Department of Obstetrics & Gynaecology, Erasmus Medical Center, Rotterdam, the Netherlands.
Department of Obstetrics & Gynaecology, Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania.
BMC Pregnancy Childbirth. 2020 Oct 7;20(1):594. doi: 10.1186/s12884-020-03261-8.
This study aims to explore the stories of three women from Zanzibar, Tanzania, who survived life-threatening obstetric complications. Their narratives will increase understanding of the individual and community-level burden masked behind the statistics of maternal morbidity and mortality in Tanzania. In line with a recent systematic review of women-centred, qualitative maternal morbidity research, this study will contribute to guidance of local and global maternal health agendas.
This two-phased qualitative study was conducted in July-August 2017 and July-August 2018, and involved three key informants, who were recruited from a maternal near-miss cohort in May 2017 in Mnazi Mmoja Hospital, Zanzibar. The used methods were participant observation, interviews (informal, unstructured and semi-structured), participatory methods and focus group discussions. Data analysis relied primarily on grounded theory, leading to a theoretical model, which was validated repeatedly by the informants and within the study team. The findings were then positioned in the existing literature. Approval was granted by Zanzibar's Medical Ethical Research Committee (reference number: ZAMREC/0002/JUN/17).
The impact of severe maternal morbidity was found to be multi-dimensional and to extend beyond hospital discharge and thus institutionalized care. Four key areas impacted by maternal morbidities emerged, namely (1) social, (2) sexual and reproductive, (3) psychological, and (4) economic well-being.
This study showed how three women's lives and livelihoods were profoundly impacted by the severe obstetric complications they had survived, even up to 16 months later. These impacts took a toll on their physical, social, economic, sexual and psychological well-being, and affected family and community members alike. These findings advocate for a holistic, dignified, patient value-based approach to the necessary improvement of maternal health care in low-income settings. Furthermore, it emphasizes the need for strategies to be directed not only towards quality of care during pregnancy and delivery, but also towards support after obstetric complications.
本研究旨在探讨坦桑尼亚桑给巴尔岛的三位妇女的故事，她们在经历危及生命的产科并发症后幸存下来。她们的叙述将增加对坦桑尼亚孕产妇发病率和死亡率统计数据背后的个人和社区层面负担的理解。本研究符合最近对以妇女为中心的定性孕产妇发病率研究的系统评价，将有助于指导当地和全球孕产妇健康议程。
这项两阶段的定性研究于 2017 年 7 月至 8 月和 2018 年 7 月至 8 月进行，涉及三位关键知情者，她们是 2017 年 5 月在桑给巴尔岛 Mnazi Mmoja 医院产妇接近死亡队列中招募的。使用的方法是参与者观察、访谈（非正式、非结构化和半结构化）、参与性方法和焦点小组讨论。数据分析主要依赖于扎根理论，导致理论模型，该模型由知情者和研究团队反复验证。研究结果随后被定位在现有文献中。桑给巴尔医学伦理研究委员会（编号：ZAMREC/0002/JUN/17）批准了该研究。
研究发现严重孕产妇发病率的影响是多方面的，并超出了出院和因此机构化护理的范围。出现了四个受孕产妇发病率影响的关键领域，分别是（1）社会，（2）性和生殖，（3）心理，和（4）经济福祉。
这项研究表明，三名妇女的生活和生计是如何受到她们所经历的严重产科并发症的深刻影响的，甚至在 16 个月后仍然如此。这些影响对她们的身体、社会、经济、性和心理福祉造成了影响，并影响了家庭和社区成员。这些发现主张采取全面、有尊严、以患者价值为基础的方法，必要改善低收入环境中的孕产妇保健。此外，它强调不仅需要针对妊娠和分娩期间的护理质量制定战略，还需要针对产科并发症后提供支持。
