背景:尽管全球在使卫生服务更接近人群方面取得了进展,母亲及其新生儿仍然接受不合格的护理,导致发病率和死亡率。卫生设施提供服务的能力是高质量医疗保健的先决条件。本研究旨在评估医疗机构是否准备好提供全面的产科和新生儿急诊护理(CEMONC),包括输血,剖腹产和基本服务,从而为改善坦桑尼亚的护理干预质量提供信息。
方法:在2020年12月至2021年1月期间,对坦桑尼亚五个地区实施“更安全出生捆绑医疗”的30个CEMONC医疗机构进行了横断面评估。我们采用了世界卫生组织的服务可用性和就绪性评估工具来评估便利设施,设备,训练有素的工作人员,指导方针,药物,和诊断设施。计算每个类别的综合准备度得分,并在医疗机构级别比较结果。对于分类变量,我们通过费舍尔的精确检验来测试差异;对于准备分数,通过线性混合模型分析检验了差异,考虑到区域内的依赖性。我们使用p<0.05作为我们的显著性水平。
结果:提供CEMONC的总体准备率为69.0%,地区医院其次是地区医院,明显更高。基本设施的平均准备率为78.9%,医疗设备占76.7%,诊断和治疗商品占76.0%,人员配备占63.6%,指导方针占50.0%。在各个卫生设施级别和各个设施级别之间,物品的可用性存在差异。我们发现基本设施的可用性存在显着差异,设备,人员配备,和地区之间的指导方针,以及地区医院和保健中心(p=0.05)。地区医院的医疗设备得分明显高于地区医院和卫生院(p=0.02)。在不同设施级别之间,诊断和治疗用商品的可用性没有显着差异。
结论:设施的准备工作不充分,并且在设施的不同级别之间存在差异。还有改进设施的空间,以提供优质的孕产妇和新生儿护理。负责当局应立即采取行动,解决观察到的缺陷,同时认真选择最有效和可行的干预措施,并监测准备情况的进展。
BACKGROUND: Despite the global progress in bringing health services closer to the population, mothers and their newborns still receive substandard care leading to morbidity and mortality. Health facilities\' capacity to deliver the service is a prerequisite for quality health care. This study aimed to assess health facilities\' readiness to provide comprehensive emergency
obstetric and newborn care (CEmONC), comprising of blood transfusion, caesarean section and basic services, and hence to inform improvement in the quality of care interventions in Tanzania.
METHODS: A cross-sectional assessment of 30 CEmONC health facilities implementing the Safer Births Bundle of Care package in five regions of Tanzania was carried out between December 2020 and January 2021. We adapted the World Health Organization\'s Service Availability and Readiness Assessment tool to assess amenities, equipment, trained staff, guidelines, medicines, and diagnostic facilities. Composite readiness scores were calculated for each category and results were compared at the health facility level. For categorical variables, we tested for differences by Fisher\'s exact test; for readiness scores, differences were tested by a linear mixed model analysis, taking into account dependencies within the regions. We used p < 0.05 as our level of significance.
RESULTS: The overall readiness to provide CEmONC was 69.0% and significantly higher for regional hospitals followed by district hospitals. Average readiness was 78.9% for basic amenities, 76.7% for medical equipment, 76.0% for diagnosis and treatment commodities, 63.6% for staffing and 50.0% for guidelines. There was a variation in the availability of items at the individual health facility level and across levels of facilities. We found a significant difference in the availability of basic amenities, equipment, staffing, and guidelines between regional, and district hospitals and health centres (p = 0.05). Regional hospitals had significantly higher scores of medical equipment than district hospitals and health centers (p = 0.02). There was no significant difference in the availability of commodities for diagnosis and treatment between different facility levels.
CONCLUSIONS: Facilities\' readiness was inadequate and varied across different levels of the facility. There is room to improve the facilities\' readiness to deliver quality maternal and newborn care. The responsible authorities should take immediate actions to address the observed deficiencies while carefully choosing the most effective and feasible interventions and monitoring progress in readiness.