Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
BMC Womens Health. 2010 Feb 17;10:6. doi: 10.1186/1472-6874-10-6.
The continuing burden of maternal mortality, especially in developing countries has prompted a shift in paradigm from the traditional risk assessment approach to the provision of access to emergency obstetric care services for all women who are pregnant. This study assessed the knowledge of maternity unit operatives at the primary and secondary levels of care about the concept of emergency obstetric care (EmOC) and investigated the contents of antenatal care (ANC) counseling services they delivered to clients. It also described the operatives' preferred strategies and practices for promoting safe motherhood and averting maternal mortality in South-west Nigeria.
The study population included all the 152 health workers (doctors, midwives, nurses and community health extension workers) employed in the maternity units of all the public health facilities (n = 22) offering maternity care in five cities of 2 states. Data were collected with the aid of a self-administered, semi-structured questionnaire and non-participant observation checklist. Results were presented using descriptive statistics.
Ninety one percent of the maternity unit staff had poor knowledge concerning the concept of EmOC, with no difference in knowledge of respondents across age groups. While consistently more than 60% of staff reported the inclusion of specific client-centered messages such as birth preparedness and warning/danger signs of pregnancy and delivery in the (ANC) delivered to clients, structured observations revealed that less than a quarter of staff actually did this. Furthermore, only 40% of staff reported counseling clients on complication readiness, but structured observations revealed that no staff did. Only 9% of staff had ever been trained in lifesaving skills (LSS). Concerning strategies for averting maternal deaths, 70% of respondents still preferred the strengthening of routine ANC services in the health facilities to the provision of access to EmOC services for all pregnant women who need it.
We concluded that maternity unit operatives at the primary and secondary care levels in South-west Nigeria were poorly knowledgeable about the concept of emergency obstetric care services and they still prioritized the strengthening of routine antenatal care services based on the risk approach over other interventions for promoting safe motherhood despite a global current shift in paradigm. There is an urgent need to reorientate/retrain the staff in line with global best practices.
孕产妇死亡率持续居高不下，尤其是在发展中国家，这促使人们从传统的风险评估方法转变为为所有孕妇提供紧急产科护理服务，以实现这一目标。本研究评估了初级和二级保健医护人员对紧急产科护理（EmOC）概念的了解，并调查了他们向客户提供的产前护理（ANC）咨询服务的内容。它还描述了在尼日利亚西南部，医护人员为促进安全孕产和避免孕产妇死亡而采用的首选策略和做法。
研究人群包括在为提供产科护理的所有公共卫生设施的产科病房工作的 152 名卫生工作者（医生、助产士、护士和社区卫生推广工作者）（n=22）。数据收集借助于自我管理的半结构化问卷和非参与观察清单。结果采用描述性统计方法呈现。
91%的产科病房工作人员对 EmOC 概念的了解较差，不同年龄组的受访者在知识方面没有差异。尽管始终有超过 60%的工作人员报告在提供给客户的（ANC）中包含了特定的以客户为中心的信息，如生育准备和妊娠和分娩的危险/警告信号，但结构观察显示，不到四分之一的工作人员实际这样做。此外，只有 40%的工作人员报告在为客户提供关于并发症准备的咨询，但结构观察显示，没有工作人员这样做。只有 9%的工作人员接受过救生技能（LSS）培训。关于避免孕产妇死亡的策略，70%的受访者仍然更喜欢加强卫生设施的常规 ANC 服务，而不是为所有需要的孕妇提供紧急产科护理服务。
我们得出结论，尼日利亚西南部初级和二级保健医护人员对紧急产科护理服务的概念了解甚少，尽管全球目前的模式已经转变，但他们仍然优先考虑加强基于风险的常规产前护理服务，而不是其他促进安全孕产的干预措施。迫切需要根据全球最佳做法重新调整/培训工作人员。
