Kwesiga Doris, Eriksson Leif, Orach Christopher Garimoi, Tawiah Charlotte, Imam Md Ali, Fisker Ane B, Enuameh Yeetey, Lawn Joy E, Blencowe Hannah, Waiswa Peter, Bradby Hannah, Malqvist Mats
Department of Women's and Children's Health, Uppsala University; Uppsala Global Health Research On Implementation and Sustainability (UGHRIS), Uppsala University, Uppsala, Sweden.
Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
BMC Pregnancy Childbirth. 2022 Apr 6;22(1):292. doi: 10.1186/s12884-022-04622-1.
Globally, approximately 6,700 newborn deaths and 5,400 stillbirths occur daily. The true figure is likely higher, with under reporting of adverse pregnancy outcomes (APOs) noted. Decision-making in health is influenced by various factors, including one's social networks. We sought to understand APOs disclosure within social networks in Uganda, Ghana, Guinea-Bissau and Bangladesh and how this could improve formal reporting of APOs in surveys. METHODS: A qualitative, exploratory multi-country study was conducted within four health and demographic surveillance system sites. 16 focus group discussions were held with 147 women aged 15-49 years, who had participated in a recent household survey. Thematic analysis, with both deductive and inductive elements, using three pre-defined themes of Sender, Message and Receiver was done using NVivo software.
Disclosure of APOs was a community concern, with news often shared with people around the bereaved for different reasons, including making sense of what happened and decision-making roles of receivers. Social networks responded with comfort, providing emotional, in-kind and financial support. Key decision makers included men, spiritual and traditional leaders. Non-disclosure was usually to avoid rumors in cases of induced abortions, or after a previous bad experience with health workers, who were frequently excluded from disclosure, except for instances where a woman sought advice on APOs.
Communities must understand why they should report APOs and to whom. Efforts to improve APOs reporting could be guided by diffusion of innovation theory, for instance for community entry and sensitization before the survey, since it highlights how information can be disseminated through community role models. In this case, these gatekeepers we identified could promote reporting of APOs. The stage at which a person is in decision-making, what kind of adopter they are and their take on the benefits and other attributes of reporting are important. In moving beyond survey reporting to getting better routine data, the theory would be applicable too. Health workers should demonstrate a more comforting and supportive response to APOs as the social networks do, which could encourage more bereaved women to inform them and seek care.
全球范围内，每天约有6700例新生儿死亡和5400例死产发生。实际数字可能更高，因为存在不良妊娠结局（APO）报告不足的情况。卫生领域的决策受多种因素影响，包括个人的社交网络。我们试图了解乌干达、加纳、几内亚比绍和孟加拉国社交网络中APO的披露情况，以及这如何能改善调查中APO的正式报告。
在四个卫生和人口监测系统站点开展了一项定性、探索性的多国研究。与147名年龄在15至49岁之间、近期参与过家庭调查的女性进行了16次焦点小组讨论。使用NVivo软件，采用既有演绎又有归纳元素的主题分析方法，依据发送者、信息和接收者这三个预先定义的主题进行分析。
APO的披露是社区关注的问题，消息通常会因不同原因与丧亲者周围的人分享，包括理解所发生的事情以及接收者的决策作用。社交网络给予安慰，提供情感、实物和经济支持。关键决策者包括男性、宗教和传统领袖。不披露通常是为了避免在人工流产情况下出现谣言，或者是因为之前与卫生工作者有过不愉快经历，除了女性就APO寻求建议的情况外，卫生工作者通常被排除在披露范围之外。
社区必须明白为何要报告APO以及向谁报告。改善APO报告的努力可以以创新扩散理论为指导，例如在调查前进行社区介入和宣传，因为该理论突出了信息如何通过社区榜样进行传播。在这种情况下，我们确定的这些把关人可以促进APO的报告。一个人在决策过程中的阶段、他们属于哪种采用者以及他们对报告的益处和其他属性的看法很重要。在从调查报告转向获取更好的常规数据方面，该理论也将适用。卫生工作者应该像社交网络一样，对APO表现出更令人安心和支持性的反应，这可能会鼓励更多丧亲女性告知他们并寻求护理。
