Quality of Maternal and Neonatal Health (MNH) care in for profit private sectors in urban Bangladesh
Quality of Maternal and Neonatal Health (MNH) care in for profit private sectors in urban Bangladesh
复制标题
孟加拉国城市营利性私营部门的孕产妇和新生儿健康 (MNH) 护理质量
DOI：
10.1093/eurpub/ckw171.065
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发表时间：
2016
影响因子：
4.4
通讯作者：
Anwar I
中科院分区：
文献类型：
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作者：
Anwar I
在许多发展中国家，营利性私营部门对产妇保健服务的贡献越来越大。然而，它们的运作超出了任何监管框架，引起了对质量、成本和公平的关注。在孟加拉国，60%的设施交付被放置在私人health sectors.MethodsThis横断面调查进行了34为利润私营医院提供MNH服务的锡耶特市公司，在2015年6月至8月。最后3个月住院分娩病例记录进行了审查（n= 1343），以评估技术方面，而设施调查（n= 34）进行了探索的结构和结果维度的服务质量的一部分，实施research.ResultsThe基本设施和设备的是在大多数的调查设施。然而，缺少的基础设施组成部分是：分娩室（39%），新生儿护理病房（79%）和母乳喂养角（92%）。专职产科医生、麻醉师和儿科医生的中位数均< 1人;未注册护士（n= 9）多于注册护士（n= 3）。世卫组织建议，只有18%的情况下存在废物隔离和处置。作为以患者为中心的护理证据的过程指标的可用性各不相同，床边屏幕（55%），评论框（32%），BCC材料（15%），接待员（100%）和显示服务价格（15%）。高剖宫产率（80%），无支持性产程图（< 1%）表示循证实践的表现较差。不论分娩方式如何，大部分（67%）分娩是在下午2时后进行。报告的孕产妇和新生儿并发症分别为12.5%和21.5%respectively。在公立医院办公时间后进行分娩的趋势表明双重临床实践可能会危及公共和私人卫生系统。不必要的剖腹产背后的原因需要进一步调查
BackgroundFor-profit private sector is increasingly contributing in MNH services in many developing countries. However, they operate beyond any regulatory frame-work that raises concerns about quality, cost and equity. In Bangladesh, 60% of facility deliveries are placed at private health sectors.MethodsThis cross sectional survey was conducted in 34 for profit private hospitals providing MNH services in Sylhet City Corporation, during June to August, 2015. The last 3 months inpatient delivery case records were reviewed (n= 1343) to assess technical aspects while facility survey (n= 34) were done to explore the structural and outcome dimension of quality of services as part of an implementation research.ResultsThe basic amenities and equipment’s were available in most of the surveyed facilities. However, missing infrastructural components were; labor room (39%), neonatal care unit (79%) and breast feeding corner (92%). The median number of full time obstetrician, Anesthetist and Pediatrician was< 1; and unregistered nurses (n= 9) were more than registered nurses (n= 3). WHO recommended waste segregation and disposal was existent only in 18% cases. The availability of process indicators as a proof to patient centered care were varied, bed side screen (55%), comment box (32%), BCC materials (15%), receptionist (100%) and displayed service price (15%). High caesarean delivery rate (80%) without supporting partograph (< 1%) denote poor performance on evidence based practice. Irrespective of mode of deliveries, majority of them (67%) took place after 2 pm. Reported maternal and neonatal complications were 12.5% and 21.5% respectively.ConclusionsObserved quality indicators under all 3 dimensions were much deficient. Tendency of delivery being conducted after office time of public hospital indicate dual clinical practice that can jeopardize both public and private health system. The reasons behind unnecessary caesarean deliveries need to be investigated further