Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Curtin School of Population Health, Curtin University, Curtin, WA, Australia.
BMJ Open. 2024 Jul 25;14(7):e082507. doi: 10.1136/bmjopen-2023-082507.
In Ethiopia, information about health system responsiveness (HSR) in conflict-affected areas is limited. No previous local study was conducted on the assessment of HSR at the community level. Hence, the study assessed HSR for intrapartum care in conflict-affected areas in Amhara region, Ethiopia.
Community-based cross-sectional study design.
Wadila, Gayint and Meket districts, Amhara region, Ethiopia.
The participants were 419 mothers who gave birth in conflict-affected areas within the last 6 months. The study included all mothers who gave birth at health facilities but excluded those who delivered at home, critically ill or unable to hear.
HSR was the outcome variable. In this regard, the study assessed how mothers were treated and the situation in which they were cared for in relation to their experience during the conflict.
We conducted the study in the community, where we analysed eight domains of HSR to identify 30 measurement items related to intrapartum care responsiveness. The domains we looked at were dignity (4), autonomy (4), confidentiality (2), communication (5), prompt attention (5), social support (3), choice (3) and basic amenities (4). We used a multiple linear regression model to analyse the data, and in this model, we used an unstandardized β coefficient with a 95% CI and a p value of less than 0.05 to determine the factors significantly associated with HSR.
The findings of our study revealed that the overall proportion of HSR in intrapartum care was 45.11% (95% CI: 40.38 to 49.92). The performance of responsiveness was the lowest in the autonomy, choice and prompt attention domains at 35.5%, 49.4% and 52.0%, respectively. Mothers living in urban areas (β=4.28; 95% CI: 2.06 to 6.50), government employees (β=4.99; 95% CI: 0.51 to 9.48), those mothers stayed at the health facilities before delivery/during conflict (β=0.22; 95% CI: 0.09 to 0.35), those who were satisfied with the healthcare service (β=0.69; 95% CI: 0.08 to 1.30) and those who perceived the quality of healthcare favourable (β=0.96; 95% CI: 0.72 to 1.19) were more likely to rate HSR positively. On the other hand, joint decision-making for health (β=-2.46; 95% CI: -4.81 to -0.10) and hospital delivery (β=-3.62; 95% CI: -5.60 to -1.63) were negatively associated with HSR.
In the Amhara region of Ethiopia, over 50% of mothers living in areas affected by conflict reported that health systems were not responsive with respect to intrapartum care. Therefore, all stakeholders should work together to ensure that intrapartum care is responsive to conflict-affected areas, with a focus on providing women autonomy and choice.
在埃塞俄比亚，有关冲突地区卫生系统反应性（HSR）的信息有限。以前没有在当地进行过关于社区一级 HSR 评估的研究。因此，本研究评估了阿姆哈拉地区冲突地区的分娩期护理的 HSR。
基于社区的横断面研究设计。
阿姆哈拉地区的瓦迪拉、加因特和梅凯特区。
参与者为过去 6 个月内在冲突地区分娩的 419 名母亲。研究包括所有在卫生设施分娩的母亲，但排除在家中分娩、病情严重或无法听到的母亲。
HSR 是结果变量。在这方面，该研究评估了母亲在冲突期间的经历如何对待她们以及她们的护理情况。
我们在社区进行了这项研究，分析了 HSR 的八个领域，以确定与分娩期护理反应性相关的 30 个测量项目。我们观察的领域是尊严（4）、自主权（4）、保密性（2）、沟通（5）、及时关注（5）、社会支持（3）、选择（3）和基本设施（4）。我们使用多元线性回归模型分析数据，在该模型中，我们使用标准化β系数和 95%CI 以及 p 值<0.05 来确定与 HSR 显著相关的因素。
在埃塞俄比亚的阿姆哈拉地区，超过 50%的生活在受冲突影响地区的母亲报告说，卫生系统在分娩期护理方面没有反应。因此，所有利益攸关方应共同努力，确保分娩期护理对冲突地区作出反应，重点是赋予妇女自主权和选择权。
