Unité Mixte Internationale-Résiliences (Université Catholique de Madagascar, Institut de Recherche pour le Développement), Université Catholique de Madagascar, BP 6059, 101, Antananarivo, Madagascar.
IRD, Ceped (IRD, Université Paris Descartes, INSERM), équipe SAGESUD, Paris, France.
BMC Pregnancy Childbirth. 2021 Jun 16;21(1):428. doi: 10.1186/s12884-021-03930-2.
In Madagascar, maternal mortality remains stable and high (426 deaths per 100,000 live births). This situation is mainly due to a delay or lack of use of maternal healthcare services. Problems related to maternal healthcare services are well documented in Madagascar, but little information related to maternal healthcare seeking is known. Thus, this paper aims to identify and analyze the factors that influence the utilization of maternal services, specifically, the use of antenatal care (ANC) during pregnancy and the use of skilled birth attendants (SBAs) at delivery.
We used quantitative and qualitative approaches in the study. Two communes of the Vakinankaratra region, which are located in the highlands, were the settings. Data collection occurred from October 2016 to July 2017. A total of 245 pregnant women were included and followed up in the quantitative survey, and among them, 35 participated in in-depth interviews(IDIs). Logistic regressions were applied to explore the influencing factors of antenatal and delivery healthcare seeking practices through thematic qualitative analysis.
Among the 245 women surveyed, 13.9% did not attend any ANC visits. School level, occupation and gravidity positively influenced the likelihood of attending one or more ANC visits. The additional use of traditional caregivers remained predominant and was perceived as potentially complementary to medical care. Nine in ten (91%) women expressed a preference for delivery at healthcare facilities (HFs), but 61% of births were assisted by a skilled birth attendant (SBA).The school level; the frequency of ANCs; the origin region; and the preference between modern or traditional care influenced the use of SBAs at delivery. A lack of preparation (financial and logistics problems) and women's low involvement in decision making at delivery were the main barriers to giving birth at HFs.
The use of maternal healthcare services is starting to gain ground, although many women and their relatives still use traditional caregivers at the same time. Relatives play a crucial role in maternal healthcare seeking. It would be necessary to target women's relatives for awareness-raising messages about ANC and childbirth in healthcare facilities and to support and formalize collaborations between traditional healers and biomedical caregivers.
在马达加斯加，孕产妇死亡率仍然居高不下（每 10 万例活产中有 426 例死亡）。这种情况主要是由于孕产妇保健服务的延迟或缺乏使用。马达加斯加已经很好地记录了与孕产妇保健服务相关的问题，但对寻求孕产妇保健服务的信息知之甚少。因此，本文旨在确定和分析影响孕产妇服务利用的因素，特别是在怀孕期间使用产前护理（ANC）和在分娩时使用熟练的接生员（SBA）。
我们在研究中使用了定量和定性方法。两个高地的瓦卡纳卡兰特拉地区的社区是研究地点。数据收集于 2016 年 10 月至 2017 年 7 月进行。共有 245 名孕妇参与了定量调查，并对其中 35 名孕妇进行了深入访谈（IDIs）。通过主题定性分析，应用逻辑回归探讨了影响产前和分娩保健寻求实践的因素。
在接受调查的 245 名妇女中，有 13.9%的人没有接受任何 ANC 检查。学校水平、职业和孕次积极影响了参加一次或多次 ANC 检查的可能性。传统照料者的额外使用仍然占主导地位，被认为是对医疗保健的潜在补充。十分之九（91%）的妇女表示倾向于在医疗机构（HFs）分娩，但只有 61%的分娩由熟练的接生员（SBA）协助。学校水平；ANC 的频率；原籍地区；以及对现代或传统护理的偏好，影响了分娩时使用 SBA 的情况。缺乏准备（财务和物流问题）和妇女在分娩时参与决策程度低是在 HFs 分娩的主要障碍。
尽管许多妇女及其亲属仍然同时使用传统照料者，但孕产妇保健服务的使用正在开始普及。亲属在孕产妇保健服务寻求中起着至关重要的作用。有必要针对妇女的亲属开展关于 ANC 和在医疗机构分娩的提高认识信息宣传，并支持和正式化传统治疗师和生物医学护理人员之间的合作。
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