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Digital Health Divide: Opportunities for Reducing Health Disparities and Promoting Equitable Care for Maternal and Child Health Populations. 数字健康鸿沟:减少健康差距和促进对孕产妇和儿童健康人群公平护理的机会。
Pub Date : 2024-12-20 eCollection Date: 2024-01-01 DOI: 10.25259/IJMA_41_2024
Mehrete Girmay

The integration of telehealth into maternal and child health (MCH) care presents an opportunity to enhance health equity, offering solutions to bridge gaps in access and quality of care. This paper explores the impact and reach of telehealth services on MCH, emphasizing its potential to address disparities in healthcare access, particularly for underserved and marginalized populations. Telehealth facilitates improved access to care by reducing geographical barriers, offering convenient and flexible consultation options, and providing cost-effective solutions for low-income families. This paper also crystallizes the importance of telehealth services on the continuity of care through consistent remote monitoring, which is crucial for managing chronic conditions and ensuring timely interventions during pregnancy and early childhood. However, the effective implementation of telehealth in MCH also faces significant challenges, including the digital divide, which limits technology access and digital literacy among vulnerable populations. Enhancing digital literacy is essential for empowering individuals to navigate telehealth services effectively and to make informed health decisions. To advance health equity, it is crucial to address these challenges by expanding technology access, improving digital literacy, and developing supportive policies that ensure comprehensive telehealth coverage while considering the Social Determinants of Health (SDoH). This paper explores the importance of leveraging telehealth and other timely interventions to improve MCH equity and justice, including the provision of technological resources and comprehensive policy frameworks. By addressing these factors, telehealth can significantly contribute to reducing health disparities and promoting equitable care for all maternal and child populations.

将远程保健纳入妇幼保健提供了一个加强保健公平的机会,提供了解决办法,弥合在获得保健和保健质量方面的差距。本文探讨了远程医疗服务对妇幼保健的影响和影响范围,强调了其解决医疗保健获取差距的潜力,特别是对于服务不足和边缘化人群。远程保健通过减少地理障碍、提供方便和灵活的咨询选择以及为低收入家庭提供具有成本效益的解决办法,促进改善获得保健的机会。本文还明确了远程保健服务通过持续的远程监测对护理连续性的重要性,这对于管理慢性病和确保在怀孕和幼儿期及时采取干预措施至关重要。然而,在妇幼保健中有效实施远程保健也面临重大挑战,包括数字鸿沟,这限制了弱势群体获得技术和数字素养。提高数字素养对于增强个人能力,使其能够有效利用远程保健服务并作出知情的卫生决定至关重要。为促进卫生公平,应对这些挑战至关重要,办法是扩大技术可及性,提高数字素养,制定支持性政策,确保全面的远程医疗覆盖,同时考虑健康的社会决定因素。本文探讨了利用远程医疗和其他及时干预措施改善妇幼保健公平和正义的重要性,包括提供技术资源和综合政策框架。通过解决这些因素,远程保健可以大大有助于减少保健差距,促进对所有孕产妇和儿童群体的公平护理。
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引用次数: 0
Adapted Counseling Care Model for Management of Female Sexual Dysfunction Among Women Living With and Without HIV. 适应咨询护理模式管理女性性功能障碍感染和没有艾滋病毒。
Pub Date : 2024-11-08 eCollection Date: 2024-01-01 DOI: 10.25259/IJMA_37_2024
Fatima M Damagum, Zainab D Ahmed, Rabiu I Jalo, Hamisu M Salihu, C William Wester, Muktar H Aliyu

Background and objective: Sexual health research among women living with human immunodeficiency virus (HIV) has focused mainly on sexual practices and risk behaviors, with little consideration for treating sexual dysfunction and improving sexual satisfaction. The aim of this pilot study was to assess the effectiveness of an adaptive counseling care model in the management of female sexual dysfunction (FSD) among women living with HIV and without HIV in northern Nigeria.

Methods: This was a prospective cohort study of 200 women with HIV and a matched comparison arm of 200 women without HIV. Sexual function was assessed using the Female Sexual Function Index (FSFI), with a score ≤ 26.55 indicating FSD. We counseled women with FSD using the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model and evaluated the effectiveness of the model by comparing mean differences in baseline and six weeks post-intervention FSFI scores.

