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Abstract：
BACKGROUND: Considering the high maternal mortality rate, the government of Pakistan has deployed Community Midwives (CMWs) in rural areas of Pakistan. This relatively new cadre of community-based skilled birth attendants has previously reported to experience several challenges in providing maternal and child healthcare. However, what barriers they experience in providing basic emergency obstetric and newborn care needs to be further studied.
METHODS: This was a cross-sectional study conducted in twelve districts in Sindh province, Pakistan, with poor maternal and child health indicators. A total of 258 CMWs participated in this study and completed the questionnaire on a pretested, validated tool in their community-based stations. The trained data collectors completed the questionnaires from the respondents. The problems identified were categorized into three major issues: financial, and transport and security related; and were analyzed accordingly. Ethical approval was obtained from the institutional review board (IRB) of Health Services Academy (HSA) Islamabad, Pakistan.
RESULTS: The majority (90%) of 258 CMWs had formal training in maternal and neonatal care from the recognized institutions. Financial difficulties faced by CMWs were identified as the most frequent barriers and others were transport, security, and other issues. In univariate analysis, 38.1% and 61.9% of the community midwives who faced financial difficulties had completed a graduation or intermediate level of education, respectively (p = 0.006). Round-the-clock availability for emergencies was inversely associated with having financial difficulties, i.e., 71.4%, in contrast to 28.4% who had financial difficulties were available round-the-clock for emergency calls in their community clinics (p = 0.008). Formal training (p = 0.001), work experience (p = 0.015), longer duration of work (p = 0.003), and liaison with health workers and posting district (p = 0.001) had statistically significantly higher transport related issues. Security difficulties faced by CMWs and a set of correlates such as formal training (p = 0.019), working experience (p = 0.001), longer duration of work (p = 0.023), 24 h of availability on call (p = 0.004), liaison with traditional birth attendants (TBAs) in the community (p = 0.002), and district of posting (p = 0.001) were statistically significantly different. Other issues like working experience (p = < 0.001) and Liaison with TBAs in the community (p = < 0.001) were found statistically significant.
CONCLUSIONS: Financial, transportation and security related barriers were commonly reported by community midwives in the delivery of basic emergency obstetric and newborn care in rural Pakistan.
METHODS: This was a cross-sectional study conducted in twelve districts in Sindh province, Pakistan, with poor maternal and child health indicators. A total of 258 CMWs participated in this study and completed the questionnaire on a pretested, validated tool in their community-based stations. The trained data collectors completed the questionnaires from the respondents. The problems identified were categorized into three major issues: financial, and transport and security related; and were analyzed accordingly. Ethical approval was obtained from the institutional review board (IRB) of Health Services Academy (HSA) Islamabad, Pakistan.
RESULTS: The majority (90%) of 258 CMWs had formal training in maternal and neonatal care from the recognized institutions. Financial difficulties faced by CMWs were identified as the most frequent barriers and others were transport, security, and other issues. In univariate analysis, 38.1% and 61.9% of the community midwives who faced financial difficulties had completed a graduation or intermediate level of education, respectively (p = 0.006). Round-the-clock availability for emergencies was inversely associated with having financial difficulties, i.e., 71.4%, in contrast to 28.4% who had financial difficulties were available round-the-clock for emergency calls in their community clinics (p = 0.008). Formal training (p = 0.001), work experience (p = 0.015), longer duration of work (p = 0.003), and liaison with health workers and posting district (p = 0.001) had statistically significantly higher transport related issues. Security difficulties faced by CMWs and a set of correlates such as formal training (p = 0.019), working experience (p = 0.001), longer duration of work (p = 0.023), 24 h of availability on call (p = 0.004), liaison with traditional birth attendants (TBAs) in the community (p = 0.002), and district of posting (p = 0.001) were statistically significantly different. Other issues like working experience (p = < 0.001) and Liaison with TBAs in the community (p = < 0.001) were found statistically significant.
CONCLUSIONS: Financial, transportation and security related barriers were commonly reported by community midwives in the delivery of basic emergency obstetric and newborn care in rural Pakistan.
