Halim Abdul, Abdullah Abu Sayeed Md, Rahman Fazlur, Bazirete Oliva, Turkmani Sabera, Hughes Kirsty, Lopes Sofia Castro, Nove Andrea, Forrester Mandy, Scarf Vanessa, Callander Emily, Homer Caroline S E
Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
University of Rwanda, Kigali, Rwanda.
PLOS Glob Public Health. 2024 Dec 10;4(12):e0004033. doi: 10.1371/journal.pgph.0004033. eCollection 2024.
In Bangladesh, Midwife Led Birthing Centres (MLBCs) have been established to provide midwifery care and sexual and reproductive health services for the displaced Rohingya population in Cox's Bazar. The aim of this study was to explore MLBCs in this humanitarian context from the perspectives of women, midwives, and other key stakeholders. A mixed-method case study was conducted at one of the MLBCs within the Rohingya refugee camps in Cox's Bazar. The MLBC serves a population of approximately 8,500 people. Quantitative data were collected from the medical records and documents of the MLBC. Qualitative data included two key informant interviews (KIIs) with policy makers, one focus group discussion (FGD) with 7 midwives and ten in-depth interviews (IDIs) with Rohingya women who gave birth in this MLBC. Thematic analysis of qualitative data was performed. In 2022, 267 women gave birth at the MLBC, and 70 women with complications were transferred to higher-level facilities. Women chose the MLBC because of the respectful care provided by kind and skillful midwives, and the high-quality services. The MLBC was often recommended by community volunteers and relatives. Midwives provided a range of health services including antenatal, labour and birth, postnatal, family planning, mental health support and gender-based violence services. Challenges included language barriers, difficulty obtaining transport from home and back particularly at night in remote areas, security fears and weak cell phone coverage that affected communication for referral and follow-up. Recommendations included increased support and security staff, establishing a referral hospital nearer to the camp, refresher training for midwives and monitoring, and mentoring to improve service quality. The MLBC in the Rohingya camp shows that respectful midwifery care including management and referral of obstetric complications with wider sexual and reproductive health services can be provided in a humanitarian setting to optimize maternal and neonatal health outcomes.
在孟加拉国，已设立了助产士主导的分娩中心（MLBCs），为科克斯巴扎尔流离失所的罗兴亚人口提供助产护理以及性健康和生殖健康服务。本研究的目的是从妇女、助产士和其他关键利益相关者的角度，探讨在这一人道主义背景下的助产士主导的分娩中心。在科克斯巴扎尔罗兴亚难民营内的一个助产士主导的分娩中心进行了一项混合方法的案例研究。该分娩中心服务于约8500人。定量数据从该分娩中心的医疗记录和文件中收集。定性数据包括对政策制定者进行的两次关键信息访谈（KIIs）、与7名助产士进行的一次焦点小组讨论（FGD）以及对在该分娩中心分娩的罗兴亚妇女进行的十次深入访谈（IDIs）。对定性数据进行了主题分析。2022年，有267名妇女在该分娩中心分娩，70名有并发症的妇女被转诊到更高级别的医疗机构。妇女选择该分娩中心是因为善良且技术娴熟的助产士提供的贴心护理以及高质量的服务。该分娩中心经常得到社区志愿者和亲属的推荐。助产士提供一系列健康服务，包括产前、分娩和产后护理、计划生育、心理健康支持以及基于性别的暴力服务。挑战包括语言障碍、从家中往返交通困难，尤其是在偏远地区的夜间，安全担忧以及手机信号覆盖薄弱影响转诊和后续跟进的沟通。建议包括增加支持人员和安保人员、在营地附近设立转诊医院、为助产士提供进修培训以及进行监测和指导以提高服务质量。罗兴亚难民营中的助产士主导的分娩中心表明，在人道主义环境中可以提供包括产科并发症管理和转诊以及更广泛的性健康和生殖健康服务在内的贴心助产护理，以优化孕产妇和新生儿的健康结局。
