Are national policies and programs for prevention and management of postpartum hemorrhage and preeclampsia adequate? A key informant survey in 37 countries.
Are national policies and programs for prevention and management of postpartum hemorrhage and preeclampsia adequate? A key informant survey in 37 countries.
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DOI：
10.9745/ghsp-d-14-00034
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发表时间：
2014-08
期刊：
影响因子：
--
通讯作者：
Perri J
中科院分区：
文献类型：
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作者：
Smith JM;Currie S;Cannon T;Armbruster D;Perri J
大多数接受调查的国家都有许多支持性政策和方案要素，但仍然存在阻碍孕产妇保健工作的问题，包括：基本商品，特别是米索前列醇的供应不一致;助产士的执业范围受到限制;服务提供指南不完整或过时;报告系统薄弱。大多数接受调查的国家都有许多支持性政策和方案要素，但仍然存在阻碍孕产妇保健工作的问题，包括：基本商品，特别是米索前列醇的供应不一致;助产士的执业范围受到限制;服务提供指南不完整或过时;报告系统薄弱。虽然近年来孕产妇死亡率大幅下降，但必须系统地加大力度解决产后出血和先兆子痫/子痫问题，以进一步降低孕产妇死亡率。2012年，进行了一次关键的知情人调查，以确定国家和全球在PPH和PE/E方案优先事项方面的差距，并突出未来国家和全球方案编制的重点领域。2012年1月至3月期间，37个国家的国家方案小组完成了一项44项调查，主要包括“是”/“否”的二分答复，涉及6个核心方案领域：政策、培训、药品分配和后勤、国家关键指标报告、方案拟订以及扩大规模的挑战和机遇。一名国内协调人领导了从当地主要利益攸关方收集必要信息的进程。一些国家还提供了国家基本药物清单和服务提供准则，以供比较和进一步分析。大多数接受调查的国家都制定了许多处理产后出血和PE/E的要素，但在政策和实践方面仍存在明显差距。据报告，分别有89%和76%的国家的设施定期提供催产素和硫酸镁。然而，只有27%的国家注意到卫生设施中经常提供米索前列醇。在许多国家，助产士在PPH和PE/E方面的实践范围与全球规范不一致：22%的国家不允许助产士使用硫酸镁，30%的国家不允许他们进行人工胎盘切除。接受调查的大多数国家都有许多预防/管理PPH和PE/E的基本政策和方案要素，但缺乏商品（特别是米索前列醇），助产士的实践范围有限，以及将孕产妇健康指标纳入国家数据系统方面的差距阻碍了在全国范围内扩大方案的努力。
Most surveyed countries have many supportive policies and program elements, but issues remain that impede maternal health efforts, including: inconsistent availability of essential commodities, particularly misoprostol; limitations on midwives' scope of practice; incomplete or out-of-date service delivery guidelines; and weak reporting systems. Most surveyed countries have many supportive policies and program elements, but issues remain that impede maternal health efforts, including: inconsistent availability of essential commodities, particularly misoprostol; limitations on midwives' scope of practice; incomplete or out-of-date service delivery guidelines; and weak reporting systems. Although maternal mortality has declined substantially in recent years, efforts to address postpartum hemorrhage (PPH) and preeclampsia/eclampsia (PE/E) must be systematically scaled up in order for further reduction to take place. In 2012, a key informant survey was conducted to identify both national and global gaps in PPH and PE/E program priorities and to highlight focus areas for future national and global programming. Between January and March 2012, national program teams in 37 countries completed a 44-item survey, consisting mostly of dichotomous yes/no responses and addressing 6 core programmatic areas: policy, training, medication distribution and logistics, national reporting of key indicators, programming, and challenges to and opportunities for scale up. An in-country focal person led the process to gather the necessary information from key local stakeholders. Some countries also provided national essential medicines lists and service delivery guidelines for comparison and further analysis. Most surveyed countries have many elements in place to address PPH and PE/E, but notable gaps remain in both policy and practice. Oxytocin and magnesium sulfate were reported to be regularly available in facilities in 89% and 76% of countries, respectively. Only 27% of countries, however, noted regular availability of misoprostol in health facilities. Midwife scope of practice regarding PPH and PE/E is inconsistent with global norms in a number of countries: 22% of countries do not allow midwives to administer magnesium sulfate and 30% do not allow them to perform manual removal of the placenta. Most countries surveyed have many of the essential policies and program elements to prevent/manage PPH and PE/E, but absence of commodities (especially misoprostol), limitations in scope of practice for midwives, and gaps in inclusion of maternal health indicators in the national data systems have impeded efforts to scale up programs nationally.