Barriers to formal emergency obstetric care services' utilization.
Barriers to formal emergency obstetric care services' utilization.
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DOI：
10.1007/s11524-010-9481-1
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发表时间：
2011-06
影响因子：
6.6
通讯作者：
Fotso, Jean-Christophe
中科院分区：
文献类型：
--
作者：
Essendi, Hildah;Mills, Samuel;Fotso, Jean-Christophe
获得适当的保健服务，包括分娩时的熟练助产服务和及时转介产科急诊服务，可大大减少孕产妇死亡和残疾，但撒哈拉以南非洲妇女获得熟练接生服务的机会仍然有限。这项研究依赖于2006年从肯尼亚内罗毕两个贫民窟的居民收集的定性数据，以调查人们对接受正规产科服务的障碍的看法。数据表明，贫民窟居民更喜欢正规的产科服务，而不是非正规的产科服务。然而，她们利用正规产科急诊服务的努力受到各种因素的制约，包括家庭一级的保健决策效率低下、前往正规护理设施的交通设施不足、夜间不安全、保健服务费用高、正规服务提供者不好客以及贫民窟的保健设施设备差。因此，大多数贫民窟居民选择由缺乏基本技能和设备的传统助产士提供接生服务，从而增加了死亡和残疾的风险。根据这些调查结果，我们认为，城市贫困妇女在家庭、社区和卫生设施层面面临获得正规产科服务的障碍，降低城市贫困妇女产妇发病率和死亡率的努力必须解决这些障碍，这些障碍在这些不同层面上起作用，阻碍妇女获得正规产科护理服务。我们建议继续进行有关妊娠并发症症状的社区教育，并及时转诊。注重对保健人员进行“公共关系”方面的培训，也可以恢复民众对保健系统的信心。此外，我们建议改善贫民窟的卫生设施，通过能力建设改善传统助产士提供的服务，并让传统助产士参与转诊程序，以便及时获得服务。还可以采取措施加强贫民窟夜间的安全。
Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on “public relations” could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be put in place to enhance security in the slums at night.
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影响因子：
2.1
作者：
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通讯作者：
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通讯作者：
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