نگرش كاركنان ستادي و افراد صاحب نظر در مورد نحوه اجراي نظام كشوري مراقبت مرگ مادري در ايران

Maternal mortality surveillance system: attitude of health care staff and experts

مرگ مادران يكي از مهم‌ترين شاخص‌هاي توسعه جوامع به شمار مي‌رود. در كشور ايران نظام مراقبت مرگ مادري از سال 1380 آغاز به كار نموده است. در اين نظام مسيري كه هر مادر تا زمان مرگ طي كرده است، كشف شده، عوامل قابل اجتناب شناسايي وبراي آنها مداخله طراحي و اجرا مي‌شود. اين مطالعه در دو بخش كمي و كيفي انجام شد: در بخش كمي، نگرش 104 تن از كاركنان ستادي از طريق پرسشنامه و در بخش كيفي، نظرات 6 نفر از پژوهشگران و سياستگزاران در مورد نقاط ضعف اجراي نظام مراقبت مرگ مادري از طريق مصاحبه عميق مورد بررسي قرار گرفت. نتايج بخش كمي نشان داد كه بيشترين درصد كاركنان در مورد هر 3 مرحله جمع آوري اطلاعات، طراحي مداخله و اجراي مداخله نگرش نسبتاً مطلوب داشتند. نامناسب بودن پرسش در مورد اطلاعات جمعيتي متوفي و خانوار و مشكل بودن جمع بندي آنها، عدم تفكيك مناسب رده‌هاي مختلف كادر درماني نيازمند به آموزش و نيز محل فوت (در مرحله جمع آوري اطلاعات)، برگزاري كميته‌ها به صورت تشريفاتي (در مرحله طراحي مداخله) و نيز عدم طراحي مداخلات يا عدم اجراي صحيح آنها (در مرحله اجراي مداخله) از موارد ضعف اشاره شده در بخش كيفي توسط پژوهشگران و سياست گزاران بود.

Objective(s): Maternal mortality surveillance system has been functioning from 2000 in Iran. This system is implemented to reduce pregnancy-related deaths through illuminating the path that took the deceased mother to her death, identify preventable factors and devising and implementing intervention to resolve the problem and prevent similar death. To know executive personnel’s attitude about this system and identify how can be improved by interview with experts. Methods: This study had two sections. at the first one(quantitative) a questionnaire developed which included phrases about 3 steps of maternal mortality surveillance system. Reliability and validity of the tools were tested. Then 104 head quarters and staffs completed it and data in Spss software were analyzed. In the second section (qualitative) we interviewed with 6 experts and health manager who had previous study in safe motherhood subject. Results: all 3 steps of system are moderately good in their opinion. Mean score in implementation of intervention (59 from 100) was lower than designing intervention (63 from 100) and information collection (67 from 100). The information collected is often insufficient to identify demographic data. Poor cooperation from the obstetrician due to lack of time, leads that death cases haven’t been reviewed perfectly. Obstetrician isnʹt charge for maternal health in the provinces. Interventions should be done in high level of treatment team but because it is very difficult, it is focused on lower level of team such as health workers. Therefore interventions are not effective and they can’t prevent avoidable factors. Conclusion: current forms and questions using in maternal mortality surveillance system in general is suitable. Some suggestions for improvement are these: - Demographic and socioeconomic information (father’s name, ID number, literature and socioeconomic level of deceased woman and her husband) should be added in the forms as check mark or optional questions to evaluate relation of social factors and maternal deaths. - In educational and treatment deputies a job vacancy as in charge of maternal mortality be added - Considering these items in faculty members promotion are recommended: (attending in questionnaire team and active attendance in mortality committee) - Considering the implementation of intervention in hospital annual evaluation score. - Using the national clinical guidelines by the providers to prevent mismanagements or faults.