Christou Aliki, Raynes-Greenow Camille, Mubasher Adela, Hofiani Sayed Murtaza Sadat, Rasooly Mohammad Hafiz, Rashidi Mohammad Khakerah, Alam Neeloy Ashraful
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
PLOS Glob Public Health. 2023 Jun 21;3(6):e0001420. doi: 10.1371/journal.pgph.0001420. eCollection 2023.
Local perceptions and understanding of the causes of ill health and death can influence health-seeking behaviour and practices in pregnancy. We aimed to understand individual explanatory models for stillbirth in Afghanistan to inform future stillbirth prevention. This was an exploratory qualitative study of 42 semi-structured interviews with women and men whose child was stillborn, community elders, and healthcare providers in Kabul province, Afghanistan between October-November 2017. We used thematic data analysis framing the findings around Kleinman's explanatory framework. Perceived causes of stillbirth were broadly classified into four categories-biomedical, spiritual and supernatural, extrinsic factors, and mental wellbeing. Most respondents attributed stillbirths to multiple categories, and many believed that stillbirths could be prevented. Prevention practices in pregnancy aligned with perceived causes and included engaging self-care, religious rituals, superstitious practices and imposing social restrictions. Symptoms preceding the stillbirth included both physical and non-physical symptoms or no symptoms at all. The impacts of stillbirth concerned psychological effects and grief, the physical effect on women's health, and social implications for women and how their communities perceive them. Our findings show that local explanations for stillbirth vary and need to be taken into consideration when developing health education messages for stillbirth prevention. The overarching belief that stillbirth was preventable is encouraging and offers opportunities for health education. Such messages should emphasise the importance of care-seeking for problems and should be delivered at all levels in the community. Community engagement will be important to dispel misinformation around pregnancy loss and reduce social stigma.
当地人对健康问题和死亡原因的认知与理解会影响孕期的就医行为和做法。我们旨在了解阿富汗关于死产的个体解释模型,以为未来的死产预防工作提供参考。这是一项探索性定性研究,于2017年10月至11月期间,在阿富汗喀布尔省对42名经历过死产的女性和男性、社区长者以及医疗服务提供者进行了半结构化访谈。我们运用主题数据分析,将研究结果围绕克莱曼的解释框架展开。死产的感知原因大致分为四类:生物医学因素、精神和超自然因素、外在因素以及心理健康。大多数受访者将死产归因于多个类别,并且许多人认为死产是可以预防的。孕期的预防措施与感知到的原因相符,包括进行自我护理、宗教仪式、迷信做法以及施加社会限制。死产前的症状包括身体症状和非身体症状,或者根本没有症状。死产的影响涉及心理影响和悲伤情绪、对女性健康的身体影响,以及对女性及其社区如何看待她们的社会影响。我们的研究结果表明,当地对死产的解释各不相同,在制定死产预防的健康教育信息时需要加以考虑。认为死产可预防的总体信念令人鼓舞,并为健康教育提供了机会。此类信息应强调针对问题寻求护理的重要性,并应在社区的各个层面进行传播。社区参与对于消除围绕流产的错误信息和减少社会污名至关重要。
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