Quality of labor and birth care in Sindh Province, Pakistan: Findings from direct observations at health facilities
| Autor: | Emma K. Williams, Laura Fitzgerald, Farhana Shahid, Wajiha Javed, Aslam Fareed, Sheena Currie, Shaista Rahim, Sohail Agha, Presha Rajbhandari |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Maternal Health
Breastfeeding Pediatrics Neonatal Care Midwives Geographical Locations Maternal child health Labor and Delivery 0302 clinical medicine Pregnancy Medicine and Health Sciences Infection control Childbirth Quality of Care Pakistan Public Health Surveillance 030212 general & internal medicine Medical Personnel media_common 030219 obstetrics & reproductive medicine Multidisciplinary Labor Obstetric Obstetrics and Gynecology Professions Medicine Female Research Article medicine.medical_specialty Asia Referral media_common.quotation_subject Science Vital signs 03 medical and health sciences medicine Humans Quality (business) Maternal Health Services Quality of Health Care business.industry Parturition Biology and Life Sciences Neonates Health Care mChip Health Care Facilities Family medicine People and Places Birth Women's Health Population Groupings Health Facilities Neonatology business Developmental Biology |
| Zdroj: | PLoS ONE PLoS ONE, Vol 14, Iss 10, p e0223701 (2019) |
| ISSN: | 1932-6203 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|