تأثير طرح تحول نظام سلامت بر شاخص‌هاي زايمان طبيعي و سزارين: تحليل سري زماني منقطع در يك بيمارستان خصوصي تهران

Effect of health transformation plan on natural childbirth and cesarean section indicators: An Interrupted Time Series Analysis in a Private Hospital of Tehran

افزايش زايمان طبيعي و كاهش سزارين، يكي از راهكارهاي ارتقاي شاخص سلامت مادران و نوزادان، در پي دستيابي به اهداف توسعه هزاره مي‌باشد كه در راستاي دستيابي به اين هدف، طرح تحول سلامت و برنامه ترويج زايمان طبيعي در كشور تدوين و در حال اجرا مي­باشد، لذا مطالعه حاضر با هدف تحليل روند شاخص‌هاي زايمان طبيعي و سزارين در راستاي تحقق اهداف طرح تحول نظام سلامت در بيمارستان مدائن تهران انجام شد. روش‌كار: در اين مطالعه مقطعي داده‌هاي زايمان و سزارين از سال 96-1392 به ماه جمع‌آوري شد. تغيير در سطح و روند متغيرهاي زايمان طبيعي و سزارين قبل و بعد از طرح تحول سلامت با استفاده آزمون تي مستقل و مدل رگرسيون قطعه‌اي شده در نرم‌افزار stata (نسخه 15) مورد ارزيابي قرار گرفت. ﯾﺎﻓﺘﻪ ﻫﺎ: ﺑﺮ اﺳﺎس ﻧﺘﺎﯾﺞ ﻣﻄﺎﻟﻌﻪ، روﻧﺪ زاﯾﻤﺎن ﻃﺒﯿﻌﯽ ﺑﻌﺪ از اﺟﺮاي ﻃﺮح ﺗﺤﻮل ﺳﻼﻣﺖ 0/685% در ﻫﺮ ﻣﺎه اﻓﺰاﯾﺶ )0/020=p( و روﻧﺪ زاﯾﻤﺎن ﺳﺰارﯾﻦ 0/749% در ﻫﺮ ﻣﺎه ﮐﺎﻫﺶ ﯾﺎﻓﺘﻪ ﺑﻮد )0/011=p(. ﻫﻤﭽﻨﯿﻦ در دوره 3 ﺳﺎﻟﻪ ﺑﻌﺪ از ﻃﺮح ﺗﺤﻮل ﺳﻼﻣﺖ، درﺻﺪ زاﯾﻤﺎن ﻃﺒﯿﻌﯽ ﺑﻪ ﻃﻮر ﻣﺎﻫﺎﻧﻪ 0/680 اﻓﺰاﯾﺶ )0/001

Increasing natural childbirth and decreasing cesarean section is one of the strategies for improving maternal and neonatal health to achieve the millennium development goals. In order to achieve this goal, health transformation plan and program for promotion of natural childbirth have been developed and implemented in Iran. Therefore, this study was performed with aim to analyze the trend of natural childbirth and cesarean section indicators in order to realize the goals of the health transformation plan in Madaen Hospital, Tehran. Methods: In this cross-sectional study, the data of delivery and cesarean section were collected from 2013 to 2017. Changes in the level and trend of natural childbirth and cesarean sections before and after transformation plan were evaluated by independent t-test and regression model of cut-off in STATA software (version 15). Results: The trend of natural childbirth after implementation of the plan increased by 0.685% per month (p=0.020) and the trend of cesarean section decreased by 0.749% per month (p=0.011). In the 3-year period after the health transformation plan, the percentage of natural childbirth increased by 0.680 per month (p<0.001) and the percentage of cesarean section decreased by 0.744 per month (p<0.001). Conclusion: According to the results of the study, implementation of adoption policies was effective in reducing the rate of cesarean section in the private hospital. Therefore, the promotion of natural childbirth in order to implement the transformation plan leads to achieve the goals of improving maternal and neonatal health.