Improving Primary Healthcare Project, JSI Research & Training Institute, Addis Ababa, Ethiopia
Behavioral Science, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
BMJ Open. 2023 Jul 5;13(7):e073118. doi: 10.1136/bmjopen-2023-073118.
Implementation research was employed to examine rates and contextual factors associated with mothers' care-seeking for their sick neonates and identify challenges for community-based possible serious bacterial infection (PSBI) services access and implementation during the COVID-19 pandemic.
We conducted formative research involving household survey and programmatic qualitative study.
This formative study was conducted in Dembecha and Lume woredas of Amhara and Oromia regions.
Data were captured from 4262 mothers aged 15-49 years who gave live birth 2-14 months before data collection, and interviews with 18 programme managers and 16 service providers in April to May 2021.
A multilevel regression model was employed to identify predictors of maternal care-seeking for PSBI and thematic qualitative analysis to inform strategy development to strengthen PSBI implementation.
Overall, 12% (95% CI 11.0% to 12.9%) and 8% (95% CI 7.9% to 9.6%) of mothers reported any newborn illness and severe neonatal infection (PSBI), respectively. More than half of mothers sought formal medical care, 56% (95% CI 50.7% to 60.8%) for PSBI. Women who received postnatal care within 6 weeks (adjusted OR (AOR) 2.08; 95% CI 1.12 to 3.87) and complete antenatal care (ie, weight measured, blood pressure taken, urine and blood tested) (AOR 2.04; 95% CI 1.12 to 3.75) had higher odds of care-seeking for PSBI. Conversely, fear of COVID-19 (AOR 0.27; 95% CI 0.15 to 0.47) and residing more than 2 hours of walking distance from the health centre (AOR 0.39; 95% CI 0.16 to 0.93) were negatively associated with care-seeking for severe newborn infection. Multiple pre-existing health system bottlenecks were identified from interviews as barriers to PSBI service delivery and exacerbated by the COVID-19 pandemic.
We found gaps in and factors associated with care-seeking behaviour of mothers for their sick young infants including fear of COVID-19 and pre-existing health system-level barriers. The findings of the study were used to design and implement strategies to mitigate COVID-19 impacts on management of PSBI.
采用实施研究的方法，调查母亲为其患病新生儿寻求医疗的比例和相关因素，并确定在 COVID-19 大流行期间，社区为可能发生严重细菌感染（PSBI）的新生儿提供服务的可及性和实施所面临的挑战。
我们进行了一项包括家庭调查和方案定性研究的形成性研究。
这项形成性研究在阿姆哈拉和奥罗米亚地区的德贝恰和卢梅沃雷达进行。
数据来自于 4262 名年龄在 15-49 岁之间、在数据收集前 2-14 个月内分娩的母亲，以及 2021 年 4 月至 5 月期间接受的 18 名方案管理人员和 16 名服务提供者的访谈。
采用多水平回归模型来确定母亲寻求 PSBI 治疗的预测因素，并进行专题定性分析，为加强 PSBI 实施制定策略。
总体而言，12%（95%CI 11.0%至 12.9%）和 8%（95%CI 7.9%至 9.6%）的母亲报告了新生儿出现任何疾病和严重新生儿感染（PSBI）的情况。超过一半的母亲寻求了正规医疗服务，其中 56%（95%CI 50.7%至 60.8%）是为了 PSBI。在产后 6 周内接受过产后护理（调整后的比值比（AOR）2.08；95%CI 1.12 至 3.87）和完成了完整的产前护理（即体重测量、血压测量、尿液和血液检查）（AOR 2.04；95%CI 1.12 至 3.75）的母亲更有可能寻求 PSBI 治疗。相反，对 COVID-19 的恐惧（AOR 0.27；95%CI 0.15 至 0.47）和距离卫生中心步行超过 2 小时（AOR 0.39；95%CI 0.16 至 0.93）与寻求严重新生儿感染的治疗呈负相关。访谈中还确定了多个预先存在的卫生系统瓶颈，这些瓶颈是 PSBI 服务提供的障碍，并因 COVID-19 大流行而加剧。
我们发现了母亲为其患病婴儿寻求治疗的行为方面存在差距和相关因素，包括对 COVID-19 的恐惧和预先存在的卫生系统层面的障碍。研究结果被用于设计和实施战略，以减轻 COVID-19 对 PSBI 管理的影响。
