Oo Kyaw, Win Le Le, Saw Saw, Mon Myo Myo, Oo Yin Thet Nu, Maung Thae Maung, Myint Su Latt Tun, Myint Theingi
Department of Medical Research (Lower ), Ministry of Health, Yangon, Myanmar.
Department of Health, Ministry of Health, Yangon, Myanmar.
WHO South East Asia J Public Health. 2012 Oct-Dec;1(4):467-476. doi: 10.4103/2224-3151.207049.
In Myanmar a large proportion of antenatal and intrapartum care in rural areas is provided by skilled birth attendants (SBAs), this study assessed the coverage by these health workers of all births, their adherence to service guidelines, and community opinion on the antenatal and delivery care they give in two rural health centres in Pathein Township, Ayeyarwaddy Region to identify the challenges and improve antenatal and intrapartum service delivery provided by the SBAs.
A structured questionnaire was used to interview 304 women who had infants under one year of age, and in-depth interviews were held with 12 SBAs and 10 community members.
Of the 304 pregnancies, 93% had received antenatal care (ANC); 97% of these were covered by SBAs at an average 15 weeks' gestation. The average frequency of ANC visits was 9. Rates of home and hospital deliveries were 84.5% and 13.8% respectively. Among home deliveries, use rate of SBA was 51.4%, while for postnatal care, 31.3% was given by unskilled providers (traditional birth attendants (TBAs) 17.5%, auxiliary midwives (AMWs),13.8%). Multivariate analysis showed that interviewees aged 30 years and below (OR=0.468, P=0.046), with an education at primary level and below that of husband (OR=0.391, P=0.007) or not residing in the village of the rural/station health centre (OR=0.457, P=0.011) were significantly less likely to use SBAs. The categories of supervision, referral, and health education activities of SBAs were not in line with service guidelines. The main reasons were lack of access and community acceptance of TBAs.
Heavy workload, geographical location, transportation and financial concerns were major challenges for SBAs, along with community compliance and mutual coordination. Good communication and service management skills were important to overcome these challenges.
在缅甸农村地区，很大一部分产前和产时护理由熟练的助产人员（SBA）提供。本研究评估了这些卫生工作者对所有分娩的覆盖情况、他们对服务指南的遵守情况，以及伊洛瓦底江省勃生镇两个农村卫生中心的社区对他们提供的产前和分娩护理的看法，以确定挑战并改善SBA提供的产前和产时服务。
使用结构化问卷对304名有一岁以下婴儿的妇女进行访谈，并与12名SBA和10名社区成员进行深入访谈。
在304例妊娠中，93%接受了产前护理（ANC）；其中97%在平均妊娠15周时由SBA提供护理。ANC就诊的平均次数为9次。家庭分娩率和医院分娩率分别为84.5%和13.8%。在家庭分娩中，SBA的使用率为51.4%，而产后护理方面，31.3%由非熟练提供者提供（传统助产士（TBA）占17.5%，辅助助产士（AMW）占13.8%）。多因素分析显示，30岁及以下的受访者（OR=0.468，P=0.046）、小学及以下学历且低于丈夫学历的受访者（OR=0.391，P=0.007）或不住在农村/驻地卫生中心所在村庄的受访者（OR=0.457，P=0.011）使用SBA的可能性显著降低。SBA的监督、转诊和健康教育活动类别不符合服务指南。主要原因是难以获得服务以及社区对TBA的接受。
工作量大、地理位置、交通和经济问题是SBA面临的主要挑战，同时还有社区依从性和相互协调问题。良好的沟通和服务管理技能对于克服这些挑战很重要。
