Tita A T N, Selwyn B J, Waller D K, Kapadia A S, Dongmo S
Center for Research in Women's Health, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
BJOG. 2006 Sep;113(9):1060-6. doi: 10.1111/j.1471-0528.2006.01042.x.
To identify the factors associated with important (> or =50%) variation in awareness and practice of evidence-based obstetric interventions in an African setting where we have previously reported poor awareness and use of evidence-based reproductive interventions.
Cross-sectional analysis of data from our Reproductive Health Interventions Study.
North-west province, Cameroon, Africa.
Health workers including obstetricians, other physicians, midwives, nurses and other staff providing reproductive care.
Prevalence ratios (PR) of uniform awareness and practice of four key evidence-based obstetric interventions from the World Health Organization Reproductive Health Library (WHO RHL): antiretrovirals to prevent mother-to-child transmission of HIV/AIDS, antenatal corticosteroids for prematurity, uterotonics to prevent postpartum haemorrhage and magnesium sulphate for seizure prophylaxis.
Comparisons of descriptive covariates, applying logistic regression to estimate independent relationships with awareness and use of evidence-based interventions.
A total of 15.5% (50/322) of health workers were aware of all the four interventions while only 3.8% (12/312) reported optimal practice. Evidence-based awareness was strongly associated with practice (PR = 15.4; 96% CI: 4.3-55.0). Factors significantly associated with awareness were: attending continuing education, access to the WHO RHL, employment as an obstetrician/gynaecologist and working in autonomous military or National Insurance Fund facilities. Controlling for potential confounding, working as an obstetrician was associated with increased awareness (adjusted prevalence odds ratio [aPOR] = 8.3; 95% CI: 1.3-53.8) as was median work experience of 5-15 years (aPOR = 2.0; 95% CI: 1.0-3.8). Internet access was associated with increased practice (aPOR = 3.4; 95% CI: 1.0-11.8). Other potentially important variations were observed, although they did not attain statistical significance.
Several factors including obstetric training and continuous education positively influence evidence-based awareness and practice of key obstetric interventions. Confirmation and application of this information may enhance the effectiveness of programmes to improve maternal and perinatal outcomes.
在一个我们此前报道过循证生殖干预措施的知晓率和使用率较低的非洲地区，确定与循证产科干预措施的知晓率和实践中重要（≥50%）差异相关的因素。
对我们的生殖健康干预研究数据进行横断面分析。
非洲喀麦隆西北部省份。
包括产科医生、其他医生、助产士、护士及提供生殖保健的其他工作人员在内的卫生工作者。
世界卫生组织生殖健康图书馆（WHO RHL）中四项关键循证产科干预措施的统一知晓率和实践率的患病率比（PR）：用于预防母婴传播艾滋病毒/艾滋病的抗逆转录病毒药物、用于早产的产前皮质类固醇、用于预防产后出血的宫缩剂以及用于预防惊厥的硫酸镁。
对描述性协变量进行比较，应用逻辑回归估计与循证干预措施的知晓率和使用情况的独立关系。
共有15.5%（50/322）的卫生工作者知晓所有四项干预措施，而只有3.8%（12/312）报告有最佳实践。循证知晓率与实践密切相关（PR = 15.4；96%CI：4.3 - 55.0）。与知晓率显著相关的因素包括：参加继续教育、可获取WHO RHL、担任产科医生/妇科医生以及在自主的军事或国家保险基金机构工作。在控制潜在混杂因素后，担任产科医生与知晓率增加相关（调整患病率比值比[aPOR] = 8.3；95%CI：1.3 - 53.8），工作年限中位数为5至15年也与知晓率增加相关（aPOR = 2.0；95%CI：1.0 - 3.8）。互联网接入与实践增加相关（aPOR = 3.4；95%CI：1.0 - 11.8）。还观察到其他一些潜在的重要差异，尽管未达到统计学显著性。
包括产科培训和继续教育在内的几个因素对关键产科干预措施的循证知晓率和实践有积极影响。确认并应用这些信息可能会提高改善孕产妇和围产儿结局项目的有效性。
