Experience with a context-specific modified WHO safe childbirth checklist at two tertiary care settings in Sri Lanka
Experience with a context-specific modified WHO safe childbirth checklist at two tertiary care settings in Sri Lanka
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DOI：
10.1186/s12884-018-2040-6
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发表时间：
2018-10-20
影响因子：
3.1
通讯作者：
Ramachandran, Rathigashini
中科院分区：
文献类型：
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作者：
Senanayake, Hemantha M.;Patabendige, Malitha;Ramachandran, Rathigashini
背景资料：这项研究的目的是评估是否更具体的修改版本的世界卫生组织安全分娩清单（mSCC）将导致在提高adoption rate.Methods：一个前瞻性的观察性研究进行了在大学产科单位德索萨妇女医院（DSHW），科隆博和两个产科单位在教学医院，Mahamodara，加勒（THMG），斯里兰卡。2017年引入mSCC后，研究在DSHW进行了8周以上，在THMG进行了4周以上。世卫组织SCC从2013年开始在DSHW使用，直到被mSCC取代。入院时随附检查表，出院时收集。最后使用自填问卷评估接受程度。结果的措施是采用率（交付的百分比，其中mSCC是使用，可以找到），遵守的做法（检查项目的平均百分比），答复率（工作人员回答问卷的百分比）和接受程度（李克特规模的百分比“非常同意/同意”的五个问题接受mSCC）。回应也采取了开放式的问题上的障碍implementation.Results：在DSHW，在研究期间的606出生，有329活产中使用的mSCC，可以找到给54.3%的采用率。在THMG中，采用率为153/814（18.8%）。在DSHW，问卷的回答率为40.5%，在THMG，40.0%。对调查表作出答复的人的接受程度良好。在DSHW和THMG中，对检查表实践的平均（95% CI）依从性分别为52.7%（44.1-58.5）和32.2%（24.5-39.1），两种情况下的范围为1-100%。大多数人提到缺乏工作人员、缺乏热情、关于使用微型儿童保育器的培训和咨询不足，以及缺乏来自部委/机构一级的监督。大多数人建议参与医生，删除的需要，把签名和单独的责任，每27个项目和适当的培训课程的可取性，关于mSCC.Conclusion：基于清单的干预措施，在孕产妇保健不能指望仅仅通过使他们上下文特定的改善。应探索其他办法，以最大限度地发挥其效益。
Background: The aim of the study was to assess whether a more context-specific modified version of WHO Safe Childbirth Checklist (mSCC) would result in improved adoption rate.Methods: A prospective observational study was conducted in University Obstetrics Unit at De Soysa Hospital for Women (DSHW), Colombo and two Obstetric Units at Teaching Hospital, Mahamodara, Galle (THMG), Sri Lanka. Study was conducted over 8 weeks at DSHW and over 4 weeks at THMG after introduction of the mSCC in 2017. The WHO SCC was in use at DSHW from 2013 until its replacement by the mSCC. Checklists were kept attached at admission and collected on discharge. Level of acceptance was assessed using a self-administered questionnaire at the end. Outcome measures were adoption rate (percentage of deliveries where mSCC was used and could be found), adherence to practices (mean percentage of items checked), response rate (percentage of staff members responded to questionnaire) and level of acceptance (percentage of "strongly agree/agree" in Likert scale to five questions regarding acceptance of mSCC). Responses were also taken to the open-ended question on barriers to implementation.Results: In DSHW, out of 606 births during study period, there were 329 live births in which the mSCC was used and could be found giving an adoption rate of 54.3%. In THMG adoption rate was 153/814 (18.8%). In DSHW, response rate for the questionnaire was 40.5% and in THMG, 40.0%. Level of acceptance was good among those who responded to the questionnaire. Mean (95% CI) adherence to the Checklist practices was 52.7% (44.1-58.5) in DSHW and 32.2% (24.5-39.1) in THMG with a range of 1-100% in both settings. Majority mentioned the lack of staff, lack of enthusiasm, inadequate training and advice on use of mSCC and lack of supervision from Ministry/institutional level. Majority suggested the involvement of medical doctors, removal of the need to place the signature and separate accountability to each 27-items and the desirability of proper training sessions regarding the mSCC.Conclusion: Checklist-based interventions in maternity care cannot be expected to improve by merely making them ontext-specific. Other approaches should be explored to maximize its benefits.