Mentoring and measurement for better maternal and newborn survival: developing an intervention to put accountability into practice in Tanzania

指导和衡量以提高孕产妇和新生儿的生存率：制定干预措施，在坦桑尼亚将问责制付诸实践

• 批准号: MR/N003985/1
• 负责人: Joanna Schellenberg
• 金额: $ 12.66万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2015
• 资助国家: 英国
• 起止时间: 2015 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN003985%2F1
• 关键词: Mentoring; measurement; better; maternal; newborn

Illness and death in pregnancy and childbirth are a major health problems in many low-income countries. In sub-Saharan Africa every year 179 000 women and over one million babies die around the time of childbirth. Maternal mortality ratios are high at 500 per 100 000 livebirths and newborn mortality at 30 per 1000: in Tanzania for every 200 babies born, one woman dies in childbirth and six babies do not survive the first four weeks of life. The most common cause of maternal death is severe bleeding, which can happen quickly just after the baby is born. Other common causes of death are related to hypertension and infection, including sepsis, malaria, HIV and anaemia. Many babies die because childbirth care is poor or because the mother has an infection in pregnancy which means the baby is premature, which means born too soon. Simple, low-cost ways to tackle these issues are available, and most are affordable even in low-resource settings. However, many women and children simply do not get the interventions they need, particularly during labour, childbirth, and the first few hours of the baby's life. For example, a woman with a life-threatening complication might not find a skilled health care worker to deliver the baby because trained health staff are either absent or busy with other work. Vital equipment might have broken down and be unrepaired, and drugs and supplies may be out of stock. There may be no mechanism to ensure that equipment, drugs and supplies are always available and weak leadership might lead to a culture of frustration or resignation among health staff. Maternal and perinatal deaths reviews have helped to reduce maternal deaths in the United Kingdom. Death reviews and other quality improvement approaches can stimulate changes in management and support structures so that equipment, supplies and drugs together with skilled professionals are always available for women in need. For more than a decade, the World Health Organization has promoted the use of death reviews to reduce maternal mortality. In Tanzania, however, death reviews are not done systematically or at scale. They are often based on deaths in hospital, while most maternal deaths occur in the community. And reviews often conclude that the woman herself was to blame rather than identifying areas for improvement under the control of the health staff which can be followed up to see whether the change results in improvement. In order to improve quality of care, a review system needs skills including mentoring, communication, analysis and intersectoral collaboration. The new WHO approach of "maternal death surveillance and response" aims to address these weaknesses and emphasizes 1) death surveillance at the community level, 2) analysis of trends, causes, risk factors and underlying causes of deaths and 3) the use of data to adapt local and national strategies. Careful adaptation and a link to mentoring is needed to develop a sustainable surveillance and response approach in Tanzania that is both embedded in the health system and designed for subsequent implementation on a national scale. We will support the Tanzanian government in preparing, supporting and piloting an adapted and scalable maternal and perinatal death surveillance and response approach based on mentoring and measurement. Our work will include synthesising evidence on direct causes and underlying factors for maternal and newborn deaths, and developing a way to find out about, and act on, all maternal and newborn deaths.

怀孕和分娩期间的疾病和死亡是许多低收入国家的主要健康问题。在撒哈拉以南非洲地区，每年有 179 000 名妇女和超过 100 万婴儿在分娩期间死亡。孕产妇死亡率高达每 10 万例活产儿 500 例，新生儿死亡率高达每 1000 例 30 例：在坦桑尼亚，每 200 名婴儿出生，就有 1 名妇女在分娩过程中死亡，6 名婴儿在出生后的前 4 周内无法存活。孕产妇死亡最常见的原因是严重出血，这种情况可能在婴儿出生后很快发生。其他常见死因与高血压和感染有关，包括败血症、疟疾、艾滋病毒和贫血。许多婴儿死亡是因为分娩护理不佳，或者是因为母亲在怀孕期间感染，这意味着婴儿早产，这意味着出生得太早。解决这些问题的简单、低成本的方法是可行的，而且即使在资源匮乏的环境中，大多数方法也是可以承受的。然而，许多妇女和儿童根本得不到所需的干预措施，特别是在临产、分娩和婴儿出生后的最初几个小时。例如，一名患有危及生命的并发症的妇女可能找不到熟练的医护人员来接生，因为训练有素的医护人员要么缺席，要么忙于其他工作。重要设备可能已损坏且无法修复，药品和用品可能缺货。可能没有任何机制来确保设备、药品和用品始终可用，领导力薄弱可能会导致卫生工作人员产生沮丧或辞职的文化。孕产妇和围产期死亡审查有助于减少英国的孕产妇死亡率。死亡审查和其他质量改进方法可以刺激管理和支持结构的变化，以便始终为有需要的妇女提供设备、用品和药品以及熟练的专业人员。十多年来，世界卫生组织一直在推广使用死亡审查来降低孕产妇死亡率。然而，在坦桑尼亚，死亡审查并未系统或大规模地进行。它们通常基于医院内的死亡，而大多数孕产妇死亡发生在社区。评论常常得出结论，认为女性自己应该受到责备，而不是在卫生人员的控制下确定需要改进的领域，然后进行跟进，看看这些改变是否会带来改善。为了提高护理质量，审查系统需要包括指导、沟通、分析和部门间协作等技能。世卫组织“孕产妇死亡监测和应对”新方法旨在解决这些弱点，并强调 1) 社区一级的死亡监测，2) 分析死亡趋势、原因、风险因素和根本原因，以及 3) 使用数据来调整地方和国家战略。在坦桑尼亚，需要仔细调整并与指导联系起来，制定可持续的监测和应对方法，该方法既嵌入卫生系统，又旨在随后在全国范围内实施。我们将支持坦桑尼亚政府准备、支持和试点基于指导和测量的适应性和可扩展的孕产妇和围产期死亡监测和应对方法。我们的工作将包括综合关于孕产妇和新生儿死亡的直接原因和根本因素的证据，并开发一种方法来查明所有孕产妇和新生儿死亡并采取行动。