Results: The overall prevalence of FSD was 96.8%, with no difference between HIV-positive and HIV-negative participants (p = 0.398). Based on the six domains of the FSFI, the most common reported dysfunctions were sexual pain (21.7%), sexual desire disorder (17.6%), orgasm disorder (17.6%), lubrication disorder (17.2%), sexual arousal (16.9%), and poor sexual satisfaction (9.0%). The overall mean FSFI score (±standard deviation, SD) for those with FSD, in both groups (n = 387) prior to the counseling intervention was 16.05±10.65 (HIV-positive: 18.58±8.46; HIV-negative: 13.98±10.85). At the end of the intervention, the overall mean FSFI score in both groups increased to 23.58±16.53 (HIV-positive: 21.37±11.24; HIV-negative: 16.72±13.81) (p < 0.05 in all cases).

Conclusion and global health implications: FSD is very common among women in Northern Nigeria, irrespective of HIV status. An adapted counseling care model improved sexual function in both HIV-positive and HIV-negative women. The PLISSIT model can guide healthcare providers to initiate and navigate sexual health discussions with women in this setting.

背景与目的:人类免疫缺陷病毒(HIV)感染妇女的性健康研究主要集中在性行为和风险行为方面,很少考虑治疗性功能障碍和提高性满意度。这项试点研究的目的是评估适应性咨询护理模式在尼日利亚北部感染艾滋病毒和未感染艾滋病毒的妇女中管理女性性功能障碍(FSD)的有效性。方法:这是一项前瞻性队列研究,包括200名感染艾滋病毒的妇女和200名未感染艾滋病毒的妇女。使用女性性功能指数(FSFI)评估性功能,得分≤26.55为FSD。我们使用许可,有限信息,具体建议,强化治疗(PLISSIT)模型对患有FSD的妇女进行咨询,并通过比较基线和干预后六周FSFI评分的平均差异来评估该模型的有效性。结果:FSD的总体患病率为96.8%,hiv阳性和hiv阴性参与者之间无差异(p = 0.398)。根据FSFI的六个领域,最常见的性功能障碍是性疼痛(21.7%)、性欲障碍(17.6%)、性高潮障碍(17.6%)、润滑障碍(17.2%)、性唤起(16.9%)和性满意度差(9.0%)。两组(n = 387) FSD患者在咨询干预前的总体平均FSFI评分(±标准差,SD)为16.05±10.65 (hiv阳性:18.58±8.46;艾滋病毒阴性:13.98±10.85)。干预结束时,两组患者FSFI总平均评分均提高至23.58±16.53分(hiv阳性:21.37±11.24分;hiv阴性:16.72±13.81)(p < 0.05)。结论和对全球健康的影响:无论艾滋病毒状况如何,在尼日利亚北部妇女中,FSD非常普遍。一种适应的咨询护理模式改善了hiv阳性和hiv阴性妇女的性功能。PLISSIT模式可以指导医疗保健提供者发起和导航性健康讨论与妇女在这种设置。
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引用次数: 0
Assessing the Impact of an Intervention on Caregivers' Awareness and Completion of Continuum of Care Among Pregnant Women. 评估干预措施对照顾者认识和完成孕妇连续护理的影响。
Pub Date : 2024-10-04 eCollection Date: 2024-01-01 DOI: 10.25259/IJMA_22_2024
May Soe Aung, Myint Moh Soe, Hla Hla Win, Kyaw Swa Mya

Background and objective: The continuum of care (CoC) is an important approach that should be prioritized for improving maternal health. The World Health Organization recommends working with individuals, families, and communities to ensure continuous care throughout pregnancy, childbirth, and the postpartum period. The purpose of this study was to assess the impact of an intervention on the awareness of the CoC among main caregivers and the completion of CoC among pregnant women.

Methods: During the COVID-19 pandemic, a community-based quasi-experimental study was conducted in two townships of the Yangon Region, including 200 pairs of pregnant women and their caregivers. The intervention focused on providing health education sessions and distributing pamphlets to caregivers in the intervention group. The study aimed to assess the awareness of main caregivers about CoC and completion of CoC among pregnant women. A key predictor variable for evaluating the outcome was receiving an intervention package by the main caregivers in the intervention. The analysis used logistic regression, including the propensity score model, and was conducted using STATA vs 15.1.

Results: The final analysis included 193 pairs. Most main caregivers were husbands: 47 were husbands in the intervention and 59 in the control group, while 24 mothers were included in both groups. The awareness of CoC for maternal health among main caregivers from the intervention group was 9.97 times higher than those from the control group (AOR = 9.97, 95% CI: 5.12 to 19.43, p < 0.001). The completion of CoC among women from the intervention group was 2.17 times higher than those from the controls (AOR = 2.17, 95% CI 1.08 to 4.37, p < 0.05). The awareness of main caregivers was found to be a significant predictor for completion of CoC.

