Oluoch-Aridi Jackline, Chelagat Tecla, Nyikuri Mary M, Onyango Joseph, Guzman Danice, Makanga Cindy, Miller-Graff Laura, Dowd Robert
The Ford Family Program in Human Development Studies and Solidarity, Kellogg Institute for International Studies, University of Notre Dame, Notre Dame, IN, United States.
Strathmore Business School, Institute of Healthcare Management, Strathmore University, Nairobi, Kenya.
Front Glob Womens Health. 2020 Nov 26;1:599267. doi: 10.3389/fgwh.2020.599267. eCollection 2020.
Maternal mortality continues to be one of the biggest challenges of the health system in Kenya. Informal settlements in Kenya have been known to have higher rates of maternal mortality and also receive maternity services of varied quality. Data assessing progress on key maternal health indicators within informal settlements are also often scarce. The COVID-19 pandemic hit Kenya in March this year and so far, the impact of the pandemic on access to maternal health has not been established. This study aims to add to the body of knowledge by investigating the effects of the COVID-19 pandemic and mitigation strategies on access to health care services in informal settlements. Qualitative methods using in-depth interviews were used to assess women's experiences of maternity care during the COVID-19 era and the impact of proposed mitigation strategies such as the lockdown and the curfew. Other aspects of the maternity experience such as women's knowledge of COVID-19, their perceived risk of infection, access to health facilities, perceived quality of care were assessed. Challenges that women facing as a result of the lockdown and curfew with respect to maternal health access and quality were also assessed. Our findings illustrate that there was a high awareness of the symptoms and preventative measures for COVID-19 amongst women in informal settlements. Our findings also show that women's perception of risk to themselves was high, whereas risk to family and friends, and in their neighborhood was perceived as low. Less than half of women reported reduced access due to fear of contracting Coronavirus, Deprioritization of health services, economic constraints, and psychosocial effects were reported due to the imposed lockdown and curfew. Most respondents perceived improvements in quality of care due to short-waiting times, hygiene measures, and responsive health personnel. However, this was only reported for the outpatient services and not in-patient services. The most important recommendation was for the Government to provide food followed by financial support and other basic amenities. This has implications for the Government's mitigation measures that are focused on public health measures and lack social safety-net approaches for the most vulnerable communities.
孕产妇死亡率仍然是肯尼亚卫生系统面临的最大挑战之一。众所周知，肯尼亚的非正式定居点孕产妇死亡率较高，而且获得的孕产妇服务质量参差不齐。评估非正式定居点内关键孕产妇健康指标进展情况的数据也常常匮乏。今年3月，新冠疫情袭击了肯尼亚，到目前为止，疫情对孕产妇保健服务可及性的影响尚未明确。本研究旨在通过调查新冠疫情及其缓解策略对非正式定居点医疗服务可及性的影响，来丰富相关知识体系。采用深度访谈的定性方法，评估了女性在新冠疫情期间的孕产妇保健经历，以及诸如封锁和宵禁等拟议缓解策略的影响。还评估了孕产妇经历的其他方面，如女性对新冠病毒的了解、她们感知到的感染风险、获得卫生设施的情况、感知到的护理质量。还评估了女性因封锁和宵禁在孕产妇保健可及性和质量方面面临的挑战。我们的研究结果表明，非正式定居点的女性对新冠病毒的症状和预防措施有很高的认知度。我们的研究结果还表明，女性对自身感染风险的认知较高，而对家人、朋友和邻里感染风险的认知较低。不到一半的女性报告称，由于担心感染新冠病毒，医疗服务可及性降低，还有报告称，由于实施封锁和宵禁，出现了医疗服务被边缘化、经济困难以及心理社会影响。大多数受访者认为，由于候诊时间缩短、卫生措施以及医护人员反应迅速，护理质量有所提高。然而，这仅针对门诊服务，而非住院服务。最重要的建议是政府提供食物，其次是财政支持和其他基本便利设施。这对政府侧重于公共卫生措施、缺乏针对最脆弱社区的社会安全网方法的缓解措施具有启示意义。
