Bolam A, Manandhar D S, Shrestha P, Ellis M, Malla K, Costello A M
Centre for International Child Health, Institute of Child Health, London.
Health Policy Plan. 1998 Jun;13(2):152-8. doi: 10.1093/heapol/13.2.152.
This nested case-control study compares the characteristics of mothers having home or institutional deliveries in Kathmandu, Nepal, and explores the reasons given by mothers for a home delivery. The delivery patterns of mothers were identified in a cross-sectional survey of two communities: an urban area of central Kathmandu (Kalimati) and a peri-urban area (Kirtipur and Panga) five kilometres from the city centre. 357 pregnant women were identified from a survey of 6130 households: 183 from 3663 households in Kirtipur and Panga, 174 from 2467 households in Kalimati. Methods involved a structured baseline household questionnaire and detailed follow-up of identified pregnant women with structured and semi-structured interviews in hospital and the community. The main outcome measures were social and economic household details of pregnant women; pregnancy and obstetric details; place of delivery; delivery attendant; and reasons given for home delivery. The delivery place of 334/357 (94%) of the pregnant women identified at the survey was determined. 272 (81%) had an institutional delivery and 62 (19%) delivered at home. In univariate analysis comparing home and institutional deliverers, maternal education, parity, and poverty indicators (income, size of house, ownership of house) were associated with place of delivery. After multivariate analysis, low maternal educational level (no education, OR 5.04 [95% CI 1.61-15.8], class 1-10, OR 3.36 [1.04-10.8] compared to those with higher education) and multiparity (OR 3.1 [1.63-5.74] compared to primiparity) were significant risk factors for a home delivery. Of home deliverers, only 24% used a traditional birth attendant, and over half were unplanned due to precipitate labour or lack of transport. We conclude that poor education and multiparity rather than poverty per se increase the risk of a home delivery in Kathmandu. Training TBAs in this setting would probably not be cost-effective. Community-based midwife-run delivery units could reduce the incidence of unplanned home deliveries.
这项巢式病例对照研究比较了尼泊尔加德满都在家分娩和在医疗机构分娩的母亲的特征，并探究了母亲选择在家分娩的原因。通过对两个社区进行横断面调查确定母亲的分娩方式：一个是加德满都中部的市区（卡里马蒂），另一个是距市中心5公里的城郊地区（基尔蒂普尔和潘加）。在对6130户家庭进行的调查中识别出357名孕妇：183名来自基尔蒂普尔和潘加的3663户家庭，174名来自卡里马蒂的2467户家庭。方法包括一份结构化的基线家庭调查问卷，以及对识别出的孕妇在医院和社区进行结构化和半结构化访谈的详细随访。主要结局指标包括孕妇的社会和经济家庭细节、妊娠和产科细节、分娩地点、接生人员以及选择在家分娩的原因。在调查中识别出的357名孕妇中，确定了334名（94%）的分娩地点。272名（81%）在医疗机构分娩，62名（19%）在家分娩。在比较在家分娩者和在医疗机构分娩者的单因素分析中，母亲的教育程度、产次和贫困指标（收入、房屋面积、房屋所有权）与分娩地点有关。多因素分析后，母亲教育水平低（与受过高等教育者相比，未受过教育，比值比5.04 [95%置信区间1.61 - 15.8]；1 - 10年级，比值比3.36 [1.04 - 10.8]）和多产次（与初产妇相比，比值比3.1 [1.63 - 5.74]）是在家分娩的显著危险因素。在家分娩者中，只有24%使用传统接生员，超过一半是由于急产或缺乏交通工具导致的非计划分娩。我们得出结论，教育程度低和多产次而非贫困本身增加了加德满都在家分娩的风险。在此背景下培训传统接生员可能不具有成本效益。以社区为基础的由助产士管理的分娩单位可以降低非计划在家分娩的发生率。
