The Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
PLoS One. 2023 Jun 29;18(6):e0276357. doi: 10.1371/journal.pone.0276357. eCollection 2023.
Evidence is being consolidated that shows that the utilization of antenatal and immunization services has declined in low-income countries (LICs) during the COVID-19 pandemic. Very little is known about the effects of the pandemic on antenatal and immunization service utilization in The Gambia. We set out to explore the COVID-19-related factors affecting the utilization of antenatal and immunization services in two Local Government Areas (LGAs) in The Gambia.
A qualitative methodology was used to explore patients' and providers' experiences of antenatal and immunization services during the pandemic in two LGAs in The Gambia. Thirty-one study participants were recruited from four health facilities, applying a theory-driven sampling framework, including health workers as well as female patients. Qualitative evidence was collected through theory-driven semi-structured interviews, and was recorded, translated into English, transcribed, and analysed thematically, applying a social-ecological framework.
In our interviews, we identified themes at five different levels: individual, interpersonal, community, institutional and policy factors. Individual factors revolved around patients' fear of being infected in the facilities, and of being quarantined, and their anxiety about passing on infections to family members. Interpersonal factors involved the reluctance of partners and family members, as well as perceived negligence and disrespect by health workers. Community factors included misinformation within the community and mistrust of vaccines. Institutional factors included the shortage of health workers, closures of health facilities, and the lack of personal protective equipment (PPEs) and essential medicines. Finally, policy factors revolved around the consequences of COVID-19 prevention measures, particularly the shortage of transport options and mandatory wearing of face masks.
Our findings suggest that patients' fears of contagion, perceptions of poor treatment in the health system, and a general anxiety around the imposing of prevention measures, undermined the uptake of services. In future emergencies, the government in The Gambia, and governments in other LICs, will need to consider the unintended consequences of epidemic control measures on the uptake of antenatal and immunization services.
有证据表明，在 COVID-19 大流行期间，低收入国家（LICs）的产前和免疫服务利用率有所下降。关于大流行对冈比亚产前和免疫服务利用的影响知之甚少。我们旨在探讨与 COVID-19 相关的因素，这些因素影响冈比亚两个地方政府区（LGAs）的产前和免疫服务的利用。
采用定性方法探讨了 COVID-19 大流行期间冈比亚两个地方政府区的患者和提供者对产前和免疫服务的体验。从四个卫生设施中招募了 31 名研究参与者，采用理论驱动的抽样框架，包括卫生工作者和女性患者。通过理论驱动的半结构化访谈收集定性证据，并将其记录、翻译成英文、转录和主题分析，应用社会生态框架。
在我们的访谈中，我们确定了五个不同层面的主题：个人、人际、社区、机构和政策因素。个人因素主要围绕着患者在设施中感染的恐惧，以及被隔离和将感染传染给家人的焦虑。人际因素涉及伴侣和家庭成员的不情愿，以及卫生工作者的疏忽和不尊重。社区因素包括社区内的错误信息和对疫苗的不信任。机构因素包括卫生工作者短缺、卫生设施关闭，以及缺乏个人防护设备（PPEs）和基本药物。最后，政策因素主要涉及 COVID-19 预防措施的后果，特别是运输选择和强制戴口罩的短缺。
我们的研究结果表明，患者对传染的恐惧、对卫生系统治疗不佳的看法，以及对实施预防措施的普遍焦虑，破坏了服务的利用。在未来的紧急情况下，冈比亚政府和其他低收入国家的政府将需要考虑控制传染病措施对产前和免疫服务利用率的意外后果。
