Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment
Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment
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DOI：
10.1186/s12884-015-0444-0
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发表时间：
2015-02-05
影响因子：
3.1
通讯作者：
McGready, Rose
中科院分区：
文献类型：
--
作者：
Hoogenboom, Gabie;Thwin, May Myo;McGready, Rose
背景资料：作为降低孕产妇死亡率和发病率的战略之一，增加由熟练助产士接生的妇女人数必须与最低标准的护理相配合。这篇手稿介绍了分娩时护理的质量提供的SBA在美拉营，低资源，长期难民背景下的泰缅边境。方法：在产科部门的Shoklo疟疾研究单位（SMRU）的标准化世卫组织安全孕产需求评估工具进行了调整，以适应设置和使用：评估设施，采访SBA;收集一年期间的产妇记录数据（2007年8月至2008年）;并观察分娩和分娩期间的做法。设施评估没有记录“缺货”或“过期”的药物和用品，设备处于运行状态，并有必要的基础设施，如备用应急车。系统测试不可用。SBA访谈确定，除败血症和肠炎外，危险体征和症状均已识别。所有专业助理都承认接受过理论和“实践”培训，并定期参加分娩。根据产妇记录，产前保健基本要素的得分很高（>90%），例如提供补充剂、记录风险因素以及定期和正确使用产程图。观察到的良好临床实践包括：支持人员在场;第三阶段的积极管理;产后监测;以及立即和正确的新生儿护理。观察到的不正确做法包括：不适当的控制脐带牵引;洗手不充分;未产妇的会阴切开率为49%（34/70），出生后第一个小时内新生儿监测率低30%（6/20）。在劳动和分娩过程中观察到的并发症是低与产后出血是最常见的，在这种情况下，SBAs遵循的协议，但缓慢认识到严重程度，并采取action.Conclusions：在诊所的SMRU在Mae La难民营，SBAs能够遵守循证指南，但需要支持，以提高护理质量在特定领域。世卫组织安全孕产需求评估的结构使人们能够对分娩期间护理的质量有深刻的了解，特别是通过直接观察，确定了提高质量的明确途径。
Background: Increasing the number of women birthing with skilled birth attendants (SBAs) as one of the strategies to reduce maternal mortality and morbidity must be partnered with a minimum standard of care. This manuscript describes the quality of intrapartum care provided by SBAs in Mae La camp, a low resource, protracted refugee context on the Thai-Myanmar border.Methods: In the obstetric department of Shoklo Malaria Research Unit (SMRU) the standardized WHO Safe Motherhood Needs Assessment tool was adapted to the setting and used: to assess the facility; interview SBAs; collect data from maternal records during a one year period (August 2007 -2008); and observe practice during labour and childbirth.Results: The facility assessment recorded no 'out of stock' or 'out of date' drugs and supplies, equipment was in operating order and necessary infrastructure e.g. a stand-by emergency car, was present. Syphilis testing was not available. SBA interviews established that danger signs and symptoms were recognized except for sepsis and endometritis. All SBAs acknowledged receiving theoretical and 'hands-on' training and regularly attended deliveries. Scores for the essential elements of antenatal care from maternal records were high (>90%) e.g. providing supplements, recording risk factors as well as regular and correct partogram use. Observed good clinical practice included: presence of a support person; active management of third stage; post-partum monitoring; and immediate and correct neonatal care. Observed incorrect practice included: improper controlled cord traction; inadequate hand washing; an episiotomy rate in nulliparous women 49% (34/70) and low rates 30% (6/20) of newborn monitoring in the first hours following birth. Overall observed complications during labour and birth were low with post-partum haemorrhage being the most common in which case the SBAs followed the protocol but were slow to recognize severity and take action.Conclusions: In the clinic of SMRU in Mae La refugee camp, SBAs were able to comply with evidence-based guidelines but support to improve quality of care in specific areas is required. The structure of the WHO Safe Motherhood Needs Assessment allowed significant insights into the quality of intrapartum care particularly through direct observation, identifying a clear pathway for quality improvement.