Agbré-Yacé Marie Laurette, Kourouma Kadidiatou Raïssa, Doukouré Daouda, Ndia Félix Anon, Kpébo Denise, Koumi-Mélèdje Marie Dorothée, Yaya Bocoum Fadima, Bousso Senghor Diarra, Aké-Tano Odile
Institut national de santé publique de Côte d’Ivoire – Abidjan – Côte d’Ivoire
Cellule de recherche en santé de la reproduction de Côte d’Ivoire – Abidjan – Côte d’Ivoire
Sante Publique. 2023 Oct 17;35(3):297-306. doi: 10.3917/spub.233.0297.
Improving Reproductive Maternal Newborn Child Adolescent Health Plus Nutrition (RMNCAH+N) indicators is a challenge for health systems, especially those in sub-Saharan Africa. The objective of this study was to identify barriers and facilitators to the use of RMNCAH+N services in areas with low indicators in Cote d’Ivoire.
A qualitative case study was conducted in September 2021, with 76 beneficiaries of RMNCAH+N services in the health districts of Boundiali, Toulepleu and Tanda. Individual interviews (09) and focus groups (09) were conducted with community leaders/tradi-practitioners/midwives and pregnant women/ women of childbearing age/men who have or are responsible for a child under the age of 5, respectively. A thematic analysis was performed after coding the data in NVivo 12.
Barriers to utilization of RMNCAH+N services were unavailability of certain equipment/amenities, disrespectful care in some RMNCAH+N services, women’s lack of financial autonomy, lack of autonomy in decision making, and male healthcare providers. Facilitators identified were geographic accessibility, men’s involvement in the mother-child dyad’s health, and community awareness.
Improving utilization of RMNCAH+N services requires the implementation of interventions that address these barriers and facilitators, such as raising community awareness of RMNCAH+N services and promoting respectful, patient-centered, humanized care among healthcare providers.
改善生殖、孕产妇、新生儿、儿童、青少年健康及营养（RMNCAH+N）指标对卫生系统而言是一项挑战，尤其是撒哈拉以南非洲地区的卫生系统。本研究的目的是确定科特迪瓦指标较低地区使用RMNCAH+N服务的障碍和促进因素。
2021年9月进行了一项定性案例研究，在布恩迪阿利、图莱普勒和坦达卫生区对76名RMNCAH+N服务受益人进行了调查。分别与社区领袖/传统从业者/助产士以及有5岁以下子女或负责照顾5岁以下子女的孕妇/育龄妇女/男性进行了个人访谈（9次）和焦点小组访谈（9次）。在NVivo 12中对数据进行编码后进行了主题分析。
使用RMNCAH+N服务的障碍包括某些设备/设施不可用、一些RMNCAH+N服务中存在不尊重的护理、女性缺乏经济自主权、决策缺乏自主权以及男性医疗服务提供者。确定的促进因素包括地理可达性、男性参与母婴健康以及社区意识。
提高RMNCAH+N服务的利用率需要实施解决这些障碍和促进因素的干预措施，例如提高社区对RMNCAH+N服务的认识，并在医疗服务提供者中推广尊重、以患者为中心的人性化护理。
