Brown School of Social Work, One Brookings Drive, CB 1196, Washington University, St. Louis, MO 63130, USA.
Soc Sci Med. 2011 Nov;73(10):1477-89. doi: 10.1016/j.socscimed.2011.08.040. Epub 2011 Sep 29.
This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services. We conclude that disparity in access to government-supported health care facilities constitutes a major and persisting health inequity between persons with and without disabilities in Sierra Leone. Ensuring equal access will require further strengthening of the country's health care system. Furthermore, because the morbidity and mortality rates of pregnant women are persistently high in Sierra Leone, assessing the quality of services received is an important priority for future research.
这是第一项比较塞拉利昂城乡地区残疾和非残疾男女健康状况和获得医疗保健服务情况的研究。它特别关注残疾妇女获得生殖保健服务和孕产妇保健的情况。2009 年在塞拉利昂的 5 个区进行了一项横断面研究，随机选择了 17 个集群，总样本量为 425 户。所有被确定为残疾的成年人以及随机选择的非残疾成年人对照组都接受了关于健康和生殖健康的访谈。不出所料，我们发现，在调整其他社会经济特征（双变量模型）后，严重残疾者获得公共医疗保健服务的机会比非残疾者少。然而，在报告使用避孕措施方面，残疾人和非残疾人之间没有显著差异；与预期相反，残疾妇女获得孕产妇保健服务的可能性与非残疾妇女一样大。决定获得这些服务的不是残疾，而是社会经济不平等。我们还发现，残疾妇女与非残疾妇女一样有可能报告有子女和希望再有一个孩子：她们不仅有性行为，而且还需要获得生殖健康服务。我们的结论是，在获得政府支持的医疗保健设施方面的差异是塞拉利昂残疾人和非残疾人之间存在的一个主要和持续存在的健康不平等现象。确保平等获得服务将需要进一步加强该国的医疗保健系统。此外，由于塞拉利昂孕妇的发病率和死亡率一直很高，评估所获得服务的质量是未来研究的一个重要优先事项。