摘要：
背景：考虑到产妇死亡率高，巴基斯坦政府已在巴基斯坦农村地区部署了社区助产士（CMW）。这个相对较新的以社区为基础的熟练助产士干部以前曾报道过在提供母婴保健方面遇到过一些挑战。然而,他们在提供基本急诊产科和新生儿护理方面遇到的障碍需要进一步研究。
方法：这是一项在信德省12个地区进行的横断面研究，巴基斯坦,母婴健康指标差。共有258名CMW参加了这项研究，并完成了一份预先测试的问卷，在他们基于社区的站点中使用经过验证的工具。经过培训的数据收集者完成了受访者的问卷。发现的问题分为三个主要问题：财务，与运输和安全相关；并进行了相应的分析。从伊斯兰堡卫生服务学院（HSA）的机构审查委员会（IRB）获得了道德批准，巴基斯坦。
结果：258名CMW中的大多数（90％）接受了来自公认机构的孕产妇和新生儿护理的正规培训。CMW面临的财务困难被认为是最常见的障碍，其他障碍是运输，安全,和其他问题。在单变量分析中，在经济困难的社区助产士中,有38.1%及61.9%完成毕业或中级教育,分别(p=0.006)。全天候提供紧急情况与财政困难成反比，即，71.4%,相比之下，有经济困难的28.4%的人可以在社区诊所全天候拨打紧急电话(p=0.008)。正式训练（p=0.001），工作经验（p=0.015），较长的工作时间（p=0.003），与卫生工作者和邮政区的联络(p=0.001)在统计学上显著高于与交通相关的问题。CMW面临的安全困难和一系列相关因素，如正式培训(p=0.019)，工作经验（p=0.001），较长的工作时间（p=0.023），24小时待命(p=0.004)，与社区传统助产士(TBA)的联络(p=0.002)，和发布地区（p=0.001）在统计学上有显着差异。其他问题，如工作经验（p=<0.001）和与社区TBA的联系（p=<0.001），具有统计学意义。
结论：财务，在巴基斯坦农村地区,社区助产士在提供基本紧急产科和新生儿护理时,普遍报告了与交通和安全相关的障碍.
方法：这是一项在信德省12个地区进行的横断面研究，巴基斯坦,母婴健康指标差。共有258名CMW参加了这项研究，并完成了一份预先测试的问卷，在他们基于社区的站点中使用经过验证的工具。经过培训的数据收集者完成了受访者的问卷。发现的问题分为三个主要问题：财务，与运输和安全相关；并进行了相应的分析。从伊斯兰堡卫生服务学院（HSA）的机构审查委员会（IRB）获得了道德批准，巴基斯坦。
结果：258名CMW中的大多数（90％）接受了来自公认机构的孕产妇和新生儿护理的正规培训。CMW面临的财务困难被认为是最常见的障碍，其他障碍是运输，安全,和其他问题。在单变量分析中，在经济困难的社区助产士中,有38.1%及61.9%完成毕业或中级教育,分别(p=0.006)。全天候提供紧急情况与财政困难成反比，即，71.4%,相比之下，有经济困难的28.4%的人可以在社区诊所全天候拨打紧急电话(p=0.008)。正式训练（p=0.001），工作经验（p=0.015），较长的工作时间（p=0.003），与卫生工作者和邮政区的联络(p=0.001)在统计学上显著高于与交通相关的问题。CMW面临的安全困难和一系列相关因素，如正式培训(p=0.019)，工作经验（p=0.001），较长的工作时间（p=0.023），24小时待命(p=0.004)，与社区传统助产士(TBA)的联络(p=0.002)，和发布地区（p=0.001）在统计学上有显着差异。其他问题，如工作经验（p=<0.001）和与社区TBA的联系（p=<0.001），具有统计学意义。
结论：财务，在巴基斯坦农村地区,社区助产士在提供基本紧急产科和新生儿护理时,普遍报告了与交通和安全相关的障碍.
