Perceptions of the effects of armed conflict on maternal and reproductive health services and outcomes in Burundi and Northern Uganda: a qualitative study
Perceptions of the effects of armed conflict on maternal and reproductive health services and outcomes in Burundi and Northern Uganda: a qualitative study
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DOI：
10.1186/s12914-015-0045-z
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发表时间：
2015-04-03
影响因子：
3
通讯作者：
Sundby, Johanne
中科院分区：
文献类型：
--
作者：
Chi, Primus Che;Bulage, Patience;Sundby, Johanne
背景：武装冲突可能对孕产妇和生殖健康 (MRH) 服务的获取和质量构成严重挑战，导致孕产妇发病率和死亡率增加。武装冲突的影响可能因环境而异，包括冲突可能导致卫生服务的获取和质量不佳的机制/渠道。本研究旨在探讨武装冲突对布隆迪和乌干达北部 MRH 的影响。 方法：这是一项描述性定性研究，采用与妇女、卫生服务提供者和非政府组织工作人员进行深度访谈 (IDI) 和焦点小组讨论 (FGD) 来收集数据。讨论的问题包括武装冲突对 MRH 服务的获取和质量及结果的影响，以及武装冲突导致 MRH 服务的获取和质量不佳的机制。总共进行了 63 次 IDI 和 8 次 FGD，涉及 115 名参与者。结果：研究得出的主题是：武装冲突是 MRH 服务获取有限和质量差的原因；武装冲突是 MRH 结果不佳的一个原因；和武装冲突作为改善获得医疗保健的途径。冲突导致 MRH 服务的获取和质量不佳的主要机制因地点而异：袭击两个地点的医疗设施和抢劫医疗用品；布隆迪有针对性地杀害医务人员并在提供医疗保健方面偏袒；乌干达北部的医务人员被绑架。冲突对 MRH 结果的影响包括： 孕产妇和新生儿发病率和死亡率增加；艾滋病毒/艾滋病和性暴力和性暴力的流行率很高；卖淫、少女怀孕和秘密堕胎现象增多；和高生育水平。人们认为搬迁到政府认可的国内流离失所者营地可以改善获得医疗服务的机会。结论：武装冲突对 MRH 服务和结果的影响是巨大的。武装冲突导致 MRH 服务的获取和质量较差的机制因情况而异。在设计和实施干预措施以改善这些环境中的 MRH 时，需要考虑所有这些问题。
Background: Armed conflict potentially poses serious challenges to access and quality of maternal and reproductive health (MRH) services, resulting in increased maternal morbidity and mortality. The effects of armed conflict may vary from one setting to another, including the mechanisms/channels through which the conflict may lead to poor access to and quality of health services. This study aims to explore the effects of armed conflict on MRH in Burundi and Northern Uganda.Methods: This is a descriptive qualitative study that used in-depth interviews (IDIs) and focus group discussions (FGDs) with women, health providers and staff of NGOs for data collection. Issues discussed include the effects of armed conflict on access and quality of MRH services and outcomes, and the mechanisms through which armed conflict leads to poor access and quality of MRH services. A total of 63 IDIs and 8 FGDs were conducted involving 115 participants.Results: The main themes that emerged from the study were: armed conflict as a cause of limited access to and poor quality of MRH services; armed conflict as a cause of poor MRH outcomes; and armed conflict as a route to improved access to health care. The main mechanisms through which the conflict led to poor access and quality of MRH services varied across the sites: attacks on health facilities and looting of medical supplies in both sites; targeted killing of health personnel and favouritism in the provision of healthcare in Burundi; and abduction of health providers in Northern Uganda. The perceived effects of the conflict on MRH outcomes included: increased maternal and newborn morbidity and mortality; high prevalence of HIV/AIDS and SGBV; increased levels of prostitution, teenage pregnancy and clandestine abortion; and high fertility levels. Relocation to government recognised IDP camps was perceived to improve access to health services.Conclusions: The effects of armed conflict on MRH services and outcomes are substantial. The mechanisms through which armed conflict leads to poor access and quality of MRH services vary from one setting to another. All these issues need to be considered in the design and implementation of interventions to improve MRH in these settings.