背景:在医疗机构提供优质产科护理对于降低孕产妇死亡率至关重要,但是仅仅增加设施中的分娩是不够的,有证据表明,撒哈拉以南非洲的许多设施甚至没有满足安全分娩护理的基本要求。关于是否推荐医院分娩政策的争论正在进行中,在人员配备和能力可能更好的地方,在较低级别的设施上,它们离妇女的家更近,更容易进入。对利比里亚分娩护理的质量知之甚少,近几十年来,设施出生人数有所增加,但是孕产妇死亡率仍然是世界上最高的。我们会分析急救及转诊准备情况的质量,人员配备,和出生的数量。
方法:我们使用三个数据源评估了利比里亚卫生系统在分娩期间提供安全护理的准备情况:人口与健康调查(DHS),服务可用性和就绪性评估(SARA)和健康管理信息系统(HMIS)。我们从3项DHS调查(2007年,2013年和2019-20年)中估计了按地点和人口剖腹产覆盖率划分的出生率趋势。我们通过分析SARA2018报告的紧急产科和新生儿护理信号功能(EMONC)和人员配备,并与HMIS2019报告的分娩量联系起来,检查了所有利比里亚医疗机构安全分娩护理的准备情况。
结果:在2004年至2017年期间,设施中的分娩百分比从37%增加到80%,而剖腹产率从3.3%增加到5.0%。18%的设施可以执行基本的EMONC信号功能,8%可以提供输血和剖腹产。总的来说,63%的设施出生在没有完全基本应急准备的地方。60%的设施无法进行紧急转介,54%的人每两天出生不到一次。
结论:设施分娩的比例随着时间的推移而增加,这是因为妇女在较低级别的设施分娩。然而,大多数设施的容量非常低,并且不能提供安全的EMONC,即使在基本层面。这给卫生系统带来了严峻的挑战,以确保安全,优质的分娩服务。
BACKGROUND: The provision of quality obstetric care in health facilities is central to reducing maternal mortality, but simply increasing childbirth in facilities not enough, with evidence that many facilities in sub-Saharan Africa do not fulfil even basic requirements for safe childbirth care. There is ongoing debate on whether to recommend a policy of birth in hospitals, where staffing and capacity may be better, over lower level facilities, which are closer to women\'s homes and more accessible. Little is known about the quality of childbirth care in Liberia, where facility births have increased in recent decades, but maternal mortality remains among the highest in the world. We will analyse quality in terms of readiness for emergency care and referral, staffing, and volume of births.
METHODS: We assessed the readiness of the Liberian health system to provide safe care during childbirth use using three data sources: Demographic and Health Surveys (DHS), Service Availability and Readiness Assessments (SARA), and the Health Management Information System (HMIS). We estimated trends in the percentage of births by location and population caesarean-section coverage from 3 DHS surveys (2007, 2013 and 2019-20). We examined readiness for safe childbirth care among all Liberian health facilities by analysing reported emergency obstetric and neonatal care signal functions (EmONC) and staffing from SARA 2018, and linking with volume of births reported in HMIS 2019.
RESULTS: The percentage of births in facilities increased from 37 to 80% between 2004 and 2017, while the caesarean section rate increased from 3.3 to 5.0%. 18% of facilities could carry out basic EmONC signal functions, and 8% could provide blood transfusion and caesarean section. Overall, 63% of facility births were in places without full basic emergency readiness. 60% of facilities could not make emergency referrals, and 54% had fewer than one birth every two days.
CONCLUSIONS: The increase in proportions of facility births over time occurred because women gave birth in lower-level facilities. However, most facilities are very low volume, and cannot provide safe EmONC, even at the basic level. This presents the health system with a serious challenge for assuring safe, good-quality childbirth services.