Experiences from the Field: A Qualitative Study Exploring Barriers to Maternal and Child Health Service Utilization in IDP Settings Somalia.
Experiences from the Field: A Qualitative Study Exploring Barriers to Maternal and Child Health Service Utilization in IDP Settings Somalia.
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DOI：
10.2147/ijwh.s330069
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Omer M
中科院分区：
文献类型：
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作者：
Mohamed AA;Bocher T;Magan MA;Omar A;Mutai O;Mohamoud SA;Omer M
在索马里，孕产妇和儿童保健服务的利用率低得令人无法接受。人们对导致索马里妇幼保健服务利用率低的因素知之甚少，特别是在国内流离失所者 (IDP) 环境中。本研究旨在了解摩加迪沙境内流离失所者使用孕产妇和儿童保健服务的障碍。我们对哺乳/怀孕母亲、医疗保健提供者、传统助产士 (TBA) 和国内流离失所者营地领导人进行了 17 次深度访谈 (IDI)、7 次焦点小组讨论 (FGD) 和现场观察。采用社会生态模型（SEM）框架对医疗保健利用障碍进行分类，并进行进一步分析以了解障碍的主要类型和性质。使用SEM，确定了阻碍妇幼保健服务利用的以下主要障碍。社会经济地位低下、妇女缺乏决策权、TBA 信任、对怀孕危险迹象的知识和认识不足、害怕去不熟悉的地区被确定为个人层面的障碍。传统信仰、男性在决策中的主导地位以及缺乏家庭支持也被认为是人际层面的障碍。安全和武装冲突障碍以及距卫生机构的遥远距离被确定为社区一级的障碍。机构内缺乏隐私、交通困难、功能服务差、负面体验、医疗机构在几个小时内关闭以及缺乏适当的转诊途径被确定为组织或政策层面的障碍。总体而言，不同SEM水平的各种因素被认为是利用妇幼保健服务的障碍。因此，需要针对这些复杂和多方面的障碍实施多方面的干预措施，以改善索马里摩加迪沙境内流离失所者的孕产妇和儿童保健服务利用率。
In Somalia, maternal and child health service utilization is unacceptably low. Little is known about factors contributing to low maternal and child health service utilization in Somalia, especially in internally displaced people (IDP) settings. This study aimed to understand barriers to the use of maternal and child health-care services among IDPs in Mogadishu. A total of 17 in-depth interviews (IDIs), 7 focus group discussions (FGDs), and field observations were conducted on lactating/pregnant mothers, health-care providers, traditional birth attendants (TBA), and IDP camp leaders. The socio-ecological model (SEM) framework was employed for the categorization of barriers to healthcare utilization and further analysis was conducted to understand the major types and nature of barriers. Using the SEM, the following major barriers that hinder maternal and child health service utilization were identified. Low socio-economic, lack of decision making power of women, TBA trust, poor knowledge and awareness on pregnancy danger signs, fear of going to unfamiliar areas were identified barriers at individual level. Traditional beliefs, male dominance in decision making, and lack of family support were also identified barriers at interpersonal level. Security and armed conflict barriers and formidable distance to health facility were identified barrier at the community level. Lack of privacy in the facility, transportation challenges, poor functional services, negative experiences, closure of the health facility in some hours, and lack of proper referral pathways were identified barriers at organizational or policy level. Overall, various factors across different levels of SEM were identified as barrier to the utilization of maternal and child health services. Hence, multi-component interventions that target these complex and multifaceted barriers are required to be implemented in order to improve maternal and child health services utilization among IDP in Mogadishu, Somalia.