Shafiq Yasir, Muhammad Ameer, Suhag Zamir Hussain, Tahir Rehman, Jan Abdullah, Atiq Huba, Khakwani Shayan, Ahmed Muhammad, Eva Dua, Ragazzoni Luca, Barone-Adesi Francesco, Valente Martina
Centre of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan.
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Womens Health (Lond). 2025 Jan-Dec;21:17455057251347081. doi: 10.1177/17455057251347081. Epub 2025 Jun 24.
BACKGROUND: Balochistan, Pakistan's most economically and health system-deprived province, hosts a significant portion of the Afghan refugee population. The province's already fragile healthcare infrastructure faces additional strain due to the refugees. OBJECTIVE: This study aimed to investigate the barriers to antenatal and intrapartum care seeking among Afghan refugee women in Balochistan during the Coronavirus disease 2019 (COVID-19) pandemic. DESIGN: This study employed a cross-sectional survey approach to assess antenatal and intrapartum care-seeking behavior among Afghan refugee women residing in Balochistan, Pakistan. The study focused on refugee women living in Kharotabad Union Council in Quetta city to understand their barriers to accessing maternal healthcare services. METHODS: The survey focused on antenatal and childbirth care-seeking behaviors among married women of reproductive age (MWRA) with at least one child aged 12-23 months born during the first four waves of COVID-19 in Pakistan. RESULTS: Of 480 MWRAs, only 36.9% sought antenatal care (ANC); only 13.1% received at least four ANC visits. Furthermore, only 38.8% of MWRA had skilled birth attendance. Only 32.9% of MWRAs received at least one ANC and had skilled birth attendance (i.e., comprehensive care). Accessing comprehensive care was associated with maternal age less than 25 years (adjusted odds ratio (OR): 0.40; 95% confidence interval (CI): 0.21, 0.78), Tajik ethnicity (adjusted OR: 0.40; 95% CI: 0.23, 0.70) and large family size (adjusted OR: 0.58; 95% CI: 0.37, 0.93). Predictors of poor access were concern related to documentation of the refugee women they faced (adjusted OR: 1.52; 95% CI: 1.00, 2.34), women with no one at household to accompany them at health facility (adjusted OR: 1.75; 95% CI: 1.13, 2.70), myths and misconceptions related to available care (adjusted OR: 1.89; 95% CI: 1.18, 3.02), and the transport availability (adjusted OR: 1.76; 95% CI: 1.12, 2.77). Concerns related to COVID-19 had no association. CONCLUSION: The study highlights the barriers to maternal, neonatal and child health service utilization among Afghan refugee women in Balochistan. Tailoring healthcare services to consider age, ethnicity, cultural dynamics, and system constraints is crucial for improving access.
背景：俾路支省是巴基斯坦经济和卫生系统最匮乏的省份，接纳了很大一部分阿富汗难民人口。由于难民的涌入，该省本就脆弱的医疗基础设施面临着更大的压力。 目的：本研究旨在调查2019年冠状病毒病（COVID-19）大流行期间，俾路支省阿富汗难民妇女在产前和分娩期间寻求护理的障碍。 设计：本研究采用横断面调查方法，评估居住在巴基斯坦俾路支省的阿富汗难民妇女的产前和分娩期间寻求护理的行为。该研究聚焦于奎达市卡罗塔巴德联合委员会的难民妇女，以了解她们在获得孕产妇保健服务方面的障碍。 方法：该调查聚焦于在巴基斯坦COVID-19前四波疫情期间生育过至少一个12至23个月大孩子的育龄已婚妇女（MWRA）的产前和分娩护理寻求行为。 结果：在480名MWRA中，只有36.9%的人寻求过产前护理（ANC）；只有13.1%的人接受过至少四次ANC检查。此外，只有38.8%的MWRA有熟练的助产服务。只有32.9%的MWRA接受过至少一次ANC检查并有熟练的助产服务（即全面护理）。获得全面护理与以下因素相关：母亲年龄小于25岁（调整后的优势比（OR）：0.40；95%置信区间（CI）：0.21，0.78）、塔吉克族裔（调整后的OR：0.40；95%CI：0.23，0.70）和家庭规模较大（调整后的OR：0.58；95%CI：0.37，0.93）。获得护理不佳的预测因素包括：对她们面临的难民妇女文件的担忧（调整后的OR：1.52；95%CI：1.00，2.34）、在医疗机构无人陪同的妇女（调整后的OR：1.75；95%CI：1.13，2.70）、与现有护理相关的神话和误解（调整后的OR：1.89；95%CI：1.18，3.02）以及交通便利性（调整后的OR：1.76；95%CI：1.12，2.77）。与COVID-19相关的担忧没有关联。 结论：该研究突出了俾路支省阿富汗难民妇女在孕产妇、新生儿和儿童健康服务利用方面的障碍。根据年龄、族裔、文化动态和系统限制来调整医疗服务对于改善可及性至关重要。
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