Biza Adriano, Jille-Traas Ingeborg, Colomar Mercedes, Belizan Maria, Requejo Harris Jennifer, Crahay Beatrice, Merialdi Mario, Nguyen My Huong, Althabe Fernando, Aleman Alicia, Bergel Eduardo, Carbonell Alicia, Chavane Leonardo, Delvaux Therese, Geelhoed Diederike, Gülmezoglu Metin, Malapende Celsa Regina, Melo Armando, Osman Nafissa Bique, Widmer Mariana, Temmerman Marleen, Betrán Ana Pilar
International Center for Reproductive Health (ICRH-Mozambique), Maputo, Mozambique.
Montevideo Clinical and Epidemiological Research Unit (UNICEM), Montevideo, Uruguay.
BMC Pregnancy Childbirth. 2015 Sep 2;15:200. doi: 10.1186/s12884-015-0625-x.
Maternal mortality remains a daunting problem in Mozambique and many other low-resource countries. High quality antenatal care (ANC) services can improve maternal and newborn health outcomes and increase the likelihood that women will seek skilled delivery care. This study explores the factors influencing provider uptake of the recommended package of ANC interventions in Mozambique.
This study used qualitative research methods including key informant interviews with stakeholders from the health sector and a total of five focus group discussions with women with experience with ANC or women from the community. Study participants were selected from three health centers located in Maputo city, Tete, and Cabo Delgado provinces in Mozambique. Staff responsible for the medicines/supply chain at national, provincial and district level were interviewed. A check list was implemented to confirm the availability of the supplies required for ANC. Deductive content analysis was conducted.
Three main groups of factors were identified that hinder the implementation of the ANC package in the study setting: a) system or organizational: include chronic supply chain deficiencies, failures in the continuing education system, lack of regular audits and supervision, absence of an efficient patient record system and poor environmental conditions at the health center; b) health care provider factors: such as limited awareness of current clinical guidelines and a resistant attitude to adopting new recommendations; and c) Users: challenges with accessing ANC, poor recognition amongst women about the purpose and importance of the specific interventions provided through ANC, and widespread perception of an unfriendly environment at the health center.
The ANC package in Mozambique is not being fully implemented in the three study facilities, and a major barrier is poor functioning of the supply chain system. Recommendations for improving the implementation of antenatal interventions include ensuring clinical protocols based on the ANC model. Increasing the community understanding of the importance of ANC would improve demand for high quality ANC services. The supply chain functioning could be strengthened through the introduction of a kit system with all the necessary supplies for ANC and a simple monitoring system to track the stock levels is recommended.
在莫桑比克和许多其他资源匮乏的国家，孕产妇死亡率仍然是一个严峻的问题。高质量的产前保健（ANC）服务可以改善孕产妇和新生儿的健康结局，并增加妇女寻求熟练接生护理的可能性。本研究探讨了影响莫桑比克医疗服务提供者采用推荐的ANC干预措施组合的因素。
本研究采用定性研究方法，包括对卫生部门的利益相关者进行关键信息访谈，以及与有ANC经验的妇女或社区妇女进行总共五次焦点小组讨论。研究参与者从莫桑比克马普托市、太特省和德尔加杜角省的三个卫生中心中选取。对国家、省和地区层面负责药品/供应链的工作人员进行了访谈。实施了一份清单以确认ANC所需用品的可用性。进行了演绎性内容分析。
确定了阻碍在研究环境中实施ANC干预措施组合的三大类因素：a）系统或组织因素：包括长期的供应链缺陷、继续教育系统失灵、缺乏定期审计和监督、缺乏高效的患者记录系统以及卫生中心的环境条件差；b）医疗服务提供者因素：如对当前临床指南的认识有限以及对采用新建议的抵触态度；c）用户因素：获得ANC存在困难、妇女对通过ANC提供的特定干预措施的目的和重要性认识不足，以及普遍认为卫生中心环境不友好。
莫桑比克的ANC干预措施组合在三个研究机构中未得到充分实施，主要障碍是供应链系统运作不佳。改善产前干预措施实施的建议包括确保基于ANC模式的临床方案。提高社区对ANC重要性的认识将增加对高质量ANC服务的需求。建议引入包含ANC所有必要用品的试剂盒系统并建立一个简单的监测系统来跟踪库存水平，以加强供应链运作。
