影响农村妇女孕产期保健的社会因素分析

目的:探讨影响农村妇女孕产期保健的社会因素。方法:采用定性研究方法,根据目的抽样的原则,抽取孕产期保健服务的提供者、利用者以及地方级别的关键知情人士进行焦点小组访谈、个人深入访谈和关键人物访谈。结果:家庭经济贫困的妇女相对经济好的妇女更不容易利用保健服务;新型农村合作医疗可以吸引妇女到医院分娩,提高住院分娩率,降低母婴死亡率;交通对孕产妇利用保健服务有很大的影响;计划生育政策是计划外生育妇女利用孕产期服务最主要的障碍;流动妇女对孕产期保健服务的利用率低;当地农村仍奉行一些关于生孩子的传统习俗。结论:建议政府制定相关政策限制日益增长的医疗费用;加强流动人口和计划外生育妇女的管理;对农村妇女进行孕产期健康教育;扩大新型农村合作医疗的覆盖范围。     

Community-based approach to refugee relief: experiences from Thailand

The Community Based Emergency Relief Services (CBERS) of Thailand pioneered a new approach to solving the problem of assisting Cambodian refugees. In 1980 following the influx of more than 150,000 Cambodians into Thailand CBERS proposed family planning to address the potential infant and maternal health threat posed by hazardous conditions within the refugee camps. Based on a survey CBERS launched a voluntary family planning and maternal and child health care program which offered oral contraceptives (OCs), IUDs, and injectables through existing health units, mobile service vans, and community-based distributors. Approximately 1500 Khmer leaders were trained in family planning and mass media techniques passed the information to the general population. Movies were shown and desensitization techniques were used. Each acceptor was counseled about choice and method as well as use of contraceptives and appropriate health education; sessions were held in groups of 30 women. A total of 8236 women chose to practice family planning during the campaign with 95% of all acceptors choosing the injectable contraceptive. Following service delivery a community-based family planning program was initiated to provide followup services. Other services provided by CBERS include sanitation services, vector control, and waste disposal as well as agriculture and skills development programs to train the refugees. By the end of 1981 over 12,000 people received specialized training. These programs have heightened the refugees' self esteem and they are well prepared to begin their return to Cambodia.     

Implementation of maternal influenza immunization in El Salvador: Experiences and lessons learned from a mixed-methods study

IntroductionThe World Health Organization (WHO) recommends that countries prioritize pregnant women for influenza vaccination, yet few low- or middle-income countries (LMICs) have implemented maternal influenza immunization programs. To inform vaccine decision-making and operational planning in LMICs, there is a need to document and share experiences from countries that provide seasonal influenza vaccine to pregnant women, particularly those with high coverage, like El Salvador.MethodsIn 2015 and 2016, PATH and country researchers conducted a mixed-methods study to document the experience and lessons learned from maternal influenza immunization delivery and acceptance in El Salvador as part of a collaborative effort between WHO and PATH. Researchers conducted focus group discussions, semi-structured interviews, antenatal clinic exit interviews, and key informant interviews with 326 participants from two municipalities in each of the country’s three regions. Respondents included pregnant and recently pregnant women, family members, community leaders, health personnel, public health managers and partners, and policymakers.ResultsFactors perceived as positively influencing maternal influenza immunization delivery and acceptance in El Salvador include the use of multiple vaccine delivery strategies, targeted education and community engagement efforts, and a high degree of trust between the community and health care providers. Influenza vaccine acceptance by pregnant women is high and has improved over time, largely attributed to education targeting health care advisors. Perceived challenges to pregnant women receiving health care and vaccination include the need for permission to attend services and limited access to health services in insecure areas related to the presence of criminal gang activity.ConclusionsWe identified approaches and barriers perceived to affect maternal influenza vaccine delivery in El Salvador. This information will be useful to public health decision-makers and implementers in El Salvador and other countries considering introduction of new maternal vaccines or striving to increase coverage of vaccines currently provided.     

流动人口特约分娩点孕产妇保健状况调查

目的:了解流动人口特约分娩点孕产妇保健状况,为进一步完善流动人口孕产妇保健管理提供依据。方法:以2005年1~12月在上海市南汇区新场社区卫生服务中心分娩的所有流动人口孕产妇为研究对象,收集病史资料和流动人口分娩登记表信息,对1152例流动孕产妇构成、产前检查次数、分娩方式及分娩费用等进行分析。结果:没有做过产前检查或只有1次产前检查的流动孕产妇占60%,产前检查次数与产次有关(P<0.0001),流动孕产妇剖宫产组平均住院费用为3 387元,阴道分娩组平均住院费用为1105元,结论:流动人口妇女孕产期保健服务利用率低,住院分娩费用相对其收入仍偏高,需要加强对流动人口孕产期保健知识的宣传,降低经济负担,为更多的孕产妇提供限价服务。     

