Okeke Chinelo Ifeoma, Agwu Prince, Etiaba Enyi, Onwujekwe Obinna
Department of Community Medicine, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.
Health Policy and Research Group (HPRG) University of Nigeria, Nsukka, Nigeria.
PLOS Glob Public Health. 2024 Dec 2;4(12):e0003886. doi: 10.1371/journal.pgph.0003886. eCollection 2024.
Despite global efforts encouraging institutional deliveries with skilled attendants, many pregnant women in developing countries such as Nigeria continue to rely on traditional birth attendants (TBAs) for child delivery. Attempts at weeding off TBAs have been firmly resisted by their clients who have developed confidence and trust in their services and herald them as first and trusted responders to child delivery cases. Unfortunately, recent evidence has shown that TBAs in servicing public trust and for other reasons, often do not timely refer their clients to the closest source of formal healthcare-primary healthcare centres (PHCs). Looking into the motivations for these reasons is the crux of the current study. Data were collected through qualitative interviews with 85 respondents across three states in Nigeria. The qualitative data comprised of 73 in-depth interviews and 12 focus group discussions. Respondents were TBAs and other informal health providers, formal health workers, policymakers, community leaders and service users. Data were analysed thematically to explore the demand and supply determinants of referrals from TBAs to the formal healthcare providers. Demand side factors that constrain referrals from TBAs to PHCs were community preference for TBAs, and cultural and religious inclinations of the consumers to TBAs' practices of infusing religious teachings and rules into the process of child delivery. Supply-side factors were infrastructural deficits, staff shortages and lack of sanctions for poor practices in PHCs. Demand and supply-side factors constrain the referral of pregnant women from TBAs to the PHC facility for child delivery. These factors should be addressed, and innovative interventions used to link the TBAs to the formal health system for increased institutional deliveries with skilled birth attendants. The interventions could include incentives to TBAs to encourage early referrals.
尽管全球都在努力鼓励在有专业医护人员陪同的情况下进行机构分娩，但在尼日利亚等发展中国家，许多孕妇在分娩时仍依赖传统接生员。试图淘汰传统接生员的做法遭到了其客户的坚决抵制，这些客户对她们的服务产生了信心和信任，并将她们视为分娩案例的首要且值得信赖的响应者。不幸的是，最近的证据表明，传统接生员出于维护公众信任等原因，往往不及时将她们的客户转诊至最近的正规医疗保健机构——初级医疗保健中心。探究这些原因背后的动机是当前研究的关键所在。通过对尼日利亚三个州的85名受访者进行定性访谈收集了数据。定性数据包括73次深入访谈和12次焦点小组讨论。受访者包括传统接生员和其他非正规卫生服务提供者、正规卫生工作者、政策制定者、社区领袖和服务使用者。对数据进行了主题分析，以探讨传统接生员向正规医疗服务提供者转诊的需求和供给决定因素。限制传统接生员向初级医疗保健中心转诊的需求侧因素包括社区对传统接生员的偏好，以及消费者在文化和宗教上倾向于传统接生员在分娩过程中融入宗教教义和规则的做法。供给侧因素包括基础设施不足、人员短缺以及对初级医疗保健中心不良做法缺乏制裁。需求和供给侧因素限制了孕妇从传统接生员处转诊至初级医疗保健机构进行分娩。应解决这些因素，并采用创新干预措施，将传统接生员与正规卫生系统联系起来，以增加有专业接生人员陪同的机构分娩。这些干预措施可以包括对传统接生员的激励措施，以鼓励她们尽早转诊。
