UNU MERIT, Boschstraat, 246211 AX, Maastricht, The Netherlands.
A9 Marshlands Village Box 32379, Lusaka, Zambia.
BMC Pregnancy Childbirth. 2019 Apr 24;19(1):135. doi: 10.1186/s12884-019-2282-y.
There is growing demand for high quality evidence-based practice in the fight against negative maternal health outcomes in Sub-Saharan Africa (SSA). Zambia is one of the countries that has transposed this evidence-based approach by outlawing Traditional Birth Attendants (TBAs) and recommending exclusive skilled-care. There is division among scholars regarding the usefulness of this approach to maternal health in SSA in general. One strand of scholars praises the approach and the other criticizes it. However, there is still lack of evidence to legitimize either of the two positions in poor-settings. Thus the aim of this study is to fill this gap by investigating local people's views on the evidence-based practice in the form of skilled-maternal-care in Zambia, by using Mfuwe as a case study.
With the help of the Social Representation theory, Focus Group Discussions (FGDs) were conducted in Mfuwe, Zambia with 63 participants.
The study shows that the evidence-based strategy (of exclusive skilled-care) led to improved quality of care in cases where it was accessible. However, not all women had access to skilled-care; thus the act of outlawing the only alternative form of care (TBAs) seemed to have been counterproductive in the context of Mfuwe. The study therefore demonstrates that incorporating TBAs rather than obscuring them may offer an opportunity for improving their potential benefits and minimizing their limitations thereby increasing access and quality of care to women of Mfuwe.
This study illustrates that while evidence-based strategies remain useful in improving maternal care, they need to be carefully appropriated in poor settings in order to increase access and quality of care.
在与撒哈拉以南非洲（SSA）的负面母婴健康结果作斗争的过程中，人们对高质量基于证据的实践的需求日益增长。赞比亚是通过取缔传统助产妇并推荐专业人员进行独家护理，将这种基于证据的方法转变为法律的国家之一。对于这种方法在 SSA 对母婴健康的总体有用性，学者们存在分歧。一些学者称赞这种方法，而另一些则批评它。然而，在贫困环境中，仍然缺乏证据来证明这两种立场中的任何一种是合理的。因此，本研究旨在通过以姆富韦为例，以实地研究的形式，调查当地人对赞比亚熟练护理形式的基于证据的实践的看法，从而填补这一空白。
在社会代表理论的帮助下，在赞比亚姆富韦进行了 63 名参与者的焦点小组讨论（FGD）。
该研究表明，基于证据的策略（专业护理的排他性）在可获得的情况下提高了护理质量。然而，并非所有妇女都能获得熟练的护理；因此，取缔唯一替代护理形式（传统助产妇）的行为在姆富韦的背景下似乎适得其反。因此，该研究表明，将传统助产妇纳入其中，而不是将其掩盖起来，可能会为提高其潜在利益和最小化其局限性提供机会，从而增加姆富韦妇女获得护理的机会和提高护理质量。
本研究表明，虽然基于证据的策略在改善母婴护理方面仍然有用，但在贫困环境中需要谨慎采用，以增加获得护理的机会和提高护理质量。
