高 ANC 覆盖率和低熟练助产士比例：坦桑尼亚农村地区实施分娩计划干预的案例。
High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention.
机构信息
Infectious Diseases Epidemiology Unit, Department of Epidemiology and Population, Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
出版信息
BMC Pregnancy Childbirth. 2010 Mar 19;10:13. doi: 10.1186/1471-2393-10-13.
BACKGROUND
In Tanzania, more than 90% of all pregnant women attend antenatal care at least once and approximately 62% four times or more, yet less than five in ten receive skilled delivery care at available health units. We conducted a qualitative study in Ngorongoro district, Northern Tanzania, in order to gain an understanding of the health systems and socio-cultural factors underlying this divergent pattern of high use of antenatal services and low use of skilled delivery care. Specifically, the study examined beliefs and behaviors related to antenatal, labor, delivery and postnatal care among the Maasai and Watemi ethnic groups. The perspectives of health care providers and traditional birth attendants on childbirth and the factors determining where women deliver were also investigated.
METHODS
Twelve key informant interviews and fifteen focus group discussions were held with Maasai and Watemi women, traditional birth attendants, health care providers, and community members. Principles of the grounded theory approach were used to elicit and assess the various perspectives of each group of participants interviewed.
RESULTS
The Maasai and Watemi women's preferences for a home birth and lack of planning for delivery are reinforced by the failure of health care providers to consistently communicate the importance of skilled delivery and immediate post-partum care for all women during routine antenatal visits. Husbands typically serve as gatekeepers of women's reproductive health in the two groups - including decisions about where they will deliver- yet they are rarely encouraged to attend antenatal sessions. While husbands are encouraged to participate in programs to prevent maternal-to-child transmission of HIV, messages about the importance of skilled delivery care for all women are not given emphasis.
CONCLUSIONS
Increasing coverage of skilled delivery care and achieving the full implementation of Tanzania's Focused Antenatal Care Package in Ngorongoro depends upon improved training and monitoring of health care providers, and greater family participation in antenatal care visits.
背景
在坦桑尼亚，超过 90%的孕妇至少接受过一次产前护理，约 62%的孕妇接受过四次或更多次产前护理，但不到十分之五的孕妇在可获得的卫生单位接受熟练的分娩护理。为了了解导致高比例产前服务利用和低比例熟练分娩护理利用的卫生系统和社会文化因素，我们在坦桑尼亚北部的恩戈罗恩戈罗地区进行了一项定性研究。具体来说，该研究考察了马赛和沃特米族群体中与产前、分娩、分娩和产后护理相关的信念和行为。还调查了医疗保健提供者和传统助产士对分娩的看法以及决定妇女分娩地点的因素。
方法
与马赛和沃特米妇女、传统助产士、医疗保健提供者和社区成员进行了 12 次关键知情人访谈和 15 次焦点小组讨论。采用扎根理论方法的原则来引出和评估受访者的不同群体的各种观点。
结果
马赛和沃特米妇女喜欢在家分娩，而且不计划分娩，这是因为医疗保健提供者未能在常规产前检查中始终如一地传达所有妇女都需要熟练的分娩和立即产后护理的重要性。在这两个群体中，丈夫通常是妇女生殖健康的把关人，包括他们在哪里分娩的决定——但很少鼓励他们参加产前课程。虽然鼓励丈夫参加预防母婴传播艾滋病毒的项目，但不会强调所有妇女都需要熟练的分娩护理的重要性。
结论
要增加熟练分娩护理的覆盖率，并在恩戈罗恩戈罗实现坦桑尼亚重点产前护理方案的全面实施，就需要改进医疗保健提供者的培训和监测，以及更大程度地让家庭参与产前护理访问。
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