Alternative measures of spatial distribution and availability of health facilities for the delivery of emergency obstetric services in island communities.
Alternative measures of spatial distribution and availability of health facilities for the delivery of emergency obstetric services in island communities.
复制标题
用于在岛屿社区提供紧急产科服务的卫生设施的空间分布和可用性的替代措施。
DOI：
10.1007/s10995-013-1376-9
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发表时间：
2014
影响因子：
2.3
通讯作者：
Baravilala,Wame
中科院分区：
文献类型：
--
作者：
Oyerinde,Koyejo;Baravilala,Wame
关于产科急诊服务的提供和空间分布的国际准则和建议没有充分解决在岛屿社区提供紧急保健服务的挑战。岛屿和偏远地区人口的特点是与世隔绝和人口规模小，这限制了国际准则在这些社区的适用性。在孕妇出现并发症时，普遍提供产科急诊护理服务是降低孕产妇和新生儿死亡率的三项关键战略之一;另外两项战略是计划生育和分娩期间的熟练护理。选定的救生临床干预措施（信号功能）在3个月内的表现通常用于评估和分配卫生设施的性能类别，但岛屿社区可能没有足够的人口来产生对3个月内所有信号功能的需求。同样，可用性和空间分布建议通常基于集水区人口的规模，但岛屿社区的人口往往分布稀疏。我们以六个南太平洋岛国为例，认为关于卫生设施的建议，即至少应有五个紧急产科护理设施，（包括至少一个综合设施），以及关于公平分配保健设施的建议，即所有国家以下地区都达到提供保健设施的建议，可以代之以重点为岛屿上所有怀孕居民在2小时内获得输血和产科手术护理。如果需要，岛屿社区可以在3个月的时间内用已证明的履行信号职能的能力来取代信号职能。
International guidelines and recommendations for availability and spatial distribution of emergency obstetric care services do not adequately address the challenges of providing emergency health services in island communities. The isolation and small population sizes that are typical of islands and remote populations limit the applicability of international guidelines in such communities. Universal access to emergency obstetric care services, when pregnant women encounter complications, is one of the three key strategies for reducing maternal and newborn mortality; the other two being family planning and skilled care during labor. The performance of selected lifesaving clinical interventions (signal functions) over a 3-month period is commonly used to assess and assign performance categories to health facilities but island communities might not have a large enough population to generate demand for all the signal functions over a 3-month period. Similarly, availability and spatial distribution recommendations are typically based on the size of catchment populations, but the populations of island communities tend to be sparsely distributed. With illustrations from six South Pacific Island states, we argue that the recommendation for availability of health facilities, that there should be at least five emergency obstetric care facilities (including at least one comprehensive facility) for every 500,000 population, and the recommendation for equitable distribution of health facilities, that all subnational areas meet the availability recommendation, can be substituted with a focus on access to blood transfusion and obstetric surgical care within 2 hours for all pregnant residents of islands. Island communities could replace the performance of signal functions over a 3-month period with a demonstrated capacity to perform signal functions if the need arises.