尼日利亚南部农村三级中心产妇严重发病和死亡的横断面研究。
A cross sectional study of maternal near miss and mortality at a rural tertiary centre in southern nigeria.
机构信息
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Awka, Nnewi Campus, Nnewi, Anambra State, Nigeria.
Department of Obstetrics and Gynaecology, Madonna University Teaching Hospital, Elele, Rivers State, Nigeria.
出版信息
BMC Pregnancy Childbirth. 2017 Jul 28;17(1):251. doi: 10.1186/s12884-017-1436-z.
BACKGROUND
The study evaluated the pattern of severe maternal outcome, near miss indicators and associated patient and healthcare factors at a private referral hospital in rural Nigeria.
METHODS
This was a cross sectional study conducted from September 2014 to August 2015 in Madonna University Teaching Hospital Elele, Rivers State, Nigeria. Pregnant and postpartum women were recruited for the study using Nigeria near miss network proforma which was adopted from the WHO near miss proforma. We explored administrative, patient related and medical delays. Statistical analysis was done using SPSS version 20.
RESULTS
Of the 262 deliveries, 5 women died and 52 women had a near miss event. The maternal mortality rate was 1908/100,000. The maternal near miss mortality ratio was 11.4: 1 while the mortality index was 8.8%. Three out of the five deaths that occurred were in the age category of 20-24 years. Abortive outcome was the leading cause of maternal mortality contributing 2 of the 5 maternal mortality. The severe maternal outcome ratio was 218/1000 and maternal near miss incidence ratio was 198/1000. Hypertensive disorders of pregnancy contributed 16(28.1%) of the 57 cases with severe maternal outcome while Obstetrics hemorrhage and abortive outcome each contributed 14(24.6%). 6(10.5%) received treatment within 30 min of diagnosis while 19(33.3%) waited for greater than 240 min before they received intervention. There was a statistically significant association between time of intervention and final maternal outcome (p-value = 0.003). Administrative delay was noted in 20 cases, while patient related delay was noted in 44 cases.
CONCLUSION
There is a high burden of near miss and unmet need for reproductive health services in rural areas of Nigeria. Different levels of delays abound and contribute to the disease burden. Periodic reviews will aid in elimination of the delays. There should be better communication between different levels of care and emphasis should be on early identification and referral of women for prompt management.
背景
本研究评估了尼日利亚农村一家私立转诊医院严重产妇结局、接近失败指标以及相关患者和医疗保健因素的模式。
方法
这是一项 2014 年 9 月至 2015 年 8 月在尼日利亚河流州圣母大学教学医院 Elele 进行的横断面研究。使用尼日利亚接近失败网络表格（改编自世卫组织接近失败表格）招募了孕妇和产后妇女进行研究。我们探讨了行政、患者相关和医疗延误。使用 SPSS 版本 20 进行统计分析。
结果
在 262 例分娩中，有 5 名妇女死亡，52 名妇女出现接近失败事件。孕产妇死亡率为 1908/100,000。孕产妇接近失败死亡率为 11.4:1，死亡率指数为 8.8%。发生的 5 例死亡中有 3 例发生在 20-24 岁年龄组。流产结局是导致孕产妇死亡的主要原因，占 5 例孕产妇死亡中的 2 例。严重产妇结局发生率为 218/1000，产妇接近失败发生率为 198/1000。妊娠高血压疾病导致 57 例严重产妇结局中的 16 例（28.1%），产科出血和流产结局各导致 14 例（24.6%）。6 例（10.5%）在诊断后 30 分钟内接受治疗，19 例（33.3%）在接受干预前等待超过 240 分钟。干预时间与最终产妇结局之间存在统计学显著关联（p 值=0.003）。20 例存在行政延误，44 例存在患者相关延误。
结论
尼日利亚农村地区接近失败的负担很高，生殖健康服务需求未得到满足。不同层次的延误普遍存在，并导致疾病负担增加。定期审查将有助于消除这些延误。不同层次的医疗保健之间应加强沟通，重点应放在早期识别和转介妇女，以便及时进行管理。
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