Challenges and opportunities for implementing evidence-based antenatal care in Mozambique: a qualitative study.
Challenges and opportunities for implementing evidence-based antenatal care in Mozambique: a qualitative study.
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DOI：
10.1186/s12884-015-0625-x
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发表时间：
2015-09-02
影响因子：
3.1
通讯作者：
Betrán AP
中科院分区：
文献类型：
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作者：
Biza A;Jille-Traas I;Colomar M;Belizan M;Requejo Harris J;Crahay B;Merialdi M;Nguyen MH;Althabe F;Aleman A;Bergel E;Carbonell A;Chavane L;Delvaux T;Geelhoed D;Gülmezoglu M;Malapende CR;Melo A;Osman NB;Widmer M;Temmerman M;Betrán AP
在莫桑比克和其他许多资源贫乏的国家，产妇死亡率仍然是一个令人生畏的问题。高质量的产前保健服务可以改善孕产妇和新生儿的健康结果，并增加妇女寻求熟练分娩护理的可能性。本研究探讨了影响供应商在莫桑比克的ANC干预措施的建议包摄取的因素。这项研究采用了定性研究方法，包括与卫生部门利益攸关方进行的关键知情人访谈，以及与有产前护理经验的妇女或社区妇女进行的总共五次重点小组讨论。研究参与者选自莫桑比克马普托市、太特省和德尔加多角省的三个卫生中心。对国家、省和地区各级负责药品/供应链的工作人员进行了访谈。为确认ANC所需用品的供应情况，编制了一份核对表，并进行了演绎含量分析。确定了三组主要因素，阻碍了ANC包在研究环境中的实施：a）系统或组织：包括长期供应链缺陷，继续教育系统的失败，缺乏定期审计和监督，缺乏有效的病历系统和健康中心的环境条件差; B）医疗保健提供者因素：如对当前临床指南的认识有限，对采用新的建议持抵制态度;以及c）用户：在获得产前护理方面存在挑战，妇女对通过产前护理提供的具体干预措施的目的和重要性认识不足，以及普遍认为保健中心的环境不友好。莫桑比克的产前护理方案在三个学习设施中没有得到充分实施，一个主要障碍是供应链系统运作不良。改进产前干预措施执行情况的建议包括确保根据产前护理模式制定临床方案。提高社区对ANC重要性的认识将提高对高质量ANC服务的需求。可以通过采用一个装有产前护理所需所有用品的成套用品系统来加强供应链的运作，并建议采用一个简单的监测系统来跟踪库存水平。本文的在线版本（doi：10.1186/s12884-015-0625-x）包含补充材料，可供授权用户使用。
Maternal mortality remains a daunting problem in Mozambique and many other low-resource countries. High quality antenatal care (ANC) services can improve maternal and newborn health outcomes and increase the likelihood that women will seek skilled delivery care. This study explores the factors influencing provider uptake of the recommended package of ANC interventions in Mozambique. This study used qualitative research methods including key informant interviews with stakeholders from the health sector and a total of five focus group discussions with women with experience with ANC or women from the community. Study participants were selected from three health centers located in Maputo city, Tete, and Cabo Delgado provinces in Mozambique. Staff responsible for the medicines/supply chain at national, provincial and district level were interviewed. A check list was implemented to confirm the availability of the supplies required for ANC. Deductive content analysis was conducted. Three main groups of factors were identified that hinder the implementation of the ANC package in the study setting: a) system or organizational: include chronic supply chain deficiencies, failures in the continuing education system, lack of regular audits and supervision, absence of an efficient patient record system and poor environmental conditions at the health center; b) health care provider factors: such as limited awareness of current clinical guidelines and a resistant attitude to adopting new recommendations; and c) Users: challenges with accessing ANC, poor recognition amongst women about the purpose and importance of the specific interventions provided through ANC, and widespread perception of an unfriendly environment at the health center. The ANC package in Mozambique is not being fully implemented in the three study facilities, and a major barrier is poor functioning of the supply chain system. Recommendations for improving the implementation of antenatal interventions include ensuring clinical protocols based on the ANC model. Increasing the community understanding of the importance of ANC would improve demand for high quality ANC services. The supply chain functioning could be strengthened through the introduction of a kit system with all the necessary supplies for ANC and a simple monitoring system to track the stock levels is recommended. The online version of this article (doi:10.1186/s12884-015-0625-x) contains supplementary material, which is available to authorized users.