Busumani William, Mundagowa Paddington T
Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
Ministry of Health and Child Care, Bulawayo, Zimbabwe.
BMC Health Serv Res. 2021 Mar 25;21(1):276. doi: 10.1186/s12913-021-06289-4.
Between the years 2000 and 2017, the global maternal mortality rate dropped by 38% however, 94% of maternal deaths still emanated from low-to middle-income countries. Rural women are at a significantly higher risk of dying from pregnancy when compared to their urban counterparts. Early detection of complications and prompt referral to higher levels of care can reduce the associated maternal and perinatal mortality. This study aimed to determine the maternal and perinatal outcomes of pregnancy-related referrals from rural health facilities to central hospitals in Harare, Zimbabwe.
A prospective descriptive study was conducted using a sample of 206 patients. All mothers who were referred from rural healthcare facilities were recruited for participation. Data were extracted from patient notes using a structured questionnaire and missing information was obtained from the mother after she had recovered. Bivariate analysis was done using IBM SPSS.
The average age of study participants was 27.4 ± 7.7 years. 87.4% had booked for antenatal care and 81.6% presented to the tertiary facility with their referral notes. The major reasons for referring patients were previous cesarean section (20.4%) and hypertensive disorders in pregnancy (18.4%). There were nine maternal deaths thus a case fatality rate of 4.4% while the perinatal mortality rate was 151/1000 live births. Young mothers were at a higher risk of having adverse perinatal outcomes while primiparous mothers were more likely to have a blood transfusion. Mothers who traveled for > 100 km to the tertiary facility and those who did not attend any antenatal visit were more likely to need blood transfusion. Delivering at the rural health facility was significantly associated with receiving a blood transfusion at the tertiary facility. Mothers who did not attend antenatal visits were more likely to have negative perinatal outcomes.
The proportion of obstetric patients being referred from rural facilities to tertiary institutions for complications reveals how primary and secondary healthcare facilities in Zimbabwe are falling short of offering the services they should be offering. Equipping these facilities with skilled human resources as well as contemporary equipment could help decongest the central hospitals consequently reducing the adverse maternal and perinatal outcomes.
在2000年至2017年期间，全球孕产妇死亡率下降了38%，然而，94%的孕产妇死亡仍发生在低收入和中等收入国家。与城市妇女相比，农村妇女死于妊娠的风险要高得多。早期发现并发症并及时转诊到更高水平的医疗机构可以降低孕产妇和围产儿相关死亡率。本研究旨在确定从津巴布韦哈拉雷农村卫生设施转诊至中心医院的妊娠相关病例的孕产妇和围产儿结局。
采用前瞻性描述性研究，样本为206例患者。招募所有从农村医疗机构转诊的母亲参与研究。使用结构化问卷从患者病历中提取数据，缺失信息在母亲康复后获取。使用IBM SPSS进行双变量分析。
研究参与者的平均年龄为27.4±7.7岁。87.4%的人进行了产前检查登记，81.6%的人带着转诊记录到三级医疗机构就诊。转诊患者的主要原因是既往剖宫产（20.4%）和妊娠期高血压疾病（18.4%）。有9例孕产妇死亡，因此病死率为4.4%，围产儿死亡率为每1000例活产151例。年轻母亲发生不良围产儿结局的风险更高，而初产妇更有可能接受输血。前往三级医疗机构距离超过100公里的母亲以及未进行任何产前检查的母亲更有可能需要输血。在农村卫生设施分娩与在三级医疗机构接受输血显著相关。未进行产前检查的母亲更有可能出现不良围产儿结局。
因并发症从农村医疗机构转诊至三级医疗机构的产科患者比例揭示了津巴布韦的初级和二级医疗机构在提供应提供的服务方面存在不足。为这些机构配备熟练的人力资源和现代设备有助于减轻中心医院的负担，从而降低不良孕产妇和围产儿结局。
