Ditai James, Frye Laura J, Durocher Jill, Byrne Meagan E, Ononge Sam, Winikoff Beverly, Weeks Andrew D
Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, P.O Box 2190, Mbale, Uganda.
Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's' Hospital, Crown Street, Liverpool, L8 7SS, UK.
BMC Res Notes. 2017 Oct 26;10(1):516. doi: 10.1186/s13104-017-2849-5.
Advance provision of misoprostol to women during antenatal care aims to achieve broader access to uterotonics for the prevention of postpartum hemorrhage. Studies of this community-based approach usually involve antenatal education as well as timely postpartum follow-up visits to confirm maternal and neonatal outcomes. The MamaMiso study in Mbale, Uganda sought to assess the feasibility of conducting follow-up visits in the postpartum period following advance provision of misoprostol for postpartum hemorrhage prevention. MamaMiso recruited women during antenatal care visits. Participants were asked to contact the research team within 48 h of giving birth so that postpartum follow-up visits could be carried out at their homes. Women's baseline and delivery characteristics were collected and analyzed with respect to follow-up time ('on time' ≤ 7 days, 'late' > 7 days, and 'lost to follow up'). Every woman who was followed up late due to a failure to report the delivery was asked for the underlying reasons for the delay. When attempts at following up participants were unsuccessful, a file note was generated explaining the details of the failure. We abstracted data and identified themes from these notes.
Of 748 recruited women, 700 (94%) were successfully followed up during the study period, 465 (62%) within the first week postpartum. The median time to follow up was 4 days and was similar for women who delivered at home or in facilities and for women who had attended or unattended births. Women recruited at the urban hospital site (as opposed to rural health clinics) were more likely to be lost to follow up or followed up late. Of the women followed up late, 202 provided a reason. File notes explaining failed attempts at follow up were generated for 164 participants. Several themes emerged from qualitative analysis of these notes including phone difficulties, inaccurate baseline information, misperceptions, postpartum travel, and the condition of the mother and neonate.
Keeping women connected to the health system in the postpartum period is feasible, though reaching them within the first week of their delivery is challenging. Understanding characteristics of women who are harder to reach can help tailor follow-up efforts and elucidate possible biases in postpartum study data. Trial Registration Number ISRCTN70408620 December 28, 2011.
在产前护理期间提前向妇女提供米索前列醇旨在使更多人能够获得宫缩剂以预防产后出血。对这种基于社区的方法的研究通常包括产前教育以及产后及时随访以确认母婴结局。乌干达姆巴莱的“妈妈米索”研究旨在评估在提前提供米索前列醇预防产后出血后进行产后随访的可行性。“妈妈米索”研究在产前护理就诊期间招募妇女。参与者被要求在分娩后48小时内联系研究团队，以便能在其家中进行产后随访。收集并分析了妇女的基线和分娩特征，并根据随访时间（“按时”≤7天、“延迟”>7天和“失访”）进行分析。每一位因未报告分娩而随访延迟的妇女都被询问延迟的根本原因。当对参与者的随访尝试未成功时，会生成一份文件说明失败的详细情况。我们从这些说明中提取数据并确定主题。
在748名招募的妇女中，700名（94%）在研究期间成功随访，465名（62%）在产后第一周内随访。随访的中位时间为4天，在家分娩或在医疗机构分娩的妇女以及有无陪产的妇女的随访时间相似。在城市医院招募的妇女（与农村健康诊所相比）更有可能失访或随访延迟。在随访延迟的妇女中，202人给出了原因。为164名参与者生成了说明随访尝试失败的文件。对这些说明进行定性分析后出现了几个主题，包括电话问题、不准确的基线信息、误解、产后出行以及母亲和新生儿的状况。
在产后期间使妇女与卫生系统保持联系是可行的，尽管在她们分娩后的第一周内联系到她们具有挑战性。了解难以联系到的妇女的特征有助于调整随访工作，并阐明产后研究数据中可能存在的偏差。试验注册号ISRCTN70408620，2011年12月28日。