Conclusion and global health implications: Health education intervention for main caregivers could improve CoC completion among pregnant women. It provided baseline information for further interventions at the family level for improving CoC among pregnant women in the future.

背景和目标:持续护理(CoC)是改善孕产妇健康应优先考虑的重要方法。世界卫生组织建议与个人、家庭和社区合作,确保在怀孕、分娩和产后期间提供持续护理。本研究的目的是评估一项干预措施对主要护理人员的持续护理意识和孕妇完成持续护理的影响:方法:在 COVID-19 大流行期间,我们在仰光地区的两个乡镇开展了一项基于社区的准实验研究,其中包括 200 对孕妇及其护理人员。干预的重点是为干预组中的护理人员提供健康教育课程和分发宣传册。研究旨在评估主要照顾者对孕妇保健的认识以及孕妇完成保健的情况。评估结果的一个关键预测变量是干预组的主要照顾者是否接受了干预包。分析采用逻辑回归法,包括倾向得分模型,使用 STATA vs 15.1 进行:最终分析包括 193 对患者。大多数主要照顾者是丈夫:干预组中有 47 对是丈夫,对照组中有 59 对是丈夫,而两组中都有 24 对母亲。干预组主要照顾者对产妇保健一致性的认识是对照组的 9.97 倍(AOR = 9.97,95% CI:5.12 至 19.43,p < 0.001)。干预组妇女完成 CoC 的比例是对照组的 2.17 倍(AOR = 2.17,95% CI 1.08 至 4.37,p < 0.05)。研究发现,主要照顾者的意识是完成CoC的重要预测因素:对主要照顾者的健康教育干预可提高孕妇完成CoC的比例。它为今后在家庭层面采取进一步干预措施以改善孕妇的CoC提供了基线信息。
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引用次数: 0
Involvement of Male Partners in Sustaining Interventions for Preventing Mother-to-Child Transmission of HIV Among Women with HIV. 男性伴侣参与预防感染艾滋病毒妇女的母婴传播干预措施的持续性。
Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.25259/IJMA_645
Fulufhedzani C Malindi, Maria S Maputle

Background and objective: Although male partners are eager to support the implementation of prevention of mother-to-child transmission (PMTCT) of HIV programs, several obstacles prevent them from participating. The purpose of this study was to explore the support of male partners of HIV-positive women in sustaining the implementation of PMTCT interventions.

Methods: This study adopted a qualitative approach. The case study research design was used to generate an in-depth understanding of the factors that hinder male participation in PMTCT interventions. Non-probability purposive sampling was used to 20 sample participants. Data was collected from two focus group discussions and analyzed using open coding. Trustworthiness was achieved by credibility, transferability, and confirmability. Adherence to ethical principles was upheld.

Results: Findings revealed two themes, perceived practices that hinder the provision of support and perceived support provided to sustain PMTCT intervention during childbirth. Sustaining PMTCT interventions included how the male partner adheres to interventions that prevent the transmission of the virus, like consistent condom use, especially during breastfeeding, support in exclusive breastfeeding, adherence to ART, and limiting the use of cultural practices.

Conclusion and global health implications: The involvement of males in the interventions of PMTCT has been found to improve the sustainability of eliminating transmission of the virus to the baby. All clinics were recommended to be men user-friendly to encourage men to accompany their partners. Men are to be actively involved during decision-making and physical examination, where possible. Workshops and information-sharing sessions for men forums and community members on PMTCT interventions to be conducted.

