PDF(Pubmed)
Abstract：
OBJECTIVE: In Ethiopia, information about health system responsiveness (HSR) in conflict-affected areas is limited. No previous local study was conducted on the assessment of HSR at the community level. Hence, the study assessed HSR for intrapartum care in conflict-affected areas in Amhara region, Ethiopia.
METHODS: Community-based cross-sectional study design.
METHODS: Wadila, Gayint and Meket districts, Amhara region, Ethiopia.
METHODS: The participants were 419 mothers who gave birth in conflict-affected areas within the last 6 months. The study included all mothers who gave birth at health facilities but excluded those who delivered at home, critically ill or unable to hear.
RESULTS: HSR was the outcome variable. In this regard, the study assessed how mothers were treated and the situation in which they were cared for in relation to their experience during the conflict.
METHODS: We conducted the study in the community, where we analysed eight domains of HSR to identify 30 measurement items related to intrapartum care responsiveness. The domains we looked at were dignity (4), autonomy (4), confidentiality (2), communication (5), prompt attention (5), social support (3), choice (3) and basic amenities (4). We used a multiple linear regression model to analyse the data, and in this model, we used an unstandardized β coefficient with a 95% CI and a p value of less than 0.05 to determine the factors significantly associated with HSR.
RESULTS: The findings of our study revealed that the overall proportion of HSR in intrapartum care was 45.11% (95% CI: 40.38 to 49.92). The performance of responsiveness was the lowest in the autonomy, choice and prompt attention domains at 35.5%, 49.4% and 52.0%, respectively. Mothers living in urban areas (β=4.28; 95% CI: 2.06 to 6.50), government employees (β=4.99; 95% CI: 0.51 to 9.48), those mothers stayed at the health facilities before delivery/during conflict (β=0.22; 95% CI: 0.09 to 0.35), those who were satisfied with the healthcare service (β=0.69; 95% CI: 0.08 to 1.30) and those who perceived the quality of healthcare favourable (β=0.96; 95% CI: 0.72 to 1.19) were more likely to rate HSR positively. On the other hand, joint decision-making for health (β=-2.46; 95% CI: -4.81 to -0.10) and hospital delivery (β=-3.62; 95% CI: -5.60 to -1.63) were negatively associated with HSR.
CONCLUSIONS: In the Amhara region of Ethiopia, over 50% of mothers living in areas affected by conflict reported that health systems were not responsive with respect to intrapartum care. Therefore, all stakeholders should work together to ensure that intrapartum care is responsive to conflict-affected areas, with a focus on providing women autonomy and choice.
METHODS: Community-based cross-sectional study design.
METHODS: Wadila, Gayint and Meket districts, Amhara region, Ethiopia.
METHODS: The participants were 419 mothers who gave birth in conflict-affected areas within the last 6 months. The study included all mothers who gave birth at health facilities but excluded those who delivered at home, critically ill or unable to hear.
RESULTS: HSR was the outcome variable. In this regard, the study assessed how mothers were treated and the situation in which they were cared for in relation to their experience during the conflict.
METHODS: We conducted the study in the community, where we analysed eight domains of HSR to identify 30 measurement items related to intrapartum care responsiveness. The domains we looked at were dignity (4), autonomy (4), confidentiality (2), communication (5), prompt attention (5), social support (3), choice (3) and basic amenities (4). We used a multiple linear regression model to analyse the data, and in this model, we used an unstandardized β coefficient with a 95% CI and a p value of less than 0.05 to determine the factors significantly associated with HSR.
RESULTS: The findings of our study revealed that the overall proportion of HSR in intrapartum care was 45.11% (95% CI: 40.38 to 49.92). The performance of responsiveness was the lowest in the autonomy, choice and prompt attention domains at 35.5%, 49.4% and 52.0%, respectively. Mothers living in urban areas (β=4.28; 95% CI: 2.06 to 6.50), government employees (β=4.99; 95% CI: 0.51 to 9.48), those mothers stayed at the health facilities before delivery/during conflict (β=0.22; 95% CI: 0.09 to 0.35), those who were satisfied with the healthcare service (β=0.69; 95% CI: 0.08 to 1.30) and those who perceived the quality of healthcare favourable (β=0.96; 95% CI: 0.72 to 1.19) were more likely to rate HSR positively. On the other hand, joint decision-making for health (β=-2.46; 95% CI: -4.81 to -0.10) and hospital delivery (β=-3.62; 95% CI: -5.60 to -1.63) were negatively associated with HSR.
