Utilization of maternal health care services and their determinants in Karnataka State, India.
Utilization of maternal health care services and their determinants in Karnataka State, India.
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DOI：
10.1186/s12978-016-0138-8
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发表时间：
2016-06-08
影响因子：
3.4
通讯作者：
Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group
中科院分区：
文献类型：
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作者：
Vidler M;Ramadurg U;Charantimath U;Katageri G;Karadiguddi C;Sawchuck D;Qureshi R;Dharamsi S;Joshi A;von Dadelszen P;Derman R;Bellad M;Goudar S;Mallapur A;Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group
卡纳塔克邦的孕产妇死亡率仍然是印度南部最高的，为144/10万活产，但低于全国估计的190-220/100,000活产死亡率。在怀孕、分娩和产后及时和适当地利用服务方面存在各种障碍。这项研究旨在描述印度卡纳塔克邦农村地区常规和紧急孕产妇保健利用的模式和决定因素。这项研究于2012-2013年在卡纳塔克邦进行。采用有目的的抽样方法，召集了23个焦点小组，并对社区和卫生系统的代表进行了12次个别访谈：辅助护士助产士和工作人员、经认可的社会卫生活动家、社区领导人、男性决策者、女性决策者、育龄妇女、医务人员、私人保健提供者、高级卫生行政人员、地区卫生干事和产科医生。熟悉当地环境和语言的研究人员进行了所有焦点小组和采访，这些研究人员对社区参与者来说并不知情。所有的讨论都被录音、转录并翻译成英语进行分析。采用了一种主题分析方法，利用先验主题框架以及主题的归纳确定。焦点小组中的大多数妇女报告定期进行产前护理，平均就诊四次，更经常的是高危怀孕。产前护理通常由非专业提供者在外围提供。参与者报告说，寻求IS护理的妇女经历了并发症的危险迹象。据报道，产后护理很少见，主要是为了新生儿护理。影响妇女寻求护理的因素包括她们的自主性有限、非紧急情况的交通便利和资金不足、人们认为卫生保健设施质量差以及护理费用。印度南部农村社区报告说，在怀孕和分娩期间经常使用保健服务。产妇保健服务的普及归因于新的政府方案和产妇服务可获得性的增加；然而，一些妇女推迟披露怀孕情况和第一次产前检查。应加强以社区为基础的倡议，鼓励及早披露怀孕情况，并向社区提供有关以设施为基础的护理重要性的信息。卡纳塔克邦农村的卫生设施基础设施也应得到加强，以确保稳定的电力供应和改善病房的清洁。NCT01911494本文的在线版本(doi：10.1186/s129780160138-8)包含补充材料，授权用户可以使用。
Karnataka State continues to have the highest rates of maternal mortality in south India at 144/100,000 live births, but lower than the national estimates of 190–220/100,000 live births. Various barriers exist to timely and appropriate utilization of services during pregnancy, childbirth and postpartum. This study aimed to describe the patterns and determinants of routine and emergency maternal health care utilization in rural Karnataka State, India. This study was conducted in Karnataka in 2012–2013. Purposive sampling was used to convene twenty three focus groups and twelve individual interviews with community and health system representatives: Auxiliary Nurse Midwives and Staff Nurses, Accredited Social Health Activists, community leaders, male decision-makers, female decision-makers, women of reproductive age, medical officers, private health care providers, senior health administrators, District health officers, and obstetricians. Local researchers familiar with the setting and language conducted all focus groups and interviews, these researchers were not known to community participants. All discussions were audio recorded, transcribed, and translated to English for analysis. A thematic analysis approach was taken utilizing an a priori thematic framework as well as inductive identification of themes. Most women in the focus groups reported regular antenatal care attendance, for an average of four visits, and more often for high-risk pregnancies. Antenatal care was typically delivered at the periphery by non-specialised providers. Participants reported that sought was care women experienced danger signs of complications. Postpartum care was reportedly rare, and mainly sought for the purpose of neonatal care. Factors that influenced women’s care-seeking included their limited autonomy, poor access to and funding for transport for non-emergent conditions, perceived poor quality of health care facilities, and the costs of care. Rural south Indian communities reported regular use of health care services during pregnancy and for delivery. Uptake of maternity care services was attributed to new government programmes and increased availability of maternity services; nevertheless, some women delayed disclosure of pregnancy and first antenatal visit. Community-based initiatives should be enhanced to encourage early disclosure of pregnancies and to provide the community information regarding the importance of facility-based care. Health facility infrastructure in rural Karnataka should also be enhanced to ensure a consistent power supply and improved cleanliness on the wards. NCT01911494 The online version of this article (doi:10.1186/s12978-016-0138-8) contains supplementary material, which is available to authorized users.