Yoseph Amanuel, Teklesilasie Wondwosen, Guillen-Grima Francisco, Astatkie Ayalew
School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
PLoS One. 2024 Dec 19;19(12):e0312484. doi: 10.1371/journal.pone.0312484. eCollection 2024.
Maternal health service (MHS) use is a key strategy to reduce maternal mortality. However, evidence is scarce in designing efficient intervention strategies in Ethiopia. Thus, we aimed to explore community members and healthcare providers' perceptions of MHS and barriers and facilitators of MHS use in southern Ethiopia.
A phenomenological qualitative study was conducted in the month of November, 2022, in the northern zone of the Sidama region. There were sixteen in-depth interviews, nine focus group discussions, and 15 key informant interviews with 112 study participants. A maximum variance sampling method was used to select study participants. Data coding and analysis were done using MAXQDA 2020 software and presented in narratives.
Communities have positive perceptions and good practices of skilled antenatal care (ANC) and health facility delivery (HFD) but lack awareness of postnatal care (PNC) services and schedules. Some have experienced negative interactions with health care providers, health facilities, and ambulance drivers. The main identified barriers to ANC use were lack of awareness of ANC benefits, distance from a health facility, costs associated with ANC use, long waiting time, lack of road access, and women being busy with different household chores. Distance from health facilities, costs associated with HFD use, unpredicted labor, lack of an ANC visit, lack of a birth preparedness plan, and non-dignified care were the main barriers to HFD. The major barriers to PNC use were home delivery, lack of awareness of PNC service and schedule, and socio-cultural beliefs. The main identified facilitators of MHS use were previous experience and fear of obstetric complications, health extension workers and women's development teams, and pregnant women's forums.
Rural women still encounter challenges when using MHS, even though communities have positive perceptions and good practices of skilled MHS. Bad experiences mothers faced in health facilities, challenges associated with the costs of MHS use, poor awareness of service, and unpredictable labor continued to be fundamental barriers to MHS use. Intervention approaches should consider inter-sectoral collaboration to address community and health facility barriers. The programs must emphasize the transportation arrangements during unpredictable labor and the needs of poor mothers and women with poor awareness of MHS at the community level.
利用孕产妇保健服务（MHS）是降低孕产妇死亡率的关键策略。然而，在埃塞俄比亚设计有效的干预策略方面，证据匮乏。因此，我们旨在探讨埃塞俄比亚南部社区成员和医疗保健提供者对孕产妇保健服务的看法以及使用孕产妇保健服务的障碍和促进因素。
2022年11月，在锡达马地区北部开展了一项现象学定性研究。对112名研究参与者进行了16次深入访谈、9次焦点小组讨论和15次关键信息人访谈。采用最大差异抽样方法选择研究参与者。使用MAXQDA 2020软件进行数据编码和分析，并以叙述形式呈现。
社区对熟练的产前护理（ANC）和医疗机构分娩（HFD）有积极的看法和良好的做法，但对产后护理（PNC）服务和时间表缺乏认识。一些人在与医疗保健提供者、医疗机构和救护车司机的互动中经历了负面情况。确定的使用产前护理的主要障碍包括对产前护理益处缺乏认识、距离医疗机构较远、产前护理使用相关费用、等待时间长、缺乏道路通行条件以及妇女忙于各种家务。距离医疗机构较远、医疗机构分娩使用相关费用、不可预测的分娩、缺乏产前检查、缺乏分娩准备计划以及不体面的护理是医疗机构分娩的主要障碍。使用产后护理的主要障碍是在家分娩、对产后护理服务和时间表缺乏认识以及社会文化观念。确定的孕产妇保健服务使用的主要促进因素是既往经历和对产科并发症的恐惧、健康推广工作者和妇女发展团队以及孕妇论坛。
尽管社区对熟练的孕产妇保健服务有积极的看法和良好的做法，但农村妇女在使用孕产妇保健服务时仍面临挑战。母亲们在医疗机构中面临的糟糕经历、与孕产妇保健服务使用成本相关的挑战、对服务的认识不足以及不可预测的分娩仍然是使用孕产妇保健服务的根本障碍。干预方法应考虑跨部门合作，以解决社区和医疗机构的障碍。这些项目必须强调在不可预测的分娩期间的交通安排以及社区层面贫困母亲和对孕产妇保健服务认识不足的妇女的需求。
