肯尼亚西部产前和分娩护理的障碍与促进因素：一项定性研究
Barriers and facilitators to antenatal and delivery care in western Kenya: a qualitative study.
作者信息
Mason Linda, Dellicour Stephanie, Ter Kuile Feiko, Ouma Peter, Phillips-Howard Penny, Were Florence, Laserson Kayla, Desai Meghna
机构信息
Child and Reproductive Health, Liverpool School of Tropical Medicine, Merseyside, UK.
Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya.
出版信息
BMC Pregnancy Childbirth. 2015 Feb 13;15:26. doi: 10.1186/s12884-015-0453-z.
BACKGROUND
In western Kenya, maternal mortality is a major public health problem estimated at 730/100,000 live births, higher than the Kenyan national average of 488/100,000 women. Many women do not attend antenatal care (ANC) in the first trimester, half do not receive 4 ANC visits. A high proportion use traditional birth attendants (TBA) for delivery and 1 in five deliver unassisted. The present study was carried out to ascertain why women do not fully utilise health facility ANC and delivery services.
METHODS
A qualitative study using 8 focus group discussions each consisting of 8-10 women, aged 15-49 years. Thematic analysis identified the main barriers and facilitators to health facility based ANC and delivery.
RESULTS
Attending health facility for ANC was viewed positively. Three elements of care were important; testing for disease including HIV, checking the position of the foetus, and receiving injections and / or medications. Receiving a bed net and obtaining a registration card were also valuable. Four barriers to attending a health facility for ANC were evident; attitudes of clinic staff, long clinic waiting times, HIV testing and cost, although not all women felt the cost was prohibitive being worth it for the health of the child. Most women preferred to deliver in a health facility due to better management of complications. However cost was a barrier, and a reason to visit a TBA because of flexible payment. Other barriers were unpredictable labour and transport, staff attitudes and husbands' preference.
CONCLUSIONS
Our findings suggest that women in western Kenya are amenable to ANC and would be willing and even prefer to deliver in a healthcare facility, if it were affordable and accessible to them. However for this to happen there needs to be investment in health promotion, and transport, as well as reducing or removing all fees associated with antenatal and delivery care. Yet creating demand for service will need to go alongside investment in antenatal services at organisational, staffing and facility level in order to meet both current and future increase in demand.
背景
在肯尼亚西部，孕产妇死亡率是一个重大的公共卫生问题，估计每10万例活产中有730例死亡，高于肯尼亚全国每10万名妇女488例的平均水平。许多妇女在孕早期没有接受产前护理（ANC），一半的妇女没有接受4次产前检查。很大一部分妇女在分娩时使用传统助产士（TBA），五分之一的妇女分娩时无人协助。本研究旨在确定妇女为何没有充分利用医疗机构的产前护理和分娩服务。
方法
采用定性研究方法，进行了8次焦点小组讨论，每组由8至10名年龄在15至49岁之间的妇女组成。主题分析确定了基于医疗机构的产前护理和分娩的主要障碍和促进因素。
结果
对到医疗机构接受产前护理持积极看法。护理的三个要素很重要；疾病检测，包括艾滋病毒检测、检查胎儿位置以及接受注射和/或药物治疗。领取蚊帐和获得登记卡也很有价值。到医疗机构接受产前护理存在四个明显障碍；诊所工作人员的态度、诊所等待时间长、艾滋病毒检测和费用，尽管并非所有妇女都认为费用过高，认为为了孩子的健康是值得的。由于并发症管理更好，大多数妇女更愿意在医疗机构分娩。然而，费用是一个障碍，也是选择传统助产士的一个原因，因为付款方式灵活。其他障碍包括不可预测的分娩和交通、工作人员态度以及丈夫的偏好。
结论
我们的研究结果表明，肯尼亚西部的妇女愿意接受产前护理，并且如果负担得起且能够获得服务，她们愿意甚至更愿意在医疗机构分娩。然而，要实现这一点，需要在健康促进、交通方面进行投资，同时减少或取消与产前和分娩护理相关的所有费用。然而，在创造服务需求的同时，还需要在组织、人员配备和设施层面投资于产前服务，以满足当前和未来不断增长的需求。
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