Nesbitt Robin C, Lohela Terhi J, Manu Alexander, Vesel Linda, Okyere Eunice, Edmond Karen, Owusu-Agyei Seth, Kirkwood Betty R, Gabrysch Sabine
Epidemiology and Biostatistics Unit, Institute of Public Health, Heidelberg University, Heidelberg, Germany.
PLoS One. 2013 Nov 27;8(11):e81089. doi: 10.1371/journal.pone.0081089. eCollection 2013.
To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate "effective coverage" of skilled attendance in Brong Ahafo, Ghana.
We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC), emergency newborn care (EmNC) and non-medical quality. Linking the health facility assessment to surveillance data we estimated "effective coverage" of skilled attendance as the proportion of births in facilities of high quality.
Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as "low" or "substandard" for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was "low" or "substandard" in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with "high" or "highest" quality in all dimensions.
Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated "effective coverage" of skilled attendance at 18%, thus revealing a large "quality gap." Effective coverage could be a meaningful indicator of progress towards reducing maternal and newborn mortality.
通过医疗机构评估来评价常规及紧急分娩期和产后护理的质量，并估算加纳布朗阿哈福地区熟练医护人员的“有效覆盖率”。
我们对布朗阿哈福七个区的所有86家医疗机构进行了评估。利用关键信号功能的执行情况以及相关药品、设备和经过培训的卫生专业人员的可获得性，我们在四个维度创建了综合质量类别：常规分娩护理、紧急产科护理（EmOC）、紧急新生儿护理（EmNC）和非医疗质量。将医疗机构评估与监测数据相联系，我们将熟练医护人员的“有效覆盖率”估算为高质量医疗机构中分娩的比例。
86家医疗机构中有64家提供分娩护理；在任何维度中，只有3%-13%的机构达到我们对最高质量类别的要求。紧急护理维度的质量最低，分别有63%和58%的机构在EmOC和EmNC方面被归类为“低”或“不合格”。这意味着执行少于四项EmOC或三项EmNC信号功能，和/或雇用少于两名熟练的卫生专业人员，和/或在我们访问期间没有卫生专业人员在场。39%的机构常规分娩护理为“低”或“不合格”，这意味着64家机构中有25家执行少于六项常规信号功能，和/或拥有少于两名熟练的卫生专业人员和/或少于一名助产士。虽然68%的分娩发生在医疗机构，但只有18%发生在所有维度都为“高”或“最高”质量的机构。
我们全面的机构评估表明，研究地区常规及紧急分娩期和产后护理的质量普遍较低。虽然机构分娩覆盖率为68%，但我们估算熟练医护人员的“有效覆盖率”为18%，从而揭示了巨大的“质量差距”。有效覆盖率可能是降低孕产妇和新生儿死亡率进展的一个有意义的指标。
