Raman Shanti, Iljadica Alexandra, Gyaneshwar Rajat, Taito Rigamoto, Fong James
Department of Community Paediatrics, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia.
Discipline of International Business, University of Sydney, Camperdown, NSW, Australia.
Int J Gynaecol Obstet. 2015 May;129(2):165-8. doi: 10.1016/j.ijgo.2014.11.010. Epub 2015 Jan 17.
To develop a standardized process of perinatal mortality audit (PMA) and improve the capacity of health workers to identify and correct factors underlying preventable deaths in Fiji.
In a pilot study, clinicians and healthcare managers in obstetrics and pediatrics were trained to investigate stillbirths and neonatal deaths according to current guidelines. A pre-existing PMA datasheet was refined for use in Fiji and trialed in three divisional hospitals in 2011-12. Key informant interviews identified factors influencing PMA uptake.
Overall, 141 stillbirths and neonatal deaths were analyzed (57 from hospital A and 84 from hospital B; forms from hospital C excluded because incomplete/illegible). Between-site variations in mortality were recorded on the basis of the level of tertiary care available; 28 (49%) stillbirths were recorded in hospital A compared with 53 (63%) in hospital B. Substantial health system factors contributing to preventable deaths were identified, and included inadequate staffing, problems with medical equipment, and lack of clinical skills. Leadership, teamwork, communication, and having a standardized process were associated with uptake of PMA.
The use of PMAs by health workers in Fiji and other Pacific island countries could potentially rectify gaps in maternal and neonatal service delivery.
制定围产期死亡审核（PMA）的标准化流程，并提高斐济卫生工作者识别和纠正可预防死亡潜在因素的能力。
在一项试点研究中，对产科和儿科的临床医生及医疗管理人员进行培训，使其根据现行指南调查死产和新生儿死亡情况。对一份现有的PMA数据表进行完善以便在斐济使用，并于2011 - 12年在三家分区医院进行试用。关键知情人访谈确定了影响PMA实施的因素。
总体而言，分析了141例死产和新生儿死亡病例（医院A有57例，医院B有84例；医院C的表格因不完整/字迹模糊被排除）。根据可获得的三级护理水平记录了不同医院间的死亡率差异；医院A记录了28例（49%）死产，而医院B记录了53例（63%）。确定了导致可预防死亡的大量卫生系统因素，包括人员配备不足、医疗设备问题和临床技能缺乏。领导力、团队合作、沟通以及拥有标准化流程与PMA的实施相关。
斐济和其他太平洋岛国的卫生工作者使用PMA可能会弥补孕产妇和新生儿服务提供方面的差距。
