Quality of labor and birth care in Sindh Province, Pakistan: Findings from direct observations at health facilities


Autoři: Sohail Agha aff001;  Laura Fitzgerald aff002;  Aslam Fareed aff003;  Presha Rajbhandari aff002;  Shaista Rahim aff004;  Farhana Shahid aff005;  Emma Williams aff002;  Wajiha Javed aff005;  Sheena Currie aff002
Působiště autorů: The Bill and Melinda Gates Foundation, Seattle, Washington, United States of America aff001;  Jhpiego, Baltimore, Maryland, United States of America aff002;  The Indus Hospital, Karachi, Pakistan aff003;  Murshid Hospital, Karachi, Pakistan aff004;  Jhpiego, Karachi, Pakistan aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223701

Souhrn

This study presents data from the first observation of labor, childbirth and immediate newborn care in a clinical setting in Sindh, the second most populous province of Pakistan. Trained midwives observed 310 births at 126 district level referral facilities and primary health care facilities in 10 districts of Sindh where the USAID-funded Maternal Child Health Integrated Program (MCHIP) was implemented. The facility participation rate was 78%. The findings show that monitoring vital signs during the initial examination was conducted for less than one-in-ten women. Infection prevention practices were only observed for one-in-four women. Modesty was preserved for less than half of women. In spite of an absence of monitoring during the first and second stages of labor, providers augmented labor with oxytocin in two-thirds of births. To prevent post-partum hemorrhage, oxytocin was administered within a minute of birth in 51% of cases. Immediate drying of the baby was nearly universal and eight out of ten babies were wrapped in a dry towel. Newborn vital signs and the baby’s weight were taken in one-in-ten cases. Breastfeeding was initiated during the first hour of birth in 18% of cases. A support-person was present during labor and birth for 90% of women. While quality of care is poor across all facilities, the provision of care at district-level referral facilities was even lower quality than at primary health care facilities. This is because dais or assistants without formal training provided labor, birth, and newborn care for 40% of deliveries during night shifts at referral facilities. This study found many examples of suboptimal practice by skilled birth attendants across all levels of health facilities. There remains an urgent need to improve quality of service provision among skilled birth attendants in Pakistan.

Klíčová slova:

Birth – Health care facilities – Labor and delivery – Midwives – Neonatal care – Neonates – Pakistan – Quality of care


Zdroje

1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379: 2151–2161. doi: 10.1016/S0140-6736(12)60560-1 22579125

2. World Health Organization. Standards for Improving Quality of Maternal and Newborn Care in Health Facilities. Geneva: World Health Organization; 2016.

3. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2: e323–333. doi: 10.1016/S2214-109X(14)70227-X 25103301

4. Austin A, Langer A, Salam RA, Lassi ZS, Das JK, Bhutta ZA. Approaches to improve the quality of maternal and newborn health care: an overview of the evidence. Reprod Health. 2014;11 Suppl 2: S1. doi: 10.1186/1742-4755-11-S2-S1 25209614

5. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384: 347–370. doi: 10.1016/S0140-6736(14)60792-3 24853604

6. Metcalfe R, Adegoke AA. Strategies to increase facility-based skilled birth attendance in South Asia: a literature review. Int Health. 2013;5: 96–105. doi: 10.1093/inthealth/ihs001 24030109

7. Paredes-Solís S, Andersson N, Ledogar RJ, Cockcroft A. Use of social audits to examine unofficial payments in government health services: experience in South Asia, Africa, and Europe. BMC Health Serv Res. 2011;11 Suppl 2: S12. doi: 10.1186/1472-6963-11-S2-S12 22376233

8. Harvey SA, Blandón YCW, McCaw-Binns A, Sandino I, Urbina L, Rodríguez C, et al. Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward. Bull World Health Organ. 2007;85: 783–790. doi: 10.2471/BLT.06.038455 18038060

9. Ariff S, Soofi SB, Sadiq K, Feroze AB, Khan S, Jafarey SN, et al. Evaluation of health workforce competence in maternal and neonatal issues in public health sector of Pakistan: an assessment of their training needs. BMC Health Serv Res. 2010;10: 319. doi: 10.1186/1472-6963-10-319 21110888

10. Bartlett L, Cantor D, Lynam P, Kaur G, Rawlins B, Ricca J, et al. Facility-based active management of the third stage of labour: assessment of quality in six countries in sub-Saharan Africa. Bull World Health Organ. 2015;93: 759–767. doi: 10.2471/BLT.14.142604 26549903

11. de Graft-Johnson J, Vesel L, Rosen HE, Rawlins B, Abwao S, Mazia G, et al. Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries. BMJ Open. 2017;7: e014680. doi: 10.1136/bmjopen-2016-014680 28348194

12. National Institute of Population Studies (NIPS) II. Pakistan Demographic and Health Survey 2012–13. Islamabad, Pakistan and Calverton, Maryland, USA: NIPS and ICF International; 2013.

