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首页> 外文期刊>BMC Pregnancy and Childbirth >Persistent barriers to the use of maternal, newborn and child health services in Garissa sub-county, Kenya: a qualitative study
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Persistent barriers to the use of maternal, newborn and child health services in Garissa sub-county, Kenya: a qualitative study

机译：肯尼亚省帕萨达县县县妇幼的孕产妇，新生儿和儿童保健服务的持续障碍：一个定性研究

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BACKGROUND:North Eastern Kenya has persistently had poor maternal, new-born and child health (MNCH) indicators. Barriers to access and utilisation of MNCH services are structural, individual and community-level factors rooted in sociocultural norms. A package of interventions was designed and implemented in Garissa sub-County aimed at creating demand for services. Community Health Volunteers (CHVs) were trained to generate demand for and facilitate access to MNCH care in communities, while health care providers were trained on providing culturally acceptable and sensitive services. Minor structural improvements were made in the control areas of two facilities to absorb the demand created. Community leaders and other social actors were engaged as influencers for demand creation as well as to hold service providers accountable. This qualitative research was part of a larger mixed methods study and only the qualitative results are presented. In this paper, we explore the barriers to health care seeking that were deemed persistent by the end of the intervention period following a similar assessment at baseline.METHODS:An exploratory qualitative research design with participatory approach was undertaken as part of an impact evaluation of an innovation project in three sites (two interventions and one control). Semi-structured interviews were conducted with women who had given birth during the intervention period. Focus group discussions were conducted among the wider community members and key informant interviews among healthcare managers and other stakeholders. Participants were purposively selected. Data were analysed using content analysis by reading through transcripts. Interview data from different sources on a single event were triangulated to increase the internal validity and analysis of multiple cases strengthened external validity.RESULTS:Three themes were pre-established: 1) barriers and solutions to MNCH use at the community and health system level; 2) perceptions about women delivering in health facilities and 3) community/social norms on using health facilities. Generally, participants reported satisfaction with services offered in the intervention health facilities and many indicated that they would use the services again. There were notable differences between the intervention and control site in attitudes towards use of services (skilled birth attendance, postnatal care). Despite the apparent improvements, there still exist barriers to MNCH services use. Persistent barriers identified were gender of service provider, insecurity, poverty, lack of transport, distance from health facilities, lack of information, absence of staff especially at night-time and quality of maternity care.CONCLUSION:Attitudes towards MNCH services are generally positive, however some barriers still hinder utilization. The County health department and community leaders need to sustain the momentum gained by ensuring that service access and quality challenges are continually addressed.
机译：背景：肯尼亚北东部持续存在粮食，新生和儿童健康（MNCH）指标。访问和利用MNCH服务的障碍是植根于社会文化规范的结构，个人和社区层面因素。一揽子干预措施是在Garissa Sub-County设计和实施的，旨在为服务创造需求。社区健康志愿者（CHVS）受过培训，以产生对社区的需求，并促进社区的使用，而医疗保健提供者则在提供文化可接受和敏感的服务方面培训。在两个设施的控制区域进行了少量的结构改进，以吸收所产生的需求。社区领导人和其他社会行动者作为需求创造的影响因素，并持有服务提供商负责任。这种定性研究是较大的混合方法研究的一部分，并且只提出了定性结果。在本文中，我们探讨了在基线类似的评估后，在干预期间被视为持续存在的医疗保健的障碍。方法：采用参与式方法的探索性定性研究设计作为一个影响评估的一部分三个地点的创新项目（两个干预和一个控制）。半结构性访谈与在干预期间出生的妇女进行。焦点小组讨论是在更广泛的社区成员之间进行的，并在医疗管理人员和其他利益攸关方之间进行了关键的线人访谈。参与者被默许选择。通过通过转录物读数来分析数据进行分析。从单个事件上采访不同来源的数据是三角形的，以提高多个案例的内部有效性和分析加强了外部有效性。结果：三个主题是预先建立的：1）MNCH在社区和卫生系统中使用的障碍和解决方案; 2）关于卫生设施中妇女提供的妇女的看法，以及3）使用卫生设施的社区/社会规范。一般而言，与会者报告了干预卫生设施中提供的服务的满意度，许多人表示他们将再次使用这些服务。干预和控制现场在利用服务（熟练的出生出席，产后护理）之间存在显着差异。尽管有明显的改进，但MNCH服务仍然存在障碍。确定的持久性障碍是服务提供者的性别，不安全，贫困，缺乏运输，距离卫生设施的距离，缺乏信息，缺乏员工，尤其是常年和产科护理的质量。结论：对Mnch服务的态度通常是积极的，然而，一些障碍仍然妨碍利用。县卫生部门和社区领导者需要通过确保不断解决服务访问和质量挑战来维持获得的势头。

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