ABSTRACT
<p><b>Objectives</b></p><p> The aim of this study was to investigate the knowledge, attitude, and practice (KAP) of healthcare providers regarding the utilization of oxytocin for induction or augmentation of labor.</p><p><b>Methods</b></p><p> A qualitative study composed of direct observation and individual interview was conducted at a national tertiary maternity hospital in Phnom Penh, Cambodia in January and February 2013. The progress of labor in women who received oxytocin for induction or augmentation of labor was directly observed to confirm the healthcare providers’ management of oxytocin infusion. The attending doctors and midwives were individually interviewed after the women delivered. </p><p><b>Results</b></p><p> During the study period, 10 women were observed, and 12 healthcare providers (three doctors and nine midwives) were interviewed individually. Indications for labor induction or augmentation seemed to be appropriate for nine women. However, we found discrepancies between the national protocol and healthcare providers’ knowledge and actual practices. For example, 11 healthcare providers had never read the national protocol for the management of labor induction and augmentation, which implied limited access to the correct knowledge. A misconception was noted in that the sudden increase of oxytocin was not dangerous during the second stage of labor, despite the establishment of a good contraction pattern. Furthermore, a lack of unified initial dose and extremely high maximum dose above that recommended by the national protocol were observed. About half of observed women were not monitored for more than 2 hours from the beginning of oxytocin infusion.</p><p><b>Conclusion</b></p><p> In the present study, lack of knowledge, misconceptions regarding the management of oxytocin infusion, and a large gap between the national protocol and the actual clinical practices were confirmed. To maximize patient safety and therapeutic benefit, dissemination of the national protocol through in-service training is required.</p>
ABSTRACT
<b>Introduction</b><br> Maternal mortality ratio is widely used to provide a general sense of size of the problem of maternal deaths. However, it cannot be used to measure progress of maternal health programme on an annual basis and to compare geographic areas, because of its wide range of errors. This research estimates maternal mortality in six districts by using “unmet obstetric need” indicator in Tambacounda region, Senegal and describes possible application of the indicator to monitor, evaluate and facilitate maternal mortality reduction.<br><b>Methods</b><br> We used data on caesarean sections performed in seven health facilities in Tambacounda and Kaolack regions in 2005, and calculated rates of the intervention for the residents of Tambacounda. We estimated maternal mortality ratios for selected severe obstetric complications in six districts by calculating the number of deficits for the caesarean sections for absolute maternal indications, which were the number of women who developed life-threatening events but could not receive the appropriate interventions for the diseases.<br><b>Results</b><br> The rates of caesarean sections for all indications and for absolute maternal indications in the six districts ranged from 0.3 to 2.0% and from 0.1 to 0.9%, respectively. The estimated maternal mortality ratio for the absolute maternal indications in Tambacounda region was 651 (95%CI 554-761). Statistically significant differences in the ratios were observed between Koumpentoum district (maternal mortality ratio 966, 95%CI 741-1239) and Goudiry (877, 588-1260), and Kédougou (249, 119-457) and Bakel (296, 128-584).<br><b>Conclusions</b><br> This study method enabled us to distinguish the difference in maternal mortality ratios for the selected severe obstetric complications between the small districts. It implies that the “unmet obstetric need” indicator can be used to compare geographic areas, to monitor trends, and to evaluate programme impact as well as baseline data to establish necessary measures to decrease maternal deaths.
ABSTRACT
This study aims to analyze the perinatal care provided to non-Japanese speakers in one hospital in Tokyo from 1990 to 2001. It attempts to identify critical issues in perinatal care services and to recommend measures which should be taken to improve them.<br>Two major problems were identified: firstly, communication difficulties between health-care providers and the women and, secondly, a severe lack of information available to the women regarding health, medical and welfare services in Japan.<br>In particular, communication difficulties were a big burden for health care providers in that they presented an obstacle to collecting medical histories, to finding out about symptoms, to establishing good rapport with the patients and to providing spiritual support. It also made it difficult to provide health care based on informed consent.<br>Systematic assistance from medical interpreters is urgently needed in order to provide foreign women with the same level of care as that provided to Japanese patients.