A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda
A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda
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DOI：
10.1186/s12884-015-0449-8
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发表时间：
2015-02-05
影响因子：
3.1
通讯作者：
Sundby, Johanne
中科院分区：
文献类型：
--
作者：
Chi, Primus Che;Bulage, Patience;Sundby, Johanne
背景：武装冲突被描述为健康的社会决定因素的重要促成因素和健康不平等的驱动因素，包括孕产妇健康。这些冲突可能严重减少获得孕产妇保健服务的机会，从而导致在冲突本身之后的一段时间内孕产妇保健结果不佳。因此，了解如何在冲突后社会改善孕产妇寻求保健的行为和孕产妇保健服务的利用是至关重要的。本研究旨在探讨撒哈拉以南非洲两个冲突后环境中妇女接受孕产妇、性健康和生殖健康服务（MSRHS）的决定因素（障碍和促进因素）；布隆迪和乌干达北部，以及受武装冲突影响的情况。方法：这是一项定性研究，利用深度访谈和焦点小组讨论（fgd）进行数据收集。在两种研究环境中，共有115名参与者参加了访谈和fgd。与会者是育龄妇女、当地保健提供者和非政府组织的工作人员。探讨的问题包括影响妇女利用一系列MSRHS的因素与冲突暴露。采用归纳和演绎相结合的框架法对数据进行分析。结果：一系列复杂且相互关联的因素影响着冲突后环境中妇女对MSRHS的利用。暴露于武装冲突影响妇女利用这些服务，主要是通过阻碍妇女寻求保健的行为和社区对保健服务的看法。所确定的因素涉及个人、社会文化、政治和卫生系统领域，主要决定因素包括妇女对发生与妊娠有关的并发症的恐惧、赋予妇女权力的状况和在家庭和社区一级的支持、取消用户费用、靠近卫生设施以及卫生提供者的态度。结论：改善冲突后环境中妇女对MSRHS的接受需要卫生系统加强倡议，以解决跨越个人、社会文化、政治和卫生系统领域的障碍。虽然解决获取药物的财务障碍至关重要，但也应注意非财务障碍。目标应该是建立一个公平和可持续的卫生系统。
Background: Armed conflict has been described as an important contributor to the social determinants of health and a driver of health inequity, including maternal health. These conflicts may severely reduce access to maternal health services and, as a consequence, lead to poor maternal health outcomes for a period extending beyond the conflict itself. As such, understanding how maternal health-seeking behaviour and utilisation of maternal health services can be improved in post-conflict societies is of crucial importance. This study aims to explore the determinants (barriers and facilitators) of women's uptake of maternal, sexual and reproductive health services (MSRHS) in two post-conflict settings in sub-Saharan Africa; Burundi and Northern Uganda, and how uptake is affected by exposure to armed conflict.Methods: This is a qualitative study that utilised in-depth interviews and focus group discussions (FGDs) for data collection. One hundred and fifteen participants took part in the interviews and FGDs across the two study settings. Participants were women of reproductive age, local health providers and staff of non-governmental organizations. Issues explored included the factors affecting women's utilisation of a range of MSRHS vis-a-vis conflict exposure. The framework method, making use of both inductive and deductive approaches, was used for analyzing the data.Results: A complex and inter-related set of factors affect women's utilisation of MSRHS in post-conflict settings. Exposure to armed conflict affects women's utilisation of these services mainly through impeding women's health seeking behaviour and community perception of health services. The factors identified cut across the individual, socio-cultural, and political and health system spheres, and the main determinants include women's fear of developing pregnancy-related complications, status of women empowerment and support at the household and community levels, removal of user-fees, proximity to the health facility, and attitude of health providers.Conclusions: Improving women's uptake of MSRHS in post-conflict settings requires health system strengthening initiatives that address the barriers across the individual, socio-cultural, and political and health system spheres. While addressing financial barriers to access is crucial, attention should be paid to non-financial barriers as well. The goal should be to develop an equitable and sustainable health system.