背景和目的:尽管男性伴侣渴望支持预防母婴传播(PMTCT)艾滋病项目的实施,但一些障碍阻碍了他们的参与。本研究旨在探讨艾滋病病毒抗体阳性妇女的男性伴侣对持续实施预防母婴传播干预措施的支持情况:本研究采用定性方法。方法:本研究采用了定性研究方法,通过案例研究设计来深入了解阻碍男性参与预防母婴传播干预措施的因素。研究采用了非概率目的性抽样方法,抽取了 20 名样本参与者。从两次焦点小组讨论中收集数据,并采用开放式编码进行分析。可信度通过可信度、可转移性和可确认性来实现。结果:研究结果揭示了两个主题,即认为阻碍提供支持的做法和认为在分娩期间为维持预防母婴传播干预措施而提供的支持。维持预防母婴传播干预措施包括男性伴侣如何坚持采取预防病毒传播的干预措施,如坚持使用安全套(尤其是在哺乳期间)、支持纯母乳喂养、坚持抗逆转录病毒疗法以及限制文化习俗的使用:研究发现,男性参与预防母婴传播的干预措施可提高消除病毒传播给婴儿的可持续性。建议所有诊所都要方便男性用户,以鼓励男性陪伴其伴侣。在可能的情况下,男性应积极参与决策和身体检查。为男性论坛和社区成员举办有关预防母婴传播干预措施的讲习班和信息分享会。
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引用次数: 0
Empowering Midwives in Humanitarian Settings: Integrating Heat-Stable Carbetocin and Tranexamic Acid into Postpartum Hemorrhage Training. 在人道主义环境中赋予助产士权力:将热稳定的卡霉素和氨甲环酸纳入产后出血培训。
Pub Date : 2024-09-23 eCollection Date: 2024-09-01 DOI: 10.25259/IJMA_10_2023
Alice Rosmini, Kidza Mugerwa, Awatta Walter Ochan, Sarah Muwanguzi, Jemelia Sake, Richard Mwesigwa, Okpwoku Sukere, Catrin Schulte-Hillen, Nguyen Toan Tran

Background and objective: Maternal mortality remains extremely high in fragile settings, with hemorrhage as the leading cause. This study describes a new model for more effective training on postpartum hemorrhage (PPH) prevention and treatment.

Methods: Using a low-dose (of information) and high-frequency (of repetitions) approach (LDHF), the strategy comprised an introductory webinar, self-paced study, 2-day in-person workshops, cascade training, continuous facility-based skills drills, and a WhatsApp community of practice and supervision (CoP). Innovations consisted of the practical, midwifery-centered, and short-duration training, and the integration of tranexamic acid (TXA) and heat-stable carbetocin (HSC) into existing modules from the "Bleeding-After-Birth-Complete" toolkit. Effects were assessed through mixed-methods evaluation. Confidentiality and "do-not-harm" principles were respected.

Results: Nine training sessions were conducted in South Sudan and Uganda combined, engaging 126 participants. Average knowledge increases of 21% in South Sudan and 18% in Uganda were recorded. Feedback also indicated changes in practices and attitudes: enhanced competency, teamwork, clinical protocols adherence, appreciation for midwife-led practical sessions, the LDHF method, and continuous support through the WhatsApp CoP. In post-workshop action plans, facility teams outlined steps to apply acquired knowledge and skills. These included training colleagues, establishing quality improvement projects, conducting skill drills, ensuring job aid visibility, and systematically reporting on PPH in the data collection templates of the facilities.

Conclusion and global health implications: This case study highlights the value of a practical, LDHF refresher training strategy. This strategy bolstered providers' skills, knowledge, and confidence in using HSC and TXA for PPH prevention and treatment. Findings can guide future training in similar fragile, low-resource, and humanitarian settings. Strengthening midwifery leadership, fostering interdisciplinary collaboration, and using the LDHF training approach can contribute to resilient health systems and taskforce, aligning with global efforts to reduce maternal mortality.

背景和目的:在脆弱环境中,产妇死亡率仍然非常高,出血是主要原因。本研究为更有效的产后出血(PPH)预防和治疗培训提供了一种新的模式。方法:采用低剂量(信息)和高频率(重复)方法(LDHF),该策略包括介绍性网络研讨会、自主学习、2天的面对面研讨会、级联培训、持续的基于设施的技能练习以及WhatsApp实践和监督社区(CoP)。创新包括实用的、以助产为中心的短期培训,以及将氨甲环酸(TXA)和热稳定卡霉素(HSC)整合到“产后出血”工具包的现有模块中。通过混合方法评价效果。保密和“不伤害”原则得到尊重。结果:在南苏丹和乌干达共开展了9期培训,126人参加。南苏丹和乌干达的平均知识增长分别为21%和18%。反馈还表明了实践和态度的变化:能力增强,团队合作,临床协议遵守,对助产士领导的实践课程,LDHF方法的赞赏,以及通过WhatsApp CoP的持续支持。在讲习班结束后的行动计划中,设施小组概述了应用获得的知识和技能的步骤。这些措施包括培训同事,建立质量改进项目,进行技能训练,确保工作辅助可见性,并在设施的数据收集模板中系统地报告PPH。结论和全球健康影响:本案例研究突出了实用的LDHF进修培训战略的价值。这一策略增强了提供者使用HSC和TXA预防和治疗PPH的技能、知识和信心。研究结果可以指导未来在类似脆弱、资源匮乏和人道主义环境下的培训。加强助产领导,促进跨学科合作,并采用LDHF培训方法,可有助于建立具有复原力的卫生系统和工作组,与全球降低孕产妇死亡率的努力保持一致。
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引用次数: 0
Feasibility, Acceptability, and Appropriate Use of Novel and Lesser-Used Medicines for Prevention and Treatment of Postpartum Hemorrhage: Evidence from Implementation Research. 新型和少用药物预防和治疗产后出血的可行性、可接受性和合理使用:来自实施研究的证据。
Pub Date : 2024-09-23 eCollection Date: 2024-09-01 DOI: 10.25259/IJMA_17_2023
Sara Rushwan, Tesfaye Tufa, Metin Gülmezoglu