Critical health infrastructure for refugee resettlement in rural Australia: Case study of four rural towns

Objective: To explore the reported impact of regional resettlement of refugees on rural health services, and identify critical health infrastructure for refugee resettlement. Design: Comparative case study, using interviews and situational analysis. Setting: Four rural communities in New South Wales, which had been the focus of regional resettlement of refugees since 1999. Participants: Refugees, general practitioners, practice managers and volunteer support workers in each town (n = 24). Results: The capacity of health care workers to provide comprehensive care is threatened by low numbers of practitioners, and high levels of turnover of health care staff, which results in attrition of specialised knowledge among health care workers treating refugees. Critical health infrastructure includes general practices with interest and surge capacity, subsidised dental services, mental health support services; clinical support services for rural practitioners; care coordination in the early settlement period; and a supported volunteer network. The need for intensive medical support is greatest in the early resettlement period for ‘catch‐up’ primary health care. Conclusion: The difficulties experienced by rural Australia in securing equitable access to health services are amplified for refugees. While there are economic arguments about resettlement of refugees in regional Australia, the fragility of health services in regional Australia should also be factored into considerations about which towns are best suited to regional resettlement.     

非户籍妇女孕产期保健服务利用影响因素的定性研究

目的:了解非户籍妇女孕产期保健服务利用状况,并分析其影响因素,为研究孕产期保健服务的可及性和公平性提供依据。方法:通过个别深入访谈的方法,选择在上海市南汇区分娩的非户籍人口孕产妇进行调查。结果:非户籍妇女孕产期保健服务利用不足。社会经济地位、本人及她人既往分娩经历、妇女的角色与孩子的性别均不同程度影响非户籍妇女的孕产期保健服务利用。结论:应针对非户籍妇女进行形式多样的孕产期保健宣传教育,包括其家庭成员的教育,在城市建立流动人口平产分娩点对非户籍妇女孕产期保健具有积极意义,政府应支持多部门协作,对非户籍人口实行综合管理,同时在财政上予以支持。     

Reproductive health for refugees by refugees in Guinea III: maternal health

Background  

Maternal mortality can be particularly high in conflict and chronic emergency settings, partly due to inaccessible maternal care. This paper examines associations of refugee-led health education, formal education, age, and parity on maternal knowledge, attitudes, and practices among reproductive-age women in refugee camps in Guinea.     

Addressing chronic diseases in protracted emergencies: Lessons from HIV for a new health imperative

Forcible displacement has reached unprecedented levels, with more refugees and internally displaced people reported since comprehensive statistics have been collected. The rising numbers of refugees requiring health services, the protracted nature of modern displacement, and the changing demographics of refugee populations have created compelling new health needs and challenges. In addition to the risk of malnutrition, infectious diseases and exposure to the elements attendant upon conflict and the breakdown of public health systems, many displaced people now require continuity care for the prevention and treatment of cardiovascular disease, diabetes, asthma, cancer, and mental health, as well as maternal and child health services. In some regions, most refugee health services need to be provided in dispersed settings within host communities, rather than in traditional refugee camps, and the number of refugees suffering protracted displacement is growing rapidly. These realities highlight a significant disconnect between the health needs of twenty-first century refugees, and the global systems that have been established to address them. The global response to the HIV epidemic offers lessons about ways to support continuity care for chronic conditions during complex emergencies and may provide important blueprints as the global community struggles to redesign refugee health services.     

Utilization of Maternal Health Care Services among Married Adolescent Women: Insights from the Nigeria Demographic and Health Survey, 2008

BackgroundAn ongoing social catastrophe of very poor performance in maternal health coupled with an unacceptably high number of maternal deaths is evident in Nigeria, especially among adolescent women. This study examines the factors associated with selected maternity services—married adolescent women who have had at least four antenatal care (ANC) visits, those who have undergone safe delivery care, and those who received postnatal care within 42 days of delivery.MethodsData from Nigeria Demographic and Health Survey, 2008, were used. An eligible sample of 2,434 married adolescent (aged 15–19 years) women was included in the analysis. Pearson chi-square test and binary logistic regression were performed to fulfill the study objective.ResultsIt was found that about 35% of adolescent women had at least four ANC visits, a little over 25% had undergone safe delivery care, and nearly 32% received postnatal care within 42 days of delivery. Women's education, husband's education, wealth quintile, and region of residence were documented as the most important factors associated with maternal healthcare service utilization. The ANC visit was found to be vital in the utilization of safe delivery and postnatal care.ConclusionFindings indicate that programs to improve maternal healthcare have not succeeded in overcoming the socioeconomic obstacles in the way of adolescents' utilizing maternity services. In the long run, the content and service delivery strategy of maternity programs must be designed in keeping with the socioeconomic context with special attention to adolescent women who are uneducated, poor, and residing in rural areas.     

