Referral patterns through the lens of health facility readiness to manage obstetric complications: national facility-based results from Ghana
Referral patterns through the lens of health facility readiness to manage obstetric complications: national facility-based results from Ghana
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DOI：
10.1186/s12978-019-0684-y
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发表时间：
2019-02-18
影响因子：
3.4
通讯作者：
Singh, Kavita
中科院分区：
文献类型：
--
作者：
Bailey, Patricia E.;Awoonor-Williams, John Koku;Singh, Kavita
介绍孕产妇和新生儿死亡率高的国家可以受益于国家设施级数据，这些数据描述了重大产科并发症的设施内紧急转诊模式。本文评估了加纳卫生系统各级转诊和设施准备治疗并发症之间的关系。我们还调查了其他设施的特点与referreration.MethodsThe国家紧急产科和新生儿护理评估2010年提供的汇总信息，从977卫生设施。准备就绪的定义分为两步：有一名卫生工作者可以提供拯救生命的干预措施，以及最低限度的药物、用品和设备来执行干预措施。第二步是针对主要产科并发症采取干预措施。我们使用描述性统计和简单的线性回归。ResultsLower-level设施可能会提到几乎所有的妇女并发症。地区医院解决了近三分之二的复杂病例，占9%。最常见的转诊指征是分娩时间延长/难产和产前出血。除子宫破裂外，准备好治疗并发症与所有并发症的转诊减少相关。设施准备程度较低：大约40%的医院和10%的低级别设施达到了准备门槛。设施转介较少的妇女时，他们有较高的工作量，更多的助产士，更好的基础设施，以及通信和transport.DiscussionUnderstanding系统的交付和产科并发症如何分布在整个卫生系统，帮助决策者上下文的路径，以提供孕产妇服务的决定。改善转诊条件（通过增加利用通信和交通系统的机会）和管理产科并发症（提高准备程度）将提高护理质量，使转诊更加有效和高效。
IntroductionCountries with high maternal and newborn mortality can benefit from national facility level data that describe intra-facility emergency referral patterns for major obstetric complications. This paper assesses the relationship between referral and facilities' readiness to treat complications at each level of the health system in Ghana. We also investigate other facility characteristics associated with referral.MethodsThe National Emergency Obstetric and Newborn Care Assessment 2010 provided aggregated information from 977 health facilities. Readiness was defined in a 2-step process: availability of a health worker who could provide life-saving interventions and a minimum package of drugs, supplies, and equipment to perform the interventions. The second step mapped interventions to major obstetric complications. We used descriptive statistics and simple linear regression.ResultsLower level facilities were likely to refer nearly all women with complications. District hospitals resolved almost two-thirds of all complicated cases, referring 9%. The most prevalent indications for referral were prolonged/obstructed labor and antepartum hemorrhage. Readiness to treat a complication was correlated with a reduction in referral for all complications except uterine rupture. Facility readiness was low: roughly 40% of hospitals and 10% of lower level facilities met the readiness threshold. Facilities referred fewer women when they had higher caseloads, more midwives, better infrastructure, and systems of communication and transport.DiscussionUnderstanding how deliveries and obstetric complications are distributed across the health system helps policy makers contextualize decisions about the pathways to providing maternity services. Improving conditions for referral (by increasing access to communication and transport systems) and the management of obstetric complications (increasing readiness) will enhance quality of care and make referral more effective and efficient.