13. Shaikh BT, Hatcher J. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. J Public Health. 2005;27: 49–54. doi: 10.1093/pubmed/fdh207 15590705

14. Fikree FF, Mir AM, Haq I. She may reach a facility but will still die! An analysis of quality of public sector maternal health services, District Multan, Pakistan. JPMA J Pak Med Assoc. 2006;56: 156–163. 16711335

15. Regmi P, Shahid F, Baig K, Williams E. MCHIP Pakistan End-of-Project Report. Washington D.C.: MCHIP; 2018.

16. Sharma G, Powel-Jackson T, Haldar K, Bradley J, Filippi V. Quality of routine essential care during childbirth: clinical observations of uncomplicated births in Uttar Pradesh, India. Bull World Health Organ. 2017;95: 419–429. doi: 10.2471/BLT.16.179291 28603308

17. Singh A, Chhugani M, James M. Direct observation on respectful maternity care in India: a cross sectional study on health professionals of three different health facilities in New Delhi. International Journal of Science and Research. 2016, doi: 10.21275/ART20182649

18. Stanton C, Deepak N, Mallapur A, Katageri G, Mullany L, Koski A, et al. Direct observation of uterotonic drug use at public health facility-based deliveries in four districts in India. Int J Gynaecol Obstet. 2014;127: 25–30. doi: 10.1016/j.ijgo.2014.04.014 25026891

19. Stanton C, Armbruster D, Knight R, Ariawan I, Gbangbade S, Getachew A, et al. Use of active management of the third stage of labour in seven developing countries. Bull World Health Organ. 2009;87: 207–215. doi: 10.2471/BLT.08.052597 19377717

20. IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.

21. StataCorp. 2017. Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC.

22. National Institute of Population Studies (NIPS) [Pakistan], Macro International Inc. Pakistan Demographic and Health Survey 2006–07. Islamabad, Pakistan: National Institute of Population Studies and Macro International; 2008.

23. Kampf G, Löffler H, Gastmeier P. Hand hygiene for the prevention of nosocomial infections. Dtsch Ärztebl Int. 2009;106: 649–655. doi: 10.3238/arztebl.2009.0649 19890431

24. World Health Organization. Standards for Improving Quality of Maternal and Newborn Care in Health Facilities. Geneva: World Health Organization; 2016.

25. Tunçalp Ӧ, Were WM, MacLennan C, Oladapo OT, Gülmezoglu AM, Bahl R, et al. Quality of care for pregnant women and newborns-the WHO vision. BJOG Int J Obstet Gynaecol. 2015;122: 1045–1049. doi: 10.1111/1471-0528.13451 25929823

26. Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med. 2015;12: e1001847; discussion e1001847. doi: 10.1371/journal.pmed.1001847 26126110

27. World Health Organization. WHO recommendation on companionship during labor and childbirth. Geneva: World Health Organization; 2018

28. World Health Organization. WHO Recommendations for Augmentation of Labor. Geneva: World Health Organization; 2014.

29. Brhlikova P, Jeffery P, Bhatia GP, Khurana S. Intrapartum Oxytocin (Mis)use in South Asia. Journal of Health Studies. 2009; 2: 33–50

30. Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet. 2016;387: 587–603. doi: 10.1016/S0140-6736(15)00837-5

31. McClure EM, Saleem S, Goudar SS, Moore JL, Garces A, Esamai F, et al. Stillbirth rates in low-middle income countries 2010–2013: a population-based, multi-country study from the Global Network. Reprod Health. 2015;12: S7. doi: 10.1186/1742-4755-12-S2-S7 26063292

32. Darmstadt GL, Kinney MV, Chopra M, Cousens S, Kak L, Paul VK, et al. Who has been caring for the baby? Lancet. 2014;384: 174–188. doi: 10.1016/S0140-6736(14)60458-X 24853603

33. Abuya T, Ndwiga C, Ritter J, Kanya L, Bellows B, Binkin N, et al. The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya. BMC Pregnancy Childbirth. 2015;15: 224. doi: 10.1186/s12884-015-0645-6 26394616

34. Faqir M, Zainullah P, Tappis H, Mungia J, Currie S, Kim YM. Availability and distribution of human resources for provision of comprehensive emergency obstetric and newborn care in Afghanistan: a cross-sectional study. Confl Health. 2015;9: 9. doi: 10.1186/s13031-015-0037-6 25825592

35. Filby A, McConville F, Portela A. What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective. PloS One. 2016;11: e0153391. doi: 10.1371/journal.pone.0153391 27135248

36. Shaikh BT. Private sector in health care delivery: a reality and a challenge in Pakistan. Journal of Ayub Medical College. 2015; 27: 496–498. 26411151

37. Chowdhury S, Hossain SA, Halim A. Assessment of quality of care in maternal and newborn health services available in public health care facilities in Bangladesh. Bangladesh Med Res Counc Bull. 2009;35: 53–56. 20120780

38. Arnold R, van Teijlingen E, Ryan K, Holloway I. Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital. BJOG Int J Obstet Gynaecol. 2015;122: 260–267. doi: 10.1111/1471-0528.13179 25394518

39. Jayanna K, Bradley J, Mony P, Cunningham T, Washington M, Bhat S, et al. Effectiveness of onsite nurse mentoring in improving quality of institutional births in the primary health centres of high priority districts of Karnataka, South India: a cluster randomized trial. PloS One. 2016;11: e0161957. doi: 10.1371/journal.pone.0161957 27658215

40. Mumtaz Z, Levay A, Bhatti A, Salway S. Good on paper: the gap between programme theory and real-world context in Pakistan’s Community Midwife programme. BJOG Int J Obstet Gynaecol. 2015;122: 249–258. doi: 10.1111/1471-0528.13112 25315837

41. Sarfraz M, Hamid S. Challenges in delivery of skilled maternal care—experiences of community midwives in Pakistan. BMC Pregnancy Childbirth. 2014;14: 59. doi: 10.1186/1471-2393-14-59 24499344

42. Saleem Z, Jan R, McInytre H, Rattani SA, Sikandar R. Midwives’ perception about their practice in a midwifery-led care model in karachi, Pakistan. Br J Midwifery. 2015;23: 200–207. doi: 10.12968/bjom.2015.23.3.200

43. Das J, Holla A, Mohpal A, Muralidharan K. Quality and accountability in health care delivery: audit-study evidence from primary care in India. Am Econ Rev. 2016;106: 3765–3799. doi: 10.1257/aer.20151138 29553219


Článek vyšel v časopise

PLOS One


2019 Číslo 10