Boene Helena, Vidler Marianne, Augusto Orvalho, Sidat Mohsin, Macete Eusébio, Menéndez Clara, Sawchuck Diane, Qureshi Rahat, von Dadelszen Peter, Munguambe Khátia, Sevene Esperança
Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.
Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, V5Z4H4, Canada.
Reprod Health. 2016 Sep 30;13(Suppl 2):105. doi: 10.1186/s12978-016-0220-2.
Mozambique has drastically improved an array of health indicators in recent years, including maternal mortality rates which decreased 63 % from 1990-2013 but the rates still high. Pre-eclampsia and eclampsia constitute the third major cause of maternal death in the country. Women in rural areas, with limited access to health facilities are at greatest risk. This study aimed to assess the current state of knowledge and the regular practices regarding pre-eclampsia and eclampsia by community health workers in southern Mozambique.
This mixed methods study was conducted from 2013 to 2014, in Maputo and Gaza Provinces, southern Mozambique. Self-administered questionnaires, in-depth interviews and focus group discussions were conducted with CHWs, district medical officers, community health workers' supervisors, Gynaecologists-Obstetricians and matrons. Quantitative data were entered into a database written in REDCap and subsequently analyzed using Stata 13. Qualitative data was imported into NVivo10 for thematic analysis.
Ninety-three percent of CHW had some awareness of pregnancy complications. Forty-one percent were able to describe the signs and symptoms of hypertension. In cases of eclampsia, CHWs reported to immediately refer the women. The vast majority of the CHWs surveyed reported that they could neither measure blood pressure nor proteinuria (90 %). Fewer reported confidence in providing oral antihypertensives (14 %) or injections in pregnancy (5 %). The other community health care providers are matrons. They do not formally offer health services, but assists pregnant women in case of an emergency. Regarding pre-eclampsia and eclampsia, matrons were unable to recognise these biomedical terms.
Although CHWs are aware of pregnancy complications, they hold limited knowledge specific to pre-eclampsia and eclampsia. There is a need to promote studies to evaluate the impact of enhancing their training to include additional content related to the identification and management of pre-eclampsia and eclampsia.
近年来，莫桑比克在一系列健康指标方面取得了显著改善，包括孕产妇死亡率从1990年至2013年下降了63%，但该比率仍然很高。先兆子痫和子痫是该国孕产妇死亡的第三大主要原因。农村地区的妇女获得医疗设施的机会有限，面临的风险最大。本研究旨在评估莫桑比克南部社区卫生工作者关于先兆子痫和子痫的知识现状及常规做法。
2013年至2014年，在莫桑比克南部的马普托省和加扎省开展了这项混合方法研究。对社区卫生工作者、地区医务人员、社区卫生工作者监督员、妇产科医生和护士长进行了自填式问卷调查、深入访谈和焦点小组讨论。定量数据录入用REDCap编写的数据库，随后使用Stata 13进行分析。定性数据导入NVivo10进行主题分析。
93%的社区卫生工作者对妊娠并发症有一定认识。41%的人能够描述高血压的体征和症状。对于子痫病例，社区卫生工作者报告称会立即转诊妇女。绝大多数接受调查的社区卫生工作者表示，他们既不会测量血压也不会检测蛋白尿（90%）。较少有人表示有信心提供口服抗高血压药物（14%）或孕期注射药物（5%）。其他社区医疗服务提供者是护士长。她们不提供正规的医疗服务，但在紧急情况下协助孕妇。关于先兆子痫和子痫，护士长无法识别这些生物医学术语。
尽管社区卫生工作者了解妊娠并发症，但他们对先兆子痫和子痫的具体知识有限。有必要推动开展研究，以评估加强其培训以纳入与先兆子痫和子痫的识别及管理相关的额外内容的影响。
