背景：缺乏及时和高质量的紧急产科护理（EmOC）极大地增加了孕产妇的发病率和死亡率，特别是在低收入和中等收入国家（LMICs）。自2009年以来，全球准则，称为“手册”，已用于监视可用性，利用率，EMOC的质量。
目的：评估LMIC研究人员在评估EmOC方面的应用和经验。
方法：系统审查了多个同行评审文献数据库中关于LMIC的EmOC评估，自2009年。按照设定的标准，我们包括文章，根据新开发的清单评估质量，并使用预先设计的提取工具提取数据。我们使用主题摘要来浓缩我们的发现并绘制我们观察到的模式。分析改进EmOC评估的经验和建议，我们对框架综合采用了演绎的方法。
结果：27项研究符合我们的纳入标准，17被判定为高质量。发表频率最高的是在2015年。大多数评估是在尼日利亚和坦桑尼亚(各进行四项研究)以及孟加拉国和加纳(各进行三项)进行的。大多数研究（17）是在国家以下级别进行的，其中23项研究仅使用“手册”，而其他人则将“手册”与其他框架结合在一起。17项研究进行了基于设施的调查，而其他人则使用混合方法。由于不同的原因,EmOC机构的产时和极早期新生儿死亡率以及间接原因导致的死亡比例是报告最少的指标。新出现的关键主题表明，EmOC评估的数据质量可以提高，指标要细化,EMOC评估需要整体方法，评估应作为常规过程进行。
结论：有明确的理由审查如何进行EmOC评估。研究人员之间的协同作用，EmOC项目经理,和其他关键利益攸关方对改进评估至关重要，这将有助于加强问责制和最终提供服务。
BACKGROUND: Lack of timely and quality emergency obstetric care (EmOC) has contributed significantly to maternal morbidity and mortality, particularly in low- and middle-income countries (LMICs). Since 2009, the global
guideline, referred to as the \'handbook\', has been used to monitor availability, utilization, and quality of EmOC.
OBJECTIVE: To assess application and explore experiences of researchers in LMICs in assessing EmOC.
METHODS: Multiple databases of peer-reviewed literature were systematically reviewed on EmOC assessments in LMICs, since 2009. Following set criteria, we included articles, assessed for quality based on a newly developed checklist, and extracted data using a pre-designed extraction tool. We used thematic summaries to condense our findings and mapped patterns that we observed. To analyze experiences and recommendations for improved EmOC assessments, we took a deductive approach for the framework synthesis.
RESULTS: Twenty-seven studies met our inclusion criteria, with 17 judged as high quality. The highest publication frequency was observed in 2015. Most assessments were conducted in Nigeria and Tanzania (four studies each) and Bangladesh and Ghana (three each). Most studies (17) were done at subnational levels with 23 studies using the \'handbook\' alone, whereas the others combined the \'handbook\' with other frameworks. Seventeen studies conducted facility-based surveys, whereas others used mixed methods. For different reasons, intrapartum and very early neonatal death rate and proportion of deaths due to indirect causes in EmOC facilities were the least reported indicators. Key emerging themes indicate that data quality for EmOC assessments can be improved, indicators should be refined, a holistic approach is required for EmOC assessments, and assessments should be conducted as routine processes.
CONCLUSIONS: There is clear justification to review how EmOC assessments are being conducted. Synergy between researchers, EmOC program managers, and other key stakeholders would be critical for improved assessments, which would contribute to increased accountability and ultimately service provision.
PDF(Sci-hub)