Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities
Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities
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DOI：
10.1186/s12913-020-05110-y
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发表时间：
2020-03-24
影响因子：
2.8
通讯作者：
Chipato, Tsungai
中科院分区：
文献类型：
--
作者：
Riley, Taylor;Madziyire, Mugove G.;Chipato, Tsungai
据估计，2016年津巴布韦发生了65，000例堕胎，其中40%导致了需要治疗的并发症。高质量的堕胎后护理服务对于治疗堕胎并发症和预防未来的意外怀孕至关重要，最近全国都在努力改善堕胎后护理服务。本研究评估了护理质量的两个组成部分：结构质量，使用PAC信号功能，治疗堕胎并发症的关键救生干预措施的监测框架;和过程质量，检查为PAC患者提供的护理标准。方法我们利用了2016年津巴布韦全国卫生设施普查与PAC能力（n = 227）和前瞻性的，基于设施的28天的妇女寻求PAC在这些设施的全国代表性样本（n = 1002 PAC患者在127设施）的调查。人工流产综合症信号功能是管理人工流产并发症的关键服务，用于将设施划分为有能力提供基本或全面护理的设施。所有设施都应提供基本护理，社区一级的设施旨在提供全面护理。我们还根据世卫组织建议的每50万居民5个设施的产科服务，评估了PAC服务的人口覆盖率。结果我们发现关键的差距，PAC服务的可用性，只有21%的设施有基本的PAC能力和10%的转诊设施有综合能力。对于过程质量，只有四分之一（25%）的PAC患者接受了适当的医疗程序。卫生系统仅拥有为满足津巴布韦人口需要而建议的初级保健设施的41%，以及建议的综合初级保健设施的55%。结论这是第一次对津巴布韦卫生系统的覆盖面和PAC服务质量进行国家评估。这些调查结果突出表明，在具备基本和全面PAC能力的设施的可用性和分布方面存在巨大差距。这些结构性差距是提供循证护理的一个障碍。这项研究表明，有必要增加关注和投资，以扩大这些必不可少的、拯救生命的PAC服务的提供和提高其质量。
Background An estimated 65,000 abortions occurred in Zimbabwe in 2016, and 40 % resulted in complications that required treatment. Quality post-abortion care (PAC) services are essential to treat abortion complications and prevent future unintended pregnancies, and there have been recent national efforts to improve PAC provision. This study evaluates two components of quality of care: structural quality, using PAC signal functions, a monitoring framework of key life-saving interventions that treat abortion complications; and process quality, which examines the standards of care provided to PAC patients. Methods We utilized a 2016 national census of health facilities in Zimbabwe with PAC capacity (n = 227) and a prospective, facility-based 28-day survey of women seeking PAC in a nationally representative sample of those facilities (n = 1002 PAC patients at 127 facilities). PAC signal functions, which are the critical services in the management of abortion complications, were used to classify facilities as having the capability to provide basic or comprehensive care. All facilities were expected to provide basic care, and referral-level facilities were designed to provide comprehensive care. We also assessed population coverage of PAC services based on the WHO recommendation for obstetric services of 5 facilities per 500,000 residents. Results We found critical gaps in the availability of PAC services; only 21% of facilities had basic PAC capability and 10% of referral facilities had comprehensive capability. For process quality, only one-fourth (25%) of PAC patients were treated with the appropriate medical procedure. The health system had only 41% of the basic PAC facilities recommended for the needs of Zimbabwe's population, and 55% of the recommended comprehensive PAC facilities. Conclusion This is the first national assessment of the Zimbabwean health system's coverage and quality of PAC services. These findings highlight the large gaps in the availability and distribution of facilities with basic and comprehensive PAC capability. These structural gaps are a contributing barrier to the provision of evidence-based care. This study shows the need for increased focus and investment in expanding the provision of and improving the quality of these essential, life-saving PAC services.