背景:COVID-19大流行扰乱了孟加拉国的孕产妇和新生儿保健服务,加剧了大流行之前存在的服务利用方面的巨大差距。作为回应的一部分,孟加拉国在孟加拉国64个地区中的五个地区的36个分区医院中,由助产士领导,启动了远程产前和产后护理远程医疗服务。基于性别的暴力筛查和转诊被纳入该服务,以解决该国大流行封锁后暴力上升的报告。
方法:使用混合方法实施研究来开发描述远程医疗计划的设计和实施的内在案例研究。定性分析包括文件审查,关键线人采访,和焦点小组讨论。定量分析采用了分段多变量回归的间断时间序列分析,以比较实施前后的产妇护理服务使用趋势。泊松回归分析用于检查基于性别的暴力远程筛查数量的趋势,会议举行,和确定的案件。
结果:在采用远程医疗后,观察到现场产前和产后护理以及因社区产后出血而在医院寻求护理的妇女的趋势发生了统计学上的显着变化。适当识别和管理的设施出生和子痫病例也有显著增加。此外,超过6917名女性接受了GBV筛查,223人接受了咨询,34人被推荐,在实施远程医疗计划后,频率随时间的统计显着增加。挑战包括并非所有助产士都采用GBV筛查,一些女性不愿意讨论GBV,在所有干预医院中引入患者就诊安排系统是意料之外的需要,由于缺乏访问或网络覆盖,许多妇女无法通过电话联系。
结论:由助产士领导的孕产妇健康和基于性别的暴力远程医疗是有效的,孟加拉国的低成本干预措施,以解决大流行和大流行前服务使用方面的差距。其他计划通过助产士实施远程孕产妇保健干预措施的低收入和中等收入国家应考虑是否需要引入患者就诊安排系统,以及围绕移动电话接入和连接的限制。未来的研究应包括护理质量的监督和改进,和更明智的策略,以促进有效的GBV筛查。
为了支持在大流行封锁后继续提供性健康和生殖健康服务,孟加拉国推出了由助产士主导的远程医疗计划。通过该计划,已经在卫生系统工作的助产士提供了远程产前和产后护理,包括基于性别的暴力筛查和转诊。该计划在孟加拉国64个地区中的5个地区的36个分区医院中开展。内部实施研究用于开发描述远程医疗计划的设计和实施的案例研究。定性和定量方法包括文件审查,关键线人采访,焦点小组讨论,和服务使用趋势。对数据的分析发现,大多数产妇护理服务的统计显着增长趋势。虽然随着时间的推移,它们确实显著增加,GBV的推荐低于预期,这可能与一些没有筛查GBV的助产士有关,和/或许多女性不愿讨论GBV。此外,在所有干预医院中引入患者就诊安排系统是意料之外的需要,由于缺乏访问或网络覆盖,许多妇女无法通过电话联系。尽管如此,6197名女性接受了GBV筛查。其中,223人接受了咨询,34人接受了转介。总的来说,由助产士领导的远程医疗是有效的,对孕产妇健康的低成本干预,并在孟加拉国朝着加强GBV反应迈出了一步。其他计划通过助产士实施远程孕产妇保健干预措施的低收入和中等收入国家应考虑在性别暴力筛查方面为提供者和妇女提供舒适所需的条件。以及有关引入调度系统和限制移动电话接入和连接的实际问题。
BACKGROUND: The COVID-19 pandemic disrupted maternal and newborn health services in Bangladesh, exacerbating the large gaps in service utilization that existed prior to the pandemic. As part of its response, Bangladesh initiated remote antenatal and postnatal care telemedicine services led by midwives in 36 sub-district hospitals across five of Bangladesh\'s 64 districts. Gender-based violence screening and referral were integrated into the service to address a reported rise in violence following the country\'s pandemic lockdown.
METHODS: Mixed-methods implementation research was used to develop an intrinsic case study describing the design and implementation of the telemedicine program. Qualitative analysis comprised document review, key informant interviews, and focus group discussions. Quantitative analysis employed an interrupted time series analysis with segmented multi-variate regression to compare maternity care service use trends before and after implementation. Poisson regression analysis was used to examine the trend in number of gender-based violence remote screenings, sessions held, and cases identified.
RESULTS: A statistically significant change in trend for onsite antenatal and postpartum care as well as women seeking care at the hospital as a result of postpartum hemorrhage arising in the community was observed following the introduction of telemedicine. Facility births and cases of eclampsia appropriately identified and managed also had significant increases. In addition, over 6917 women were screened for GBV, 223 received counseling and 34 referrals were made, showing a statistically significant increase in frequency over time following the implementation of the telemedicine program. Challenges included that not all midwives adopted GBV screening, some women were reluctant to discuss GBV, there was an unanticipated need to introduce a patient visit scheduling system in all intervention hospitals, and many women were not reachable by phone due to lack of access or network coverage.
CONCLUSIONS: Maternal health and gender-based violence telemedicine led by midwives was an effective, low-cost intervention in Bangladesh for addressing pandemic and pre-pandemic gaps in service use. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider whether a patient visit scheduling system needs to be introduced, as well as limitations around mobile phone access and connectivity. Future research should include care quality oversight and improvement, and a more well-informed strategy for facilitating effective GBV screening.
To support the continuation of sexual and reproductive health services following pandemic lockdowns, Bangladesh introduced a midwife-led telemedicine program. Through the program, midwives who were already employed within the health system delivered remote antenatal and postnatal care, including gender-based violence screening and referral. The program operated in 36 sub-district hospitals across five of Bangladesh’s 64 districts. Intrinsic implementation research was used to develop a case study describing the design and implementation of the telemedicine program. Qualitative and quantitative methods comprised document review, key informant interviews, focus group discussions, and service use trends. Analysis of the data identified a statistically significant trend increase for most maternity care services. Although they did increase significantly over time, referrals for GBV were less than expected, which may have been related to some midwives not screening for GBV, and/or that many women were reluctant to discuss GBV. In addition, there was an unanticipated need to introduce a patient visit scheduling system in all intervention hospitals, and many women were not reachable by phone due to lack of access or network coverage. In spite of this, 6197 women were screened for GBV. Of those, 223 received counseling and 34 received referrals. Overall, telemedicine led by midwives was an effective, low-cost intervention for maternal health, and a step toward stronger GBV response in Bangladesh. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider what is needed to facilitate comfort for both providers and women as related to GBV screening, as well as practical issues regarding introducing scheduling systems and limitations of mobile phone access and connectivity.