School of Nursing, Columbia University, NYC, NY, United States of America.
Emory-Ethiopia Country Office, Emory University, Addis Ababa, Ethiopia.
PLoS One. 2023 Aug 3;18(8):e0289496. doi: 10.1371/journal.pone.0289496. eCollection 2023.
Measuring facility readiness to manage basic obstetric emergencies is a critical step toward reducing persistently elevated maternal mortality ratios (MMR). Currently, the Signal Functions (SF) is the gold standard for measuring facility readiness globally and endorsed by the World Health Organization. The presence of tracer items classifies facilities' readiness to manage basic emergencies. However, research suggests the SF may be an incomplete indicator. The Clinical Cascades (CC) have emerged as a clinically-oriented alternative to measuring readiness. The purpose of this study is to determine Amhara's clinical readiness and quantify the relationship between SF and CC estimates of readiness. Data were collected in May 2021via Open Data Kit (ODK) and KoBo Toolbox. We surveyed 20 hospitals across three levels of the health system. Commodities were used to create measures of SF-readiness (e.g., % tracers) and CC-readiness. We calculated differences in SF and CC estimates and calculated readiness loss across six emergencies and 3 stages of care in the cascades. The overall SF estimate for all six obstetric emergencies was 29.6% greater than the estimates using the CC. Consistent with global patterns, hospitals were more prepared to provide medical management (70.0% ready) compared to manual procedures (56.7% ready). The SF overestimate was greater for manual procedures 33.8% overall for retained placenta and incomplete abortion) and less for medical treatments (25.3%). Hospitals were least prepared to manage retained placentas (30.0% of facilities were ready at treatment and 0.0% were ready at monitor and modify) and most prepared to manage hypertensive emergencies (85.0% of facilities were ready at the treatment stage). When including protocols in the analysis, no facilities were ready to monitor and modify the initial therapy when clinically indicated for 3 common emergencies-sepsis, post-partum hemorrhage and retained placentas. We identified a significant discrepancy between SF and CC readiness classifications. Those facilities that fall within this discrepancy are unprepared to manage common obstetric emergencies, and employees in supply management may have difficulty identify the need. Future research should explore the possibility of modifying the SF or replacing it with a new readiness measurement.
衡量医疗机构管理基本产科急症的准备情况是降低孕产妇死亡率（MMR）的关键步骤。目前，信号功能（SF）是全球衡量医疗机构准备情况的金标准，得到世界卫生组织的认可。追踪项目的存在将医疗机构管理基本紧急情况的准备情况进行了分类。然而，研究表明，SF 可能不是一个完整的指标。临床级联（CC）作为一种以临床为导向的替代方法，已经出现，用于衡量准备情况。本研究旨在确定阿姆哈拉地区的临床准备情况，并量化 SF 和 CC 准备情况估计之间的关系。数据于 2021 年 5 月通过开放数据工具包（ODK）和 KoBo 工具箱收集。我们调查了三个卫生系统级别的 20 家医院。使用商品来创建 SF 准备情况（例如，%追踪器）和 CC 准备情况的测量值。我们计算了 SF 和 CC 估计值之间的差异，并计算了级联中六个紧急情况和三个护理阶段的准备情况损失。所有六种产科急症的整体 SF 估计值比使用 CC 的估计值高出 29.6%。与全球模式一致，与手动程序（56.7%准备）相比，医院更有准备提供医疗管理（70.0%准备）。SF 高估在手动程序中更为明显，整体高估 33.8%，涉及胎盘滞留和不完全流产；在医疗治疗中高估 25.3%。医院在处理胎盘滞留方面准备不足（治疗时准备就绪的设施比例为 30.0%，监测和修改时准备就绪的设施比例为 0.0%），在处理高血压急症方面准备最充分（治疗阶段准备就绪的设施比例为 85.0%）。当在分析中包括方案时，对于三个常见紧急情况——败血症、产后出血和胎盘滞留，没有一个设施准备好在临床上需要时监测和修改初始治疗。我们发现 SF 和 CC 准备情况分类之间存在显著差异。那些处于这种差异范围内的设施没有准备好处理常见的产科急症，供应管理部门的员工可能难以确定需求。未来的研究应探讨修改 SF 或用新的准备情况测量方法取代它的可能性。
