Utilization of services provided by village based ethnic minority midwives in mountainous villages of Vietnam
Utilization of services provided by village based ethnic minority midwives in mountainous villages of Vietnam
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DOI：
10.2147/ijwh.s112996
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发表时间：
2016-01-01
影响因子：
2.3
通讯作者：
Mirzoev, Tolib
中科院分区：
文献类型：
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作者：
Doan, Duong Thi Thuy;Bui, Ha Thi Thu;Mirzoev, Tolib
简介：自2011年起，越南卫生部实施了少数民族助产士（EMM）计划，以提高少数民族和偏远山区妇女对孕产妇保健服务的利用。本文分析了 EMM 提供的产前、分娩和产后护理的利用情况，并报告了服务使用者认为 EMM 服务利用的关键决定因素。 方法：2015 年，对奠边省和昆嵩省 31 个拥有 EMM 的村庄在 1 年内生下活产婴儿的所有母亲（n=320）进行了结构化调查。使用多变量逻辑回归模型来检查所有潜在因素与 EMM 提供的服务的使用之间的关联。结果：我们发现，与分娩服务相比，EMM 提供更多的产前护理和产后护理，这与其工作描述相符。结果还显示，EMM 提供的产前护理利用率低于产后护理。从未听说过 EMM 的人比例很高（24%）。了解EMM服务的妈妈们中，有33.4%的人做过产前检查，20.1%的人在家分娩时接受过检查，57.3%的人接受过EMM产后检查。决定使用 EMM 服务的关键因素包括了解 EMM 家的位置、卫生工作者对 EMM 的了解、对 EMM 提供的服务的信任以及认为村里许多其他母亲也了解 EMM 服务。结论：EMM 似乎是确保少数族裔群体在家分娩和产后护理期间获得援助的重要机制，因为少数民族群体往往拒绝前往医疗机构。建立信任并与社区互动是提高 EMM 所提供服务利用率的关键促进因素。旨在提高对 EMM 的认识并促进他们在村里的服务（特别是其他卫生工作者）的宣传活动，是进一步提高 EMM 计划有效性的重要战略。
Introduction: Since 2011, the Vietnam's Ministry of Health implemented the ethnic minority midwives (EMMs) scheme in order to increase the utilization of maternal health services by women from ethnic minorities and those living in hard-to-reach mountainous areas. This paper analyzes the utilization of antenatal, delivery, and postpartum care provided by EMMs and reports the key determinants of utilization of EMM services as perceived by service users.Methods: A structured questionnaire was administered in 2015 to all mothers (n=320) who gave birth to a live-born during a 1-year period in 31 villages which had EMM in two provinces, Dien Bien and Kon Tum. A multivariate logistic regression model was used to examine the association between all potential factors and the use of services provided by EMMs.Results: We found that EMMs provided more antenatal care and postnatal care as compared with delivery services, which corresponded to their job descriptions. The results also showed that utilization of antenatal care provided by EMMs was lower than that of postnatal care. The proportion of those who never heard about EMM was high (24%). Among the mothers who knew about EMM services, 33.4% had antenatal checkups, 20.1% were attended during home deliveries, and 57.3% had postnatal visits by an EMM. Key factors that determined the use of EMM services included knowledge of the location of EMM's house, being aware about EMMs by health workers, trust in services provided by EMMs, and perception that many others mothers in a village also knew about EMM services.Conclusion: EMM seems to be an important mechanism to ensure assistance during home births and postnatal care for ethnic minority groups, who are often resistant to attend health facilities. Building trust and engaging with communities are the key facilitators to increase the utilization of services provided by EMMs. Communication campaigns to raise awareness about EMMs and to promote their services in the village, particularly by other health workers, represent an important strategy to further improve effectiveness of EMM scheme.