A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic.
A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic.
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DOI：
10.1136/bmjgh-2021-008064
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发表时间：
2022-03
影响因子：
8.1
通讯作者：
Benova L
中科院分区：
文献类型：
--
作者：
Banke-Thomas A;Semaan A;Amongin D;Babah O;Dioubate N;Kikula A;Nakubulwa S;Ogein O;Adroma M;Anzo Adiga W;Diallo A;Diallo L;Cellou Diallo M;Maomou C;Mtinangi N;Sy T;Delvaux T;Afolabi BB;Delamou A;Nakimuli A;Pembe AB;Benova L
在撒哈拉以南非洲，转诊医院是关键孕产妇保健服务的重要来源，尤其是在COVID-19大流行等危机期间。这项研究前瞻性地评估了COVID-19大流行对几内亚、尼日利亚、坦桑尼亚和乌干达六家大型转诊医院在大流行第一年期间孕产妇保健服务利用率的影响。结合三种数据源的混合方法设计：（1）基于2019年3月至2021年2月收集的常规产前、分娩和产后护理数据的定量数据，（2）2020年7月至2021年2月对22名产科熟练卫生人员进行的重复半结构化访谈的定性数据，探讨他们对服务利用率的看法，以及（3）COVID的时间轴数据-19次流行病学、全球、国家和医院级活动。对定性和定量数据分别进行了分析，根据时间轴分析确定框架，并在报告时进行了三角分析。三个阶段，包括第一波，慢期和第二波。在大流行期间，除一家选定的转诊医院外，所有医院的孕产妇保健服务利用率均低于大流行前一年。于疫情期间，服务使用率在波动期间尤其低，而在缓慢期间则较高或稳定。害怕在医院感染，缺乏交通工具，即使有交通工具，交通成本高和服务关闭是影响波浪期间利用率的主要原因。然而，社区认为大流行已经结束或政府暗示这一点似乎稳定了转诊医院分娩的使用。在不同时期和不同国家，整个护理过程中孕产妇保健服务的利用情况各不相同。在COVID-19等危机情况下，需要实施限制和关闭服务，同时考虑妇女获得和使用服务的替代选择。应向妇女宣传为安全使用医院而采取的措施。
In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women.
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DOI：
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发表时间：
2021-06
期刊：
The Lancet. Global health
影响因子：
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作者：
Chmielewska B;Barratt I;Townsend R;Kalafat E;van der Meulen J;Gurol-Urganci I;O'Brien P;Morris E;Draycott T;Thangaratinam S;Le Doare K;Ladhani S;von Dadelszen P;Magee L;Khalil A
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Khalil A
影响因子：
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10.1016/s0140-6736(21)00632-2
发表时间：
2021-04-03
期刊：
Lancet (London, England)
影响因子：
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作者：
Salyer SJ;Maeda J;Sembuche S;Kebede Y;Tshangela A;Moussif M;Ihekweazu C;Mayet N;Abate E;Ouma AO;Nkengasong J
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Nkengasong J
影响因子：
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Ashish KC;Peterson SS;Gurung R;Skalkidou A;Gautam J;Malla H;Paudel P;Bhattarai K;Joshi N;Tinkari BS;Adhikari S;Shrestha D;Ghimire B;Sharma S;Khanal L;Shrestha S;Graham WJ;Kinney M
通讯作者：
Kinney M