Ricca Jim, Dwivedi Vikas, Varallo John, Singh Gajendra, Pallipamula Suranjeen Prasad, Amade Nazir, de Luz Vaz Maria, Bishanga Dustan, Plotkin Marya, Al-Makaleh Bushra, Suhowatsky Stephanie, Smith Jeffrey Michael
Maternal and Child Survival Program, Jhpiego, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA.
Maternal and Child Survival Program, JSI Research & Training Institute, Inc, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA.
BMC Health Serv Res. 2015 Jan 22;15:9. doi: 10.1186/s12913-014-0667-1.
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in developing countries. While incidence of PPH can be dramatically reduced by uterotonic use immediately following birth (UUIFB) in both community and facility settings, national coverage estimates are rare. Most national health systems have no indicator to track this, and community-based measurements are even more scarce. To fill this information gap, a methodology for estimating national coverage for UUIFB was developed and piloted in four settings.
The rapid estimation methodology consisted of convening a group of national technical experts and using the Delphi method to come to consensus on key data elements that were applied to a simple algorithm, generating a non-precise national estimate of coverage of UUIFB. Data elements needed for the calculation were the distribution of births by location and estimates of UUIFB in each of those settings, adjusted to take account of stockout rates and potency of uterotonics. This exercise was conducted in 2013 in Mozambique, Tanzania, the state of Jharkhand in India, and Yemen.
Available data showed that deliveries in public health facilities account for approximately half of births in Mozambique and Tanzania, 16% in Jharkhand and 24% of births in Yemen. Significant proportions of births occur in private facilities in Jharkhand and faith-based facilities in Tanzania. Estimated uterotonic use for facility births ranged from 70 to 100%. Uterotonics are not used routinely for PPH prevention at home births in any of the settings. National UUIFB coverage estimates of all births were 43% in Mozambique, 40% in Tanzania, 44% in Jharkhand, and 14% in Yemen.
This methodology for estimating coverage of UUIFB was found to be feasible and acceptable. While the exercise produces imprecise estimates whose validity cannot be assessed objectively in the absence of a gold standard estimate, stakeholders felt they were accurate enough to be actionable. The exercise highlighted information and practice gaps and promoted discussion on ways to improve UUIFB measurement and coverage, particularly of home births. Further follow up is needed to verify actions taken. The methodology produces useful data to help accelerate efforts to reduce maternal mortality.
产后出血（PPH）是发展中国家孕产妇死亡的主要原因。虽然在社区和医疗机构中，产后立即使用宫缩剂（UUIFB）可显著降低产后出血的发生率，但全国范围内的覆盖率估计却很少见。大多数国家卫生系统没有跟踪这一情况的指标，基于社区的测量更为稀少。为填补这一信息空白，开发了一种估计全国UUIFB覆盖率的方法，并在四个地区进行了试点。
快速估计方法包括召集一组国家技术专家，并使用德尔菲法就应用于简单算法的关键数据元素达成共识，从而得出UUIFB覆盖率的非精确全国估计值。计算所需的数据元素包括按地点划分的分娩分布情况以及每个地点的UUIFB估计值，并根据缺货率和宫缩剂效力进行调整。这项工作于2013年在莫桑比克、坦桑尼亚、印度贾坎德邦和也门开展。
现有数据显示，在莫桑比克和坦桑尼亚，公共卫生设施的分娩量约占总出生量的一半，在贾坎德邦占16%，在也门占24%。在贾坎德邦，很大一部分分娩发生在私立医疗机构，在坦桑尼亚则发生在宗教性质的医疗机构。估计医疗机构分娩中宫缩剂的使用率在70%至100%之间。在任何一个地区，家庭分娩时均未常规使用宫缩剂预防产后出血。所有分娩的全国UUIFB覆盖率估计值在莫桑比克为43%，在坦桑尼亚为40%，在贾坎德邦为44%，在也门为14%。
这种估计UUIFB覆盖率的方法被认为是可行且可接受的。虽然这项工作得出的估计值不精确，在没有金标准估计值的情况下无法客观评估其有效性，但利益相关者认为这些估计值足够准确，可以采取行动。这项工作突出了信息和实践方面的差距，并促进了关于改善UUIFB测量和覆盖率（特别是家庭分娩覆盖率）方法的讨论。需要进一步跟进以核实所采取的行动。该方法产生了有用的数据，有助于加快降低孕产妇死亡率的努力。