Maternal mortality remains one of the primary global health challenges of the 21st century, despite major medical advances in the field. Although solutions are available, inequities determine where mothers die, with the majority of maternal deaths occurring in low- and middle-income countries (LMICs). More than one-third of maternal deaths are related to obstetric hemorrhage and most commonly postpartum hemorrhage (PPH). Effective, quality-assured uterotonics significantly reduce PPH-related morbidity and mortality. Updated World Health Organization (WHO) recommendations on uterotonics used for PPH prevention include the addition of heat-stable carbetocin (HSC) to the suite of prophylactic uterotonic agents as well as the use of tranexamic acid (TXA) for PPH treatment. Both medicines are promising interventions in obstetric care. However, the introduction of these medicines faces numerous challenges to end-user access, such as decentralized procurement, time-consuming policy updates, market access barriers, lack of demand for quality-assured products, and inadequate systematic training and information provision, impeding access in many LMICs. Assessing the feasibility and acceptability of implementing these medicines in different resource settings can help bridge the gap between research and development to policy and practice, in an effort to reduce the significant health inequities facing women accessing the public health sector for quality care during labor and delivery. In this Special Collection, we explore the findings from mixed-methods implementation research studies in nine LMICs which support the acceptability and feasibility of HSC and TXA administration by healthcare providers, generating evidence to help inform the introduction and scale-up of these new and lesser-utilized PPH medicines.

尽管在该领域取得了重大的医学进展,但孕产妇死亡率仍然是21世纪全球主要的健康挑战之一。虽然有解决办法,但不平等决定了母亲的死亡地点,大多数孕产妇死亡发生在低收入和中等收入国家。超过三分之一的孕产妇死亡与产科出血和最常见的产后出血有关。有效的、有质量保证的子宫强直术显著降低pph相关的发病率和死亡率。最新的世界卫生组织(WHO)关于子宫强张剂用于预防PPH的建议包括在预防性子宫强张剂中加入热稳定的卡霉素(HSC)以及使用氨甲环酸(TXA)治疗PPH。这两种药物都是产科护理中有希望的干预措施。然而,这些药物的引进在最终用户获取方面面临着许多挑战,例如分散采购、耗时的政策更新、市场准入障碍、对有质量保证的产品缺乏需求以及系统培训和信息提供不足,阻碍了许多中低收入国家的获取。评估在不同资源环境下实施这些药物的可行性和可接受性,有助于缩小研究和开发与政策和实践之间的差距,以努力减少妇女在分娩和分娩期间在公共卫生部门获得高质量护理时面临的严重卫生不平等现象。在这个特别的集合中,我们探索了9个低收入国家的混合方法实施研究的结果,这些研究支持卫生保健提供者给药HSC和TXA的可接受性和可行性,产生证据,以帮助介绍和扩大这些新的和较少使用的PPH药物。
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引用次数: 0
Introduction of Heat-Stable Carbetocin through a Public-Private Partnership Model in India: A Retrospective Study to Determine Feasibility and Its Optimal Use in Public Health Settings. 通过公私伙伴关系模式在印度引入热稳定卡贝菌素:一项确定可行性及其在公共卫生环境中最佳使用的回顾性研究。
Pub Date : 2024-09-23 eCollection Date: 2024-09-01 DOI: 10.25259/IJMA_11_2023
Vaishali Alwadhi, Archana Mishra, Anil Nagendra, Devina Bajpayee, Naresh Chandra Joshi, Sachin Gupta, Harish Kumar

Background and objective: The optimal use of oxytocin for preventing postpartum hemorrhage (PPH) faces challenges in many low-middle income countries (LMICs) owing to its storage and transportation prerequisites. We demonstrated Heat-Stable Carbetocin (HSC) for PPH prevention through an innovative Public-Private Partnership (PPP) model in 15 public health facilities of the Dewas District of Madhya Pradesh (MP) state in India. This study evaluates the feasibility and appropriate utilization of HSC in public health settings.

