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Fetal heart rate monitoring practices at a public hospital in Northern Uganda - what health workers document, do and say.
Ayebare, Elizabeth; Jonas, Wibke; Ndeezi, Grace; Nankunda, Jolly; Hanson, Claudia; Tumwine, James K; Hjelmstedt, Anna.
Afiliação
  • Ayebare E; Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
  • Jonas W; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
  • Ndeezi G; Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
  • Nankunda J; Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
  • Hanson C; Department of Neonatology, Mulago Specialized Women's & Neonatal Hospital, Kampala, Uganda.
  • Tumwine JK; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
  • Hjelmstedt A; Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Glob Health Action ; 13(1): 1711618, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31955672
ABSTRACT

Background:

In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings.

Objective:

To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda.

Methods:

A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data.

Results:

FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30-120) minutes in patients' records versus 139 (IQR 87-662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different.

Conclusions:

When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother's negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality.
Assuntos
Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: ODS3 - Saúde e Bem-Estar Tema em saúde: Meta 3.1: Reduzir a mortalidade materna / Meta 3.2: Reduzir as mortes de recém nascidos e crianças com menos de 5 anos Base de dados: MEDLINE Assunto principal: Frequência Cardíaca Fetal / Trabalho de Parto / Monitorização Fetal / Mão de Obra em Saúde / Hospitais Públicos Tipo de estudo: Guia de prática clínica / Pesquisa qualitativa Limite: Feminino / Humanos / Lactente / Recém-Nascido / Gravidez País/Região como assunto: África Idioma: Inglês Revista: Glob Health Action Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Uganda

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Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: ODS3 - Saúde e Bem-Estar Tema em saúde: Meta 3.1: Reduzir a mortalidade materna / Meta 3.2: Reduzir as mortes de recém nascidos e crianças com menos de 5 anos Base de dados: MEDLINE Assunto principal: Frequência Cardíaca Fetal / Trabalho de Parto / Monitorização Fetal / Mão de Obra em Saúde / Hospitais Públicos Tipo de estudo: Guia de prática clínica / Pesquisa qualitativa Limite: Feminino / Humanos / Lactente / Recém-Nascido / Gravidez País/Região como assunto: África Idioma: Inglês Revista: Glob Health Action Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Uganda