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

项目概要/摘要 当有医学指征时，剖宫产可以挽救产妇、胎儿和新生儿的生命。历史上，世界 世界卫生组织（WHO）建议全球人口剖宫产率为10 - 15%， 一些作者认为9 - 19%更合适。因此，作为一种基于证据的干预措施， 防止不良妊娠结局，剖宫产率低于2%，这是西南农村的情况 埃塞俄比亚，是一个不可接受的公共卫生问题。剖腹产率低困扰着许多地区， 撒哈拉非洲，因此埃塞俄比亚西南部农村的背景可能适用于许多其他环境， 剖腹产率低得令人无法接受正确使用剖宫产作为干预措施的障碍， 在撒哈拉以南非洲，预防发病率和死亡率包括三个延迟模型所描述的那些：1） 延误寻求护理的决定，2）延误获得适当的紧急产科护理，以及3） 在到达该设施时得到适当的照顾。来自西南部目标社区的初步数据 埃塞俄比亚发现，三个延迟是获得剖腹产的障碍的代表，这使得它 许多妇女“几乎不可能”获得必要的产科急诊。 目前还没有任何干预措施确定对农村服务水平低下的妇女进行剖腹产的最有效方式 和撒哈拉以南非洲的低资源地区，即使三个延迟模型发表了25年， 前因此，在确定如何最好地提供剖腹产方面存在实施差距， 非洲大陆广大地区的三次延误。移动的手术装置已成功地用于拉丁美洲 美国提供妇科手术和无国界医生组织提供剖腹产手术 在资源匮乏和饱受战争蹂躏的环境中提供装备齐全的帐篷。我们的首要假设是：1）剖腹产 埃塞俄比亚农村地区的外科差异可以通过实施一种新的、基于移动的社区的 剖腹产中心配备中级供应商，和2）预实施的方法，我们将使用， 探索（AIM 1），准备（AIM 2）和设计（AIM 2）中心，以最终实施，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， 在全球这项拟议的工作将产生影响，因为它研究如何最好地提供剖腹产的地区， 世界上还没有机会接受这种救命手术的人。它将推动知识领域的发展， 实施科学，因为它研究了一种新颖的和创新的临床解决方案的预实施， 剖宫产率差距采用EPIS框架的探索和准备方面，并实施 方法，将推广到其他设置和条件，高度创新，分散， 可能需要务实的解决办法。

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.