Methods: We analyzed facility-level data collected between August 2022 and July 2023 from selected 15 health facilities, where HSC was introduced. Prior to the introduction of HSC, all healthcare providers received training on Active Management of the Third Stage of Labor (AMTSL), use of HSC, and recording and reporting procedures. The supply of HSC in health facilities was ensured, and a robust mechanism was set up to monitor the progress.

Results: A total of 18,497 women were admitted for delivery in the 15 selected facilities. Uterotonic administration within one minute of delivery was almost universal (99.9%). No instance was recorded of using HSC either for induction of labor or management of PPH. In 636 cases (3.43%), HSC was not given for PPH prevention. Pearson's chi-square test was conducted to assess the relationship between HSC usage and the health facility's level. The HSC use was significantly higher in First Referral Unit (FRU) facilities compared to non-FRUs (p < 0.001). Moreover, the administration of HSC within one minute of delivery was also more prevalent in FRU facilities compared to non-FRUs (p < 0.001). The PPH incidence and case referral rates noted in this study were 0.7% and 16.7%, respectively, with no reported adverse drug events or deaths.

Conclusion and global health implications: Our study suggests the safe and appropriate use of HSC within India's public health system.

背景与目的:在许多中低收入国家,由于其储存和运输条件的限制,催产素用于预防产后出血(PPH)的最佳使用面临着挑战。我们通过创新的公私伙伴关系(PPP)模式,在印度中央邦德瓦斯地区的15家公共卫生机构中展示了热稳定卡贝菌素(HSC)预防PPH的效果。本研究评估HSC在公共卫生机构的可行性和适当利用。方法:我们分析了选定的15家引入HSC的卫生机构在2022年8月至2023年7月期间收集的设施级数据。在引入HSC之前,所有医疗保健提供者都接受了关于第三产程主动管理(AMTSL)、HSC使用以及记录和报告程序的培训。确保了保健设施中HSC的供应,并建立了一个强有力的机制来监测进展情况。结果:15家医院共收治产妇18497例。分娩1分钟内给药几乎是普遍的(99.9%)。没有记录使用HSC引产或管理PPH的实例。636例(3.43%)未给予HSC预防PPH。采用Pearson卡方检验评估HSC使用与卫生机构水平之间的关系。第一转诊单位(FRU)的HSC使用率明显高于非FRU (p < 0.001)。此外,与非FRU相比,FRU设施在分娩后1分钟内给药HSC也更为普遍(p < 0.001)。本研究中PPH的发病率和病例转诊率分别为0.7%和16.7%,未报告药物不良事件或死亡。结论和全球健康影响:我们的研究建议在印度公共卫生系统中安全、适当地使用HSC。
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引用次数: 0
Postpartum Hemorrhage in Humanitarian Settings: Implementation Insights from Using Heat-Stable Carbetocin and Tranexamic Acid. 人道主义环境下的产后出血:使用热稳定的卡霉素和氨甲环酸的实施见解。
Pub Date : 2024-09-23 eCollection Date: 2024-09-01 DOI: 10.25259/IJMA_7_2023
Nguyen Toan Tran, Kidza Mugerwa, Awatta Walter Ochan, Sarah Muwanguzi, Jemelia Sake, Richard Mwesigwa, Okpwoku Sukere, Catrin Schulte-Hillen

Background and objective: Maternal mortality, largely due to postpartum hemorrhage (PPH), remains high in resource-limited and crisis-affected settings, where heat-stable carbetocin (HSC) and tranexamic acid (TXA) offer promise for PPH prevention and treatment but lack evidence. This study, implemented in basic maternity facilities within humanitarian settings, explores healthcare providers' perspectives on an HSC and TXA-inclusive PPH intervention package and related operational challenges and facilitators.

Methods: Based on semi-structured interview guides and using thematic analysis, this qualitative research, through 13 focus group discussions and individual interviews, investigated the perspectives of 64 healthcare staff (mostly midwives) from eight basic emergency obstetric care facilities in South Sudanese and Ugandan settings hosting large numbers of forcibly displaced populations. The PPH intervention package comprised refresher training, an online provider community, PPH readiness kits, alarm bells, and displayed algorithms.

