Mohamed Adam A, Bocher Temesgen, Magan Mohamed A, Omar Ali, Mutai Olive, Mohamoud Said A, Omer Meftuh
Save the Children International, Mogadishu, Somalia.
Department of Public Health, Institute of Health Sciences, Baskent University, Ankara, Turkey.
Int J Womens Health. 2021 Nov 25;13:1147-1160. doi: 10.2147/IJWH.S330069. eCollection 2021.
In Somalia, maternal and child health service utilization is unacceptably low. Little is known about factors contributing to low maternal and child health service utilization in Somalia, especially in internally displaced people (IDP) settings. This study aimed to understand barriers to the use of maternal and child health-care services among IDPs in Mogadishu.
A total of 17 in-depth interviews (IDIs), 7 focus group discussions (FGDs), and field observations were conducted on lactating/pregnant mothers, health-care providers, traditional birth attendants (TBA), and IDP camp leaders. The socio-ecological model (SEM) framework was employed for the categorization of barriers to healthcare utilization and further analysis was conducted to understand the major types and nature of barriers.
Using the SEM, the following major barriers that hinder maternal and child health service utilization were identified. Low socio-economic, lack of decision making power of women, TBA trust, poor knowledge and awareness on pregnancy danger signs, fear of going to unfamiliar areas were identified barriers at individual level. Traditional beliefs, male dominance in decision making, and lack of family support were also identified barriers at interpersonal level. Security and armed conflict barriers and formidable distance to health facility were identified barrier at the community level. Lack of privacy in the facility, transportation challenges, poor functional services, negative experiences, closure of the health facility in some hours, and lack of proper referral pathways were identified barriers at organizational or policy level.
Overall, various factors across different levels of SEM were identified as barrier to the utilization of maternal and child health services. Hence, multi-component interventions that target these complex and multifaceted barriers are required to be implemented in order to improve maternal and child health services utilization among IDP in Mogadishu, Somalia.
在索马里，孕产妇和儿童保健服务的利用率低得令人无法接受。对于导致索马里孕产妇和儿童保健服务利用率低下的因素，人们知之甚少，尤其是在境内流离失所者（IDP）环境中。本研究旨在了解摩加迪沙境内流离失所者使用孕产妇和儿童保健服务的障碍。
对哺乳期/怀孕母亲、医疗保健提供者、传统助产士（TBA）和境内流离失所者营地负责人进行了总共17次深入访谈（IDI）、7次焦点小组讨论（FGD）以及实地观察。采用社会生态模型（SEM）框架对医疗保健利用障碍进行分类，并进一步分析以了解障碍的主要类型和性质。
使用社会生态模型，确定了以下阻碍孕产妇和儿童保健服务利用的主要障碍。社会经济地位低、妇女缺乏决策权、对传统助产士的信任、对怀孕危险信号的知识和意识不足、害怕前往不熟悉的地区被确定为个人层面的障碍。传统观念、男性在决策中的主导地位以及缺乏家庭支持也被确定为人际层面的障碍。安全和武装冲突障碍以及到医疗机构的距离遥远被确定为社区层面的障碍。医疗机构缺乏隐私、交通挑战、功能服务差、负面经历、医疗机构在某些时段关闭以及缺乏适当的转诊途径被确定为组织或政策层面的障碍。
总体而言，社会生态模型不同层面的各种因素被确定为孕产妇和儿童保健服务利用的障碍。因此，需要实施针对这些复杂多面障碍的多成分干预措施，以提高索马里摩加迪沙境内流离失所者的孕产妇和儿童保健服务利用率。
