Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen, Denmark.
Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania.
Bull World Health Organ. 2019 May 1;97(5):365-370. doi: 10.2471/BLT.18.220830. Epub 2019 Mar 26.
Gaps exist between internationally derived clinical guidelines on care at the time of birth and realistic best practices in busy, low-resourced maternity units.
In 2014-2018, we carried out the PartoMa study at Zanzibar's tertiary hospital, United Republic of Tanzania. Working with local birth attendants and external experts, we created easy-to-use and locally achievable clinical guidelines and associated in-house training to assist birth attendants in intrapartum care.
Around 11 500 women gave birth annually in the hospital. Of the 35-40 birth attendants employed, each cared simultaneously for 3-6 women in labour. At baseline (1 October 2014 to 31 January 2015), there were 59 stillbirths per 1000 total births and 52 newborns with an Apgar score of 1-5 per 1000 live births. Externally derived clinical guidelines were available, but rarely used.
Staff attendance at the repeated trainings was good, despite seminars being outside working hours and without additional remuneration. Many birth attendants appreciated the intervention and were motivated to improve care. Improvements were found in knowledge, partograph skills and quality of care. After 12 intervention months, stillbirths had decreased 34% to 39 per 1000 total births, while newborns with an Apgar score of 1-5 halved to 28 per 1000 live births.
After 4 years, birth attendants still express high demand for the intervention. The development of international, regional and national clinical guidelines targeted at low-resource maternity units needs to be better attuned to input from end-users and the local conditions, and thereby easier to use effectively.
在分娩时的护理方面，国际上制定的临床指南与资源匮乏的产科单位的实际最佳实践之间存在差距。
2014 年至 2018 年，我们在坦桑尼亚联合共和国的桑给巴尔三级医院开展了 PartoMa 研究。我们与当地的分娩助手和外部专家合作，制定了易于使用且在当地可行的临床指南，并开展了内部培训，以协助分娩助手进行产时护理。
医院每年约有 11500 名妇女分娩。在受雇的 35-40 名分娩助手中，每位同时照顾 3-6 名产妇。在基线（2014 年 10 月 1 日至 2015 年 1 月 31 日）时，每 1000 例总分娩中有 59 例死产，每 1000 例活产中有 52 例新生儿 Apgar 评分为 1-5 分。有外部制定的临床指南，但很少使用。
尽管研讨会在工作时间之外举行，且没有额外报酬，但工作人员对重复培训的出勤率很高。许多分娩助手对干预措施表示赞赏，并积极改进护理。知识、产程图技能和护理质量都有所提高。在 12 个干预月后，死产率从每 1000 例总分娩中的 59 例下降了 34%至 39 例，而 Apgar 评分为 1-5 分的新生儿数减少了一半，降至每 1000 例活产中 28 例。
4 年后，分娩助手仍对干预措施有很高的需求。针对资源匮乏的产科单位制定的国际、区域和国家临床指南需要更好地考虑最终用户和当地情况的投入，从而更容易有效使用。
