Provider exposure to perinatal loss (N = 67).

Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries, such as Tanzania. Despite the profound burden of perinatal loss in these regions, access to facility or community-based palliative and psychosocial care is poor and understudied. In this study we explore perinatal loss through the lens of front-line healthcare providers, to better understand the knowledge and beliefs that guide their engagement with bereaved families. A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to healthcare professionals working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed in R Studio. 74 providers completed the survey. Pediatric providers saw a yearly average of 5 stillbirths and 32.7 neonatal deaths. Obstetric providers saw an average of 11.5 stillbirths and 13.12 neonatal deaths. Most providers would provide resuscitation beginning at 28 weeks gestational age. Respondents estimated that a 50% chance of survival for a newborn occurred at 28 weeks both nationally and at KCMC. Most providers felt that stillbirth and neonatal mortality were not the mother’s fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth. A majority perceived that women wanted hold their child after stillbirth (63.0%) or neonatal death (70.3%). Overall, this study found that providers at KCMC perceived that women are at greater risk of psychosocial or physical harm following perinatal loss. How women can best be supported by both the health system and their community remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.

全球超98%的死胎与新生儿死亡案例发生在坦桑尼亚这类低收入和中等收入国家（Low- and Middle-Income Countries，以下简称LMICs）。尽管此类地区围产期丧失（perinatal loss）负担沉重，但机构或社区姑息照护与社会心理照护的可及性极差，且相关研究仍较为匮乏。本研究从一线医疗服务提供者的视角切入探讨围产期丧失，以期更好地理解指导其与丧亲家庭互动沟通的认知与信念。研究团队开发了针对坦桑尼亚围产期丧失的知识、态度与实践（Knowledge, Attitudes and Practices，以下简称KAP）调查问卷，将其译为斯瓦希里语，并于4个月内面向乞力马扎罗山基督教医疗中心（Kilimanjaro Christian Medical Center，以下简称KCMC）的医疗专业人员开展调研。调研数据录入REDCap数据库，并通过R Studio完成统计分析。最终共有74名医疗从业者完成问卷。儿科医师年均接诊死胎5例、新生儿死亡32.7例；产科医师年均接诊死胎11.5例、新生儿死亡13.12例。多数受访者表示会在胎龄28周时启动新生儿复苏程序。受访者估算，在全国范围内及KCMC院内，新生儿存活概率达50%的胎龄均为28周。多数医护人员认为死胎与新生儿死亡并非产妇的过错（占比分别为78.4%与81.1%）。然而近半数（44.6%）的受访者认为死胎会对产妇产生负面影响，且62.2%的受访者认同产妇在死胎后面临更高的虐待或遗弃风险。多数医护人员感知到，产妇在死胎后（63.0%）或新生儿死亡后（70.3%）希望怀抱自己的孩子。总体而言，本研究发现KCMC的医护人员认为产妇在围产期丧失后面临更高的社会心理或躯体伤害风险。目前，医疗系统与社区应如何为产妇提供最优支持仍不明确。针对低收入和中等收入国家的围产期丧失与丧亲相关研究仍有待加强，以指导资源匮乏或非西方场景下特有的照护缺口相关的患者个体与医疗系统干预措施。