

87.087.0

0

20

40

60

80

100

B: D>:A D QA:? ? :7@ = >B =>B?

F./ \ G. (n= 44) ; . (n=37) ; . (n=23)


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57

63.6

36.4 34.136.4

48.6

21.6

43.2 40.5

47.843.5

52.2 47.8

0

10

20

30

40

50

60

70

841 ; 728 841TV. 0:+9 8419 9: : 0: 841

? ./ \ @. (n= 44) 7. (n=37) 7. (n=23)

3.3.3.

30 - 50 /-/

36

3.3.4

29 21 1-3 (n = 26 ) 1 2 6 19

1 - 6 (n = 55) ( 58 ) 29 13 13 1


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58

24.0

12.7

38.3

29.136.0

29.2

58.2

40.0

12.5

0

20

40

60

80

1-6 . @ 7 - 12 . @ 13 - 48 . @

3B 5A C 5AAB=B>

37

3.3.5

54 1 (SD = 33.49) 10 180 3 30 1 30 18 1 1.30 10 1.30

(X = 45.87 , SD = 28.39 )

/(X = 52.93 , SD = 34.87) (X = 68.61 , SD = 34.67)

38

35-60 @

39.4%

10 - 30 @

31.7%

122 180 @

5.8%

95 120 @

4.8%

61-90 @

18.3%


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59

3.3.6

2

3

39

Plot 40-60

72 50 40

100 60

Plot 4050

15.4%

1.9%

29.8%

52.9%


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60

11

Assess Record Explain

() 56.7 94.2 99.0 65.4plot () 33.7 na 59.6 58.7/ () 54.8 89.4 94.2 50.0 () 52.9 87.5 91.3 41.3 () 92.3 na na 58.7 43.3 na na 61.5 () 26.9 72.1 61.5 71.2 () 90.4 na na na () 88.5 49.0 na 45.2 () 76.9 40.4 na 44.2 () 87.5 93.3 99.0 86.5 () 98.1 na 100.0 89.4 () 7.7 30.8 13.5 20.2 () 6.7 16.3 11.5 12.5

na = not applicable


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61

/ (OPD Card) () // ( 12 2548) 2

..2540

/

() /

/ /

3 10 / ()


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62

()

3 / 12

VDRL/HIV, Hepatitis //

- 9 9

( 3)

/ /

/ CPU -


94/110

63

- 2

()

/

Plot Plot (.) Plot ..2549 Plot Plot

/

/


95/110

64

.

.

..

.

40 41

1.

2.

3. Albumin Sugar Bacteriuria Multiple Dipstick Test

4. ()


96/110

65

5.

6. 1.

Pre-counselling2. 1-2

3.

4. 5. Ultrasound 24-28

Ultrasound 6. 37

40


97/110

66

40

24-28

Post-counseling

37

.

.

. .

. .

. .

-

-

/

. ()

2 3 1

24

Pre-counseling . .

./.

:


98/110

67

1.

2./ ( 0-2 )3.

4.5.

41


99/110

68

41

/

()

1

.

(./.)


100/110

69

1. 1 10

2. One Stop Service

(Counseling)3. (Flow) 4.

2

5. 6.

(Stand by)

7. 8.

9.

10.

11. ANC core knowledge

12. WCC core knowledge

13.


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70

(2549).

.

:

(2542). (). :

(2546). :

. . : .. 1-11.

(2546). . , , , . . : .

(2547). . : .

CIDA, UNICEF (1997). Proceeding of the safe motherhood Asia 1997 workshop a

ten-country consultation workshop on lesson learned, South Sulawesi: CIDA: 1-55.

Mayer VA, Butler M. (2004). Gap in the evidence for well-child care: a challenge to our profession.

Pediatrics. 114(6): 1511-21.

Osborn LM (1994). Effective well-child care. Current Problems in Pediatrics 24(9): 306-26.

WHO (1994). Mother-baby package: implementing safe motherhood in countries. Geneva: WHO, 1-10.

WHO (2002). WHO Antenatal care randomized trial: manual for the implementation of the new model.

Geneva: WHO.


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72

( ) 1. ( ) 2. ./. ( ) 3. .

. .. ANC

ANC

ANC /

...

WCC

WCC

WCC /

...

- ( ) 1. ( ) 2. .

- ( ) 1. ( ) 2. .(/)

- ( ) 1. ( ) 2. .(/)

- 3 ( ) 1. ( ) 2.

1 6 - ( ) 1. ( ) 2.

- ( ) 1. ( ) 2.

ANC WCC 30


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Documents

Health Services Systems Project for Quality Antenatal Care and Well-Child Clinics