評估馬拉威北區第三級醫院產檢執行現況

Abstract

背景及目的：孕產婦健康一直是全球努力的目標，主要是為了降低孕產婦死亡率。生產時接受技術人員的照護可以有效降低孕產婦死亡率，但生產是一個過程，母嬰健康仍須透過產前檢查來維護。在馬拉威，懷孕婦女在產檢指標的到院產檢比例已逐年上升，但產檢完成度則會受到資源、設備或人的因素影響完成度，實際上比例描述是一個整體的概括，但無法知道實際執行狀況，所以此研究目的為：(1)評估Mzuzu Central Hospital產前檢查項目是否符合產檢指標。(2)評估Mzuzu Central Hospital產檢流程現況。 方法：本研究為回溯性病歷研究，收案時間及族群為2014年1月1日至2016年12月31日到院產檢的懷孕婦女，地點在馬拉威北部三級轉診醫院(Mzuzu Central Hospital)的產檢中心，以產檢中心為主要單位並向外延伸至彩虹門診、性傳染病治療室及實驗室將相同的檢驗報告、疾病篩檢結果與治療追蹤進行資料配對。 結果：2014-2016年在Mzuzu Central Hospital進行產前檢查的懷孕婦女總共981位，平均年齡為27.7歲。在不分產檢次數三年期間完成度最高的產檢項目為血壓、蚊帳領取、愛滋病篩檢、愛滋病治療，而完成度最低的項目為鐵劑與葉酸、尿蛋白檢測及抗瘧疾藥物。在資料一致性裡，懷孕婦女在第一次當天可以取得正確的梅毒報告的比例，依照年份為72%, 77%, 75%，而血色素則為74%, 70%, 77%。在產檢中心診斷梅毒陽性患者共有19位，但只有1位(7.7%, 2016)在本院有就醫紀錄，愛滋病陽性患者共有125位（新診斷：52人、已診斷：73人），在本院有就醫紀錄共有86位，分別為20位(60%, 2014)、18位(60%, 2015)、48位(77%, 2016)。 結論：從2014-2016年產檢資料發現，現有的登記方式對產檢項目完成度可能有影響、檢體試管使用認知不一致時可能會影響報告完成時機會、登記結果不一致會影響後續疾病治療、梅毒陽性患者未能有效進行追蹤治療而愛滋病患者未能完全有轉診紀錄，以及資訊落差容易使國家政策與實際執行出現不一致的情形。建議將登記方式依照懷孕婦女產檢次數作為登記基礎、電子化身份辨識流程、減少單位間人為的資訊傳遞、統一臨床作業規範，降低人為因素而減少就醫權利。

Background and Purpose: Maternal Health, which usually aims to decrease maternal mortality is a global goal. Skilled clinicians who provide help during delivery can effectively reduce the maternal mortality ratio. Maternal health and fetus health can be improved by enhancing antenatal care (ANC). In Malawi, the number of pregnant women who visit ANC is increasing every year, but there are still many barriers, such as resources, equipment or human factor, that influence completeness of antenatal care How ANC is delivered or the quality of ANC remain a knowledge gap in Malawi. Therefore, the aim of our study is to assess (1) Whether the antenatal care meet the national standard or not and (2) The process of ANC at Mzuzu Central Hospital. Method: This retrospective study reviewed the medical records of pregnant women who visit antenatal clinic during 2014/1/1-2016/12/31 at the antenatal clinic of Mzuzu Central Hospital, a tertiary hospital in Northern Malawi. The other source of medical information, such as laboratory examination, rainbow clinic and sexual transmitted treat room. The data is collected at antenatal clinic and rainbow clinic and is screened and compare figure out the proportion HIV-positive and the syphilis-positive pregnant women, which were important indicators of antenatal care. Proportion of HIV positive or syphilis positive at antenatal clinic, the proportion of pregnant women who take medicine for HIV or syphilis, the proportion of data consistency of hemoglobin and syphilis were calculated to evaluate the quality of the antenatal care. Result: A total of 981 pregnant women presented to the antenatal clinic during 2014/1/1-2016/12/31 at Mzuzu Central Hospital. The average age of pregnant women was 27.7 years old. During the study period, the highest items were blood pressure test, bed net given, HIV screening test and HIV treatment regardless of visiting times. The lowest items were iron and folic acid, urine protein test and antimalarial regardless of visiting times. Result of hemoglobin and syphilis tests between first antenatal care and laboratory are consistent during 2014-2016. During 2014-2016, the percentage of precise syphilis data of pregnant women was 72%, 77% and 75% and the percentage of precise hemoglobin data of pregnant women was 74%, 70% and 77%, respectively. Only one (7.7%) pregnant women in 2016 who had positive syphilis result received treatment for syphilis at Mzuzu central hospital. There are 20 pregnant women (60%), 18 pregnant women (60%) and 48 pregnant women (77%) diagnosed with HIV in 2014, 2015 and 2016 at Mzuzu central hospital.

Conclusion: The transfer between different health care units of HIV/ and syphilis positive patients in not ideal. As a result, many patients were unable to trace during or after the transference. In the future, it maybe should register visiting time by pregnant women, electronically identification, decreasing information transmit by personal and conformance standard of care.