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在资源匮乏的环境下,卫生机构提供基本产科和新生儿急救服务的可得性和准备情况:来自坦桑尼亚全国调查的证据。

Health facility service availability and readiness to provide basic emergency obstetric and newborn care in a low-resource setting: evidence from a Tanzania National Survey.

机构信息

Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania.

Department of Obstetrics and Gynecology, College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania.

出版信息

BMJ Open. 2019 Feb 19;9(2):e020608. doi: 10.1136/bmjopen-2017-020608.

Abstract

OBJECTIVE

This study used a nationally representative sample from Tanzania as an example of low-resource setting with a high burden of maternal and newborn deaths, to assess the availability and readiness of health facilities to provide basic emergency obstetric and newborn care (BEmONC) and its associated factors.

DESIGN

Health facility-based cross-sectional survey.

SETTING

We analysed data for obstetric and newborn care services obtained from the 2014-2015 Tanzania Service Provision Assessment survey, using WHO-Service Availability and Readiness Assessment tool.

PRIMARY AND SECONDARY OUTCOME MEASURES

Availability of seven signal functions was measured based on the provision of 'parental administration of antibiotic', 'parental administration of oxytocic', 'parental administration of anticonvulsants', 'assisted vaginal delivery', 'manual removal of placenta', 'manual removal of retained products of conception' and 'neonatal resuscitation'. Readiness was a composite variable measured based on the availability of supportive items categorised into three domains: staff training, diagnostic equipment and basic medicines.

RESULTS

Out of 1188 facilities, 905 (76.2%) were reported to provide obstetric and newborn care services and therefore were included in the analysis of the current study. Overall availability of seven signal functions and average readiness score were consistently higher among hospitals than health centres and dispensaries (p<0.001). Furthermore, the type of facility, performing quality assurance, regular reviewing of maternal and newborn deaths, reviewing clients' opinion and number of delivery beds per facility were significantly associated with readiness to provide BEmONC.

CONCLUSION

The study findings show disparities in the availability and readiness to provide BEmONC among health facilities in Tanzania. The Tanzanian Ministry of Health should emphasise quality assurance efforts and systematic maternal and newborn death audits. Health leadership should fairly distribute clinical guidelines, essential medicines, equipment and refresher trainings to improve availability and quality BEmONC.

摘要

目的

本研究以坦桑尼亚为代表,该国有大量的孕产妇和新生儿死亡病例,资源匮乏,以此为例评估卫生机构提供基本产科和新生儿急救护理(BEmONC)的能力和准备情况及其相关因素。

设计

基于卫生机构的横断面调查。

地点

我们分析了 2014-2015 年坦桑尼亚服务提供评估调查中获得的产科和新生儿护理服务数据,使用世卫组织服务提供和准备情况评估工具。

主要和次要结果测量

根据“父母使用抗生素”、“父母使用催产素”、“父母使用抗惊厥药物”、“辅助阴道分娩”、“手动胎盘娩出”、“手动清除妊娠残留物”和“新生儿复苏”这 7 项功能的提供情况,衡量了 7 项信号功能的提供情况。准备情况是一个综合变量,根据分为 3 个领域的支持项目的提供情况进行衡量:员工培训、诊断设备和基本药物。

结果

在 1188 家机构中,有 905 家(76.2%)报告提供产科和新生儿护理服务,因此被纳入本研究的分析。与卫生中心和诊所相比,医院的 7 项信号功能的总体提供情况和平均准备得分均较高(p<0.001)。此外,机构类型、进行质量保证、定期审查孕产妇和新生儿死亡情况、审查客户意见以及每间机构的分娩床位数量与提供基本产科和新生儿急救护理的准备情况显著相关。

结论

研究结果表明,坦桑尼亚各卫生机构提供基本产科和新生儿急救护理的能力和准备情况存在差异。坦桑尼亚卫生部应加强质量保证工作和孕产妇及新生儿死亡系统审查。卫生领导层应公平分配临床指南、基本药物、设备和进修培训,以提高基本产科和新生儿急救护理的提供情况和质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3671/6398731/864a71e5c974/bmjopen-2017-020608f01.jpg

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