Health Services Academy, Islamabad, Pakistan.
College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
BMC Health Serv Res. 2023 Nov 27;23(1):1305. doi: 10.1186/s12913-023-10273-5.
Considering the high maternal mortality rate, the government of Pakistan has deployed Community Midwives (CMWs) in rural areas of Pakistan. This relatively new cadre of community-based skilled birth attendants has previously reported to experience several challenges in providing maternal and child healthcare. However, what barriers they experience in providing basic emergency obstetric and newborn care needs to be further studied.
This was a cross-sectional study conducted in twelve districts in Sindh province, Pakistan, with poor maternal and child health indicators. A total of 258 CMWs participated in this study and completed the questionnaire on a pretested, validated tool in their community-based stations. The trained data collectors completed the questionnaires from the respondents. The problems identified were categorized into three major issues: financial, and transport and security related; and were analyzed accordingly. Ethical approval was obtained from the institutional review board (IRB) of Health Services Academy (HSA) Islamabad, Pakistan.
The majority (90%) of 258 CMWs had formal training in maternal and neonatal care from the recognized institutions. Financial difficulties faced by CMWs were identified as the most frequent barriers and others were transport, security, and other issues. In univariate analysis, 38.1% and 61.9% of the community midwives who faced financial difficulties had completed a graduation or intermediate level of education, respectively (p = 0.006). Round-the-clock availability for emergencies was inversely associated with having financial difficulties, i.e., 71.4%, in contrast to 28.4% who had financial difficulties were available round-the-clock for emergency calls in their community clinics (p = 0.008). Formal training (p = 0.001), work experience (p = 0.015), longer duration of work (p = 0.003), and liaison with health workers and posting district (p = 0.001) had statistically significantly higher transport related issues. Security difficulties faced by CMWs and a set of correlates such as formal training (p = 0.019), working experience (p = 0.001), longer duration of work (p = 0.023), 24 h of availability on call (p = 0.004), liaison with traditional birth attendants (TBAs) in the community (p = 0.002), and district of posting (p = 0.001) were statistically significantly different. Other issues like working experience (p = < 0.001) and Liaison with TBAs in the community (p = < 0.001) were found statistically significant.
Financial, transportation and security related barriers were commonly reported by community midwives in the delivery of basic emergency obstetric and newborn care in rural Pakistan.
考虑到高孕产妇死亡率，巴基斯坦政府已在巴基斯坦农村地区部署了社区助产士。这个相对较新的社区基础熟练分娩助手，以前曾报告在提供母婴保健方面面临若干挑战。然而，他们在提供基本产科急症和新生儿护理方面遇到的障碍需要进一步研究。
这是在巴基斯坦信德省 12 个地区进行的一项横断面研究，这些地区的母婴健康指标较差。共有 258 名社区助产士参加了这项研究，并在他们所在的社区站使用经过预先测试和验证的工具完成了问卷。经过培训的数据收集员从受访者那里完成了问卷。将识别出的问题分为三个主要问题：财务、交通和安全相关问题，并进行了相应的分析。该研究获得了巴基斯坦伊斯兰堡卫生服务学院（HSA）机构审查委员会（IRB）的伦理批准。
258 名社区助产士中，有 90%接受过正规机构的母婴和新生儿护理培训。社区助产士面临的财务困难被认为是最常见的障碍，其他障碍还包括交通、安全和其他问题。在单变量分析中，分别有 38.1%和 61.9%的社区助产士在完成学业或中级水平教育后遇到财务困难（p=0.006）。在社区诊所 24 小时提供紧急服务与面临财务困难呈负相关，即 71.4%的社区助产士可以在社区诊所 24 小时提供紧急服务，而 28.4%的社区助产士有财务困难时无法提供 24 小时紧急服务（p=0.008）。正规培训（p=0.001）、工作经验（p=0.015）、工作时间延长（p=0.003）和与卫生工作者的联系以及岗位地区（p=0.001）与交通相关问题的统计学显著更高。社区助产士面临的安全问题以及正式培训（p=0.019）、工作经验（p=0.001）、工作时间延长（p=0.023）、24 小时随时接听电话（p=0.004）、与社区传统助产妇的联系（p=0.002）以及岗位地区（p=0.001）等因素存在统计学显著差异。其他问题，如工作经验（p<0.001）和与社区传统助产妇的联系（p<0.001）也有统计学意义。
巴基斯坦农村地区的社区助产士在提供基本产科急症和新生儿护理方面普遍报告了与财务、交通和安全相关的障碍。
