van Eijk Anna M, Bles Hanneke M, Odhiambo Frank, Ayisi John G, Blokland Ilse E, Rosen Daniel H, Adazu Kubaje, Slutsker Laurence, Lindblade Kim A
University of Amsterdam, the Netherlands.
Reprod Health. 2006 Apr 6;3:2. doi: 10.1186/1742-4755-3-2.
Improving maternal health is one of the UN Millennium Development Goals. We assessed provision and use of antenatal services and delivery care among women in rural Kenya to determine whether women were receiving appropriate care.
Population-based cross-sectional survey among women who had recently delivered.
Of 635 participants, 90% visited the antenatal clinic (ANC) at least once during their last pregnancy (median number of visits 4). Most women (64%) first visited the ANC in the third trimester; a perceived lack of quality in the ANC was associated with a late first ANC visit (Odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0-2.4). Women who did not visit an ANC were more likely to have < 8 years of education (adjusted OR [AOR] 3.0, 95% CI 1.5-6.0), and a low socio-economic status (SES) (AOR 2.8, 95% CI 1.5-5.3). The ANC provision of abdominal palpation, tetanus vaccination and weight measurement were high (>90%), but provision of other services was low, e.g. malaria prevention (21%), iron (53%) and folate (44%) supplementation, syphilis testing (19.4%) and health talks (14.4%). Eighty percent of women delivered outside a health facility; among these, traditional birth attendants assisted 42%, laypersons assisted 36%, while 22% received no assistance. Factors significantly associated with giving birth outside a health facility included: age >or= 30 years, parity >or= 5, low SES, < 8 years of education, and > 1 hour walking distance from the health facility. Women who delivered unassisted were more likely to be of parity >or= 5 (AOR 5.7, 95% CI 2.8-11.6).
In this rural area, usage of the ANC was high, but this opportunity to deliver important health services was not fully utilized. Use of professional delivery services was low, and almost 1 out of 5 women delivered unassisted. There is an urgent need to improve this dangerous situation.
改善孕产妇健康是联合国千年发展目标之一。我们评估了肯尼亚农村地区妇女的产前服务提供情况及分娩护理情况，以确定妇女是否得到了适当的护理。
对近期分娩的妇女进行基于人群的横断面调查。
在635名参与者中，90%的妇女在其最后一次怀孕期间至少去过一次产前诊所（ANC）（就诊次数中位数为4次）。大多数妇女（64%）在孕晚期首次就诊于ANC；认为ANC质量欠佳与首次就诊时间较晚相关（优势比[OR]为1.5，95%置信区间[CI]为1.0 - 2.4）。未就诊于ANC的妇女更有可能受教育年限不足8年（校正后OR[AOR]为3.0，95%CI为1.5 - 6.0），且社会经济地位较低（SES）（AOR为2.8，95%CI为1.5 - 5.3）。ANC提供腹部触诊、破伤风疫苗接种和体重测量的比例较高（>90%），但其他服务的提供比例较低，例如疟疾预防（21%）、铁（53%）和叶酸（44%）补充、梅毒检测（19.4%）以及健康宣教（14.4%）。80%的妇女在医疗机构外分娩；其中，传统助产士协助分娩的占42%，非专业人员协助的占36%，而22%未得到任何协助。与在医疗机构外分娩显著相关的因素包括：年龄≥30岁、产次≥5次、社会经济地位低、受教育年限不足8年以及距离医疗机构步行超过1小时的路程。未得到协助分娩的妇女产次≥5次的可能性更大（AOR为5.7，95%CI为2.8 - 11.6）。
在这个农村地区，ANC的使用率较高，但提供重要健康服务的这一机会未得到充分利用。专业分娩服务的使用率较低，近五分之一的妇女未得到协助分娩。迫切需要改善这种危险状况。
