Than Kyu Kyu, Morgan Alison, Pham Minh Duc, Beeson James G, Luchters Stanley
Burnet Institute, Melbourne, Australia.
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
BMJ Open. 2017 Jul 5;7(6):e017180. doi: 10.1136/bmjopen-2017-017180.
The re-emergence of community-based health workers such as the auxiliary midwives (AMWs) in Myanmar, who are local female volunteers, has been an important strategy to address global health workforce shortages. The Myanmar government recommends one AMW for every village. The aim of this study is to investigate the current knowledge of critical danger signs and practices for safe childbirth and immediate newborn care of AMWs to inform potential task shifting of additional healthcare responsibilities.
A cross-sectional survey was conducted from July 2015 to June 2016 in three hard-to-reach areas in Myanmar. Face-to-face interviews were conducted using a pretested questionnaire.
Among 262 AMWs participating in the study, only 8% of AMWs were able to identify at least 80% of 20 critical danger signs. Factors associated with greater knowledge of critical danger signs included older age over 35 years (adjusted OR (AOR) 2.19, 95% CI 0.99 to 4.83), having received refresher training within the last year (AOR 2.20, 95% CI 1.21 to 4.01) and receiving adequate supervision (AOR 5.04, 95% CI 2.74 to 9.29). Those who employed all six safe childbirth and immediate newborn care practices were more likely to report greater knowledge of danger signs (AOR 2.81, 95% CI 1.50 to 5.26), adequate work supervision (AOR 3.18 95% CI 1.62 to 6.24) and less education (AOR 0.44, 95% CI 0.23 to 0.88).
The low level of knowledge of critical danger signs and reported practices for safe childbirth identified suggest that an evaluation of the current AMW training and supervision programme needs to be revisited to ensure that existing practices, including recognition of danger signs, meet quality care standards before new interventions are introduced or new responsibilities given to AMWs.
缅甸重新启用社区卫生工作者，如当地女性志愿者辅助助产士，这是应对全球卫生人力短缺的一项重要策略。缅甸政府建议每个村庄配备一名辅助助产士。本研究旨在调查辅助助产士目前对危急征象的了解情况以及安全分娩和新生儿即时护理的实践情况，为潜在的额外医疗保健职责任务转移提供参考依据。
2015年7月至2016年6月在缅甸三个交通不便的地区进行了一项横断面调查。使用经过预测试的问卷进行面对面访谈。
在参与研究的262名辅助助产士中，只有8%的辅助助产士能够识别出20种危急征象中的至少80%。与对危急征象了解程度较高相关的因素包括年龄超过35岁（调整后比值比（AOR）为2.19，95%置信区间为0.99至4.83）、在过去一年内接受过进修培训（AOR为2.20，95%置信区间为1.21至4.01）以及接受充分监督（AOR为5.04，95%置信区间为2.74至9.29）。采用了所有六种安全分娩和新生儿即时护理实践方法的人更有可能报告对危险征象有更多了解（AOR为2.81，95%置信区间为1.50至5.26）、有充分的工作监督（AOR为3.18，95%置信区间为1.62至6.24）以及受教育程度较低（AOR为0.44，95%置信区间为0.23至0.88）。
所确定的对危急征象的低了解程度以及报告的安全分娩实践情况表明，需要重新审视当前辅助助产士培训和监督计划的评估，以确保在引入新干预措施或赋予辅助助产士新职责之前，包括识别危险征象在内的现有实践符合优质护理标准。
