改善尼日利亚转诊医院分娩期护理质量的干预措施的结果：准实验研究设计。
Outcome of interventions to improve the quality of intrapartum care in Nigeria's referral hospitals: a quasi-experimental research design.
机构信息
Centre Leader, Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria.
Department of Obstetrics and Gynaecology, University of Benin, University of Benin Teaching Hospital, Benin City, Nigeria.
出版信息
BMC Pregnancy Childbirth. 2023 Aug 26;23(1):614. doi: 10.1186/s12884-023-05893-y.
BACKGROUND
Evidence indicates that Nigeria's high maternal mortality rate is attributable primarily to events that occur during the intrapartum period. This study determines the effectiveness of multifaceted interventions in improving the quality of intrapartum care in Nigeria's referral hospitals.
METHODS
Data collected through an exit interview with 752 women who received intrapartum care in intervention and control hospitals were analyzed. The interventions were designed to improve the quality indicators in the WHO recommendations for positive childbirth and assessed using 12 quality indicators. Univariate, bivariate, Poisson, and logistic regression analyses were used to compare twelve quality indicators at intervention and control hospitals.
RESULTS
The interventions showed a 6% increase in composite score of quality of care indicators at intervention compared with control hospitals. Five signal functions of intrapartum care assessed were significantly (< 0.001) better at intervention hospitals. Quality scores for segments of intervention periods compared to baseline were higher at intervention than in control hospitals.
CONCLUSIONS
We conclude that multiple interventions that address various components of the quality of intrapartum care in Nigeria's referral hospitals have demonstrated effectiveness. The interventions improved five of ten quality indicators. We believe that this approach to developing interventions based on formative research is important, but a process of integrating the implementation activities with the normal maternal health delivery processes in the hospitals will enhance the effectiveness of this approach.
TRIAL REGISTRATION
The study was registered at the Nigeria Clinical Trials Registry. Trial Registration Number NCTR No: 91,540,209 (14/04/2016) http://www.nctr.nhrec.net/ and retrospectively with the ISRCTN. Trial Registration Number 64 ISRCTN17985403 (14/08/2020) https://doi.org/10.1186/ISRCTN17985403 .
背景
有证据表明，尼日利亚高产妇死亡率主要归因于分娩期间发生的事件。本研究旨在确定多方面干预措施在提高尼日利亚转诊医院分娩期间护理质量方面的有效性。
方法
通过对在干预和对照医院接受分娩期间护理的 752 名妇女进行出院访谈收集数据。这些干预措施旨在改善世卫组织关于积极分娩的建议中的质量指标，并使用 12 个质量指标进行评估。采用单变量、双变量、泊松和逻辑回归分析比较干预和对照医院的 12 个质量指标。
结果
与对照医院相比，干预组的护理质量指标综合评分提高了 6%。评估的分娩期间的五个信号功能在干预医院明显（<0.001）更好。与基线相比，干预期间各阶段的质量评分均高于对照医院。
结论
我们得出结论，针对尼日利亚转诊医院分娩期间护理质量的多个方面的多种干预措施已被证明是有效的。这些干预措施提高了十个质量指标中的五个。我们认为，基于形成性研究制定干预措施的方法很重要，但将实施活动与医院内正常的产妇保健提供过程相结合的过程将增强这种方法的有效性。
试验注册
该研究在尼日利亚临床试验注册处注册。试验注册编号：NCT0091540209（2016 年 4 月 14 日）http://www.nctr.nhrec.net/，以及在 ISRCTN 中进行了回顾性注册。试验注册号：64 ISRCTN17985403（2020 年 8 月 14 日）https://doi.org/10.1186/ISRCTN17985403。
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