“We need good nutrition but we have no money to buy food”: sociocultural context,care experiences,and newborn health in two UNHCR-supported camps in South Sudan

Background

Determinants of newborn health and survival exist across the reproductive life cycle, with many sociocultural and contextual factors influencing outcomes beyond the availability of, and access to, quality health services. In order to better understand key needs and opportunities to improve newborn health in refugee camp settings, we conducted a multi-methods qualitative study of the status of maternal and newborn health in refugee camps in Upper Nile state, South Sudan.

Methods

In 2016, we conducted 18 key informant interviews with health service managers and front-line providers and 13 focus group discussions in two Sudanese refugee camps in Maban County, South Sudan. Our focus group discussions comprised 147 refugee participants including groups of mothers, fathers, grandmothers, traditional birth attendants, community health workers, and midwives. We analysed our data for content and themes using inductive and deductive techniques.

Results

We found both positive practices and barriers to newborn health in the camps throughout the reproductive lifecycle. Environmental and contextual factors such as poor nutrition, lack of livelihood opportunities, and insecurity presented barriers to both general health and self-care during pregnancy. We found that the receipt of material incentives is one of the leading drivers of utilization of antenatal care and facility-based childbirth services. Barriers to facility-based childbirth included poor transportation specifically during the night; insecurity; being accustomed to home delivery; and fears of an unfamiliar birth environment, caesarean section, and encountering male health care providers during childbirth. Use of potentially harmful traditional practices with the newborn are commonplace including mixed feeding, use of herbal infusions to treat newborn illnesses, and the application of ash and oil to the newborn’s umbilicus.

Conclusions

Numerous sociocultural and contextual factors impact newborn health in this setting. Improving nutritional support during pregnancy, strengthening community-based transportation for women in labour, allowing a birth companion to be present during delivery, addressing harmful home-based newborn care practices such as mixed feeding and application of foreign substances to the umbilicus, and optimizing the networks of community health workers and traditional birth attendants are potential ways to improve newborn health outcomes.

     

北京流动人口妇幼保健现况研究

目的 了解北京流动人口妇女儿童对医疗保健服务的利用，以及流八城市的相关部门对流动人口的管理和提供服务的现状．方法 采用定性和定量方法收集资料，应用SPSS统计软件对数据进行描述性统计和统计推断。结果 被调查的539名育龄妇女．平均年龄29．6岁，90．9％已婚，其孕期早检率为43．7％、5次及以上产前检查率为37．6％，选择回户籍地分娩的妇女住院分娩率（67．5％）高于留在北京分娩的妇女的住院分娩率（37．6％）。初中及以上文化水平妇女的住院分娩率（63．8％）高于初中以下者的住院分娩率（46．4％）。定性调查发现。流八地医疗保健机构、公安、街道等部门的人员和经费是按户籍人口进行配置的．因此这些部门在对流动人口进行管理和服务时，面临人员和经费严重不足的问题。提供妇幼保健的医疗单位的现有服务模式、收费标准等影响流动人口妇女孕期保健服务的利用。结论流动人口妇女孕产期医疗保健服务利用率低下。建议政府在为医疗保健部门人员经费配置时考虑流动人口数量；另外，提供妇幼保健服务的医疗保健机构需加强多部门合作，改变现有服务模式、提供适宜流动人口的医疗保健服务。     

社区医院孕妇学校中医宣传教育模式应用及探讨

随着国家基本公共卫生服务规范不断完善,孕产妇健康管理服务日益成熟,孕妇学校对增长孕产妇保健知识发挥极其重要作用。社区医院以基本医疗和基本公共卫生服务为主,而孕产妇对保健服务需求趋向多样性、专业性和安全性变化发展,较难满足孕产妇保健服务需求,基于社区中医药服务便捷、有效特点,本研究探索社区医院孕妇学校融入中医保健服务的宣教模式,既促进社区中医药服务发展,也提高社区医院孕妇学校参与率。     

Age-specific factors related to institutional delivery in Nigeria: Insights from the 2011 Multiple Indicator Cluster Survey

With 814 maternal deaths per 100,000 live births, maternal mortality remains a significant public health problem in Nigeria. We examined associations between maternal age and institutional delivery among 9,485 women, using data from the 2011 Nigeria Multiple Indicator Cluster Survey. We used multiple logistic regression to identify enabling factors and barriers to institutional delivery. Older maternal age was positively associated with institutional delivery. In age-stratified, adjusted analyses, secondary/higher education and living in wealthy households were consistently associated with increased odds of institutional delivery among the youngest (15–19 years) and the oldest (40–49 years) women. Higher parity was associated with significantly reduced odds of institutional delivery among women <40 years, but was not associated among women aged 40–49 years. Among women of 40–49 years, attending at least four antenatal care (ANC) visits was associated with increased odds of institutional delivery; among women of ages 15–19 years, the association was not significant. Similarly, having a skilled ANC provider was not significantly associated with institutional delivery among women aged 15–19 and 40–49 years. These findings suggest that women at the highest risk for maternal death may face barriers to institutional delivery services. Focused policies and programs are needed to address women’s reproductive health vulnerabilities.     

