College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Department of Community Health & Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
BMC Health Serv Res. 2022 May 6;22(1):606. doi: 10.1186/s12913-022-08009-y.
The COVID-19 (coronavirus disease 2019) pandemic challenges provision and access to essential maternity care in low-resilience health systems. The aim of this study was to explore maternity healthcare workers' experiences of, and perceptions about providing maternity care during the COVID-19 outbreak in Lagos State, Nigeria.
This qualitative study conducted individual, remote, semi-structured interviews with midwives and traditional birth attendants (TBAs). Eligible participants spoke English, and provided maternity care during COVID-19 in Lagos, Nigeria. Participants were recruited via purposive and snowball sampling, from primary health facilities in seven Local Government Areas of Lagos State. Interview transcripts were analysed thematically following the framework method.
Sixteen midwives (n = 11) and TBAs (n = 5) were interviewed from March to April 2021. Two overarching themes were identified from the data. 'Maternity care workers' willingness and ability to work during the COVID-19 pandemic' outlined negative influences (fear and uncertainty, risk of infection, burnout, transport difficulties), and positive influences (professional duty, faith, family and employer support). Suggestions to improve ability to work included adequate protective equipment, training, financial support, and workplace flexibility. 'Perceived impact of COVID-19 on women's access and uptake of maternity care' highlighted reduced access and uptake of antenatal and immunisation services by women. Challenges included overstretched health services, movement and cost barriers, and community fear of health facilities. Participants reported delayed healthcare seeking and unattended home births. Midwives and TBAs identified a need for community outreach to raise awareness for women to safely access maternity services. Participants highlighted the responsibility of the government to improve staff welfare, and to implement public health campaigns.
Despite disruption to maternity care access and delivery due to COVID-19, midwives and TBAs in Lagos remained committed to their role in caring for women and babies. Nevertheless, participants highlighted issues of understaffing and mistrust in Lagos' underfunded maternity care system. Our findings suggest that future resilience during outbreaks depends on equipping maternity care workers with adequate working conditions and training, to rebuild public trust and improve access to maternity care.
COVID-19（冠状病毒病 2019）大流行对低弹性卫生系统提供和获取基本产妇保健服务构成挑战。本研究旨在探讨尼日利亚拉各斯州产妇保健工作者在 COVID-19 爆发期间提供产妇保健服务的经验和看法。
本定性研究对英语熟练的助产士和传统助产妇进行了个人、远程、半结构化访谈。符合条件的参与者在 COVID-19 期间在拉各斯提供产妇保健服务，并在拉各斯州的七个地方政府区域的初级保健机构中通过目的性和滚雪球抽样方法招募。采用框架方法对访谈记录进行主题分析。
2021 年 3 月至 4 月，共对 16 名助产士（n=11）和传统助产妇（n=5）进行了采访。从数据中确定了两个总体主题。“产妇保健工作者在 COVID-19 大流行期间工作的意愿和能力”概述了负面影响（恐惧和不确定性、感染风险、倦怠、交通困难）和积极影响（职业责任、信仰、家庭和雇主支持）。改善工作能力的建议包括充足的个人防护设备、培训、经济支持和工作场所灵活性。“COVID-19 对妇女获得和接受产妇保健服务的影响”强调了妇女获得和接受产前和免疫服务的机会减少。挑战包括卫生服务过度紧张、行动和成本障碍以及社区对卫生设施的恐惧。参与者报告说，医疗保健寻求延迟和无人照料的家庭分娩。助产士和传统助产妇表示需要社区外展，以提高妇女安全获得产妇服务的意识。参与者强调政府有责任改善员工福利，并开展公共卫生宣传活动。
尽管 COVID-19 对产妇保健服务的获取和提供造成了中断，但拉各斯的助产士和传统助产妇仍致力于为妇女和婴儿提供护理。然而，参与者强调了拉各斯资金不足的产妇保健系统人手不足和缺乏信任的问题。我们的研究结果表明，未来在疫情爆发期间的恢复能力取决于为产妇保健工作者配备充足的工作条件和培训，以重建公众信任并改善产妇保健服务的获取。
