Wellingara, Serekunda, The Gambia.
Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, UK.
BMC Health Serv Res. 2023 Feb 28;23(1):203. doi: 10.1186/s12913-023-09171-7.
BACKGROUND: Infertility remains a global reproductive health burden with the highest prevalence in low and middle-income countries. In sub-Saharan Africa, the ability to procreate holds great societal importance. Couples, and particularly women, with infertility can face devastating challenges, leading to social stigma, isolation and/or divorce. However, attention to addressing infertility is lacking in sub-Saharan Africa. In The Gambia, where this study is based, little is known about the potential for introduction of assisted reproductive technologies (ART) in the public health sector. METHODS: A quantitative survey was conducted using detailed questionnaires on infertility services available, staff knowledge, perceived barriers, and personal motivation to support assisted reproductive technologies. Data was collected electronically between April and June 2021 from healthcare providers (n = 70) in eleven health facilities throughout the country, as well as from medical students (n = 55) enrolled at The University of The Gambia. RESULTS: Basic infertility services were found to be lacking in the rural areas. Furthermore, 39% of staff (n = 27) providing fertility care had not receive any formal training on the topic. However, 91% of staff (n = 64) showed interest in acquiring additional knowledge and had a positive attitude towards supporting the introduction of ART. Perceived challenges of doing so included: (i) the competing importance of other health priorities; and (ii) religious and cultural barriers. CONCLUSION: This survey highlights that expansion of infertility services is needed, especially in rural areas. Staff perceived the introduction of ART as important, but this should be coupled with specialized training, as most medical staff had not received any formal infertility training. Future care providers (current medical students) showed both interest in ART and reported having received some basic training in infertility management. Given the reported lack of infrastructure and services, additional targeted investment in infertility care, including ART, will be needed to improve reproductive health for all, countrywide.
背景:不孕仍然是全球生殖健康的负担,在中低收入国家的发病率最高。在撒哈拉以南非洲,生育能力具有重要的社会意义。不孕的夫妇,尤其是妇女,可能面临毁灭性的挑战,导致社会耻辱、孤立和/或离婚。然而,撒哈拉以南非洲地区对解决不孕问题的关注不足。在本研究所在的冈比亚,人们对在公共卫生部门引入辅助生殖技术(ART)的潜力知之甚少。
方法:本研究采用详细的问卷调查了现有不孕服务、人员知识、感知障碍和支持辅助生殖技术的个人动机等方面,于 2021 年 4 月至 6 月期间,在全国 11 家卫生机构(n=70)的医疗保健提供者和冈比亚大学(n=55)的医学生中进行了电子问卷调查。
结果:农村地区基本的不孕服务匮乏。此外,39%(n=27)提供生育能力护理的工作人员没有接受过该主题的任何正规培训。然而,91%(n=64)的工作人员对获取更多知识表现出兴趣,并对支持引入 ART 持积极态度。认为这样做面临的挑战包括:(i)其他卫生重点的竞争重要性;以及(ii)宗教和文化障碍。
结论:本调查强调需要扩大不孕服务,特别是在农村地区。工作人员认为引入 ART 很重要,但这应该与专业培训相结合,因为大多数医务人员没有接受过任何正规的不孕培训。未来的医疗保健提供者(目前的医学生)对 ART 表现出兴趣,并报告说在不孕管理方面接受了一些基本培训。鉴于报告的基础设施和服务不足,需要对不孕护理(包括 ART)进行额外的有针对性的投资,以改善全国范围内所有人的生殖健康。
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