UNICEF Afghanistan, Kabul, Afghanistan.
United Nations Office Complex in Afghanistan (UNOCA), Jalalabad Road, Kabul, Afghanistan.
BMC Pregnancy Childbirth. 2018 Jun 18;18(1):246. doi: 10.1186/s12884-018-1890-2.
In the past fifteen years, Afghanistan has made substantial progress in extending primary health care. However, coverage of essential health interventions proven to improve maternal and neonatal health outcomes, particularly skilled birth attendance, remains unacceptably low. This is especially true for those in the poorest quintile of the population. This cross-sectional quantitative and qualitative study assessed barriers associated with care-seeking for institutional delivery among rural Afghan women in three provinces.
The study was conducted from November to December 2016 in 12 districts across three provinces - Badghis, Bamyan, and Kandahar - which are predominately rural. Districts were used as the primary sampling unit with district-level sample sizes reflecting the ratio of that district's population to provincial population. Villages within these districts, the secondary sampling units, were randomly selected. A household survey was used to collect data on: demographics, socio-economic status, childbearing history, health transport and service costs, maternal health seeking behavior and barriers to service uptake. Data on barriers to facility delivery were compared across provinces using chi square tests.
Of the 2479 women of child bearing age interviewed, one-third were from each province (33% n = 813 Badghis, 34% n = 840 Bamyan, 33% n = 824 Kandahar). Among those respondents who had delivered none of their children in a health center, money to pay for services appeared to be most important barrier to accessing institutional delivery (56%, n = 558). No transportation available was the second most widely cited reason (37%, n = 368), followed by family restrictions (n = 30%, n = 302). Respondents in Badghis reported the highest levels of barriers compared to the other two provinces. Respondents in Badghis were more likely to report familial or cultural constraints as the most important barrier to institutional delivery (43%) compared to Bamyan (2%) and Kandahar (12%) (p < 0.001).
Despite the socio-demographic and geographic diversity of the three provinces under study, the top barriers to institutional delivery reported in all three areas are consistent with available evidence, namely, that distance, transport cost and transport availability are the main factors limiting institutional delivery. Proven and promising approaches to overcome these barriers to institutional delivery in Afghanistan should be explored and studied.
在过去的十五年中，阿富汗在扩大初级卫生保健方面取得了重大进展。然而，覆盖面广泛的基本卫生干预措施，特别是熟练的接生服务，仍然低得令人无法接受，特别是对于最贫困的五分之一人口而言。本横断面定量和定性研究评估了在阿富汗三个省份的农村地区，与寻求机构分娩相关的障碍。
本研究于 2016 年 11 月至 12 月在巴德吉斯、巴米扬和坎大哈三个省份的 12 个地区进行，这些地区主要是农村地区。以地区为主要抽样单位，根据该地区人口与省人口的比例确定地区一级的样本量。在这些地区内，村庄作为二级抽样单位，随机选择。采用家庭调查收集以下数据：人口统计学、社会经济状况、生育史、卫生交通和服务费用、孕产妇寻求医疗行为以及服务利用的障碍。使用卡方检验比较各省之间的设施分娩障碍数据。
在所采访的 2479 名育龄妇女中，每个省各占三分之一（33%，n=813 巴德吉斯，34%，n=840 巴米扬，33%，n=824 坎大哈）。在那些没有在卫生中心分娩过的受访者中，似乎支付服务费用是获得机构分娩的最大障碍（56%，n=558）。没有交通工具是第二大普遍原因（37%，n=368），其次是家庭限制（n=30%，n=302）。与其他两个省份相比，巴德吉斯的受访者报告的障碍水平最高。巴德吉斯的受访者更有可能将家庭或文化限制报告为获得机构分娩的最重要障碍（43%），而巴米扬（2%）和坎大哈（12%）则报告（p<0.001）。
尽管研究中的三个省份在社会人口和地理方面存在差异，但在所有三个地区报告的机构分娩的主要障碍与现有证据一致，即距离、交通成本和交通可用性是限制机构分娩的主要因素。在阿富汗，应探索和研究克服机构分娩障碍的成熟且有前景的方法。
