Ejigu Hawltu Abeyu, Yazachew Lake, Amare Getasew, Tsehay Chalie Tadie, Hagos Asebe, Tafere Tesfahun Zemene
Semien Mountains Mobile Medical Service Project, Debark, Ethiopia.
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Front Glob Womens Health. 2024 Sep 3;5:1418338. doi: 10.3389/fgwh.2024.1418338. eCollection 2024.
Worldwide, nearly 830 women die from complications of pregnancy and childbirth daily. Ninety-nine per cent of these maternal deaths take place in low and middle-income countries. Basic Emergency Obstetric Care (BEmONC) is one method of reducing maternal mortality related to pregnancy and childbirth complications. However, the status of its implementation fidelity has not been investigated. Therefore, this study sought to evaluate the implementation fidelity of BEmONC services in Beyeda District, Northwest Ethiopia.
A single case study design with mixed method was employed from June 01 to July 30, 2022. 415 client exit interviews, 14 key informants' interviews and 423 retrospective document reviews were conducted. Adherence, participant responsiveness and quality of delivery dimensions from Carroll's conceptual framework, with a total of 21 indicators were used in this evaluation. The overall implementation fidelity status of BEmONC service was judged based on the pre-seated judgmental criteria as; low, medium, and high fidelity.
The overall degree of implementation fidelity of the BEmONC services was 74.5%. Moreover, the implementation fidelity status of adherence, quality of delivery, and participant responsiveness dimensions were 74.7%, 77.2%, and 71.5% respectively. Uterotonic drugs were not administered as per the recommended protocol. Participants' engagement towards the neonatal resuscitation service delivery was inadequate. Likewise, healthcare providers' respect for the clients was not sufficient. Furthermore, women aged >30 years, being government employed and ANC visits four and above were variables positively associated with the quality of delivery of BEmONC services.
The overall implementation fidelity of the BEmONC services was judged as implemented in medium fidelity. Moreover, the adherence, participant responsiveness and quality of delivery dimensions were found to be implemented in medium fidelity. Therefore, public health sectors at all levels should strive to enhance the implementation fidelity of BEmONC services. Moreover, healthcare providers should adhere to the BEmONC implementation protocol guideline during service delivery. Healthcare managers should facilitate a continuous awareness creation for mothers regarding the merit of neonatal resuscitation for neonatal complications. Furthermore, healthcare providers should give due respect to mothers while delivering the services.
在全球范围内，每天有近830名妇女死于妊娠和分娩并发症。其中99%的孕产妇死亡发生在低收入和中等收入国家。基本急诊产科护理（BEmONC）是降低与妊娠和分娩并发症相关的孕产妇死亡率的一种方法。然而，其实施保真度的状况尚未得到调查。因此，本研究旨在评估埃塞俄比亚西北部贝耶达区BEmONC服务的实施保真度。
采用单一案例研究设计并结合混合方法，时间为2022年6月1日至7月30日。进行了415次客户出院访谈、14次关键信息提供者访谈和423次回顾性文件审查。本评估使用了卡罗尔概念框架中的依从性、参与者反应性和服务提供质量维度，共21项指标。BEmONC服务的总体实施保真度状况根据预先设定的判断标准判定为低、中、高保真度。
BEmONC服务的总体实施保真度为74.5%。此外，依从性、服务提供质量和参与者反应性维度的实施保真度分别为74.7%、77.2%和71.5%。宫缩剂未按照推荐方案使用。参与者对新生儿复苏服务的参与度不足。同样，医疗保健提供者对客户的尊重也不够。此外，年龄大于30岁、受雇于政府部门以及产前检查次数为四次及以上的妇女是与BEmONC服务提供质量呈正相关的变量。
BEmONC服务的总体实施保真度被判定为中等保真度。此外，发现依从性、参与者反应性和服务提供质量维度的实施为中等保真度。因此，各级公共卫生部门应努力提高BEmONC服务的实施保真度。此外，医疗保健提供者在服务提供过程中应遵守BEmONC实施协议指南。医疗保健管理人员应促进对母亲持续开展关于新生儿复苏对新生儿并发症益处的宣传。此外，医疗保健提供者在提供服务时应给予母亲应有的尊重。
