“必要但在需要时并非总是可用”——一项关于坦桑尼亚医生使用产科超声的经历和观点的访谈研究
'Essential but not always available when needed' - an interview study of physicians' experiences and views regarding use of obstetric ultrasound in Tanzania.
作者信息
Åhman Annika, Kidanto Hussein Lesio, Ngarina Matilda, Edvardsson Kristina, Small Rhonda, Mogren Ingrid
机构信息
Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden;
Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
出版信息
Glob Health Action. 2016 Jul 22;9:31062. doi: 10.3402/gha.v9.31062. eCollection 2016.
BACKGROUND
The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries.
OBJECTIVE
We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management.
DESIGN
A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis.
RESULTS
Use of obstetric ultrasound in the management of complicated pregnancy was much appreciated by participating physicians, although they expressed considerable concern about the lack of ultrasound equipment and staff able to conduct the examinations. These limitations were recognized as restricting physicians' ability to manage complications adequately during pregnancy and birth. Better availability of ultrasound was requested to improve obstetric management. Concerns were also raised regarding pregnant women's lack of knowledge and understanding of medical issues which could make counseling in relation to obstetric ultrasound difficult. Although the physicians perceived a positive attitude toward ultrasound among most pregnant women, occasionally they came across women who feared that ultrasound might harm the fetus.
CONCLUSIONS
There seems to be a need to provide more physicians in antenatal care in Tanzania with ultrasound training to enable them to conduct obstetric ultrasound examinations and interpret the results themselves. Physicians also need to acquire adequate counseling skills as counseling can be especially challenging in this setting where many expectant parents have low levels of education. Providers of obstetric care and policy makers in Tanzania will need to take measures to ensure appropriate use of the scarce resources in the Tanzanian health care system and prevent the potential risk of overuse of ultrasound in pregnancy.
背景
产科超声在高收入国家的价值已得到广泛探讨，但关于产科超声在低收入国家的作用仍缺乏证据。
目的
我们旨在探讨坦桑尼亚从事产科护理工作的医生对于产科超声在临床管理方面作用的经验和看法。
设计
采用定性研究设计。2015年，通过对坦桑尼亚城市地区医院从事产科护理工作的医生进行16次个人访谈收集数据。使用定性内容分析法对数据进行分析。
结果
参与研究的医生高度赞赏在复杂妊娠管理中使用产科超声，尽管他们对缺乏超声设备以及能够进行检查的工作人员表示了相当大的担忧。这些限制被认为限制了医生在孕期和分娩期间充分处理并发症的能力。他们要求更好地提供超声设备以改善产科管理。还有人对孕妇缺乏医学问题的知识和理解表示担忧，这可能使产科超声咨询变得困难。尽管医生认为大多数孕妇对超声持积极态度，但偶尔也会遇到担心超声可能伤害胎儿的妇女。
结论
坦桑尼亚似乎需要为更多从事产前护理的医生提供超声培训，使他们能够自行进行产科超声检查并解读结果。医生还需要掌握足够的咨询技巧，因为在许多准父母教育水平较低的情况下，咨询可能特别具有挑战性。坦桑尼亚的产科护理提供者和政策制定者需要采取措施，确保在坦桑尼亚医疗保健系统中合理使用稀缺资源，并防止孕期超声过度使用的潜在风险。
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