Sibley Lynn, Caleb-Varkey Leila, Upadhyay Jayant, Prasad Rajendra, Saroha Ekta, Bhatla Neerja, Paul Vinod K
Lillian Carter Cancer Center for International Nursing, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
J Midwifery Womens Health. 2005 Jul-Aug;50(4):301-8. doi: 10.1016/j.jmwh.2005.03.006.
This study describes the results of a Morbidity and Performance Assessment (MAP) conducted to provide insight into the medical factors contributing to maternal and newborn morbidity and mortality in a rural district of northern India, and to use these insights to develop a locally appropriate, community-based safe motherhood program The MAP study was based on verbal autopsy method. Five hundred ninety-nine women (or in the case of 9 maternal deaths, a family member) participated in the study. This article describes a subsample of women who reported signs or symptoms suggesting excessive bleeding (n = 159). Findings include a poor knowledge of danger signs; poor problem recognition during labor, birth, and the immediate postpartum period; and a low level of health seeking that was consistent with poor recognition. Maternal sociodemographic characteristics, antenatal care use, and knowledge of danger signs were generally not associated with problem recognition and health seeking. The case fatality rate was 4%. These findings suggest an urgent need to understand the phenomenon of problem recognition and to integrate this into the design of interventions to reduce delays in health seeking.
本研究描述了一项发病率与医疗服务评估（MAP）的结果，该评估旨在深入了解印度北部一个农村地区导致孕产妇和新生儿发病及死亡的医学因素，并利用这些见解制定一个适合当地情况的、基于社区的安全孕产计划。MAP研究基于口头尸检方法。599名妇女（或在9例孕产妇死亡的情况下，由一名家庭成员）参与了该研究。本文描述了报告有提示大出血体征或症状的妇女亚样本（n = 159）。研究结果包括对危险信号的认知不足；分娩、生产及产后即刻期间对问题的识别能力差；以及与认知不足相符的低水平就医行为。孕产妇的社会人口学特征、产前保健利用情况以及对危险信号的认知通常与问题识别和就医行为无关。病死率为4%。这些研究结果表明，迫切需要了解问题识别现象，并将其纳入干预措施的设计中，以减少就医延误。
