Hagey Jill M, Kirya Julius, Kaggwa James, Headley Jennifer, Egger Joseph R, Baumgartner Joy Noel
Department of Obstetrics and Gynecology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
LifeNet International, Princes Anne Drive, Plot 56, Bugolobi, Kampala, Uganda.
Matern Child Health J. 2023 Nov;27(11):2048-2057. doi: 10.1007/s10995-023-03754-w. Epub 2023 Jul 13.
While access to basic emergency obstetric and newborn care is necessary to reduce maternal and neonatal morbidity in low- and middle-income countries, data on the timeliness and quality of care at lower-level facilities is limited. This study examines timeliness of labor and delivery interventions and maternal and neonatal health status following deliveries in Uganda.
Women were recruited from 6 rural, private facilities in the greater Masaka area, Uganda on admission to the labor ward. Research assistants directly observed timeliness and quality of care from admission through discharge. Research assistants also abstracted medical chart information. All 6 facilities received training from LifeNet International on quality-of-care interventions for maternal and newborn health.
321 participants were directly observed during delivery, and 304 participants were followed at 28 days postpartum. Labor and delivery processes were overall timely and reflect international guidance on labor interventions. Maternal and neonatal health was good at discharge (90.6% and 88.8%) and 28 days postpartum (93.1% and 87.5%). However, there was no association between health at discharge and at 28 days for mothers or neonates (p = 0.67, p = 1.0, respectively). Demographic characteristics associated with maternal and neonatal health on discharge were different than those associated with maternal and neonatal health at 28 days.
Evidence on timeliness and quality of care can help inform strategies to further decrease maternal and neonatal morbidity. Additional focus is needed to retain patients in care to identify those developing poor health after delivery.
在低收入和中等收入国家，获得基本的产科急诊和新生儿护理对于降低孕产妇和新生儿发病率是必要的，但关于基层医疗机构护理及时性和质量的数据有限。本研究调查了乌干达分娩时 labor 和分娩干预的及时性以及分娩后孕产妇和新生儿的健康状况。
从乌干达大马斯卡地区的 6 家农村私立医疗机构招募临产妇女。研究助理直接观察从入院到出院的护理及时性和质量。研究助理还提取了病历信息。所有 6 家医疗机构都接受了国际生命网关于孕产妇和新生儿健康护理质量干预的培训。
321 名参与者在分娩期间被直接观察，304 名参与者在产后 28 天接受随访。Labor 和分娩过程总体及时，符合国际上关于 labor 干预的指导。孕产妇和新生儿出院时健康状况良好（分别为 90.6%和 88.8%），产后 28 天时健康状况也良好（分别为 93.1%和 87.5%）。然而，母亲或新生儿出院时和产后 28 天的健康状况之间没有关联（p 值分别为 0.67 和 1.0）。与出院时孕产妇和新生儿健康相关的人口统计学特征与产后 28 天的不同。
关于护理及时性和质量的证据有助于为进一步降低孕产妇和新生儿发病率的策略提供信息。需要额外关注留住患者以识别分娩后健康状况不佳的人。