Mental health issues and resources in rural and regional communities: an exploration of perceptions of service providers

OBJECTIVE: To identify service providers' and community organisations' perceptions of the resources available to support people with mental illness and the unmet needs of this client group in rural Queensland. DESIGN: An exploratory study was undertaken involving focus group interviews across the study sites. SETTING: Five regional towns in rural Queensland. PARTICIPANTS: Ten to 14 members were recruited for each of the five focus groups. The groups represented a diverse mix of participants including health and community service providers and representatives from community organisations. Results: Participants identified gaps in services in relation to health, employment and education, housing and accommodation, transport and social inclusion and health promotion. Inter-service communication and inappropriate funding models were themes affecting service delivery. CONCLUSIONS: Specific service issues of housing and transport were identified to be particularly problematic for people with mental illness across all towns. Intersectoral communication and funding models require further research.     

Context matters: Successes and challenges of intrapartum care scale-up in four districts of Afghanistan

Reducing preventable maternal mortality and achieving Sustainable Development Goal targets for 2030 will require increased investment in improving access to quality health services in fragile and conflict-affected states. This study explores the conditions that affect availability and utilisation of intrapartum care services in four districts of Afghanistan where mortality studies were conducted in 2002 and 2011. Information on changes in each district was collected through interviews with community members; service providers; and district, provincial and national officials. This information was then triangulated with programme and policy documentation to identify factors that affect the coverage of safe delivery and emergency obstetric care services. Comparison of barriers to maternal health service coverage across the four districts highlights the complexities of national health policy planning and resource allocation in Afghanistan, and provides examples of the types of challenges that must be addressed to extend the reach of life-saving maternal health interventions to women in fragile and conflict-affected states. Findings suggest that improvements in service coverage must be measured at a sub-national level, and context-specific service delivery models may be needed to effectively scale up intrapartum care services in extremely remote or insecure settings.     

An investigation of culturally competent terminology in healthcare policy finds ambiguity and lack of definition

Objective : This research explored how the concept of cultural competence was represented and expressed through health policies that were intended to improve the quality and efficacy of healthcare provided to families from culturally marginalised communities, particularly women and children with refugee backgrounds. Method : A critical document analysis was conducted of policies that inform healthcare for families from culturally marginalised communities in two local government areas in South Australia. Results : The analysis identified two major themes: lack of, or inconsistent, definitions of ‘culture’ and ‘cultural competency’ and related terms; and the paradoxical use of language to determine care. Conclusions : Cultural competence within health services has been identified as an important factor that can improve the health outcomes for families from marginalised communities. However, inconsistency in definitions, understanding and implementation of cultural competence in health practice makes it difficult to implement care using these frameworks. Implications : Clearly defined pathways are necessary from health policy to inform culturally competent service delivery. The capacity for policy directives to effectively circumvent the potential deleterious outcomes of culturally incompetent services is only possible when that policy provides clear definitions and instructions. Consultation and partnership are necessary to develop effective definitions and processes relating to cultural competence.     

Utilization of maternal health care services among indigenous women in Bangladesh: A study on the Mru tribe

Despite startling developments in maternal health care services, use of these services has been disproportionately distributed among different minority groups in Bangladesh. This study aimed to explore the factors associated with the use of these services among the Mru indigenous women in Bangladesh. A total of 374 currently married Mru women were interviewed using convenience sampling from three administrative sub-districts of the Bandarban district from June to August of 2009. Associations were assessed using Chi-square tests, and a binary logistic regression model was employed to explore factors associated with the use of maternal health care services. Among the women surveyed, 30% had ever visited maternal health care services in the Mru community, a very low proportion compared with mainstream society. Multivariable logistic regression analyses revealed that place of residence, religion, school attendance, place of service provided, distance to the service center, and exposure to mass media were factors significantly associated with the use of maternal health care services among Mru women. Considering indigenous socio-cultural beliefs and practices, comprehensive community-based outreach health programs are recommended in the community with a special emphasis on awareness through maternal health education and training packages for the Mru adolescents.