Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale, Harare, Zimbabwe.
Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, K45 Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa.
BMC Pregnancy Childbirth. 2018 Jun 4;18(1):205. doi: 10.1186/s12884-018-1863-5.
To improve maternity services in any country, there is need to monitor the quality of obstetric care. There is usually disparity of obstetric care and outcomes in most countries among women giving birth in different obstetric units. However, comparing the quality of obstetric care is difficult because of heterogeneous population characteristics and the difference in prevalence of complications. The concept of the standard primipara was introduced as a tool to control for these various confounding factors. This concept was used to compare the quality of obstetric care among districts in different geographical locations in Zimbabwe.
This was a substudy of the Zimbabwe Maternal and Perinatal Mortality Study. In the main study, cluster sampling was done with the provinces as clusters and 11 districts were randomly selected with one from each of the nine provinces and two from the largest province. This database was used to identify the standard primipara defined as; a woman in her first pregnancy without any known complications who has spontaneous onset of labour at term. Obstetric process and outcome indicators of the standard primipara were then used to compare the quality of care between rural and urban, across rural and across urban districts of Zimbabwe.
A total of 45,240 births were recruited in the main study and 10,947 women met the definition of standard primipara. The maternal mortality ratio (MMR) and the perinatal mortality rate (PNMR) for the standard primiparae were 92/100000 live births and 15.4/1000 total births respectively. Compared to urban districts, the PNMR was higher in the rural districts (11/1000 total births vs 19/ 1000 total births, p < 0.001). In the urban to urban and rural to rural districts comparison, there were significant differences in most of the process indicators, but not in the PNMR.
The study has shown that the standard primipara can be used as a tool to measure and compare the quality of obstetric care in districts in different geographical areas. There is need to explore further how the quality of obstetric care can be improved in rural districts of Zimbabwe.
为了改善任何国家的产科服务，都需要监测产科护理质量。在大多数国家，不同产科单位的产妇分娩质量和结局通常存在差异。然而，由于人群特征的异质性以及并发症的流行率不同，比较产科护理质量是困难的。标准初产妇的概念被引入作为控制这些各种混杂因素的工具。该概念用于比较津巴布韦不同地理位置地区的产科护理质量。
这是津巴布韦孕产妇和围产儿死亡率研究的子研究。在主要研究中，采用以省份为单位的聚类抽样，随机选择 11 个区，其中 9 个省各选 1 个区，最大的省选 2 个区。本数据库用于确定标准初产妇的定义：无已知并发症的初产妇，足月时自然临产。然后，使用标准初产妇的产科过程和结局指标来比较津巴布韦农村和城市地区、农村和城市地区之间的护理质量。
在主要研究中，共招募了 45240 例分娩，10947 例妇女符合标准初产妇的定义。标准初产妇的孕产妇死亡率（MMR）和围产儿死亡率（PNMR）分别为 92/100000 活产和 15.4/1000 总分娩。与城市区相比，农村区的 PNMR 更高（11/1000 总分娩 vs 19/1000 总分娩，p<0.001）。在城市到城市和农村到农村的区比较中，除了 PNMR，大多数过程指标都存在显著差异。
本研究表明，标准初产妇可作为衡量和比较不同地理区域的产科护理质量的工具。需要进一步探讨如何提高津巴布韦农村地区的产科护理质量。
