虽然在许多低资源环境中,设施出生率正在增加,护理质量往往没有跟上;孕产妇和围产期死亡率和发病率仍然高得令人无法接受。因此,现实的,在资源有限的情况下,必须根据具体情况提供临床支持,以协助助产士提供尽可能好的循证和尊重的护理.我们在桑给巴尔的初步研究表明,共同创建临床实践指南(CPG)和低剂量,高频训练(PartoMa干预)与改善分娩护理和生存率相关.我们现在的目标是修改,工具,并在五个大批量中评估这种多方面的干预措施,达累斯萨拉姆的城市产科,坦桑尼亚(每年约60000人出生)。这项PartoMa扩展研究将包括四个主要步骤:I.混合方法情境分析探索影响护理的因素;II。共同创建了对试点CPG和培训的上下文修改,基于步骤I;III.修改后的干预措施的实施和评估;IV.制定共同创建特定环境的CPG和培训的框架,在可比领域具有相关性。实施和评价设计是以理论为基础的,嵌入定性和经济评估的楔形集群随机试验。积极分娩的妇女及其后代将被跟踪,直到出院,以评估提供和经验丰富的护理,医院内围产期死亡,阿普加得分,和可能避免的剖腹产。助产士的感知,将分析干预使用和可能的相关学习。此外,正如所附文章中进一步详细说明的那样,定性的深入调查将探索行为,生物医学,以及可能与非线性和倍增效应相互作用的结构要素,以塑造医疗服务提供者的临床实践。最后,计算共同创建和实施PartoMa干预的增量成本效益。在现有卫生系统中按实际情况调整的CPG和培训的实际规模扩大,可以全面了解影响是如何实现的,以及它如何在上下文和持续之间转换。试验注册号:NCT04685668。
While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice
guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants\' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers\' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained.Trial registration number: NCT04685668.