School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
Department of Organic Chemistry, College of Pharmacy, Al-Azhar University, Cairo, Egypt.
PLoS One. 2021 Aug 2;16(8):e0255193. doi: 10.1371/journal.pone.0255193. eCollection 2021.
Home delivery (HD) without skilled birth attendants (SBAs) are considered crucial risk factors increasing maternal and child mortality rates in Loa PDR. While a few studies in the literature discuss the choice of delivery in remote areas of minority ethnic groups; our work aims to identify factors that indicated their delivery place, at home or in the health facilities.
A community-based qualitative study was conducted between February and March 2020. Three types of interviews were implemented, In-depth interviews with 16 women of eight rural villages who delivered in the last 12 months in Xepon District, Savannakhet Province, Lao PDR. Also, three focus group discussions (FGDs) with nine HCPs and key-informant interviews of ten VHVs were managed. Factors affecting the choice of the delivery place were categorized according to the social-ecological model.
Our sample included five Tri women and two Mangkong women in the HD group, while the FD group included three Tri women, two Mangkong women, one Phoutai woman, two Laolung women and one Vietnamese. Our investigation inside the targeted minority showed that both positive perceptions of home delivery (HD) and low-risk perception minorities were the main reasons for the choice of HD, on the individual level. On the other hand, fear of complication, the experience of stillbirth, and prolonged labour pain during HD were reasons for facility-based delivery (FD). Notably, the women in our minority reported no link between their preference and their language, while the HCPs dated the low knowledge to the language barrier. On the interpersonal level, the FD women had better communication with their families, and better preparation for delivery compared to the HD group. The FD family prepared cash and transportation using their social network. At the community level, the trend of the delivery place had shifted from HD to FD. Improved accessibility and increased knowledge through community health education were the factors of the trend. At the societal (national policy) level, the free delivery policy and limitation of HCPs' assisted childbirth only in health facilities were the factors of increasing FD, while the absence of other incentives like transportation and food allowance was the factor of remaining of HD.
Based on the main findings of this study, we urge the enhancement of family communication on birth preparedness and birthplace. Furthermore, our findings support the need to educate mothers, especially those of younger ages, about their best options regarding the place of delivery. We propose implementing secondary services of HD to minimize the emergency risks of HD. We encourage local authorities to be aware of the medical needs of the community especially those of pregnant females and their right for a free delivery policy.
在洛奥普拉德布，没有熟练接生员（SBAs）的家庭分娩（HD）被认为是增加母婴死亡率的关键危险因素。虽然文献中有一些研究讨论了少数民族偏远地区的分娩选择，但我们的工作旨在确定表明其分娩地点的因素，是在家里还是在医疗机构。
这是一项 2020 年 2 月至 3 月期间进行的基于社区的定性研究。实施了三种类型的访谈：对来自老挝沙拉湾省 Xepon 区的 8 个农村村庄的 16 名在过去 12 个月内分娩的妇女进行深入访谈；还对 9 名卫生保健提供者进行了三次焦点小组讨论（FGD）和对 10 名 VHVs 进行了关键人物访谈。根据社会生态模型对影响分娩地点选择的因素进行了分类。
我们的样本包括 HD 组的 5 名 Tri 族妇女和 2 名 Mangkong 族妇女，FD 组包括 3 名 Tri 族妇女、2 名 Mangkong 族妇女、1 名 Phoutai 族妇女、2 名 Laolung 族妇女和 1 名越南妇女。我们对目标少数民族的调查表明，对家庭分娩（HD）的积极看法和少数民族对低风险的看法是选择 HD 的主要原因，这是个人层面的原因。另一方面，对并发症的恐惧、死产经历以及 HD 期间分娩疼痛的延长是选择医疗机构分娩（FD）的原因。值得注意的是，我们少数民族的妇女报告说，她们的偏好与语言之间没有联系，而卫生保健提供者则将知识水平低归咎于语言障碍。在人际关系层面上，FD 组的妇女与家人的沟通更好，分娩准备也更好。FD 家庭通过他们的社交网络准备现金和交通工具。在社区层面上，分娩地点的趋势已经从 HD 转向 FD。改善可及性和通过社区健康教育增加知识是这一趋势的因素。在社会（国家政策）层面上，免费分娩政策和限制卫生保健提供者仅在医疗机构协助分娩是增加 FD 的因素，而没有提供交通和食物津贴等其他激励措施是保持 HD 的因素。
根据这项研究的主要发现，我们敦促加强家庭沟通，提高生育准备和分娩地点的认识。此外，我们的研究结果支持需要教育母亲，特别是年轻母亲，了解她们在分娩地点方面的最佳选择。我们建议实施 HD 的二级服务，以最大程度地降低 HD 的紧急风险。我们鼓励地方当局了解社区的医疗需求，特别是孕妇及其免费分娩政策的权利。
