Thein Tin Tin, Myint Theingi, Lwin Saw, Oo Win Myint, Kyaw Aung Kyaw, Myint Moe Kyaw, Thant Kyaw Zin
Department of Medical Research (Upper ), Pyin Oo Lyin, Myanmar.
Maternal & Child Health Section, Department of Health, Myanmar.
WHO South East Asia J Public Health. 2012 Jul-Sep;1(3):290-298. doi: 10.4103/2224-3151.207025.
A prospective, quasi-experimental study was carried out in 2009 at urban health centres (UHCs) of five townships of Mandalay, Myanmar, to improve the skill of midwives (MWs) in diagnosis and referral of pre-eclampsia (PE) from UHC to the Central Women's Hospital (CWH) and to enhance the supervision of midwives by lady health visitors (LHVs). The intervention was training on quality antenatal care focusing on PE using an updated training manual. Altogether, 75 health care providers (MWs & LHVs) participated. In this study, data were extracted from patient registers and monthly reports of UHCs and CWH. Interviewers were trained regarding the conduct of semi-structured questionnaires to elicit knowledge and to use checklists in observation of skills in screening of PE, measuring blood pressure and urine protein (dipstick test). A guide for LHVs was also used to obtain data, and data was collected six months prior to and after the intervention. Significant improvements from baseline to endline survey occurred in the knowledge (p<0.001) and skill levels (p<0.001) including skills for screening, measuring blood pressure and urine protein. At CWH, there was an increase in referred cases of PE after the intervention, from 1.25% to 2.56% (p<0.001). In conclusion, this study highlights the early detection of pre-eclampsia by widespread use of quality antenatal care, education and training of health-care providers to improve their performance and increase human resources for health care, in order to enable women in our society to have healthy pregnancies and healthy babies.
2009年，在缅甸曼德勒五个镇区的城市健康中心开展了一项前瞻性准实验研究，旨在提高助产士对先兆子痫的诊断和转诊技能，使其能够从城市健康中心转诊至中央妇女医院，并加强女性健康访视员对助产士的监督。干预措施是使用更新后的培训手册，针对以先兆子痫为重点的优质产前护理进行培训。共有75名医疗服务提供者（助产士和女性健康访视员）参与。在本研究中，数据从城市健康中心和中央妇女医院的患者登记册及月度报告中提取。对访谈者进行了关于开展半结构化问卷的培训，以获取知识，并在观察先兆子痫筛查、测量血压和尿蛋白（试纸条检测）技能时使用检查表。还使用了一份针对女性健康访视员的指南来获取数据，在干预前后六个月收集数据。从基线调查到终末调查，知识水平（p<0.001）和技能水平（p<0.001）包括筛查、测量血压和尿蛋白的技能都有显著提高。在中央妇女医院，干预后先兆子痫的转诊病例有所增加，从1.25%增至2.56%（p<0.001）。总之，本研究强调通过广泛使用优质产前护理、对医疗服务提供者进行教育和培训以提高其绩效并增加医疗保健人力资源，从而早期发现先兆子痫，以使我们社会中的女性能够拥有健康的孕期和健康的婴儿。
