Moran Allisyn C, Winch Peter J, Sultana Nighat, Kalim Nahid, Afzal Kazi M, Koblinsky Marge, Arifeen Shams E, Seraji M Habibur R, Mannan Ishtiaq, Darmstadt Gary L, Baqui Abdullah H
Project for Advancing Health of Newborns and Mothers (PROJAHNMO), Sylhet, Bangladesh.
Trop Med Int Health. 2007 Jul;12(7):823-32. doi: 10.1111/j.1365-3156.2007.01852.x.
Seeking care from a basic or comprehensive facility in response to obstetric complications is a key behaviour promoted in safe motherhood programmes. This study examined definitions of care seeking for maternal health complications used by families in rural Bangladesh, and the frequency and determinants of locally-defined care seeking practices.
We conducted 24 semi-structured qualitative interviews with women who had recently given birth to characterize care seeking behaviours in response to perceived complications. Based on these findings, a quantitative household questionnaire was developed and administered to 1490 women, half of whom reported a 'serious or very serious' complication during their last pregnancy and/or delivery (n=769; 52%), and were included in the quantitative analysis.
Informants described three care seeking patterns in qualitative interviews: (i) sending a family member to purchase treatment to administer in the home; (ii) sending for a provider to treat the woman in the home and (iii) taking the woman outside the home to a facility or provider's office. The quantitative survey revealed that most women sought care for 'serious' complications (86%), with 42% seeking multiple sources of care. The majority of women purchased a treatment to administer at home (68%), while 20% brought a provider to the home. Thirty per cent of women were taken to a provider or facility.
Families generally seek care for complications, but care seeking does not correspond to definitions used by maternal health programmes. Local definitions of care seeking must be considered in intervention design so that promotion of care seeking increases for facility-based care for life-threatening emergencies rather than unintentionally increasing the use of home-based treatments of little medical value for prevention of mortality.
因产科并发症而到基层或综合医疗机构寻求治疗，是安全孕产项目所倡导的一项关键行为。本研究调查了孟加拉国农村家庭对孕产妇健康并发症寻求治疗的定义，以及当地界定的寻求治疗行为的频率和决定因素。
我们对近期分娩的妇女进行了24次半结构化定性访谈，以描述她们针对所察觉到的并发症的就医行为。基于这些研究结果，我们编制了一份定量家庭调查问卷，并对1490名妇女进行了调查，其中一半妇女报告在其上次怀孕和/或分娩期间出现了“严重或非常严重”的并发症（n = 769；52%），这些妇女被纳入定量分析。
受访者在定性访谈中描述了三种就医模式：（i）派家庭成员去购买治疗药物在家中自行用药；（ii）请医疗服务提供者到家中为产妇治疗；（iii）带产妇到家庭以外的医疗机构或医疗服务提供者的办公室。定量调查显示，大多数妇女因“严重”并发症而寻求治疗（86%），其中42%的妇女寻求多种治疗途径。大多数妇女购买治疗药物在家中自行用药（68%），而20%的妇女请医疗服务提供者到家中治疗。30%的妇女被带到医疗服务提供者处或医疗机构。
家庭通常会因并发症而寻求治疗，但就医行为与孕产妇健康项目所使用的定义并不相符。在干预设计中必须考虑当地对就医行为的定义，以便促进寻求治疗的行为能够增加对危及生命的紧急情况的机构化治疗，而不是无意中增加使用对预防死亡几乎没有医疗价值的家庭治疗方法。