Results: Findings from both countries converged, highlighting providers' positive views on HSC and TXA. HSC effectiveness in preventing bleeding was acknowledged, bolstering staff's confidence in its use. TXA was perceived as effective although providers reported having less experience with it due to the limited number of PPH cases. Enabling factors included the ease of administration, practical training, endorsement by national and local authorities, and the absence of a cold chain requirement. Appreciation was given to the WhatsApp community of practice as it facilitated knowledge exchange, quality improvement projects that enhanced PPH diagnosis, and innovative tools like wall clocks to record the timing of clinical actions and bells to call for assistance. Challenges included confusion between new and existing medications and record systems that inadequately capture HSC, TXA, and other PPH indicators.

Conclusion and global health implications: HSC and TXA integrated into a PPH intervention package were overall positively valued by providers in humanitarian settings. Continued education and support are crucial. Addressing challenges like medication confusion underscores the need for ongoing education and clear guidelines for the use of HSC, TXA, oxytocin, and other drugs for PPH prevention and treatment. Our findings stress the importance of a comprehensive strategy to overcome health system barriers in PPH management, potentially improving maternal health outcomes in resource-limited and fragile contexts, with broader global implications.

背景和目的:在资源有限和受危机影响的环境中,产妇死亡率主要是由于产后出血(PPH),在这些环境中,热稳定性卡霉素(HSC)和氨甲环酸(TXA)有望预防和治疗PPH,但缺乏证据。本研究在人道主义环境下的基本产科设施中实施,探讨了医疗保健提供者对包括HSC和txa在内的PPH干预方案以及相关操作挑战和促进因素的看法。方法:基于半结构化访谈指南和专题分析,本定性研究通过13个焦点小组讨论和个人访谈,调查了来自南苏丹和乌干达收容大量被迫流离失所人口的8个基本产科急诊护理机构的64名医护人员(主要是助产士)的观点。PPH干预包包括复习培训、在线提供者社区、PPH准备工具包、警报铃和显示算法。结果:两国的调查结果趋于一致,突出了提供者对HSC和TXA的积极看法。造血干细胞在预防出血方面的有效性得到了认可,增强了工作人员对其使用的信心。TXA被认为是有效的,尽管由于PPH病例数量有限,提供者报告其经验较少。促成因素包括便于管理、实际培训、得到国家和地方当局的认可以及没有冷链要求。对WhatsApp社区的实践表示赞赏,因为它促进了知识交流,提高了PPH诊断的质量改进项目,以及记录临床行动时间的挂钟和呼叫援助的铃声等创新工具。挑战包括新旧药物之间的混淆和记录系统不能充分捕获HSC、TXA和其他PPH指标。结论和全球健康影响:在人道主义环境中,提供者总体上积极评价纳入PPH干预方案的HSC和TXA。继续教育和支持是至关重要的。应对药物混淆等挑战强调需要持续的教育和明确的指导方针,以使用HSC、TXA、催产素和其他药物预防和治疗PPH。我们的研究结果强调了在PPH管理中克服卫生系统障碍的综合战略的重要性,这可能会改善资源有限和脆弱环境下的孕产妇健康结果,并具有更广泛的全球影响。
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引用次数: 0
Special Collection: Implementation Research Evidence for Prevention and Treatment of Postpartum Hemorrhage in High-Burden Low- and Middle-Income Countries. 特辑:高负担中低收入国家预防和治疗产后出血的实施研究证据。
Pub Date : 2024-09-23 eCollection Date: 2024-09-01 DOI: 10.25259/IJMA_35_2024
Hamisu M Salihu, Amina A Umar, Romuladus E Azuine

Postpartum hemorrhage (PPH), defined as a blood loss of 500 mL or more within 24 hours after birth, remains the leading cause of maternal mortality globally, accounting for over 20% of all maternal deaths. The burden of mortality from PPH is predominantly in low- and middle-income countries and demands coordinated accelerated efforts from the global maternal health community to meet the Sustainable Development 3 maternal health target by 2030. The International Journal of Maternal and Child Health and AIDS and the Concept Foundation are proud to present this Special Collection demonstrating the evidence for introducing heat-stable carbetocin and tranexamic acid, showcasing the feasibility and acceptability of their utilization for PPH prevention and management in resource-limited high-burden settings.

