PDF(Pubmed)
Abstract：
BACKGROUND: Abortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR).
METHODS: We mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals\' PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively.
RESULTS: Among the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time.
CONCLUSIONS: Our comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.
In humanitarian contexts, abortion complications are a leading cause of maternal mortality. Providing quality post-abortion care (PAC) is therefore an important part of needed services. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic). We measured quality indicators in four components: 1) an assessment of the equipment and human resources available in hospitals, 2) a survey of the knowledge, attitudes, practices, and behavior of clinicians providing PAC, 3) an assessment of the medical care provided by clinicians to women presenting with abortion complications and, 4) a survey of a subgroup of these women who were hospitalized. Both hospitals had almost all the equipment and human resources necessary to provide post-abortion care. Less than 2.5% of women received a non-recommended method to evacuate their uterus in both hospitals. More than 80% of women received a blood transfusion or antibiotics when they needed them. However, 30% of women received antibiotics without written justification and only 15% of women reported being able to ask questions about their treatment. Overall, only 65% of Nigerian women and 34% of Central African women said that the staff provided them with the best care all the time. The fact that less than 2% of women experienced a very severe complication 24 hours or more after their arrival at the two hospitals suggests that the care provided was lifesaving. But they urgently need to adopt a better patient-centered approach as well as to improve the rational management of antibiotics.
METHODS: We mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals\' PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively.
RESULTS: Among the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time.
CONCLUSIONS: Our comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.
In humanitarian contexts, abortion complications are a leading cause of maternal mortality. Providing quality post-abortion care (PAC) is therefore an important part of needed services. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic). We measured quality indicators in four components: 1) an assessment of the equipment and human resources available in hospitals, 2) a survey of the knowledge, attitudes, practices, and behavior of clinicians providing PAC, 3) an assessment of the medical care provided by clinicians to women presenting with abortion complications and, 4) a survey of a subgroup of these women who were hospitalized. Both hospitals had almost all the equipment and human resources necessary to provide post-abortion care. Less than 2.5% of women received a non-recommended method to evacuate their uterus in both hospitals. More than 80% of women received a blood transfusion or antibiotics