Chowdhury Mahbub Elahi, Ronsmans Carine, Killewo Japhet, Anwar Iqbal, Gausia Kaniz, Das-Gupta Sushil, Blum Lauren S, Dieltiens Greet, Marshall Tom, Saha Sajal, Borghi Jo
ICDDR, B: Centre for Health and Population Research, Bangladesh.
Lancet. 2006 Jan 28;367(9507):327-32. doi: 10.1016/S0140-6736(06)68070-7.
Few studies have assessed whether the poorest people in developing countries benefit from giving birth at home rather than in a facility. We analysed whether socioeconomic status results in differences in the use of professional midwives at home and in a basic obstetric facility in a rural area of Bangladesh, where obstetric care was free of charge.
We routinely obtained data from Matlab, Bangladesh between 1987 and 2001. We compared the benefits of home-based and facility-based obstetric care using a multinomial logistic and binomial log link regression, controlling for multiple confounders.
Whether or not a midwife was used at home or in a facility differed significantly with wealth (adjusted odds ratio comparing the wealthiest and poorest quintiles 1.94 [95% CI 1.69-2.24] for home-based care, and 2.05 [1.72-2.43] for facility-based care). The gap between rich and poor widened after the introduction of facility-based care in 1996. The risk ratio (RR) between the wealthiest and poorest quintiles was 1.91 (adjusted RR 1.49 [95% CI 1.16-1.91] when most births with a midwife took place at home compared with 2.71 (1.66 [1.41-1.96]) at the peak of facility-based care.
In this area of Bangladesh, a shift from home-based to facility-based basic obstetric care is feasible but might lead to increased inequities in access to health care. However, there is also evidence of substantial inequities in home births. Before developing countries reinforce home-based births with a skilled attendant, research is needed to compare the feasibility, cost, effectiveness, acceptability, and implications for health-care equity in both approaches.
很少有研究评估发展中国家最贫困人群在家分娩而非在医疗机构分娩是否有益。我们分析了社会经济地位是否会导致孟加拉国农村地区在家和在基本产科医疗机构使用专业助产士的差异，该地区产科护理是免费的。
我们定期获取1987年至2001年孟加拉国马特莱布的数据。我们使用多项逻辑回归和二项对数链接回归比较了家庭式和医疗机构式产科护理的益处，并控制了多个混杂因素。
在家或在医疗机构是否使用助产士在财富水平上存在显著差异（比较最富有和最贫困五分之一人群，家庭式护理的调整优势比为1.94[95%置信区间1.69 - 2.24]，医疗机构式护理为2.05[1.72 - 2.43]）。1996年引入医疗机构式护理后，贫富差距扩大。最富有和最贫困五分之一人群之间的风险比（RR）为1.91（当大多数有助产士参与的分娩在家中进行时，调整后的RR为1.49[95%置信区间1.16 - 1.91]，而在医疗机构式护理高峰期为2.71[1.66(1.41 - 1.96)]）。
在孟加拉国的这个地区，从家庭式基本产科护理转向医疗机构式基本产科护理是可行的，但可能会导致获得医疗保健方面的不平等加剧。然而，也有证据表明在家分娩存在严重的不平等。在发展中国家加强由熟练护理人员参与的家庭分娩之前，需要进行研究以比较两种方式的可行性、成本、有效性、可接受性以及对医疗保健公平性的影响。
