Establishing the Ethiopian Obstetric Surveillance System for Monitoring Maternal Outcomes in Eastern Ethiopia: A Pilot Study.
Establishing the Ethiopian Obstetric Surveillance System for Monitoring Maternal Outcomes in Eastern Ethiopia: A Pilot Study.
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DOI：
10.9745/ghsp-d-22-00281
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发表时间：
2023-04-28
期刊：
影响因子：
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通讯作者：
Ethiopian Obstetric Surveillance System Steering Committee
中科院分区：
文献类型：
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作者：
Tura AK;Girma S;Dessie Y;Bekele D;Stekelenburg J;van den Akker T;Knight M;Ethiopian Obstetric Surveillance System Steering Committee
作者对埃塞俄比亚产科监测系统的试点表明，在其他资源匮乏的环境中建立类似的系统来监测孕产妇结局是可行的。在埃塞俄比亚这样的环境中，通过报告临床医生和执行者网络实施产科监测是可行的。采用结合死亡率和发病率数据的区域产科监测可能有助于提供更有力、快速和对背景敏感的数据收集，从而改善护理。在资源匮乏的环境中建立产科监测需要解决与医疗记录保存和报告不良相关的挑战，以及临床医生和政策制定者在当地生成和使用研究证据的能力建设。从一开始就让执业临床医生、决策者和执行者参与进来对于成功实施和可持续性至关重要，包括发病率数据而不是仅仅关注死亡可以提高他们的参与度。卫生部、专业协会和学术机构应积极参与实施全国范围的产科死亡率和发病率监测，这可以加强这些利益攸关方目前对孕产妇和围产期死亡的监测和应对办法。虽然大多数孕产妇死亡和并发症发生在资源匮乏的环境中，但几乎所有现有的强大登记和保密查询系统都出现在资源丰富的环境中。我们在埃塞俄比亚的3个地区开发并试点了埃塞俄比亚产科监测系统（EthOSS），该系统基于成功的英国产科监测系统（UKOSS）方法，与埃塞俄比亚目前使用的孕产妇死亡监测和应对方案相比，旨在改善对孕产妇发病率和死亡率的持续监测和跟踪以及保密调查。我们于2021年4月在埃塞俄比亚东部的13家医院推出EthOSS每月病例通报系统。研究参与者包括2021年4月至9月期间因妊娠、分娩或终止妊娠后42天内出现重大不良产科状况而入院的女性。医院指定的临床医生使用一个简单的在线系统，每月向EthOSS团队报告病例和孕产妇死亡人数。我们介绍了EthOSS中不良情况的发生率和病死率。在6个月的试点期间，904名至少患有1种EthOSS疾病的女性被纳入研究，其中10人死亡（病死率为1.1%）。近一半（46.6%，421/904）发生产科大出血，38.7%（350/904）发生严重贫血，29.5%（267/904）发生子痫，8.8%（80/904）发生败血症，2.2%（20/904）发生子宫破裂。为了在监测的同时改善护理，地方委员会接受了内部和外部专家关于对孕产妇死亡进行保密调查的培训。在这个以设施为基础的项目中，通过临床医生自愿报告收集了关于严重不良产科状况的数据。必须进行进一步分析，以评估这些数据的可靠性，并计划对具体案例的产妇死亡进行保密调查，以调查护理是否适当。
The authors’ pilot of the Ethiopian Obstetric Surveillance System demonstrates the feasibility of establishing similar systems to monitor maternal outcomes in other low-resource settings. Implementation of obstetric surveillance through a network of reporting clinicians and implementers is feasible in a setting like Ethiopia. The introduction of regional obstetric surveillance combining mortality and morbidity data may help to improve care by providing more robust, rapid, and context-sensitive data collection. Establishing obstetric surveillance in low-resource settings requires addressing challenges related to poor medical recordkeeping and reporting, as well as capacity-building among clinicians and policymakers to generate and use research evidence locally. Involving practicing clinicians, decision-makers, and implementers from the onset is essential for successful implementation and sustainability, and including morbidity data rather than focusing on deaths alone could enhance their participation. Ministries of health, professional societies, and academic institutions should actively participate in implementing nationwide obstetric mortality and morbidity surveillance, which could strengthen the current approaches to maternal and perinatal death surveillance and response followed by these stakeholders. Although the majority of maternal deaths and complications occur in low-resource settings, almost all existing strong registration and confidential enquiry systems are found in high-resource settings. We developed and piloted the Ethiopian Obstetric Surveillance System (EthOSS), based on the successful United Kingdom Obstetric Surveillance System (UKOSS) methodology, in 3 regions in Ethiopia to improve ongoing surveillance and tracking of maternal morbidities and deaths, as well as confidential enquiry, compared to the currently used maternal death surveillance and response program in Ethiopia. We launched the EthOSS monthly case notification system in 13 hospitals in eastern Ethiopia in April 2021. Study participants included women admitted to the hospitals from April to September 2021 with major adverse obstetric conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. Designated clinicians at the hospitals used a simple online system to report the number of cases and maternal deaths monthly to the EthOSS team. We present findings on the incidence and case fatality rates for adverse conditions included in the EthOSS. Over the 6-month pilot period, 904 women with at least 1 EthOSS condition were included in the study, of whom 10 died (case fatality rate, 1.1%). Almost half (46.6%, 421/904) sustained major obstetric hemorrhage, 38.7% (350/904) severe anemia, 29.5% (267/904) eclampsia, 8.8% (80/904) sepsis, and 2.2% (20/904) uterine rupture. To enable care improvement alongside surveillance, the local committee received training on confidential enquiry into maternal deaths from internal and external experts. In this facility-based project, data on severe adverse obstetric conditions were captured through voluntary reporting by clinicians. Further analysis is essential to assess the robustness of these data, and confidential enquiry into maternal deaths for specific cases is planned to investigate the appropriateness of care.