Thamini Uhai, Dar es Salaam, Tanzania.
U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA.
Glob Health Sci Pract. 2022 Apr 29;10(2). doi: 10.9745/GHSP-D-21-00485. Print 2022 Apr 28.
To address high levels of maternal mortality in Kigoma, Tanzania, stakeholders increased women's access to high-quality comprehensive emergency obstetric and newborn care (EmONC) by decentralizing services from hospitals to health centers where EmONC was delivered mostly by associate clinicians and nurses. To ensure that women used services, implementers worked to continuously improve and sustain quality of care while creating demand.
Program evaluation included periodic health facility assessments, pregnancy outcome monitoring, and enhanced maternal mortality detection region-wide in program- and nonprogram-supported health facilities.
Between 2013 and 2018, the average number of lifesaving interventions performed per facility increased from 2.8 to 4.7. The increase was higher in program-supported than nonprogram-supported health centers and dispensaries. The institutional delivery rate increased from 49% to 85%; the greatest increase occurred through using health centers (15% to 25%) and dispensaries (21% to 46%). The number of cesarean deliveries almost doubled, and the population cesarean delivery rate increased from 2.6% to 4.5%. Met need for emergency obstetric care increased from 44% to 61% while the direct obstetric case fatality rate declined from 1.8% to 1.4%. The institutional maternal mortality ratio across all health facilities declined from 303 to 174 deaths per 100,000 live births. The total stillbirth rate declined from 26.7 to 12.8 per 1,000 births. The predischarge neonatal mortality rate declined from 10.7 to 7.6 per 1,000 live births. Changes in case fatality rate and maternal mortality were driven by project-supported facilities. Changes in neonatal mortality varied depending on facility type and program support status.
Decentralizing high-quality comprehensive EmONC delivered mostly by associate clinicians and nurses led to significant improvements in the availability and utilization of lifesaving care at birth in Kigoma. Dedicated efforts to sustain high-quality EmONC along with supplemental programmatic components contributed to the reduction of maternal and perinatal mortality.
为了解决坦桑尼亚基戈马地区居高不下的孕产妇死亡率问题，利益攸关方通过将服务从医院下放到主要由助理临床医生和护士提供紧急产科和新生儿护理（EmONC）的卫生中心，增加了妇女获得高质量综合紧急产科和新生儿护理的机会。为确保妇女使用这些服务，实施者努力不断提高和维持护理质量，同时创造需求。
方案评估包括定期进行卫生机构评估、妊娠结局监测以及在方案和非方案支持的卫生机构中加强全区域孕产妇死亡检测。
2013 年至 2018 年间，每个机构实施的救命干预措施数量从 2.8 项增加到 4.7 项。在方案支持的卫生中心和诊所中，这一增长幅度高于非方案支持的卫生中心和诊所。机构分娩率从 49%增加到 85%；最大的增长是通过使用卫生中心（从 15%增加到 25%）和诊所（从 21%增加到 46%）实现的。剖宫产数量几乎翻了一番，人口剖宫产率从 2.6%增加到 4.5%。紧急产科护理需求的满足率从 44%增加到 61%，而直接产科病死率从 1.8%下降到 1.4%。所有卫生机构的机构孕产妇死亡率从每 10 万活产死亡 303 人降至 174 人。总的死产率从每 1000 例活产 26.7 人下降到 12.8 人。出院前新生儿死亡率从每 1000 例活产 10.7 人下降到 7.6 人。病死率和孕产妇死亡率的变化是由项目支持的机构推动的。新生儿死亡率的变化取决于机构类型和项目支持状况。
将高质量的综合 EmONC 下放到主要由助理临床医生和护士提供，导致基戈马地区在提供和利用分娩时的救命护理方面有了显著改善。专门努力维持高质量的 EmONC 以及补充方案组成部分有助于降低孕产妇和围产期死亡率。
Zotero 插件