when they needed them. However, 30% of women received antibiotics without written justification and only 15% of women reported being able to ask questions about their treatment. Overall, only 65% of Nigerian women and 34% of Central African women said that the staff provided them with the best care all the time. The fact that less than 2% of women experienced a very severe complication 24 hours or more after their arrival at the two hospitals suggests that the care provided was lifesaving. But they urgently need to adopt a better patient-centered approach as well as to improve the rational management of antibiotics.
摘要：
背景：流产相关并发症仍然是孕产妇死亡的主要原因。在人道主义环境中，几乎没有证据表明堕胎后护理（PAC）的可用性和质量。我们在吉加瓦州（尼日利亚）和班吉（中非共和国，汽车）。
方法：我们绘制了与世卫组织孕产妇和新生儿健康护理质量框架的11个领域相对应的指标，以评估投入。流程(提供和护理经验)，以及PAC的结果。我们在横断面多方法研究的四个组成部分中测量了这些指标：1)对医院的PAC信号功能的评估，2)知识调查，态度，实践,以及提供PAC的140名尼日利亚人和84名汽车临床医生的行为，3）对520和548名出现流产并发症的妇女的医疗记录进行前瞻性审查，4）对在尼日利亚和中非共和国医院住院的360和362名妇女进行了调查，分别。
结果：在评估的27个PAC信号功能中，尼日利亚医院有25人，CAR医院有26人。在两家医院，不到2.5%的患者接受扩张术和锐利刮治治疗。超过80％的妇女在需要时接受输血或治疗性抗生素。然而,约30%无明确指征的患者接受了抗生素治疗.在CAR的出院女性中，99％的人接受了避孕咨询，但在尼日利亚只有39％的人接受了避孕咨询。尼日利亚80%以上的妇女报告了尊重和维护尊严的积极经历。相反，在车上,37％的人报告说，他们的隐私在检查期间始终受到尊重，62％的人报告说，在见到健康提供者之前，等待时间很短或很短。在沟通方面,只有15%的人认为在两家医院的治疗过程中能够提问。介绍后≥24小时发生流产的风险在尼日利亚为0.2％，在CAR为1.1％。尼日利亚医院中只有65％的妇女和CAR医院中的34％的妇女报告说，工作人员一直为她们提供最佳护理。
结论：我们的综合评估确定，这两家医院在人道主义环境中提供了拯救生命的PAC。然而,医院需要加强以患者为中心的方法，让患者参与自己的护理并确保隐私，短的等待时间和高质量的提供者-患者沟通。卫生专业人员将受益于建立抗生素管理以防止抗生素耐药性。
在人道主义背景下，人工流产并发症是孕产妇死亡的主要原因。因此，提供优质的堕胎后护理（PAC）是所需服务的重要组成部分。我们在吉加瓦州（尼日利亚）和班吉（中非共和国）的一家国际组织支持的两家医院评估了PAC的质量。我们测量了四个组成部分的质量指标：1）对医院可用的设备和人力资源的评估，2)知识调查，态度，实践,以及提供PAC的临床医生的行为，3）评估临床医生为出现流产并发症的妇女提供的医疗服务，4）对这些住院妇女的一个亚组的调查。两家医院都拥有提供堕胎后护理所需的几乎所有设备和人力资源。在两家医院中，不到2.5％的妇女接受了非推荐的子宫排空方法。超过80％的妇女在需要时接受了输血或抗生素。然而,30％的女性在没有书面理由的情况下接受抗生素治疗，只有15％的女性报告能够询问有关其治疗的问题。总的来说,只有65%的尼日利亚妇女和34%的中非妇女表示，工作人员一直为她们提供最好的护理。不到2％的妇女在到达两家医院后24小时或更长时间出现非常严重的并发症，这一事实表明所提供的护理可以挽救生命。但他们迫切需要采取更好的以患者为中心的方法，并改善抗生素的合理管理。
方法：我们绘制了与世卫组织孕产妇和新生儿健康护理质量框架的11个领域相对应的指标，以评估投入。流程(提供和护理经验)，以及PAC的结果。我们在横断面多方法研究的四个组成部分中测量了这些指标：1)对医院的PAC信号功能的评估，2)知识调查，态度，实践,以及提供PAC的140名尼日利亚人和84名汽车临床医生的行为，3）对520和548名出现流产并发症的妇女的医疗记录进行前瞻性审查，4）对在尼日利亚和中非共和国医院住院的360和362名妇女进行了调查，分别。
结果：在评估的27个PAC信号功能中，尼日利亚医院有25人，CAR医院有26人。在两家医院，不到2.5%的患者接受扩张术和锐利刮治治疗。超过80％的妇女在需要时接受输血或治疗性抗生素。然而,约30%无明确指征的患者接受了抗生素治疗.在CAR的出院女性中，99％的人接受了避孕咨询，但在尼日利亚只有39％的人接受了避孕咨询。尼日利亚80%以上的妇女报告了尊重和维护尊严的积极经历。相反，在车上,37％的人报告说，他们的隐私在检查期间始终受到尊重，62％的人报告说，在见到健康提供者之前，等待时间很短或很短。在沟通方面,只有15%的人认为在两家医院的治疗过程中能够提问。介绍后≥24小时发生流产的风险在尼日利亚为0.2％，在CAR为1.1％。尼日利亚医院中只有65％的妇女和CAR医院中的34％的妇女报告说，工作人员一直为她们提供最佳护理。
结论：我们的综合评估确定，这两家医院在人道主义环境中提供了拯救生命的PAC。然而,医院需要加强以患者为中心的方法，让患者参与自己的护理并确保隐私，短的等待时间和高质量的提供者-患者沟通。卫生专业人员将受益于建立抗生素管理以防止抗生素耐药性。
在人道主义背景下，人工流产并发症是孕产妇死亡的主要原因。因此，提供优质的堕胎后护理（PAC）是所需服务的重要组成部分。我们在吉加瓦州（尼日利亚）和班吉（中非共和国）的一家国际组织支持的两家医院评估了PAC的质量。我们测量了四个组成部分的质量指标：1）对医院可用的设备和人力资源的评估，2)知识调查，态度，实践,以及提供PAC的临床医生的行为，3）评估临床医生为出现流产并发症的妇女提供的医疗服务，4）对这些住院妇女的一个亚组的调查。两家医院都拥有提供堕胎后护理所需的几乎所有设备和人力资源。在两家医院中，不到2.5％的妇女接受了非推荐的子宫排空方法。超过80％的妇女在需要时接受了输血或抗生素。然而,30％的女性在没有书面理由的情况下接受抗生素治疗，只有15％的女性报告能够询问有关其治疗的问题。总的来说,只有65%的尼日利亚妇女和34%的中非妇女表示，工作人员一直为她们提供最好的护理。不到2％的妇女在到达两家医院后24小时或更长时间出现非常严重的并发症，这一事实表明所提供的护理可以挽救生命。但他们迫切需要采取更好的以患者为中心的方法，并改善抗生素的合理管理。
