紧急产科护理的信号功能作为降低孕产妇死亡率的干预措施：赞比亚卢萨卡地区公立和私立卫生机构的调查。
Signal functions for emergency obstetric care as an intervention for reducing maternal mortality: a survey of public and private health facilities in Lusaka District, Zambia.
机构信息
Department of Public Health, School of Medicine, University of Zambia, P.O Box 32379, Lusaka, Zambia.
Centre for Infectious Disease Research in Zambia, P.O Box 34681, Lusaka, Zambia.
出版信息
BMC Pregnancy Childbirth. 2017 Sep 6;17(1):288. doi: 10.1186/s12884-017-1451-0.
BACKGROUND
Zambia's maternal mortality ratio was estimated at 398/100,000 live births in 2014. Successful aversion of deaths is dependent on availability and usability of signal functions for emergency obstetric and neonatal care. Evidence of availability, usability and quality of signal functions in urban settings in Zambia is minimal as previous research has evaluated their distribution in rural settings. This survey evaluated the availability and usability of signal functions in private and public health facilities in Lusaka District of Zambia.
METHODS
A descriptive cross sectional study was conducted between November 2014 and February 2015 at 35 public and private health facilities. The Service Availability and Readiness Assessment tool was adapted and administered to overall in-charges, hospital administrators or maternity ward supervisors at health facilities providing maternal and newborn health services. The survey quantified infrastructure, human resources, equipment, essential drugs and supplies and used the UN process indicators to determine availability, accessibility and quality of signal functions. Data on deliveries and complications were collected from registers for periods between June 2013 and May 2014.
RESULTS
Of the 35 (25.7% private and 74.2% public) health facilities assessed, only 22 (62.8%) were staffed 24 h a day, 7 days a week and had provided obstetric care 3 months prior to the survey. Pre-eclampsia/ eclampsia and obstructed labor accounted for most direct complications while postpartum hemorrhage was the leading cause of maternal deaths. Overall, 3 (8.6%) and 5 (14.3%) of the health facilities had provided Basic and Comprehensive EmONC services, respectively. All facilities obtained blood products from the only blood bank at a government referral hospital.
CONCLUSION
The UN process indicators can be adequately used to monitor progress towards maternal mortality reduction. Lusaka district had an unmet need for BEmONC as health facilities fell below the minimum UN standard. Public health facilities with capacity to perform signal functions should be upgraded to Basic EmONC status. Efforts must focus on enhancing human resource capacity in EmONC and improving infrastructure and supply chain. Obstetric health needs and international trends must drive policy change.
背景
2014 年，赞比亚的孕产妇死亡率估计为每 10 万活产儿 398 例。成功避免死亡取决于紧急产科和新生儿护理的信号功能的可用性和实用性。由于以前的研究评估了它们在农村地区的分布情况，因此，赞比亚城市环境中信号功能的可用性、实用性和质量证据很少。本调查评估了赞比亚卢萨卡区私人和公共卫生机构中信号功能的可用性和实用性。
方法
2014 年 11 月至 2015 年 2 月，在 35 家公共和私人卫生机构进行了一项描述性的横断面研究。对提供母婴保健服务的卫生机构的总负责人、医院管理人员或产科病房主管，采用服务可用性和准备情况评估工具进行了调查。该调查量化了基础设施、人力资源、设备、基本药物和用品，并使用联合国进程指标来确定信号功能的可用性、可及性和质量。从 2013 年 6 月至 2014 年 5 月的登记册中收集了分娩和并发症的数据。
结果
在所评估的 35 家（25.7%为私人，74.2%为公共）卫生机构中，只有 22 家（62.8%）能够 24 小时/7 天/周全天候提供服务，并在调查前 3 个月提供了产科护理。先兆子痫/子痫和产道梗阻占大多数直接并发症，而产后出血是孕产妇死亡的主要原因。总体而言，有 3 家（8.6%）和 5 家（14.3%）卫生机构分别提供了基本和全面的产科急诊护理服务。所有卫生机构均从唯一的政府转诊医院的血库获取血液制品。
结论
联合国进程指标可充分用于监测减少孕产妇死亡率方面的进展。卢萨卡区基本产科急诊护理服务存在未满足的需求，因为卫生机构未达到联合国的最低标准。具有履行信号功能能力的公共卫生机构应升级为基本产科急诊护理服务。必须努力加强产科急诊护理方面的人力资源能力，并改善基础设施和供应链。产科保健需求和国际趋势必须推动政策变革。
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