Oosthuizen S J, Bergh A-M, Grimbeek J, Pattinson R C
Tshwane District Health and Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
S Afr Med J. 2019 Jan 31;109(2):95-101. doi: 10.7196/SAMJ.2019.v109i2.13429.
South Africa did not meet its Millennium Development Goals with regard to the reduction in maternal and under-5 mortality. Furthermore, many birthing women do not receive intrapartum care with empathy and endure disrespect-ful and abusive care.
To implement a multicomponent, context-specific intervention package to change the complex interplay between preventable maternal and perinatal mortality and morbidity and poor clinical governance and supervision in midwife-led labour units.
A mixed-methods intervention study was conducted in Tshwane District, South Africa, in 10 midwife-led obstetric units (MOUs), from which a purposive sample consisting of five units was selected for the intervention. The intervention took place in three phases: (i) baseline measurement; (ii) implementation of the so-called 'CLEVER' intervention package in the five intervention units, based on the results of the first phase; and (iii) a review of health systems improvements and perinatal outcomes. The intervention had three pillars: (i) feedback of the baseline measurement to the intervention units to raise awareness and solicit participation; (ii) health systems strengthening; and (iii) intensive weekly engagement for 3 months, with further monthly support afterwards. Observation of barriers during baseline activities contributed to the health systems strengthening and improvement strategies during implementation.
Perinatal outcome indicators for the year before the intervention were compared with data for the year in which the intervention took place and the year after the intervention. Significant declines were observed in in-facility fresh stillbirths, meconium aspiration and birth asphyxia in the intervention MOUs from 2015 to 2017. The control group showed some decline during the period owing to support from district clinical specialist team members.
CLEVER as a context-specific, multicomponent, clinically focused intervention package may have contributed to improved perinatal morbidity and mortality rates in MOUs.
南非在降低孕产妇和五岁以下儿童死亡率方面未实现其千年发展目标。此外，许多分娩妇女在分娩期间未得到体贴的护理，而是忍受着无礼和虐待性的护理。
实施一套针对具体情况的多层面干预措施，以改变在助产士主导的分娩单位中可预防的孕产妇和围产期死亡率及发病率与不良临床治理和监督之间的复杂相互作用。
在南非茨瓦内区的10个助产士主导的产科单位开展了一项混合方法干预研究，从中选取了5个单位作为有目的的样本进行干预。干预分三个阶段进行：（i）基线测量；（ii）根据第一阶段的结果，在5个干预单位实施所谓的“CLEVER”干预措施；（iii）审查卫生系统的改进情况和围产期结局。干预措施有三大支柱：（i）向干预单位反馈基线测量结果，以提高认识并争取参与；（ii）加强卫生系统；（iii）在3个月内每周进行密集接触，之后每月提供进一步支持。在基线活动期间对障碍的观察有助于在实施过程中制定卫生系统加强和改进战略。
将干预前一年的围产期结局指标与干预当年及干预后一年的数据进行了比较。2015年至2017年，干预产科单位的院内新鲜死产、胎粪吸入和出生窒息显著下降。由于区临床专家团队成员的支持，对照组在此期间也有一定程度的下降。
CLEVER作为一套针对具体情况、多层面、以临床为重点的干预措施，可能有助于改善产科单位的围产期发病率和死亡率。
