Assessment of antenatal care services provided to pregnant women with gestational diabetes mellitus at UNRWA health centers in Gaza governorates
Date
2008-06-09
Authors
Mariam Abd-el-Kader
مريم حسن اسماعيل عبد القادر
Journal Title
Journal ISSN
Volume Title
Publisher
Al-Quds University
Abstract
الرعاية الصحية للسيدات الحوامل تعتبر من الوسائل الأساسية لضمان حمل آمن و مواليد أصحاء، بالأخص في حالات الحمل الخطر و منها سكري الحمل.
هذه الدراسة تهتم بتقييم الرعاية الصحية ما قبل الولادة المقدمة للسيدات الحوامل اللاتي بعانين من سكري الحمل في مراكز وكالة الغوث في محافظات غزة، و تهدف إلى رفع مستوى الخدمة الصحية و تقليل مضاعفات سكري الحمل على الأم و جنينها.
لقد اشتملت عينة الدراسة على فئتين هما مقدمي خدمة رعاية السيدات الحوامل(الحمل ألخطر) العاملين في مراكز وكالة الغوث الصحية و عددهم 103 مقدم للخدمة، و السيدات الحوامل المصابات بسكري الحمل خلال فترة إجراء الدراسة وعددهم 151 سيدة، و قد كانت نسبة الاستجابة 96.1% بالنسبة للسيدات الحوامل و 98.1% بالنسبة لمقدمي الخدمة. تم جمع البيانات من خلال استبيانين، الأولى خاصة بمقدمي الخدمة و الثانية خاصة بالسيدات الحوامل تعبأ من قبل الباحث أو المساعدين.
لوحظ من خلال الدراسة إن السيدات الحوامل المصابات بسكري الحمل و اللاتي يتلقين الخدمة في مراكز وكالة الغوث كن في المعظم ربات منزل، ذوات مستوى تعليمي متدني، و دخل شهري اقل من المتوسط. وجدت الدراسة إن خدمات الرعاية الصحية للحوامل المقدمة للسيدات المصابات بسكري الحمل في مراكز الغوث متاحة لجميع السيدات من المنظور الجغرافي و من خلال وجود نظام مواعيد واضح حيث ذكر ما نسبته 70.4% من السيدات وجود نظاما مواعيد باليوم و الوقت المحددين.
بالنسبة للسيدات اللاتي بعانين من سكري الحمل محدودية المعرفة بسكري الحمل من حيث المضاعفات و طرق العلاج تعتبر مشكلة ضخمة تؤدي إلى عدم تقدير حجم المشكلة التي يواجهنها حيث وجدت الدراسة إن معظم السيدات لديهم مستوى من ضعيف إلى متوسط من المعرفة حول سكري الحمل. وجدت الدراسة انه يوجد علاقة ذات دلالة إحصائية بين مستوى المعرفة حول سكري الحمل و المستوى التعليمي للسيدة الحامل و لكن لا يوجد علاقة بين هذه المعرفة و مستوى الدخل، و العمر أو مكان السكن.
بالنسبة لمقدمي الخدمة وجدت الدراسة أن معظمهم من الإناث بنسبة 97%، و متوسط عمر مقدمي الخدمة كان 40.95 سنة بمتوسط خبرة يعادل 14.7 سنوات. 23.8% من مقدمي الخدمة كانوا أطباء و الباقون من الممرضات. أكد 70.3% من مقدمي الخدمة أنهم تلقوا تدريبا خلال السنوات الخمس الماضية، منهم حوالي النصف تلقوا تدريبا عن رعاية الحمل الخطر.
جميع الأجهزة و الأدوات و التحاليل المخبرية و الأدوية اللازمة لرعاية مرضى سكري الحمل وجد أنها متوفرة و تعمل بشكل سليم في جميع مراكز وكاله الغوث الصحية.
بالنسبة لمقدمي الخدمة، كان مستوى المعرفة بسكري الحمل، مضاعفاته و علاجه اقل بكثير من المتوقع حيث وجد أن 18.8% من هذه المجموعة لديهم مستوى متدني من المعرفة بسكري الحمل. لم يكن هناك علاقة ذات دلالة إحصائية بين مستوى المعرفة و العمر، التدريب، المحافظة أو سنوات الخبرة. بينما وجد أن هناك علاقة واضحة بين مستوى المعرفة بسكري الحمل و المؤهلات العلمية وكذلك الاطلاع على تعليمات و كاله الغوث المكتوبة للتعامل مع سكري الحمل.
خلصت الدراسة إلى عدة توصيات أهمها التركيز على برامج التدريب و التقييم المستمر لمقدمي الخدمة لما لها من بالغ الأثر على تطوير مستوى المعرفة لديهم و ذلك تحسيننا لمستوى الخدمة التي يقدمونها. يجب على المسئولين العمل على زيادة الطاقم الصحي العامل في رعاية الحوامل و ذلك لحل مشكلة الانتظار الطويل و زيادة وقت الاستشارة الطبية. تحسين خدمات التوعية الصحية للسيدات الحوامل حول سكري الحمل هو من أهم الحلول لمشكلة فقر المعرفة لديهم لذلك يجب العمل على تكثيف الإرشاد الصحي للنساء الحوامل واللاتي بعانين من سكري الحمل مع زيادة نشرات التوعية الخاصة بسكري الحمل .
