Strengthening the "P" in Maternal and Perinatal Death Surveillance and Response in Bungoma county, Kenya: implications for scale-up
Strengthening the "P" in Maternal and Perinatal Death Surveillance and Response in Bungoma county, Kenya: implications for scale-up
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DOI：
10.1186/s12913-019-4431-4
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发表时间：
2019-08-30
影响因子：
2.8
通讯作者：
Fulton, Nicole
中科院分区：
文献类型：
--
作者：
Bandali, Sarah;Thomas, Camille;Fulton, Nicole
背景本文研究了肯尼亚邦戈马县围产期死亡报告和审查，在那里取得了实质性进展，为更广泛地扩大到其他情况提供了重要的见解。方法根据地区卫生信息系统的数据，采用定量方法分析2014年至2017年肯尼亚围产期死亡报告和审查的趋势。定性方法有助于进一步了解围产期死亡报告和审查的成功，在邦戈马县通过重点小组讨论和个人访谈在5家医院和1个保健中心。采用主题分析法，编制了分析代码。结果肯尼亚47个县中只有13个县开展围产儿死亡回顾。2017年，即围产期死亡审查制度出台后的第二年，肯尼亚只有3.6%的围产期死亡得到审查。邦戈马县在肯尼亚取得了最大的进步，审查了2017年该县发生的围产期死亡的59%。邦戈马占肯尼亚审查的所有围产期死亡的51%。Bungoma取得成功的因素包括：使基于设施的围产期报告工具与国家一级的工具相统一;优先考虑记录和报告死亡率的需要;根据审查中确定的需要，定制持续的医学教育和支持性监督访问;以及更好的记录和转诊程序。支助性的管理和行政人员也有助于推动各项行动的实施，并提高了保健工作人员减少围产期死亡和提高护理质量的积极性。结论围产期死亡审查的成功实施需要明确界定行动的角色和责任，并对其进行常规监测，以跟踪实施进展。正如在其他低收入环境中一样，邦戈马县已经证明，在肯尼亚，围产期死亡审查可以通过注重学习、以解决方案为导向的反应、影响有行动能力的人、对结果负责以及明显改善护理质量来有效实施和持续。
Background This paper examines perinatal death reporting and reviews in Bungoma county, Kenya, where substantial progress has been made, providing important insights for wider scale up to other contexts. Methods Quantitative methods were used to analyse trends in perinatal death reporting and reviews between 2014 and 2017 throughout Kenya based on data from the District Health Information System. Qualitative methods helped further understand the success of perinatal death reporting and review in Bungoma county through focus group discussions and individual interviews at 5 hospitals and 1 health centre. Thematic analysis was used to draw out codes for the analysis. Results Only 13 of the 47 counties in Kenya conduct perinatal death reviews. In 2017, the year after the perinatal death review system was introduced, only 3.6% of perinatal deaths were reviewed in Kenya. Bungoma county has made the greatest strides in Kenya, reviewing 59% of the perinatal deaths that occurred within the county in 2017. Bungoma accounted for 51% of all the perinatal deaths reviewed in Kenya. Factors contributing to the success in Bungoma include harmonisation of facility based perinatal reporting tools with the national level; prioritising the need to document and report mortalities; tailoring continual medical education and supportive supervision visits to needs identified from the review; and better documentation and referral processes. Supportive management and administrative staff have also helped drive forward implementation of actions and increased health staff motivation to reduce perinatal deaths and improve quality of care. Conclusions Successful implementation of perinatal death reviews requires clear delineation of roles and responsibilities for action, which are routinely monitored to track implementation progress. As in other low-income settings, Bungoma county has demonstrated that in Kenya, perinatal death reviews can be effectively implemented and sustained, through a focus on learning, solution-oriented responses, influencing those in a power to act, accountability for results, and observable quality of care improvements.