Luginaah Isaac N, Kangmennaang Joseph, Fallah Mosoka, Dahn Bernice, Kateh Francis, Nyenswah Tolbert
Department of Geography, Western University, London, Ontario, N6H 5P7, Canada.
Department of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
Soc Sci Med. 2016 Jul;160:75-86. doi: 10.1016/j.socscimed.2016.05.019. Epub 2016 May 12.
In Liberia, 75% of those who died from 2014 Ebola epidemic were women and the effects of this gruelling epidemic were more severely felt by pregnant women. This immediately raised fears about the long-term impacts of the epidemic on maternal and child health. As part of a larger study, this paper uses Andersen's behavioural model of health care utilization and Goffman's stigma theory to explain the timing and utilization of maternal health services before the outbreak of the Ebola epidemic as a background to the potential long-term effects on maternal health. We conducted survival and multiple regression analysis using the 2007 (N = 3524) and 2013 (N = 5127) Liberia's Demographic and Health Survey (LDHS) data. Our sample consisted of women of reproductive age (15-49 years) that had given birth in the last five years preceding the survey year. The findings show that from 2007 to 2013, there was an overall improvement in the timing of first antenatal care (ANC) visits (TR = 0.92, p < 0.001), number of ANC visits and delivery with skilled birth attendants. The results also show county and regional disparities in the utilization of ANC services with South Eastern A region emerging as a relatively vulnerable place. Also, access to ANC services defined by distance to a health facility strongly predicted utilization. We argue that the Ebola epidemic likely eroded many of the previous gains in maternal health care, and may have left a lingering negative effect on the access and utilization of maternal health services in the long-term. The study makes relevant policy recommendations.
在利比里亚，2014年埃博拉疫情的死亡者中有75%是女性，而孕妇更深刻地感受到了这场残酷疫情的影响。这立即引发了人们对该疫情对母婴健康长期影响的担忧。作为一项更大规模研究的一部分，本文运用安德森的医疗保健利用行为模型和戈夫曼的污名理论，将埃博拉疫情爆发前孕产妇保健服务的时间安排和利用情况作为对孕产妇健康潜在长期影响的背景进行解释。我们使用2007年（N = 3524）和2013年（N = 5127）利比里亚人口与健康调查（LDHS）数据进行了生存分析和多元回归分析。我们的样本包括在调查年份前五年内生育过的育龄妇女（15 - 49岁）。研究结果表明，从2007年到2013年，首次产前检查（ANC）的时间安排（TR = 0.92，p < 0.001）、ANC检查次数以及由熟练助产士接生的比例总体上有所改善。结果还显示，ANC服务的利用在县和地区层面存在差异，东南部A地区成为相对脆弱的地区。此外，以距离医疗机构的远近定义的获得ANC服务的机会是利用情况的有力预测指标。我们认为，埃博拉疫情可能侵蚀了此前在孕产妇保健方面取得的许多成果，并且从长期来看，可能会对孕产妇保健服务的可及性和利用情况产生持续的负面影响。该研究提出了相关政策建议。
