Asefa Anteneh, Morgan Alison, Hailemariam Tadesse, Shiferaw Mekonnen, Mekonnen Emebet, Birhan Yifru
School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Pan Afr Med J. 2020 Jul 1;36:145. doi: 10.11604/pamj.2020.36.145.19330. eCollection 2020.
preventable mortality from complications which arise during pregnancy and childbirth continue to claim more than a quarter of million women´s lives every year, almost all in low- and middle-income countries. However, lifesaving emergency obstetric services, including caesarean section (CS), significantly contribute to prevention of maternal and newborn mortality and morbidity. Between 2009 and 2013, a task shifting intervention to train caesarean section (CS) teams involving 41 CS surgeons, 35 anesthetic nurses and 36 scrub nurses was implemented in 13 hospitals in southern Ethiopia. We report on the attrition rate of those upskilled to provide CS with a focus on the medium-term outcomes and the challenges encountered.
a cross-sectional study involving surveys of focal persons and a facility staff audit supplemented with a review of secondary data was conducted in thirteen hospitals. Mean differences were computed to appreciate the difference between numbers of CSs conducted for the six months before and after task shifting commenced.
from the trained 112 professionals, only 52 (46.4%) were available for carrying out CS in the hospitals. CS surgeons (65.9%) and nurse anesthetists (71.4%) are more likely to have left as compared to scrub nurses (22.2%). Despite the loss of trained staff, there was an increase in the number of CSs performed after the task shifting (mean difference=43.8; 95% CI: 18.3-69.4; p=0.003).
our study, one of the first to assess the medium-term effects of task shifting highlights the risk of ongoing attrition of well-trained staff and the need to reassess strategies for staff retention.
每年，妊娠和分娩期间出现的可预防并发症导致超过25万妇女死亡，几乎全部发生在低收入和中等收入国家。然而，包括剖宫产（CS）在内的救生紧急产科服务对预防孕产妇和新生儿死亡及发病有显著贡献。2009年至2013年期间，在埃塞俄比亚南部的13家医院实施了一项任务转移干预措施，培训了包括41名剖宫产外科医生、35名麻醉护士和36名洗手护士在内的剖宫产团队。我们报告了接受技能提升以提供剖宫产服务人员的流失率，重点关注中期结果及遇到的挑战。
在13家医院开展了一项横断面研究，包括对重点人员的调查、机构工作人员审计，并辅以二手数据审查。计算平均差异以了解任务转移开始前后六个月内进行的剖宫产数量之间的差异。
在接受培训的112名专业人员中，只有52名（46.4%）可在医院进行剖宫产。与洗手护士（22.2%）相比，剖宫产外科医生（65.9%）和麻醉护士（71.4%）离职的可能性更大。尽管有训练有素的工作人员流失，但任务转移后进行的剖宫产数量有所增加（平均差异=43.8；95%CI：18.3-69.4；p=0.003）。
我们的研究是最早评估任务转移中期效果的研究之一，突出了训练有素的工作人员持续流失的风险以及重新评估留住工作人员策略的必要性。
