Maternal and perinatal death surveillance and response: a systematic review of qualitative studies.
Maternal and perinatal death surveillance and response: a systematic review of qualitative studies.
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DOI：
10.2471/blt.22.288703
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发表时间：
2023-01-01
影响因子：
11.1
通讯作者：
Knight, Marian
中科院分区：
文献类型：
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作者：
Willcox, Merlin L.;Okello, Immaculate A.;Maidwell-Smith, Alice;Tura, Abera K.;van den Akker, Thomas;Knight, Marian
了解在低收入和中等收入国家实施孕产妇和/或围产期死亡监测和应对的人们的经验和看法，以及这一进程实现预期成果的机制。2022年6月，我们系统地检索了7个数据库，以获取有关在低收入和中等收入国家实施孕产妇和/或围产期死亡监测和应对的利益相关者的定性研究。两名评审员独立筛选文章并评估其质量。我们使用主题合成来获得描述性主题和现实主义的方法来理解上下文机制结果配置。59项研究符合纳入标准。良好的结果（提高护理质量或降低死亡率）得到了功能性行动周期的支持。有效的死亡监测和应对机制包括学习、警惕和执行促进进一步参与的建议。实现有效死亡监测和应对的关键背景是一个无责备的学习环境和良好的领导。由于报告不足、数据不准确、审查和建议不充分的恶性循环，结果不充分（护理和死亡率没有改善，死亡监测和反应停止），导致动力不足和脱离接触。据报告，出现了一些有害的结果，例如不适当的转诊和工作人员短缺情况恶化，这是由于担心受到指责、纪律处分或诉讼等负面后果。有效监测和应对孕产妇和/或围产期死亡所需的条件包括：将这一过程与诉讼和纪律程序分开;全面的指导方针和培训;执行建议的充足资源;以及支持性监督，以实现安全学习。
To understand the experiences and perceptions of people implementing maternal and/or perinatal death surveillance and response in low- and middle-income countries, and the mechanisms by which this process can achieve its intended outcomes. In June 2022, we systematically searched seven databases for qualitative studies of stakeholders implementing maternal and/or perinatal death surveillance and response in low- and middle-income countries. Two reviewers independently screened articles and assessed their quality. We used thematic synthesis to derive descriptive themes and a realist approach to understand the context–mechanism–outcome configurations. Fifty-nine studies met the inclusion criteria. Good outcomes (improved quality of care or reduced mortality) were underpinned by a functional action cycle. Mechanisms for effective death surveillance and response included learning, vigilance and implementation of recommendations which motivated further engagement. The key context to enable effective death surveillance and response was a blame-free learning environment with good leadership. Inadequate outcomes (lack of improvement in care and mortality and discontinuation of death surveillance and response) resulted from a vicious cycle of under-reporting, inaccurate data, and inadequate review and recommendations, which led to demotivation and disengagement. Some harmful outcomes were reported, such as inappropriate referrals and worsened staff shortages, which resulted from a fear of negative consequences, including blame, disciplinary action or litigation. Conditions needed for effective maternal and/or perinatal death surveillance and response include: separation of the process from litigation and disciplinary procedures; comprehensive guidelines and training; adequate resources to implement recommendations; and supportive supervision to enable safe learning.