Prathapan Shamini, Lindmark Gunilla, Fonseka Pushpa, Lokubalasooriya Ayesha, Prathapan Rasiah
Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
Qual Prim Care. 2011;19(4):245-50.
Sri Lanka has shown relatively good maternal outcome indicators for a developing country. However, high maternal deaths from haemorrhage and anaemia raise questions about the quality of detection and treatment of anaemia at field antenatal clinics, which is the primary care setting for pregnant women.
The aim of the study was to assess the quality of facilities and services and how satisfactory antenatal care is with regard to diagnosis and treatment of anaemia.
This study was set in field antenatal clinics and conducted in two stages based on the Lot Quality Assurance Sampling method. In the first stage 55 antenatal clinics were selected, and in the second stage 275 pregnant women were recruited from these 55 clinics. Quality of services and quality of facilities were assessed using observation, and an interviewer administered questionnaire was used to measure client satisfaction. The validity of haemoglobin colour scale results was investigated by comparing them with results from a quality assured laboratory.
Eleven health areas, other than the seven areas which had the haemoglobin investigated, were unacceptable as regards the quality of services. The quality of facilities was better than the quality of services in the Colombo district. Information and counselling was provided for only 4% of women in the clinics. The sensitivity and the specificity for the haemoglobin colour scale was 62% (95% CI: 52.9%-71.1%) and 86% (95% CI: 79.6%-93.0%) respectively.
Urgent steps should be taken to improve the quality of care in the health areas where care is substandard, in order to reduce morbidity and mortality due to anaemia.
作为一个发展中国家，斯里兰卡的孕产妇结局指标相对较好。然而，因出血和贫血导致的高孕产妇死亡率引发了对现场产前诊所贫血检测和治疗质量的质疑，而现场产前诊所是孕妇的初级保健场所。
本研究的目的是评估设施和服务的质量，以及产前护理在贫血诊断和治疗方面的满意度。
本研究在现场产前诊所进行，基于批量质量保证抽样方法分两个阶段进行。第一阶段选取了55家产前诊所，第二阶段从这55家诊所招募了275名孕妇。通过观察评估服务质量和设施质量，并使用访谈员管理的问卷来衡量客户满意度。通过将血红蛋白比色卡结果与质量保证实验室的结果进行比较，研究了其有效性。
除了对血红蛋白进行调查的七个地区外，还有11个卫生地区的服务质量不合格。科伦坡地区的设施质量优于服务质量。诊所中只有4%的女性得到了信息和咨询。血红蛋白比色卡的灵敏度和特异度分别为62%（95%可信区间：52.9%-71.1%）和86%（95%可信区间：79.6%-93.0%）。
应立即采取措施改善护理不达标的卫生地区的护理质量，以降低因贫血导致的发病率和死亡率。
