Yoder P Stanley, Nsabagasani Xavier, Eckert Erin, Moran Allisyn, Yé Yazoumé
ICF International, Rockville, MD, USA.
Makerere University, Kampala, Uganda.
BMC Health Serv Res. 2015 Aug 29;15:354. doi: 10.1186/s12913-015-0986-x.
Nearly 20 years after the adoption by the government of Malawi of the provision of intermittent preventive treatment in pregnancy (IPTp) for malaria, only 55% of pregnant women received at least two doses of sulfadoxine-pyrimethamine (SP) in 2010. Although several reasons for the low coverage have been suggested, few studies have examined the views of health care providers. This study examined the experiences of the nurses and midwives in providing antenatal care (ANC) services.
This study was conducted in health facilities in Malawi that provide routine ANC services. Providers of ANC in Malawi were selected from in eight health care facilities of Malawi. Selected providers were interviewed using a semi-structured interview guide designed to address a series of themes related to their working conditions and their delivery of IPTp.
Nurses displayed detailed knowledge of ANC services and the rationale behind them. Nurses understood that they should provide two doses of IPTp during a pregnancy, but they did not agree on the timing of the doses. Nurses gave SP as directly observed therapy (DOT) at the clinic. Nurses did not give SP pills to women to take home with them because they did not trust that women would take the pills. Women who resisted taking SP explained they do not take drugs if they had not eaten, or they feared side effects, or they were not sick. Reasons for not giving the first or second dose of SP included a delay in the first ANC visit, testing positive for HIV, and presenting with malaria. None of the nurses were able to show any specific written guidelines on when to give SP. The challenges faced by the nurses include being overworked and persuading women to take SP under observation.
The findings show that the nurses had gained the knowledge and technical skills to provide appropriate ANC services. With regard to IPTp, nurses need guidelines that would be available at the health facility about how and when to give SP. The adoption of the WHO guidelines and their diffusion to health care facilities could help increase the coverage of IPTp2 (at least two doses of sulfadoxine-pyrimethamine) in Malawi.
在马拉维政府采用孕期疟疾间歇性预防治疗（IPTp）近20年后，2010年只有55%的孕妇接受了至少两剂磺胺多辛-乙胺嘧啶（SP）。尽管有人提出了覆盖率低的几个原因，但很少有研究调查医疗服务提供者的看法。本研究调查了护士和助产士提供产前护理（ANC）服务的经历。
本研究在马拉维提供常规ANC服务的医疗机构中进行。马拉维的ANC提供者是从马拉维的八个医疗机构中挑选出来的。使用半结构化访谈指南对选定的提供者进行访谈，该指南旨在探讨一系列与他们的工作条件和IPTp的提供相关的主题。
护士们对ANC服务及其背后的基本原理有详细的了解。护士们明白她们应该在孕期提供两剂IPTp，但她们对给药时间没有达成一致。护士们在诊所将SP作为直接观察治疗（DOT）给药。护士们没有给妇女SP药片让她们带回家，因为她们不信任妇女会服药。拒绝服用SP的妇女解释说，如果她们没吃东西就不会服药，或者她们害怕副作用，或者她们没有生病。不给予第一剂或第二剂SP的原因包括首次ANC就诊延迟、HIV检测呈阳性以及患有疟疾。没有一名护士能够出示关于何时给予SP的任何具体书面指南。护士们面临的挑战包括工作过度劳累以及在观察下说服妇女服用SP。
研究结果表明，护士们已经获得了提供适当ANC服务的知识和技术技能。关于IPTp，护士们需要医疗机构提供关于如何以及何时给予SP的指南。采用世界卫生组织的指南并将其推广到医疗机构可能有助于提高马拉维IPTp2（至少两剂磺胺多辛-乙胺嘧啶）的覆盖率。
