Rosales Alfonso, Sulistyo Sigit, Miko Oktarinda, Hairani Lila K, Ilyana Meita, Thomas Joanne, Hirata Emily, Holloway Rhonda, Bantung Michael, Pabate Kristina, Wijaya Candra, Cherian Dennis
Department of Health, World Vision US, 300 I Street NE, Washington, DC, 20002, USA.
World Vision Indonesia, Jl. Wahid Hasyim 33, Jakarta Pusat, DKI, Jakarta, Indonesia.
J Health Popul Nutr. 2017 Dec 21;36(Suppl 1):44. doi: 10.1186/s41043-017-0122-0.
Indonesia's progress on reducing maternal and newborn mortality rates has slowed in recent years, predominantly in rural areas. To reduce maternal and newborn mortality, access to quality and skilled care, particularly at the facility level, is crucial. Yet, accessing such care is often delayed when maternal and newborn complications arise. Using the "Three Delays" model originated by Thaddeus and Maine (1994), investigation into reasons for delaying the decision to seek care, delaying arrival at a health facility, and delaying the receiving of adequate care, may help in establishing more focused interventions to improve maternal and newborn health in this region.
This qualitative study focused on identifying, analyzing, and describing illness recognition and care-seeking patterns related to maternal and newborn complications in the Jayawijaya district of Papua province, Indonesia. Group interviews were conducted with families and other caregivers from within 15 villages of Jayawijaya who had either experienced a maternal or newborn illness or maternal or newborn death.
For maternal cases, excessive bleeding after delivery was recognized as a danger sign, and the process to decide to seek care was relatively quick. The decision-making process was mostly dominated by the husband. Most care was started at home by birth attendants, but the majority sought care outside of the home within the public health system. For newborn cases, most of the caregivers could not easily recognize newborn danger signs. Parents acted as the main decision-makers for seeking care. Decisions to seek care from a facility, such as the clinic or hospital, were only made when healthcare workers could not handle the case within the home. All newborn deaths were associated with delays in seeking care due to caretaker limitations in danger sign identification, whereas all maternal deaths were associated with delays in receiving appropriate care at facility level.
For maternal health, emphasis needs to be placed on supply side solutions, and for newborn health, emphasis needs to be placed on demand and supply side solutions, probably including community-based interventions. Contextualized information for the design of programs aimed to affect maternal and newborn health is a prerequisite.
近年来，印度尼西亚在降低孕产妇和新生儿死亡率方面的进展有所放缓，主要是在农村地区。为降低孕产妇和新生儿死亡率，获得高质量的专业护理，尤其是在医疗机构层面，至关重要。然而，当出现孕产妇和新生儿并发症时，获得此类护理往往会延迟。运用由萨德厄斯和缅因州（1994年）提出的“三个延误”模型，调查延迟决定寻求护理、延迟到达医疗机构以及延迟获得充分护理的原因，可能有助于制定更有针对性的干预措施，以改善该地区的孕产妇和新生儿健康状况。
这项定性研究聚焦于识别、分析和描述印度尼西亚巴布亚省查亚维贾亚地区与孕产妇和新生儿并发症相关的疾病认知和寻求护理模式。对查亚维贾亚15个村庄内经历过孕产妇或新生儿疾病或孕产妇或新生儿死亡的家庭及其他照料者进行了小组访谈。
对于孕产妇病例，产后大出血被视为危险信号，决定寻求护理的过程相对较快。决策过程主要由丈夫主导。大多数护理由接生员在家中开始，但大多数人会在公共卫生系统内到医疗机构外寻求护理。对于新生儿病例，大多数照料者不容易识别新生儿危险信号。父母是寻求护理的主要决策者。只有当医护人员无法在家中处理病例时，才会决定到诊所或医院等医疗机构寻求护理。所有新生儿死亡都与照料者在识别危险信号方面的局限性导致的寻求护理延迟有关，而所有孕产妇死亡都与在医疗机构层面获得适当护理的延迟有关。
对于孕产妇健康，需要强调供应方解决方案；对于新生儿健康，则需要强调需求方和供应方解决方案，可能包括基于社区的干预措施。针对旨在影响孕产妇和新生儿健康的项目设计提供因地制宜的信息是先决条件。
