Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Women Birth. 2020 Nov;33(6):544-555. doi: 10.1016/j.wombi.2020.02.012. Epub 2020 Feb 21.
The underlying pathways leading to stillbirth in low- and middle-income countries are not well understood. Context-specific understanding of how and why stillbirths occur is needed to prioritise interventions and identify barriers to their effective implementation and uptake.
To explore the contribution of contextual, individual, household-level and health system factors to stillbirth in Afghanistan.
Using a qualitative approach, we conducted semi-structured in-depth interviews with women and men that experienced stillbirth, female elders, community health workers, healthcare providers, and government officials in Kabul province, Afghanistan between October-November 2017. We used thematic analysis to identify contributing factors and developed a conceptual map describing possible pathways to stillbirth.
We found that low utilisation and access to healthcare was a key contributing factor, as were unmanaged conditions in pregnancy that increased women's risk of complications and stillbirth. Sociocultural factors related to the treatment of women and perceptions about medical interventions deprived women of interventions that could potentially prevent stillbirth. The quality of care from public and private providers during pregnancy and childbirth was a recurring concern exacerbated by health system constraints that led to unnecessary delays; while environmental factors linked to the ongoing conflict were also perceived to contribute to stillbirth. These pathways were underscored by social, cultural, economic factors and individual perceptions that contributed to the three-delays.
Efforts are needed at the community-level to facilitate care-seeking and raise awareness of stillbirth risk factors and the facility-level to strengthen antenatal and childbirth care quality, ensure culturally appropriate and respectful care, and reduce treatment delays.
导致中低收入国家死产的潜在途径尚不清楚。需要了解特定背景下死产发生的原因和方式，以便确定干预措施的优先顺序，并确定其有效实施和采用的障碍。
探讨阿富汗死产的背景、个体、家庭层面和卫生系统因素的贡献。
我们于 2017 年 10 月至 11 月在阿富汗喀布尔省，对经历过死产的妇女和男子、女性长者、社区卫生工作者、医疗保健提供者和政府官员进行了半结构式深入访谈。我们使用主题分析来确定促成因素，并制定了一个描述死产可能途径的概念图。
我们发现，低利用和获得医疗保健是一个关键的促成因素，妊娠管理不善增加了妇女并发症和死产的风险。与妇女待遇有关的社会文化因素和对医疗干预的看法使妇女无法获得可能预防死产的干预措施。妊娠和分娩期间公共和私人提供者的护理质量是一个反复出现的问题，卫生系统的限制加剧了这一问题，导致不必要的延误；而与持续冲突相关的环境因素也被认为导致了死产。这些途径受到社会、文化、经济因素和个人观念的影响，这些因素促成了三方面的延误。
需要在社区层面努力促进寻求护理，提高对死产风险因素的认识，并在医疗机构层面加强产前和分娩护理质量，确保提供文化上适当和尊重的护理，并减少治疗延误。
