Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study
Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study
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DOI：
10.1093/intqhc/mzab049
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发表时间：
2021-03-17
影响因子：
2.6
通讯作者：
Tamang, Suresh
中科院分区：
文献类型：
--
作者：
Acharya, Yubraj;James, Nigel;Tamang, Suresh
背景：过去三十年来，尼泊尔在孕产妇和新生儿死亡率方面取得了显着进步。然而，护理质量差可能会威胁到所取得的成果，因为孕产妇和新生儿服务对护理质量特别敏感。我们的研究旨在了解当前产前护理 (ANC) 质量的过程和结果方面的差距，特别是在次国家一级。我们评估了尼泊尔 17 家初级公立医院 ANC 质量的这些维度。我们还评估了患者社会经济梯度中 ANC 过程的变化。方法：我们使用收敛混合方法，对定性和定量数据进行三角测量。在定量部分，我们观察了提供者（来自所有 7 个省的 17 家医院）和 198 名寻求 ANC 的女性之间的互动，并使用人口和健康调查计划中提供的服务提供评估协议记录了提供者执行的任务。主要结果变量是提供者在 ANC 咨询期间执行的任务数量。任务范围从识别潜在危险迹象到提供咨询。我们描述性地分析了结果数据，并评估了执行的任务数量和用户特征之间的关系。在定性部分，我们通过焦点小组讨论和深入访谈综合了用户和提供者对整体护理质量看法的叙述。结果：在世界卫生组织推荐的 59 项任务中，提供者平均只执行了 22 项任务 (37.3%)。各省执行的任务数量差异很大，省 3 的用户获得的护理质量明显高于其他省份的用户。受过教育的妇女比没有受过教育的妇女受到更好的待遇。用户和提供者一致认为整体护理质量不足，尽管提供者提到鉴于他们面临的限制，目前的质量是他们能提供的最好的。结论：尼泊尔初级医院的 ANC 质量很差，并且在教育和地理梯度方面不公平。虽然目前的努力（例如提供 24/7 分娩中心）可以缩小服务可用性方面的差距，但仍需要额外的设备、基础设施和人力资源来提高质量。提供者还需要额外的培训，重点是平等对待来自不同背景的患者。我们的研究还指出需要进行更多研究，既要更客观地记录护理质量，又要确定质量的关键决定因素，为政策提供信息。
Background: Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients' socio-economic gradient.Methods: We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users' characteristics. In the qualitative component, we synthesized users' and providers' narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews.Results: Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced.Conclusion: The quality of ANC in Nepal's primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.