产后出血(PPH)的定义是出生后24小时内失血500毫升或更多,它仍然是全球孕产妇死亡的主要原因,占孕产妇死亡总数的20%以上。PPH造成的死亡负担主要集中在低收入和中等收入国家,需要全球孕产妇卫生界协调一致,加快努力,到2030年实现可持续发展3的孕产妇保健目标。《国际妇幼保健和艾滋病杂志》和概念基金会自豪地介绍了这一特别收藏,展示了采用热稳定的卡霉素和氨甲环酸的证据,展示了在资源有限的高负担环境中利用它们预防和管理PPH的可行性和可接受性。
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引用次数: 0
Introduction of Heat-Stable Carbetocin for Postpartum Hemorrhage Prevention in Public Sector Hospitals in Kenya: Provider Experience and Policy Insights. 肯尼亚公立医院引入热稳定卡贝菌素预防产后出血:提供者经验和政策见解。
Pub Date : 2024-09-23 eCollection Date: 2024-09-01 DOI: 10.25259/IJMA_4_2024
Daisy Ruto, Michael Muthamia, Edith Njeri, Freda Nyaga, Christine Muia, Morris Kiio, Jane Wausi

Background and objective: In Kenya, the leading cause of maternal deaths is obstetric hemorrhage (39.5%), with postpartum hemorrhage (PPH) accounting for 50% with quality of uterotonics as one of the biggest challenges. The World Health Organization (WHO) in 2018 included heat-stable carbetocin (HSC) for the prevention of PPH in settings where the quality of oxytocin cannot be guaranteed. Maintenance of the cold chain for uterotonics is a challenge. HSC does not require refrigeration, reducing pressure on the fragile cold chain infrastructure. The main objective was to understand PPH prevention knowledge, experience, and perspectives, including uterotonic use, by policymakers and healthcare providers (HCPs) in the public health sector in ten counties in Kenya. HCP knowledge, perception, and experience were assessed after the HSC introduction.

Methods: The mixed methods study was implemented in 39 secondary and tertiary public hospitals from ten counties. Quantitative interviews targeting 171 HCPs at baseline and end-line were collected using REDCap software (v5.26.4) and analyzed using Stata version 17. Qualitative data was collected from 19 policymakers at the national, county, sub county, and health facility levels and analyzed using NVIVO 12.

Results: At the end line, 98.8% had administered HSC for the prevention of PPH, while 96.5% of the HCPs were aware that their facilities had protocols/guidelines in place on the use of HSC. To enhance awareness of WHO recommendations on the use of HSC among HCPs, a top-down approach was used. Over 90% of HCPs agreed that HSC was easy to administer and distinguish from other uterotonics. Policymakers agreed that there was value in the HSC introduction in the public health sector that experiences cold chain challenges and recommended budgetary allocation.

Conclusion and global health implications: The findings demonstrate that HCP's knowledge, perception, and experience coupled with the policymaker's perspective is the key to the introduction of HSC in the public sector. Policymakers find value in introducing HSC as it alleviates challenges with the fragile cold chain systems. This study contributes to the global body of knowledge on the introduction of lifesaving commodities, which is anticipated to potentially improve PPH prevention and management, and hence reduce maternal mortality.

背景和目的:在肯尼亚,产妇死亡的主要原因是产科出血(39.5%),产后出血(PPH)占50%,子宫强张质量是最大的挑战之一。2018年,世界卫生组织(WHO)将热稳定型卡贝菌素(HSC)列入了在催产素质量无法保证的环境中预防PPH的药物。子宫强直冷链的维护是一个挑战。HSC不需要制冷,减少了对脆弱的冷链基础设施的压力。主要目的是了解肯尼亚十个县公共卫生部门的决策者和卫生保健提供者(HCPs)预防PPH的知识、经验和观点,包括子宫张力使用。在引入HSC后评估HCP知识、感知和经验。方法:对全国10个县39所二、三级公立医院进行混合方法研究。使用REDCap软件(v5.26.4)收集基线和终点171名HCPs的定量访谈,并使用Stata版本17进行分析。从国家、县、次县和卫生机构层面的19名决策者那里收集定性数据,并使用NVIVO 12进行分析。结果:在终点线,98.8%的HCPs使用了HSC来预防PPH,而96.5%的HCPs知道他们的机构有关于HSC使用的协议/指南。为了提高卫生保健专业人员对世卫组织关于使用造血干细胞的建议的认识,采用了自上而下的方法。超过90%的HCPs认为HSC易于管理和与其他子宫强直剂区分。决策者一致认为,在经历冷链挑战的公共卫生部门引入HSC具有价值,并建议预算分配。结论和全球卫生影响:研究结果表明,HCP的知识、感知和经验与决策者的观点相结合,是在公共部门引入HSC的关键。决策者发现引入HSC的价值,因为它减轻了脆弱的冷链系统的挑战。这项研究有助于建立关于引进救生商品的全球知识体系,预计这将有可能改善PPH的预防和管理,从而降低孕产妇死亡率。
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引用次数: 0
期刊
International Journal of MCH and AIDS
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