Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study
Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study
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DOI：
10.1371/journal.pone.0188279
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发表时间：
2017-12-13
期刊：
影响因子：
3.7
通讯作者：
Sundby, Johanne
中科院分区：
文献类型：
--
作者：
Miltenburg, Andrea Solnes;van der Eem, Lisette;Sundby, Johanne
产前护理对于改善孕产妇和新生儿的健康和福祉至关重要。坦桑尼亚的大多数孕妇至少接受一次检查。自实施重点产前护理模式以来，护理质量评估主要侧重于产前护理常规干预措施的利用和覆盖面。本研究的目的是从整体的角度在坦桑尼亚农村地区产前保健提供的质量进行评估。探讨了质量的结构、过程和结果组成部分。本文报告了2012年至2015年期间通过对供应和服务的设施审计、ANC观察和对孕妇的离职面谈收集的数据。其他定性方法，如访谈，焦点小组的意见和参与者的意见。调查结果表明，常规ANC服务的可变性能，部分原因是资源不足。在适当的病史采集、对病人健康的关注、基本的体格检查和充分的咨询和教育方面也观察到较差的表现。要提高产前护理的质量，就需要更加关注覆盖范围以外的护理提供过程，包括关注基于反应的服务，这种服务应根据当地确定的标准进行评估。
Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client's wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for responsebased services, which should be assessed based on locally determined criteria.