Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Pôle d'Épidémiologie et Biostatistique, Université catholique de Louvain (UCLouvain), Institut de Recherche Expérimentale et Clinique (IREC), Clos Chapelle-aux-champs, 30 bte B1.30.13, 1200, Brussels, Belgium.
BMC Health Serv Res. 2020 Oct 7;20(1):926. doi: 10.1186/s12913-020-05795-1.
Hypertensive disorders in pregnancy are the second most common cause of maternal mortality in the Democratic Republic of Congo (DRC), accounting for 23% of maternal deaths. This study aimed to assess facility readiness, and providers' knowledge to prevent, diagnose, and treat pre-eclampsia.
A facility-based cross-sectional study was conducted in 30 primary health centres (PHCs) and 28 referral facilities (hospitals) randomly selected in Kinshasa, DRC. In each facility, all midwives and physicians involved in maternal care provision (n = 197) were included. Data on facility infrastructure and providers' knowledge about pre-eclampsia were collected using facility checklists and a knowledge questionnaire. Facility readiness score was defined as the sum of 13 health commodities needed to manage pre-eclampsia. A knowledge score was defined as the sum of 24 items about the diagnosis, management, and prevention of pre-eclampsia. The score ranges from 0 to 24, with higher values reflecting a better knowledge. The Mann-Witney U test was used to compare median readiness scores by facility type and ownership; and median knowledge scores between midwives in hospitals and in PHCs, and between physicians in hospitals and in PHCs.
Overall, health facilities had 7 of the 13 commodities, yielding a median readiness score of 53.8%(IQR: 46.2 to 69.2%). Although all provider groups had significant knowledge gaps about pre-eclampsia, providers in hospitals demonstrated slightly more knowledge than those in PHCs. Midwives in public facilities scored higher than those in private facilities (median(IQR): 8(5 to 12) vs 7(4 to 8), p = 0.03). Of the 197 providers, 91.4% correctly diagnosed severe pre-eclampsia. However, 43.9 and 82.2% would administer magnesium sulfate and anti-hypertensive drugs to manage severe pre-eclampsia, respectively. Merely 14.2 and 7.1% of providers were aware of prophylactic use of aspirin and calcium to prevent pre-eclampsia, respectively.
Our study showed poor availability of supplies to diagnose, prevent and treat pre-eclampsia in Kinshasa. While providers demonstrated good knowledge regarding the diagnosis of pre-eclampsia, they have poor knowledge regarding its prevention and management. The study highlights the need for strengthening knowledge of providers toward the prevention and management of pre-eclampsia, and enhancing the availability of supplies needed to address this disease.
在刚果民主共和国（DRC），妊娠高血压疾病是导致产妇死亡的第二大常见原因，占产妇死亡的 23%。本研究旨在评估预防、诊断和治疗子痫前期的医疗机构准备情况和医务人员的知识。
在金沙萨随机选择了 30 个初级保健中心（PHC）和 28 个转诊医疗机构（医院）进行了一项基于机构的横断面研究。在每个医疗机构中，均纳入了所有参与孕产妇护理的助产士和医生（n=197）。使用机构清单和知识问卷收集了有关机构基础设施和医务人员子痫前期知识的数据。机构准备情况评分定义为管理子痫前期所需的 13 种卫生用品的总和。知识评分定义为关于子痫前期的诊断、管理和预防的 24 个项目的总和。评分范围为 0 至 24，得分越高表示知识越好。采用曼-惠特尼 U 检验比较了不同类型和所有权的医疗机构的准备情况评分中位数；医院和 PHC 中的助产士之间以及医院和 PHC 中的医生之间的知识评分中位数。
总体而言，卫生机构拥有 13 种商品中的 7 种，准备情况评分为 53.8%（IQR：46.2 至 69.2%）。尽管所有医务人员群体在子痫前期方面都存在明显的知识差距，但医院的医务人员比 PHC 的医务人员略知略懂。公立机构的助产士得分高于私立机构的助产士（中位数（IQR）：8（5 至 12）比 7（4 至 8），p=0.03）。197 名提供者中有 91.4%正确诊断出严重子痫前期。然而，分别有 43.9%和 82.2%的人会分别用硫酸镁和抗高血压药物来治疗严重子痫前期。仅有 14.2%和 7.1%的医务人员分别知道阿司匹林和钙的预防性使用来预防子痫前期。
我们的研究表明，金沙萨在诊断、预防和治疗子痫前期方面的用品供应不足。尽管医务人员在子痫前期的诊断方面表现出良好的知识，但他们在预防和管理方面的知识却很差。该研究强调了需要加强提供者对子痫前期的预防和管理知识，并增强应对该疾病所需的用品供应。
