Rurangirwa Akashi Andrew, Mogren Ingrid, Ntaganira Joseph, Govender Kaymarlin, Krantz Gunilla
Department of Epidemiology and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda.
Section of Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
BMC Health Serv Res. 2018 Nov 19;18(1):865. doi: 10.1186/s12913-018-3694-5.
Although most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided. We investigated the ANC providers' (HCPs) current practices in relation to prevention, management and referral of maternal conditions as well as the information provided to pregnant women attending ANC services in Rwanda.
This facility-based, cross-sectional study included 312 ANC providers as participants and a review of 605 ANC medical records from 121 health centers. Data collection was performed using an interviewer-administered questionnaire and a structured observation checklist. For the analyses, descriptive statistics and bi-and multivariable logistic regression were used.
Nurses and midwives in ANC services failed to report a number of pregnancy-related conditions that would need urgent referral to a higher level of health care. Midwives did somewhat better than nurses in reporting these conditions. There was no statistically significant difference in how nurses and midwives informed pregnant women about pregnancy-related issues. Ever been trained in how to manage a pregnant woman exposed to violence was reported by 14% of the participants. In 12, 13 and 15% of the medical records there was no report on tetanus immunization, anthelmintic treatment and syphilis testing, respectively.
The providers in ANC clinics reported suboptimal practices on conditions of pregnancy that needed urgent referral for adequate management. Information to pregnant women on danger signs of pregnancy, recommended medicines and tests do not seem to be consistently provided. Midwifery training in Rwanda should be expanded so that most of staff at ANC clinics are trained as midwives to help lower maternal and child mortality and morbidity.
尽管卢旺达的大多数孕妇会前往产前保健（ANC）诊所就诊，但对于所提供服务的质量却鲜有研究。我们调查了卢旺达产前保健服务提供者（医护人员）在孕产妇疾病预防、管理和转诊方面的现行做法，以及向接受产前保健服务的孕妇提供的信息。
这项基于机构的横断面研究纳入了312名产前保健服务提供者作为参与者，并对来自121个健康中心的605份产前保健医疗记录进行了审查。数据收集使用了由访谈员管理的问卷和结构化观察清单。分析时使用了描述性统计以及二元和多变量逻辑回归。
产前保健服务中的护士和助产士未能报告一些需要紧急转诊至更高层级医疗保健机构的妊娠相关疾病。助产士在报告这些疾病方面比护士做得稍好一些。护士和助产士在向孕妇告知妊娠相关问题的方式上没有统计学显著差异。14%的参与者报告曾接受过如何管理遭受暴力的孕妇的培训。在12%、13%和15%的医疗记录中，分别没有关于破伤风免疫、驱虫治疗和梅毒检测的报告。
产前保健诊所的提供者报告称，在需要紧急转诊以进行适当管理的妊娠疾病方面，其做法并不理想。似乎并未始终如一地向孕妇提供有关妊娠危险信号、推荐药物和检测的信息。卢旺达应扩大助产士培训，以便产前保健诊所的大多数工作人员都接受助产士培训，以帮助降低孕产妇和儿童的死亡率及发病率。
