Cesarean delivery equipment availability.

BackgroundBangladesh faces one of the highest global burdens of maternal and newborn deaths, primarily caused by hemorrhage and eclampsia/preeclampsia. Despite reducing maternal mortality by 40%, comprehensive medical interventions remain insufficient in health facilities.ObjectivesThis study assessed the readiness of sub-district hospitals in Bangladesh to provide Emergency Obstetric and Newborn Care (EmONC) and analyzed the association between facility readiness and delivery rates.MethodsUsing Health Facility Assessment Survey data from 140 hospitals in 2014 and 141 in 2017, facility readiness was measured based on nine signal functions: administering antibiotics, oxytocin, and anticonvulsants; providing blood transfusions; performing cesarean and assisted vaginal deliveries; managing retained placentas and products of conception; and neonatal resuscitation. Donabedian’s model guided the analysis. Multiple linear regression examined associations between facility readiness and delivery rates using 2017 data.ResultsBetween 2014 and 2017, the availability of signal functions such as oxytocin (85% to 95%), anticonvulsants (58% to 63%), and blood transfusions (22% to 38%) improved. In 2014, 77% of facilities had at least 5 signal functions, 49% had 7, and 6% had all 9. By 2017, these increased to 83%, 56%, and 8%, respectively. Despite these improvements, the mean readiness index remained nearly unchanged (0.67 in 2014 vs. 0.69 in 2017). Only 8% of facilities performed fewer than 52 deliveries annually in 2017, while 26% conducted over 500. Regression analysis revealed a significant association between readiness scores and delivery rates (p = 0.009).ConclusionWhile certain indicators improved, overall readiness stagnated due to shortages of anesthetists, gynecologists, and essential supplies. With 64% of surveyed sub-district hospitals classified as comprehensive care facilities, resource and staffing investments are crucial to enhance readiness and reduce maternal and newborn mortality.背景 孟加拉国是全球孕产妇与新生儿死亡负担最高的国家之一，主要致死原因为产后出血及子痫/子痫前期。尽管该国孕产妇死亡率已下降40%，但医疗机构的综合医疗干预能力仍存在不足。 研究目标 本研究评估了孟加拉国乡级医院提供急诊产科与新生儿保健（Emergency Obstetric and Newborn Care，EmONC）的服务能力现状，并分析了医疗机构服务能力与分娩量之间的关联。 研究方法 本研究采用2014年与2017年的医疗机构评估调查数据，其中2014年纳入140家医院，2017年纳入141家医院。以9项核心服务功能作为医疗机构服务能力的评价指标：抗生素、缩宫素与抗惊厥药物的给药服务；输血服务；剖宫产与阴道助产手术；胎盘滞留与妊娠产物处置；以及新生儿复苏。本研究以唐奈兰模型（Donabedian’s model）为分析框架，并基于2017年的数据，通过多元线性回归分析检验医疗机构服务能力与分娩量之间的关联。 研究结果 2014年至2017年间，多项核心服务功能的可及性有所提升：缩宫素（85%升至95%）、抗惊厥药物（58%升至63%）以及输血服务（22%升至38%）。2014年，77%的医疗机构至少可提供5项核心服务功能，49%可提供7项，6%可提供全部9项；至2017年，该占比分别升至83%、56%与8%。尽管存在上述改善，但平均服务能力指数基本未发生变化：2014年为0.67，2017年为0.69。2017年仅8%的医疗机构年分娩量低于52例，而26%的医疗机构年分娩量超过500例。回归分析结果显示，医疗机构服务能力得分与分娩量之间存在显著关联（p=0.009）。 研究结论 尽管部分服务指标有所改善，但受麻醉医师、妇产科医师短缺以及基本物资匮乏的影响，整体服务能力仍处于停滞状态。本次调研纳入的乡级医院中，有64%被归类为综合保健机构，因此亟需通过资源与人员配置投入，提升医疗机构服务能力，进而降低孕产妇与新生儿死亡率。