Abstract
BackgroundMaternal 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.MethodsData comes from a 1999 cross-sectional survey of 444 female refugees in 23 camps. Associations of reported maternal health outcomes with exposure to health education (exposed versus unexposed), formal education (none versus some), age (adolescent versus adult), or parity (nulliparous, parous, grand multiparous), were analysed using logistic regression.ResultsNo significant differences were found in maternal knowledge or attitudes. Virtually all respondents said pregnant women should attend antenatal care and knew the importance of tetanus vaccination. Most recognised abdominal pain (75%) and headaches (24%) as maternal danger signs and recommended facility attendance for danger signs. Most had last delivered at a facility (67%), mainly for safety reasons (99%). Higher odds of facility delivery were found for those exposed to RHG health education (adjusted odds ratio 2.03, 95%CI 1.23-3.01), formally educated (adjusted OR 1.93, 95%CI 1.05-3.92), or grand multipara (adjusted OR 2.13, 95%CI 1.21-3.75). Main reasons for delivering at home were distance to a facility (94%) and privacy (55%).ConclusionsRefugee-led maternal health education appeared to increase facility delivery for these refugee women. Improved knowledge of danger signs and the importance of skilled birth attendance, while vital, may be less important in chronic emergency settings than improving facility access where quality of care is acceptable.
Highlights
Maternal mortality can be high in conflict and chronic emergency settings, partly due to inaccessible maternal care
Conflict and displacement are associated with poverty, loss of livelihood, disruption of services, breakdown of social support systems, and increased sexual violence, and are generally accompanied by reduced capacity to respond to reproductive health needs, further complicating provision of maternal care [2,3,5,6,7,8,9,10]
The primary objective was to assess whether exposure to Reproductive Health Group’ (RHG) facilitator-led health education was associated with differences in maternal knowledge, attitudes, or practices
Summary
Maternal mortality can be 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. Conflict and displacement are associated with poverty, loss of livelihood, disruption of services, breakdown of social support systems, and increased sexual violence, and are generally accompanied by reduced capacity to respond to reproductive health needs, further complicating provision of maternal care [2,3,5,6,7,8,9,10]. A study of Afghan refugees in Pakistan showed 41% of deaths among reproductive-age women were pregnancyrelated, due to inaccessibility of emergency obstetric care. This study enabled insight into the influences of refugee-led health education, formal schooling, parity, and age on maternal knowledge, attitudes and practices among reproductiveage refugee women in Guinea
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