National Institute of Preventive and Social Medicine, Mohakhali, Dhaka 1212, Bangladesh.
BMC Pregnancy Childbirth. 2011 Jan 30;11:11. doi: 10.1186/1471-2393-11-11.
Recognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC.
This cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. Pearson's chi-square test, t-test and Mann-Whitney test were performed.
The median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities.
Manoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.
认识到城市贫民窟中孕产妇死亡的负担，2007 年，BRAC（孟加拉农村发展委员会的简称）在孟加拉国的城市贫民窟中建立了一个以妇女为重点的发展干预项目，名为 Manoshi（孟加拉语中母亲、新生儿和儿童的缩写）。该干预措施强调通过社区、分娩中心（DC）以及及时将产科并发症转诊至紧急产科护理（EmOC）设施，加强孕产妇、新生儿和儿童护理的连续性。本研究旨在评估 Manoshi DC 是否减少了获得 EmOC 的延误。
本横断面研究于 2008 年 10 月至 2009 年 1 月在达卡市的贫民窟中进行，共纳入 450 例产科并发症患者，这些患者要么从 Manoshi 的 DC 转诊，要么从家中转诊至 EmOC 设施。受过培训的女性访谈员在患者家中使用结构化问卷进行访谈。采用 Pearson's chi-square 检验、t 检验和 Mann-Whitney 检验进行分析。
与从 DC 转诊的患者相比，从家中转诊的患者做出寻求医疗决策的中位数时间明显更长（9.7 小时 vs. 5.0 小时，p < 0.001）。两组到达设施和接受治疗的中位数时间相似。在从 DC 转诊的危及生命的并发症患者中，做出寻求医疗决策的时间明显更短（0.9 小时 vs. 2.3 小时，p = 0.002）。从 DC 转诊的危及生命的并发症患者获得 Manoshi 的经济援助显著减少了获得 EmOC 服务的首次延误（p = 0.006）。首次延误的原因包括对医疗干预的恐惧、无法判断产妇状况、传统观念和经济限制。性别角色被发现是决策中的一个重要问题。首次延误在老年妇女、多产、非危及生命的并发症和不参与创收活动的妇女中显著更高。
Manoshi 项目减少了危及生命的情况下的首次延误，但对非危及生命的并发症无效，尽管提供了经济援助。该项目应更加重视通过夫妻/家庭为基础的教育，提高对产妇并发症的认识，并消除对临床护理的恐惧，以加速寻求 EmOC。
