Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, the Netherlands.
Global Financing Facility, World Bank Group, Kabul, Afghanistan.
BMC Health Serv Res. 2020 Jun 2;20(1):484. doi: 10.1186/s12913-020-05342-y.
Hemorrhage is the leading cause of maternal mortality worldwide and accounts for 56% of maternal deaths in Afghanistan. Postpartum hemorrhage (PPH) is commonly caused by uterine atony, genital tract trauma, retained placenta, and coagulation disorders. The purpose of this study is to examine the quality of prevention, detection and management of PPH in both public and private hospitals in Afghanistan in 2016, and compare the quality of care in district hospitals with care in provincial, regional, and specialty hospitals.
This study uses a subset of data from the 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment. It covers a census of all accessible public hospitals, including 40 district hospitals, 27 provincial hospitals, five regional hospitals, and five specialty hospitals, as well as 10 purposively selected private hospitals.
All public and private hospitals reported 24 h/7 days a week service provision. Oxytocin was available in 90.0% of district hospitals, 89.2% of provincial, regional and specialty hospitals and all 10 private hospitals; misoprostol was available in 52.5% of district hospitals, 56.8% of provincial, regional and specialty hospitals and in all 10 private hospitals. For prevention of PPH, 73.3% women in district hospitals, 71.2% women at provincial, regional and specialty hospitals and 72.7% women at private hospital received uterotonics. Placenta and membranes were checked for completeness in almost half of women in all hospitals. Manual removal of placenta was performed in 97.8% women with retained placenta. Monitoring blood loss during the immediate postpartum period was performed in 48.4% of women in district hospitals, 36.9% of women in provincial, regional and specialty hospitals, and 43.3% in private hospitals. The most commonly observed cause of PPH was retained placenta followed by genital tract trauma and uterine atony.
Gaps in performance of skilled birth attendants are substantial across public and private hospitals. Improving and retaining skills of health workers through on-site, continuous capacity development approaches and encouraging a culture of audit, learning and quality improvement may address clinical gaps and improve quality of PPH prevention, detection and management.
出血是全球范围内导致产妇死亡的主要原因，占阿富汗产妇死亡人数的 56%。产后出血（PPH）通常由子宫收缩乏力、生殖道创伤、胎盘滞留和凝血障碍引起。本研究旨在检查 2016 年阿富汗公立和私立医院预防、检测和管理 PPH 的质量，并比较区医院与省、地区和专科医院的护理质量。
本研究使用 2016 年阿富汗国家母婴健康护理质量评估的部分数据子集。它涵盖了所有可及公立医院的普查，包括 40 个区医院、27 个省级医院、5 个地区医院和 5 个专科医院，以及 10 家有针对性选择的私立医院。
所有公立和私立医院均报告每周 7 天、每天 24 小时提供服务。催产素在 90.0%的区医院、89.2%的省级、地区和专科医院以及所有 10 家私立医院中均有供应；米索前列醇在 52.5%的区医院、56.8%的省级、地区和专科医院以及所有 10 家私立医院中均有供应。为预防 PPH，73.3%的区医院产妇、71.2%的省级、地区和专科医院产妇以及 72.7%的私立医院产妇接受了宫缩剂。几乎所有医院的一半产妇都检查了胎盘和胎膜是否完整。对 97.8%有胎盘滞留的产妇进行了手动胎盘取出。在区医院，48.4%的产妇在产后立即监测出血量，省级、地区和专科医院为 36.9%，私立医院为 43.3%。PPH 最常见的原因是胎盘滞留，其次是生殖道创伤和子宫收缩乏力。
公立和私立医院的熟练助产士表现存在较大差距。通过现场、持续的能力发展方法提高和保留卫生工作者的技能，并鼓励审计、学习和质量改进文化，可能会解决临床差距，提高 PPH 预防、检测和管理的质量。
