Hlady W G, Fauveau V A, Khan S A, Chakraborty J, Yunus M
Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland.
Asia Pac J Public Health. 1992;6(1):18-24. doi: 10.1177/101053959200600107.
Using case-control methodology, this study compared the characteristics of women who requested medically-trained birth attendants at home with those who did not, in order to identify constraints to service delivery and suggest program changes to increase service utilization in a rural area of Bangladesh. By several different measures, prior contact with medical professionals were much more common among cases than controls, with the greatest differences observed in the frequency of antenatal visits. At least one antenatal visit was the strongest predictor that a woman would call a medically-trained birth attendant, though primiparity, proximity to the provider, previous contact with the clinic, and education (both of the mother and her spouse) were also predictive. Recommendations include increasing contact through antenatal visits, and extending midwife coverage through training and supervision of traditional birth attendants. This study demonstrates the usefulness of case-control methodology in evaluating health care utilization.
本研究采用病例对照方法，比较了在家中要求由医学专业人员接生的妇女与未提出该要求的妇女的特征，以确定服务提供方面的制约因素，并提出方案改进建议，以提高孟加拉国农村地区的服务利用率。通过几种不同的衡量标准，病例组比对照组更常与医疗专业人员有过接触，其中产前检查频率的差异最为显著。至少进行一次产前检查是预测女性会呼叫医学专业接生人员的最强指标，不过初产情况、与医疗机构的距离、之前与诊所的接触以及（母亲及其配偶的）受教育程度也具有预测作用。建议包括通过产前检查增加接触，并通过对传统接生员的培训和监督扩大助产士覆盖范围。本研究证明了病例对照方法在评估医疗保健利用情况方面的有用性。
