Mihret Muhabaw Shumye, Alemu Kassahun, Beshah Debrework Tesgera, Gezie Lemma Derseh, Erlandsson Kerstin, Lindgren Helena
Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Front Public Health. 2024 Dec 11;12:1401988. doi: 10.3389/fpubh.2024.1401988. eCollection 2024.
The maternity continuum of care plays a vital role in improving maternal and neonatal outcomes. However, its uptake remains low in Ethiopia, highlighting the need to identify challenges within the primary health care system to inform practice. Hence, this study aimed to explore the challenges of the maternity continuum of care within the primary health care system in northwest Ethiopia.
An interpretive description approach was employed from March 3, 2022, to November 27, 2022, within the primary health care system in northwest Ethiopia. Maximum variation sampling was utilized, comprising 28 in-depth interviews, three focus group discussions with 29 participants, and four key informant interviews. The reflexive thematic analysis method was applied, and the results were mapped onto the constructs of the socio-ecological model.
The analysis identified four main themes: low maternity healthcare-seeking behavior (intrapersonal level), lack of peer and family support (interpersonal level), cultural influences on maternity care and low community responsiveness (community level), and inadequate health system readiness and response (health facility/system level). Some of the sub-themes include low health literacy and self-efficacy and misconceptions regarding maternity care at the intrapersonal level; peer and family pressure against seeking maternity care, low autonomy, and intimate partner violence at the interpersonal level; cultural influences on pregnancy disclosure and postnatal care and low social accountability at the community level; and delays in accessing ambulance services, long waiting times for maternity care, shortages of essential healthcare supplies, poor coordination of care, inadequate monitoring and evaluation, disrespectful maternity care, and dissatisfaction among healthcare workers at the health facility/system level.
Intrapersonal, interpersonal, community, and health facility- and system-level challenges have influenced the maternity continuum of care within the primary health care in northwest Ethiopia. Since these challenges are interdependent, considering a holistic approach within primary health care could lead to an improved maternity continuum of care.
孕产妇连续照护在改善孕产妇和新生儿结局方面发挥着至关重要的作用。然而，在埃塞俄比亚，其利用率仍然很低，这凸显了识别初级卫生保健系统中的挑战以指导实践的必要性。因此，本研究旨在探讨埃塞俄比亚西北部初级卫生保健系统中孕产妇连续照护面临的挑战。
2022年3月3日至2022年11月27日，在埃塞俄比亚西北部的初级卫生保健系统中采用解释性描述方法。采用最大差异抽样，包括28次深入访谈、与29名参与者进行的3次焦点小组讨论以及4次关键 informant 访谈。应用反思性主题分析方法，并将结果映射到社会生态模型的结构上。
分析确定了四个主要主题：孕产妇寻求医疗保健行为低（个人层面）、缺乏同伴和家庭支持（人际层面）、文化对孕产妇保健的影响以及社区反应性低（社区层面）、卫生系统准备和应对不足（卫生设施/系统层面）。一些子主题包括个人层面的健康素养和自我效能低以及对孕产妇保健的误解；人际层面同伴和家庭对寻求孕产妇保健的压力、自主权低以及亲密伴侣暴力；社区层面文化对怀孕披露和产后护理的影响以及社会问责低；以及卫生设施/系统层面获得救护车服务延迟、孕产妇护理等待时间长、基本医疗用品短缺、护理协调差、监测和评估不足、不尊重孕产妇护理以及医护人员不满。
个人、人际、社区以及卫生设施和系统层面的挑战影响了埃塞俄比亚西北部初级卫生保健中的孕产妇连续照护。由于这些挑战相互依存，在初级卫生保健中考虑采用整体方法可能会改善孕产妇连续照护。
