Allen Elizabeth N, Gomes Melba, Yevoo Lucy, Egesah Omar, Clerk Christine, Byamugisha Josaphat, Mbonye Anthony, Were Edwin, Mehta Ushma, Atuyambe Lynn M
Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
World Health Organisation, 1211 Avenue Appia, Geneva, 27, Switzerland.
BMC Health Serv Res. 2014 Oct 31;14:525. doi: 10.1186/s12913-014-0525-1.
The World Health Organisation has designed a pregnancy registry to investigate the effect of maternal drug use on pregnancy outcomes in resource-limited settings. In this sentinel surveillance system, detailed health and drug use data are prospectively collected from the first antenatal clinic visit until delivery. Over and above other clinical records, the registry relies on accurate participant reports about the drugs they use. Qualitative methods were incorporated into a pilot registry study during 2010 and 2011 to examine barriers to women reporting these drugs and other exposures at antenatal clinics, and how they might be overcome.
Twenty-seven focus group discussions were conducted in Ghana, Kenya and Uganda with a total of 208 women either enrolled in the registry or from its source communities. A question guide was designed to uncover the types of exposure data under- or inaccurately reported at antenatal clinics, the underlying reasons, and how women prefer to be asked questions. Transcripts were analysed thematically.
Women said it was important for them to report everything they had used during pregnancy. However, they expressed reservations about revealing their consumption of traditional, over-the-counter medicines and alcohol to antenatal staff because of anticipated negative reactions. Some enrolled participants' improved relationship with registry staff facilitated information sharing and the registry tools helped overcome problems with recall and naming of medicines. Decisions about where women sought care, which influenced medicines used and antenatal clinic attendance, were influenced by pressure within and outside of the formal healthcare system to conform to conflicting behaviours. Conversations also reflected women's responsibilities for producing a healthy baby.
Women in this study commonly take traditional medicines in pregnancy, and to a lesser extent over-the-counter medicines and alcohol. The World Health Organisation pregnancy registry shows potential to enhance their reporting of these substances at the antenatal clinic. However, more work is needed to find optimal techniques for eliciting accurate reports, especially where the detail of constituents may never be known. It will also be important to find ways of sustaining such drug exposure surveillance systems in busy antenatal clinics.
世界卫生组织设计了一个妊娠登记系统，以调查在资源有限的环境中孕产妇用药对妊娠结局的影响。在这个哨点监测系统中，从首次产前诊所就诊到分娩，前瞻性地收集详细的健康和用药数据。除了其他临床记录外，该登记系统还依赖于参与者对其使用药物的准确报告。2010年至2011年期间，定性方法被纳入一项登记系统试点研究，以检查妇女在产前诊所报告这些药物和其他暴露情况的障碍，以及如何克服这些障碍。
在加纳、肯尼亚和乌干达进行了27次焦点小组讨论，共有208名妇女参与登记系统或来自其来源社区。设计了一个问题指南，以揭示产前诊所报告不足或不准确的暴露数据类型、根本原因，以及妇女希望被提问的方式。对转录本进行了主题分析。
妇女表示，对她们来说，报告怀孕期间使用的所有东西很重要。然而，由于预期会有负面反应，她们对向产前工作人员透露自己使用传统非处方药和酒精有所保留。一些登记参与者与登记系统工作人员关系的改善促进了信息共享，登记工具也有助于克服药物回忆和命名方面的问题。妇女寻求护理的地点的决定影响了所使用的药物和产前诊所的就诊情况，这受到正规医疗系统内外遵守相互冲突行为的压力的影响。谈话还反映了妇女在生育健康婴儿方面的责任。
本研究中的妇女在孕期普遍服用传统药物，服用非处方药和酒精的情况较少。世界卫生组织的妊娠登记系统显示出增强她们在产前诊所报告这些物质的潜力。然而，需要做更多的工作来找到获取准确报告的最佳技术，特别是在成分细节可能永远无法知晓的情况下。在繁忙的产前诊所找到维持此类药物暴露监测系统的方法也很重要。
