University of Gondar Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
BMC Pregnancy Childbirth. 2024 Aug 12;24(1):532. doi: 10.1186/s12884-024-06725-3.
Approximately 15% of births worldwide result in life-threatening complications during pregnancy, delivery, or postpartum. Comprehensive Emergency Management of Obstetric and Newborn Care (CEmONC) is intended as one of the measures for maternal healthcare services to reduce the high burden with regard to childbirth complications. However, its state of implementation fidelity has not been well investigated. Therefore, this study aimed to evaluate the implementation fidelity of CEmONC services at University of Gondar Comprehensive Specialized Hospital, Ethiopia.
A case-study design with an embedded mixed method was employed. Adherence, quality of delivery, and participant responsiveness dimensions from Carroll's conceptual framework were used in this evaluation. Four hundred four exit interviews, 423 retrospective document reviews and 10 key informants were conducted. Moreover, a binary logistic regression model was fitted. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall implementation fidelity of the CEmONC was judged based on the pre-seated judgmental criteria.
Overall the implementation fidelity of the CEmONC service was 75.5%. Quality of delivery, participant responsiveness and adherence were 72.7%, 76.6% and 77.2% respectively. Signal functions like parenteral antibiotics and removal of retained products were insufficiently performed against the recommended protocols which was also evidenced by the key informant interviews. Healthcare providers' respect for the clients was less. Age ≥ 35 years (AOR = 0.48, 95% CI: 0.24,0.98), educational status of college and above (AOR = 2.61, 95% CI: 1.46,4.66), being government employed (AOR = 1.85, 95% CI: 1.08,3.18), having ANC follow-up (AOR = 5.50, 95% CI: 1.83, 16.47) and grand multigravida (AOR = 2.17, 95% CI: 1.08, 4.38) were factors significantly associated with participant responsiveness towards the services.
The overall implementation fidelity of the CEmONC services was implemented in good fidelity. Moreover, the quality of delivery was judged as implemented in fair fidelity. Parenteral antibiotics and removal of retained products were not found to be sufficiently performed. Respect for the clients was insufficiently delivered. Therefore, it is recommended that parenteral antibiotics drugs be adequately provided and training for healthcare providers regarding compassionate and respectful care shall be facilitated. Moreover, healthcare providers are strongly recommended to adhere to the recommended guidelines.
全球约有 15%的分娩在妊娠、分娩或产后期间出现危及生命的并发症。综合母婴急救和新生儿护理（CEmONC）旨在作为减少分娩并发症高负担的孕产妇保健服务措施之一。然而，其实施保真度尚未得到很好的调查。因此，本研究旨在评估埃塞俄比亚贡德尔大学综合专科医院的 CEmONC 服务的实施保真度。
采用案例研究设计，嵌入混合方法。该评估采用了卡罗尔概念框架中的依从性、分娩质量和参与者响应维度。进行了 404 次出院访谈、423 次回顾性文件审查和 10 名关键信息提供者。此外，还拟合了二元逻辑回归模型。将定性数据转录、翻译、编码，并使用主题分析方法进行分析。根据预先设定的判断标准，判断 CEmONC 服务的整体实施保真度。
总体而言，CEmONC 服务的实施保真度为 75.5%。分娩质量、参与者响应和依从性分别为 72.7%、76.6%和 77.2%。抗生素等信号功能的使用和残留产品的清除未按照推荐方案进行，关键信息提供者访谈也证明了这一点。医护人员对客户的尊重不够。年龄≥35 岁（AOR=0.48，95%CI：0.24，0.98）、大学及以上学历（AOR=2.61，95%CI：1.46，4.66）、政府雇员（AOR=1.85，95%CI：1.08，3.18）、接受 ANC 随访（AOR=5.50，95%CI：1.83，16.47）和多胎妊娠（AOR=2.17，95%CI：1.08，4.38）与参与者对服务的响应显著相关。
CEmONC 服务的整体实施保真度实施良好。此外，分娩质量被判定为实施得相当好。未发现抗生素和残留产品的使用充分。对客户的尊重不够。因此，建议提供足够的抗生素药物，并为医护人员提供有关同情和尊重的护理培训。此外，强烈建议医护人员遵守推荐的指南。
