“在医院里，没有人会宠着我”：埃博拉疫情后塞拉利昂以设施为基础的分娩障碍的定性评估。
"In the hospital, there will be nobody to pamper me": a qualitative assessment on barriers to facility-based delivery in post-Ebola Sierra Leone.
机构信息
Institute of Tropical Medicine and International Health, Charité- Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.
Department of Obstetrics and Gynecology, Princess Christian Maternity Hospital, Freetown, Sierra Leone.
出版信息
Reprod Health. 2018 Sep 15;15(1):155. doi: 10.1186/s12978-018-0601-9.
BACKGROUND
Sierra Leone has one of the highest maternal mortality rates in the world. Encouraging the use of skilled birth attendance in health facilities is an important step in the endeavor to increase the number of safe deliveries. However, public trust in health facilities has been greatly damaged during the Ebola epidemic outbreak in Sierra Leone in 2014/2015, and little is known about external and intrinsic barriers to facility-based delivery (FBD) in the country since the end of the Ebola epidemic.
METHODS
We conducted a qualitative study on FBD in Princess Christian Maternity Hospital, Freetown, which is the national referral maternity hospital in Sierra Leone. We performed six focus group discussions with providers, pregnant women and recent mothers surrounding experiences, attitudes and behaviors regarding FBD and potential barriers. Discussions were tape recorded, transcribed and evaluated through content analysis.
RESULTS
Women in our study were overall technically aware of the higher safety linked with FBD, but this often diverged from their individual desire to deliver in a supportive and trusted social and traditional environment. Close relatives and community members seemed to be highly influencial regarding birth practices. Many women associated FBD with negative staff attitudes and an undefined fear. Logistic issues regarding transportation problems or late referral from smaller health centers were identified as frequent barriers to FBD.
CONCLUSIONS
More supportive staff attitudes and acceptance of an accompanying person throughout delivery could be promising approaches to increase women's confidence in FBDs. However, these approaches also imply revising health systems structures, like staff working conditions that are conducive for a friendly atmosphere, sufficient space in delivery wards allowing the women to bring a birth companion, or like the establishment of a reliable peripheral ambulance system to ensure transportation and fast referral.
背景
塞拉利昂是世界上孕产妇死亡率最高的国家之一。鼓励在卫生机构中使用熟练的接生服务，是增加安全分娩数量的重要步骤。然而，在 2014-2015 年塞拉利昂埃博拉疫情爆发期间，公众对卫生机构的信任受到了极大的损害，自埃博拉疫情结束以来，人们对该国基于设施的分娩（FBD）的外部和内在障碍知之甚少。
方法
我们在弗里敦的Princess Christian 妇产医院进行了一项关于 FBD 的定性研究，该医院是塞拉利昂的国家转诊妇产医院。我们与医护人员、孕妇和最近分娩的母亲进行了六次焦点小组讨论，围绕 FBD 以及潜在障碍的经验、态度和行为展开。讨论内容被录音、转录并通过内容分析进行评估。
结果
我们的研究对象总体上对 FBD 更高的安全性有一定的了解，但这往往与她们个人在支持性和可信赖的社会和传统环境中分娩的愿望相背离。近亲及社区成员对分娩实践似乎有很大的影响力。许多妇女将 FBD 与工作人员的负面态度和无法定义的恐惧联系在一起。交通问题或从较小的卫生中心转诊延误等后勤问题被认为是 FBD 的常见障碍。
结论
更支持的工作人员态度和在分娩过程中接受陪伴人员，可能是增加妇女对 FBD 信心的有前途的方法。然而，这些方法也意味着要修改卫生系统结构，例如工作人员的工作条件要有利于营造友好的氛围，分娩病房要有足够的空间允许妇女携带分娩陪伴人员，或者建立可靠的外围救护车系统以确保交通和快速转诊。
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