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: 10214860
• 负责人: margo Shawn harrison
• 金额: $ 18.79万
• 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 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10214860
• 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; Human; 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; 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; 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.

项目概要/摘要 当有医学指征时，剖腹产可以挽救孕产妇、胎儿和新生儿的生命。从历史上看，世界 卫生组织 (WHO) 建议全球剖腹产率为 10% 至 15% 人口；一些作者建议 9 – 19% 更为合适。因此，作为一种基于证据的干预措施 为了防止不良妊娠结局，剖腹产率低于 2%，西南农村地区的情况就是如此 埃塞俄比亚是一个不可接受的公共卫生问题。低剖腹产率困扰着许多亚健康地区 撒哈拉非洲，因此埃塞俄比亚西南部农村的背景可能可以推广到许多其他环境 剖腹产率低得令人难以接受。正确使用剖腹产作为干预措施的障碍 预防撒哈拉以南非洲地区发病率和死亡率的措施包括“三个延迟模型”所描述的措施：1) 延迟做出寻求护理的决定，2) 延迟获得适当的紧急产科护理，以及 3) 到达设施后得到足够的护理。来自西南地区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 对于许多妇女来说“几乎不可能”获得必要的紧急产科护理。 目前尚无干预措施确定为服务不足的农村地区提供剖腹产的最有效方法 和撒哈拉以南非洲资源匮乏地区，尽管“三个延迟”模型发布了 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。 非洲大陆广大地区出现三次延误。移动手术台已成功应用于拉丁语 美国提供妇科手术，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配备装备齐全的帐篷。我们的首要假设是：1）剖腹产 埃塞俄比亚农村地区的手术差异可以通过实施一种新颖的、基于移动社区的 由中级提供者组成的剖腹产中心，以及 2) 我们将使用的实施前方法 探索（AIM 1）、准备（AIM 2）和设计（AIM 2）最终实施、传播和推广的中心 适应将推广到撒哈拉以南非洲的其他环境和/或手术差异，并可能 全球。这项拟议的工作将会产生影响，因为它研究了如何最好地在以下地区进行剖腹产： 世界上从未有过这种挽救生命的手术的人。它将促进该领域的知识 实施科学，因为它研究一种新颖且创新的临床解决方案的预实施 使用 EPIS 框架的探索和准备方面的剖宫产出生差异以及实施 这些方法可以推广到高度创新、分散、 务实的解决方案可能是必要的。