背景:全世界大约15%的新生儿在怀孕期间会出现危及生命的并发症,delivery,或产后。产科和新生儿护理综合应急管理(CEmONC)旨在作为孕产妇保健服务的措施之一,以减轻分娩并发症的高负担。然而,其实施保真度的状态还没有得到很好的调查。因此,这项研究旨在评估贡达尔大学综合专科医院CEMONC服务的实施保真度,埃塞俄比亚。
方法:采用嵌入混合方法的案例研究设计。坚持,交货质量,本次评估使用了卡罗尔概念框架中的参与者反应性维度。四百四次离职面谈,进行了423次回顾性文件审查和10个关键信息提供者。此外,拟合二元逻辑回归模型。定性数据被转录,翻译,编码,并采用专题分析方法进行分析。根据预先设定的判断标准来判断CEmONC的总体实施保真度。
结果:总体上,CEMONC服务的实施保真度为75.5%。交货质量,参与者反应性和依从性为72.7%,分别为76.6%和77.2%。与推荐的方案相比,肠胃外抗生素和去除残留产品等信号功能的执行不足,关键的线人访谈也证明了这一点。医疗保健提供者对客户的尊重程度较低。年龄≥35岁(AOR=0.48,95%CI:0.24,0.98),大专及以上学历(AOR=2.61,95%CI:1.46,4.66),政府雇员(AOR=1.85,95%CI:1.08,3.18),进行ANC随访(AOR=5.50,95%CI:1.83,16.47)和大量多胎(AOR=2.17,95%CI:1.08,4.38)是与参与者对服务的反应性显著相关的因素.
结论:以良好的保真度实现了CEMONC服务的整体实现保真度。此外,交付质量被判定为公平保真实施。发现肠胃外抗生素和残留产物的去除没有充分进行。对客户的尊重不够。因此,建议充分提供肠胃外抗生素药物,并应促进对医疗保健提供者进行有关同情和尊重护理的培训。此外,强烈建议医疗保健提供者遵守推荐的指南。
BACKGROUND: Approximately 15% of births worldwide result in life-threatening complications during pregnancy, delivery, or postpartum. Comprehensive Emergency Management of Obstetric and Newborn Care (CEmONC) is intended as one of the measures for maternal healthcare services to reduce the high burden with regard to childbirth complications. However, its state of implementation fidelity has not been well investigated. Therefore, this study aimed to evaluate the implementation fidelity of CEmONC services at University of Gondar Comprehensive Specialized Hospital, Ethiopia.
METHODS: A case-study design with an embedded mixed method was employed. Adherence, quality of delivery, and participant responsiveness dimensions from Carroll\'s conceptual framework were used in this evaluation. Four hundred four exit interviews, 423 retrospective document reviews and 10 key informants were conducted. Moreover, a binary logistic regression model was fitted. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall implementation fidelity of the CEmONC was judged based on the pre-seated judgmental criteria.
RESULTS: Overall the implementation fidelity of the CEmONC service was 75.5%. Quality of delivery, participant responsiveness and adherence were 72.7%, 76.6% and 77.2% respectively. Signal functions like parenteral antibiotics and removal of retained products were insufficiently performed against the recommended protocols which was also evidenced by the key informant interviews. Healthcare providers\' respect for the clients was less. Age ≥ 35 years (AOR = 0.48, 95% CI: 0.24,0.98), educational status of college and above (AOR = 2.61, 95% CI: 1.46,4.66), being government employed (AOR = 1.85, 95% CI: 1.08,3.18), having ANC follow-up (AOR = 5.50, 95% CI: 1.83, 16.47) and grand multigravida (AOR = 2.17, 95% CI: 1.08, 4.38) were factors significantly associated with participant responsiveness towards the services.
CONCLUSIONS: The overall implementation fidelity of the CEmONC services was implemented in good fidelity. Moreover, the quality of delivery was judged as implemented in fair fidelity. Parenteral antibiotics and removal of retained products were not found to be sufficiently performed. Respect for the clients was insufficiently delivered. Therefore, it is recommended that parenteral antibiotics drugs be adequately provided and training for healthcare providers regarding compassionate and respectful care shall be facilitated. Moreover, healthcare providers are strongly recommended to adhere to the recommended guidelines.