Callaghan-Koru Jennifer A, McMahon Shannon A, Chebet Joy J, Kilewo Charles, Frumence Gasto, Gupta Shivam, Stevenson Raz, Lipingu Chrisostom, Baqui Abdullah H, Winch Peter J
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Health Policy Plan. 2016 Oct;31(8):1039-49. doi: 10.1093/heapol/czw034. Epub 2016 Apr 26.
Antenatal care (ANC) remains an important contact point on the continuum of care for mothers and children in low- and middle-income countries. In Tanzania, the proportion of pregnant women completing at least four ANC visits (ANC-4) dropped from 70% to 43% between 1999 and 2010. To identify potential causes of the decline in the number of ANC visits, we conducted qualitative research at 18 health centres in Morogoro Region, exploring providers' communication about ANC visits and clients' and providers' perceptions of changes in ANC services and barriers to completing four visits. We also observed counselling messages delivered during 203 ANC consultations. Our results indicate that provider communication about ANC visit recommendations is inadequate, and confusion exists among clients about when and how often they should attend. Participants highlighted how the scale up of Prevention of Mother-to-Child Transmission, with routine human immunodeficiency virus testing for women and their male partners, presents additional barriers for some women. Changes to the timing and content of ANC services following the adoption of the Focused ANC model was described by participants as changing women's perceptions and decisions in how they utilize ANC services. In particular, condensed delivery of technical interventions fostered a sense among clients that multiple visits are unnecessary. Other barriers that may contribute to declining ANC-4 include changing norms about family planning and birth spacing, out-of-pocket costs for clients and informal practices adopted by health facilities and providers such as turning women away who attend early in pregnancy or are not accompanied by male partners. Further research is needed to determine the role and extent that these barriers may be contributing to declining ANC-4. Issues of poor communication, supply inadequacies and informal practices, deserve immediate attention from the health system.
在低收入和中等收入国家，产前保健（ANC）仍然是母婴连续护理过程中的一个重要接触点。在坦桑尼亚，1999年至2010年间，完成至少四次产前保健访视（ANC - 4）的孕妇比例从70%降至43%。为了确定产前保健访视次数下降的潜在原因，我们在莫罗戈罗地区的18个卫生中心开展了定性研究，探讨了医护人员关于产前保健访视的沟通情况，以及服务对象和医护人员对产前保健服务变化及完成四次访视障碍的看法。我们还观察了203次产前保健咨询过程中传递的咨询信息。我们的研究结果表明，医护人员关于产前保健访视建议的沟通不足，服务对象对于何时以及多久进行一次访视存在困惑。参与者强调，扩大预防母婴传播项目，对女性及其男性伴侣进行常规人类免疫缺陷病毒检测，给一些女性带来了额外障碍。参与者称，采用集中式产前保健模式后，产前保健服务的时间安排和内容发生了变化，这改变了女性对如何利用产前保健服务的看法和决定。特别是，技术干预措施的集中提供让服务对象觉得没有必要进行多次访视。其他可能导致ANC - 4访视次数下降的障碍包括计划生育和生育间隔规范的变化、服务对象的自付费用，以及卫生机构和医护人员采取的一些非正式做法，比如拒绝接待怀孕早期就诊或没有男性伴侣陪同的女性。需要进一步研究来确定这些障碍在多大程度上导致了ANC - 4访视次数的下降。沟通不畅、供应不足和非正式做法等问题，值得卫生系统立即关注。
