Improving uptake of delivery care services in rural Tanzania through demand creation, ambulance transport and quality of care: a feasibility study

通过创造需求、救护车运输和护理质量提高坦桑尼亚农村地区分娩护理服务的采用：可行性研究

• 批准号: MR/N028481/1
• 负责人: Christian Hansen
• 金额: $ 18.63万
• 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: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN028481%2F1
• 关键词: Improving; uptake; delivery; care; services

This is a proposal for a trial development and feasibility study for a complex intervention to improve pregnancy- and birth-related maternal and neonatal health outcomes in rural Tanzania.The intervention aims to prevent emergencies in pregnancy and childbirth by increasing uptake of antenatal and delivery care services in rural Tanzania. Progress has been much too slow towards reducing the high rates of avoidable pregnancy- and birth-related deaths that persist in the region despite 2015 marking the end of the MDG era, which helped place maternal and newborn health on the global agenda. More research is urgently needed to address this important public health issue. The high rates of adverse birth outcomes can largely be attributed to a handful of common complications during pregnancy and labour which are in principle trivially avoided or resolved given adequate antenatal and delivery care. The central barriers to increased uptake of facility-based delivery care are, (1) a lack of awareness of the importance of delivering with assistance from skilled birth attendants, (2) limited access to transport for women in labour, and (3) inadequate quality of delivery care in rural facilities with outdated midwifery skills among many health workers and a lack of essential equipment and consumables, poor supervision structures and inadequate procedures for timely referral to larger facilities.Our intervention consists of the following main components: (1) Campaigning in the community to raise awareness among women and their families of the importance of delivering with skilled birth attendants (which in rural Africa is only available in health facilities). (2) A free-of-charge telephone hotline to the nearest Health Centre (HC) to arrange transport at onset of labour or in case of emergency. (3) Free-of-charge transport for women in labour to the nearest HC using locally produced low-cost motorcycle-drawn ambulance trailers. (4) Strengthening of essential midwifery skills in local HCs thus improving the reputation of the care they provide.To date no feasible, cost-effective intervention has been demonstrated to simultaneously address each of the major barriers to care and improve 'hard' pregnancy outcomes. Robust evidence is needed of a scalable, affordable intervention with a sustained effect. The definitive evaluation in a main trial will estimate effectiveness and cost-effectiveness of the intervention in improving maternal and neonatal health outcomes in a cluster randomised trial with clusters comprising rural HCs and the communities (wards) they serve. The proposed early-phase study is required to strengthen the intervention, generate evidence on its feasibility, and allow us to perfect the design of the evaluation in the main trial. The objectives of this early phase study are:(-) to conduct formative research to feed into the design of the intervention, and to improve participation from potential study participants in the development of the intervention. (-)incorporating observations from the formative research phase, to finalise all aspects of the intervention components and produce a set of standard operating procedures and intervention manuals.(-) to pilot the intervention in its entirety which will help identify and resolve unforeseen challenges, facilitate operational research to evaluate process measures and feasibility of all individual aspects of the intervention.(-)to obtain preliminary indicators as to how successful the intervention is likely to be in creating increased demand for facility-based delivery care.(-)to establish and test the feasibility of survey techniques planned for the main study.

这是一项为改善坦桑尼亚农村地区与怀孕和分娩有关的孕产妇和新生儿健康结果而进行的综合干预措施的试验性开发和可行性研究提案，旨在通过增加坦桑尼亚农村地区产前和分娩护理服务的使用，预防怀孕和分娩中的紧急情况。尽管2015年标志着千年发展目标时代的结束，这有助于将孕产妇和新生儿健康纳入全球议程，但在降低本区域持续存在的可避免的妊娠和出生相关死亡率方面，进展过于缓慢。迫切需要更多的研究来解决这一重要的公共卫生问题。不良分娩结果的高发生率主要是由于怀孕和分娩期间的一些常见并发症，这些并发症原则上可以通过适当的产前和分娩护理加以避免或解决。增加接受基于设施的分娩护理的主要障碍是：（1）缺乏对在熟练助产士协助下分娩的重要性的认识，（2）分娩妇女获得交通工具的机会有限，（3）农村设施的分娩护理质量不足，许多卫生工作者的助产技能过时，缺乏必要的设备和消耗品，我们的干预措施包括以下主要组成部分：（1）在社区开展运动，提高妇女及其家庭对由熟练助产士接生的重要性的认识（在非洲农村，只有卫生设施才有这种服务）。(2)免费拨打最近的保健中心热线，以便在分娩开始时或紧急情况下安排运输。(3)使用当地生产的低成本摩托车牵引的救护车拖车，免费将分娩妇女送往最近的卫生中心。(4)加强当地保健中心的基本助产技能，从而提高它们提供的护理的声誉。迄今为止，还没有可行的、具有成本效益的干预措施被证明可以同时解决护理的每一个主要障碍并改善“困难”妊娠结局。需要有强有力的证据来证明一种可扩展的、负担得起的、具有持续效果的干预措施。在一项主要试验中的明确评价将评估干预措施在改善孕产妇和新生儿健康结局方面的有效性和成本效益，该试验是一项随机分组试验，包括农村卫生中心及其服务的社区（病房）。建议的早期研究需要加强干预，为其可行性提供证据，并允许我们完善主试验中的评价设计。本早期研究的目的是：（-）进行形成性研究，以纳入干预措施的设计，并提高潜在研究参与者对干预措施开发的参与。（-）结合形成性研究阶段的观察结果，最终确定干预组成部分的各个方面，并制定一套标准操作程序和干预手册。(-)对整个干预措施进行试点，这将有助于确定和解决不可预见的挑战，促进业务研究，以评估过程措施和干预措施各个方面的可行性。(-)to获得初步指标，说明干预措施在增加对基于设施的分娩护理的需求方面可能取得多大成功。(-)to确定并测试主要研究计划采用的调查技术的可行性。