Methods for Understanding the Cesarean Birth Surgical Disparity in Rural Ethiopia and Considering a Mobile Cesarean Birth Center as a Solution

了解埃塞俄比亚农村地区剖腹产手术差异并考虑建立移动剖腹产中心作为解决方案的方法

• 批准号: 10366070
• 负责人: Brooke Dorsey Holliman
• 金额: $ 15万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-06 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10366070
• 关键词: Address; Administrator; Africa South of the Sahara; African; Birth; Birth Rate; Birthing Centers; Caring; Cesarean section; Clinical; Cluster randomized trial; Communities; Consensus; Country; Data; Decentralization; Emergency Situation; Ensure; Ethiopia; Evidence based intervention; Exploration Preparation Implementation and Sustainment; Fetal Death; Focus Groups; Funding; Future; Geography; Gynecologic; Gynecologic Surgical Procedures; Health; Hospitals; Improve Access; Income; Individual; Infant; International; Intervention; Interview; Knowledge; Latin America; Life; Maternal Mortality; Medical; Methods; Modeling; Morbidity - disease rate; Neonatal; Neonatal Mortality; Operative Surgical Procedures; Outcome; Participant; Periodicity; Phase; Physicians; Plague; Population; Pregnant Women; Preparation; Procedures; Process; Provider; Public Health; Publishing; Research; Resource-limited setting; Resources; Rural; Savings; Structure; Testing; War; Woman; Work; World Health Organization; adverse pregnancy outcome; base; biomedical referral center; care delivery; care seeking; design; disability; effectiveness implementation study; experience; fetal; frontier; health care delivery; human centered design; implementation science; implementation strategy; innovation; interest; member; mortality; multidisciplinary; neglect; neonatal death; novel; obstetric care; prevent; rural area; rural underserved; surgical disparities; sustainability framework; treatment comparison; underserved area; virtual

Project Summary/Abstract When medically indicated, cesarean birth saves maternal, fetal, and neonatal lives. Historically, the World Health Organization (WHO) recommends a 10 – 15% population cesarean birth rate, among all global populations; some authors suggest 9 – 19% is more appropriate. Therefore, as an evidence-based intervention to prevent adverse pregnancy outcomes, cesarean birth rates of under 2%, which is the case in rural Southwest Ethiopia, is an unacceptable public health problem. Low cesarean birth rates plague many regions of sub- Saharan Africa, so the context of rural Southwest Ethiopia is likely generalizable to many other settings that experience unacceptably low cesarean birth rates. Barriers to proper use of cesarean birth as an intervention to prevent morbidity and mortality in sub-Saharan Africa include those described by the Three Delays Model: 1) the delay in the decision to seek care, 2) the delay in reaching appropriate emergency obstetrical care, and 3) receiving adequate care when the facility is reached. Preliminary data from our target community in Southwest Ethiopia found that the Three Delays is representative of barriers to accessing cesarean birth, which make it “virtually impossible” for many women to reach essential emergency obstetric care. No intervention has yet determined the most effective way of delivering cesarean birth to rural underserved and low-resource regions of sub-Saharan Africa, even though the Three Delays model was published 25 years ago. As such, there is an implementation gap in determining how best to provide cesarean birth in the face of the Three Delays in vast regions of the African continent. Mobile surgical units have been successfully used in Latin America to deliver gynecologic surgery and Médecins Sans Frontières provides cesarean birth in surgically equipped tents in low-resource and war-torn settings. Our overarching hypotheses are: 1) the cesarean birth surgical disparity in rural Ethiopia can be addressed by the implementation of a novel, mobile community-based cesarean birth center staffed by mid-level providers, and 2) the pre-implementation methods we will use to explore (AIM 1), prepare (AIM 2), and design (AIM 2) the center for eventual implementation, dissemination, and adaptation will be generalizable to other settings and/or surgical disparities in sub-Saharan Africa and potentially globally. This proposed work will have impact because it studies how best to deliver cesarean birth to regions of the world that have not ever had access to this life-saving surgery. It will advance knowledge in the field of implementation science because it studies the pre-implementation of a novel and innovative clinical solution to a cesarean birth disparity using Exploration and Preparation aspects of the EPIS framework, and implementation methods that will be generalizable to other settings and conditions where highly innovative, decentralized, pragmatic solutions may be necessary.

项目摘要/摘要 当医学上表明时，剖宫产可挽救母校，胎儿和新生儿的生命。从历史上看，世界 在所有全球 人口；一些作者认为9 - 19％更合适。因此，作为循证干预 为了防止不良怀孕结局，剖宫产的出生率不到2％，在西南农村地区就是这种情况 埃塞俄比亚是一个不可接受的公共卫生问题。低剖宫产的出生率困扰着亚群的许多地区 撒哈拉非洲，因此，埃塞俄比亚西南部农村的背景可能会推广到许多其他环境中 经历低剖宫产的低剖宫产。正确使用剖宫产的障碍作为干预 防止撒哈拉以南非洲的发病率和死亡率包括三个延迟模型所描述的那些：1） 延迟寻求护理的决定，2）延迟获得适当的紧急产科护理； 3） 到达设施时，接受足够的护理。来自西南目标社区的初步数据 埃塞俄比亚发现，这三个延误代表了进入剖宫产的障碍，这使它成为 对于许多妇女来说，“几乎不可能”获得基本的紧急产科护理。 尚无干预措施确定将剖宫产分娩给农村贫乏的最有效方法 撒哈拉以南非洲的低资源地区，尽管这三个延迟模型已出版了25年 前。因此，在确定如何最好地提供剖宫产的情况下，存在一个实施差距 非洲大陆广阔地区的三个延误。移动手术单元已成功用于拉丁语 美国提供妇科手术和梅德金斯（Médecins） 在低资源和饱受战争折磨的环境中配备了数十个。我们的总体假设是：1）剖宫产 埃塞俄比亚粗糙的手术差异可以通过实施基于移动社区的新型，基于移动的社区来解决 剖宫产中心由中层提供者组成，2）我们将使用的预料前方法 探索（AIM 1），准备（AIM 2）和设计（AIM 2）事件实施，传播和 适应将推广到撒哈拉以南非洲的其他环境和/或手术差异 全球。这项拟议的工作将产生影响，因为它研究了如何最好地将剖宫产给 从未获得过这种挽救生命的手术的世界。它将推进在领域的知识 实施科学是因为它研究了一种新颖而创新的临床解决方案的预测 剖宫产的出生差异使用EPIS框架的探索和准备方面，并实施 可以推广到其他环境和条件的方法，这些环境和条件高度创新，分散， 务实的解决方案可能是必要的。

项目成果

A mobile cesarean birth center as a solution to improve access to surgical birth in rural Ethiopia: a mixed methods research protocol.

• DOI: 10.1186/s40814-021-00955-4
• 发表时间: 2021-12-15
• 期刊: Pilot and feasibility studies
• 影响因子: 1.7
• 作者: Harrison MS;Yarinbab T;Dorsey-Holliman B;Aarons GA;Betran AP;Goldenberg RL;Muldrow M
• 通讯作者: Muldrow M