Antenatal care is a golden mean to ensure safe pregnancy and good outcome for pregnant women especially those at high-risk, e.g. patients with gestational diabetes mellitus (GDM). This study is dedicated to assess antenatal care services provided to pregnant women with gestational diabetes in UNRWA health centers in Gaza governorates and serves the overall aim to help improving antenatal care services and decrease maternal and fetal complications caused by GDM. This is a cross sectional study conducted in UNRWA health centers all over Gaza governorates. The study sample includes: all healthcare providers who work in antenatal care (ANC) in high risk pregnancy "103" staff members and all registered pregnant women with GDM "151" clients at the time of the study. The response rate was 98.1% for the providers and 96.1% for the clients. Two face-to-face questionnaires were used to collect data, one for the clients and one for healthcare providers. UNRWA antenatal care services were found to be geographically accessible and for the availability of appointment system most of the clients 70.4 % agreed on the presence of an appointments system by date and time. Lack of knowledge in the clients with GDM was found to be a huge problem that makes such women underestimate their health problems with most of clients having poor to moderate knowledge about GDM. The results revealed that there is statistical significant relation ship between client knowledge and education level, There is no statistical significant relationship between client knowledge and income, age and district distribution. The vast majority of healthcare providers were females (97%). The mean age of the providers was 40.95 years with a mean experience of 14.7 years. 23.8% of healthcare providers are doctors (obstetrician and GP) while 76.2% were Nurses. 70.3% of the ANC healthcare providers stated that they had received in- service training during the last five years of working for UNRWA only half of them received training in management of high risk pregnancy this lack in training resulted in lack of knowledge Most of the essential equipments, laboratory investigations and medications required for the management of GDM were found to be present and in working order in UNRWA health centers. The knowledge of healthcare providers was lower than expected with 18.8% having poor knowledge about GDM. There were no statistically significant relationship between healthcare provider knowledge and Years of experience, district, Age group and Training in general. There was statistically significant relationship between healthcare providers’ knowledge and qualification and there was statistical significant relationship between healthcare provider knowledge and the availability of written guidelines and reading them by the providers. The researcher recommends paying more attention to continuous effective training program for the healthcare providers and periodic assessment of their competency to improve health provider's knowledge and practice regarding management of GDM. Increasing the numbers of staff members found to be a crucial step to solve excessive workload problems, to decrease waiting time and to increase consultation time, thus the researcher recommends working on that issue. Improvement of health education services and improving the availability of teaching aids and health education materials recommended increasing the client's knowledge about GDM.
Antenatal care is a golden mean to ensure safe pregnancy and good outcome for pregnant women especially those at high-risk, e.g. patients with gestational diabetes mellitus (GDM). This study is dedicated to assess antenatal care services provided to pregnant women with gestational diabetes in UNRWA health centers in Gaza governorates and serves the overall aim to help improving antenatal care services and decrease maternal and fetal complications caused by GDM. This is a cross sectional study conducted in UNRWA health centers all over Gaza governorates. The study sample includes: all healthcare providers who work in antenatal care (ANC) in high risk pregnancy "103" staff members and all registered pregnant women with GDM "151" clients at the time of the study. The response rate was 98.1% for the providers and 96.1% for the clients. Two face-to-face questionnaires were used to collect data, one for the clients and one for healthcare providers. UNRWA antenatal care services were found to be geographically accessible and for the availability of appointment system most of the clients 70.4 % agreed on the presence of an appointments system by date and time. Lack of knowledge in the clients with GDM was found to be a huge problem that makes such women underestimate their health problems with most of clients having poor to moderate knowledge about GDM. The results revealed that there is statistical significant relation ship between client knowledge and education level, There is no statistical significant relationship between client knowledge and income, age and district distribution. The vast majority of healthcare providers were females (97%). The mean age of the providers was 40.95 years with a mean experience of 14.7 years. 23.8% of healthcare providers are doctors (obstetrician and GP) while 76.2% were Nurses. 70.3% of the ANC healthcare providers stated that they had received in- service training during the last five years of working for UNRWA only half of them received training in management of high risk pregnancy this lack in training resulted in lack of knowledge Most of the essential equipments, laboratory investigations and medications required for the management of GDM were found to be present and in working order in UNRWA health centers. The knowledge of healthcare providers was lower than expected with 18.8% having poor knowledge about GDM. There were no statistically significant relationship between healthcare provider knowledge and Years of experience, district, Age group and Training in general. There was statistically significant relationship between healthcare providers’ knowledge and qualification and there was statistical significant relationship between healthcare provider knowledge and the availability of written guidelines and reading them by the providers. The researcher recommends paying more attention to continuous effective training program for the healthcare providers and periodic assessment of their competency to improve health provider's knowledge and practice regarding management of GDM. Increasing the numbers of staff members found to be a crucial step to solve excessive workload problems, to decrease waiting time and to increase consultation time, thus the researcher recommends working on that issue. Improvement of health education services and improving the availability of teaching aids and health education materials recommended increasing the client's knowledge about GDM.