CONCLUSIONS: In the Amhara region of Ethiopia, over 50% of mothers living in areas affected by conflict reported that health systems were not responsive with respect to intrapartum care. Therefore, all stakeholders should work together to ensure that intrapartum care is responsive to conflict-affected areas, with a focus on providing women autonomy and choice.
摘要：
目标：在埃塞俄比亚，有关受冲突影响地区卫生系统响应能力（HSR）的信息有限。以前没有在社区一级进行过HSR评估的本地研究。因此，该研究评估了HSR在阿姆哈拉地区受冲突影响地区的分站护理，埃塞俄比亚。
方法：基于社区的横断面研究设计。
方法：瓦迪拉，Gayint和Meket区,阿姆哈拉地区,埃塞俄比亚。
方法：参与者是在过去6个月内在受冲突影响地区分娩的419名母亲。该研究包括所有在医疗机构分娩的母亲，但不包括在家分娩的母亲，病危或听不见。
结果：HSR是结果变量。在这方面,该研究评估了母亲在冲突期间的经历，以及她们受到照顾的情况。
方法：我们在社区进行了这项研究，我们分析了HSR的八个领域，以确定与产时护理反应性相关的30个测量项目。我们看到的领域是尊严（4），自治(4)保密(2),通信（5），迅速注意(5)，社会支持(3)选择(3)和基本设施(4)。我们使用多元线性回归模型来分析数据，在这个模型中，我们使用95%CI和p值小于0.05的未标准化β系数来确定与HSR显著相关的因素。
结果：我们的研究结果显示，产时护理中HSR的总体比例为45.11%（95%CI：40.38至49.92）。响应能力的表现是自主性中最低的，选择和提示关注领域为35.5%，49.4%和52.0%，分别。生活在城市地区的母亲（β=4.28；95％CI：2.06至6.50），政府雇员(β=4.99；95%CI：0.51至9.48)，这些母亲在分娩前/冲突期间留在医疗机构（β=0.22；95％CI：0.09至0.35），对医疗服务满意的人(β=0.69;95%CI:0.08~1.30)和认为医疗质量有利的人(β=0.96;95%CI:0.72~1.19)更有可能对HSR进行正面评价.另一方面,健康的联合决策（β=-2.46；95％CI：-4.81至-0.10）和住院分娩（β=-3.62；95％CI：-5.60至-1.63）与HSR呈负相关。
结论：在埃塞俄比亚的阿姆哈拉地区，生活在受冲突影响地区的超过50%的母亲报告说，卫生系统对产期护理没有反应。因此,所有利益攸关方应共同努力，确保分时护理对受冲突影响的地区作出反应，专注于为妇女提供自主权和选择权。
方法：基于社区的横断面研究设计。
方法：瓦迪拉，Gayint和Meket区,阿姆哈拉地区,埃塞俄比亚。
方法：参与者是在过去6个月内在受冲突影响地区分娩的419名母亲。该研究包括所有在医疗机构分娩的母亲，但不包括在家分娩的母亲，病危或听不见。
结果：HSR是结果变量。在这方面,该研究评估了母亲在冲突期间的经历，以及她们受到照顾的情况。
方法：我们在社区进行了这项研究，我们分析了HSR的八个领域，以确定与产时护理反应性相关的30个测量项目。我们看到的领域是尊严（4），自治(4)保密(2),通信（5），迅速注意(5)，社会支持(3)选择(3)和基本设施(4)。我们使用多元线性回归模型来分析数据，在这个模型中，我们使用95%CI和p值小于0.05的未标准化β系数来确定与HSR显著相关的因素。
结果：我们的研究结果显示，产时护理中HSR的总体比例为45.11%（95%CI：40.38至49.92）。响应能力的表现是自主性中最低的，选择和提示关注领域为35.5%，49.4%和52.0%，分别。生活在城市地区的母亲（β=4.28；95％CI：2.06至6.50），政府雇员(β=4.99；95%CI：0.51至9.48)，这些母亲在分娩前/冲突期间留在医疗机构（β=0.22；95％CI：0.09至0.35），对医疗服务满意的人(β=0.69;95%CI:0.08~1.30)和认为医疗质量有利的人(β=0.96;95%CI:0.72~1.19)更有可能对HSR进行正面评价.另一方面,健康的联合决策（β=-2.46；95％CI：-4.81至-0.10）和住院分娩（β=-3.62；95％CI：-5.60至-1.63）与HSR呈负相关。
结论：在埃塞俄比亚的阿姆哈拉地区，生活在受冲突影响地区的超过50%的母亲报告说，卫生系统对产期护理没有反应。因此,所有利益攸关方应共同努力，确保分时护理对受冲突影响的地区作出反应，专注于为妇女提供自主权和选择权。
