Mrisho Mwifadhi, Schellenberg Joanna A, Mushi Adiel K, Obrist Brigit, Mshinda Hassan, Tanner Marcel, Schellenberg David
Ifakara Health Research and Development Centre, Dar es Salaam, Tanzania.
Trop Med Int Health. 2007 Jul;12(7):862-72. doi: 10.1111/j.1365-3156.2007.01855.x.
Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help-seeking behaviour with epidemiological knowledge concerning place of delivery.
In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were collected in a cross-sectional survey of 21,600 randomly chosen households.
Issues of risk and vulnerability, such as lack of money, lack of transport, sudden onset of labour, short labour, staff attitudes, lack of privacy, tradition and cultures and the pattern of decision-making power within the household were perceived as key determinants of the place of delivery. More than 9000 women were interviewed about their most recent delivery in the quantitative survey. There were substantial variations between ethnic groups with respect to place of delivery (P<0.0001). Women who lived in male-headed households were less likely to deliver in a health facility than women in female-headed households (RR 0.86, 95% CI 0.80-0.91). Mothers with primary and higher education were more likely to deliver at a health facility (RR 1.30, 95% CI 1.23-1.38). Younger mothers and the least poor women were also more likely to deliver in a health facility compared with the older and the poorest women, respectively.
To address neonatal mortality, special attention should be paid to neonatal health in both maternal and child health programmes. The findings emphasize the need for a systematic approach to overcome health-system constraints, community based programmes and scale-up effective low-cost interventions which are already available.
关于影响分娩地点因素的研究很少考虑家庭内部性别角色和关系的影响。本研究将与健康及寻求帮助行为相关的性别问题理解与有关分娩地点的流行病学知识相结合。
采用深入访谈、焦点小组讨论和参与观察来探究坦桑尼亚南部家庭分娩的决定因素。通过对21600个随机选取家庭的横断面调查收集定量数据。
风险和脆弱性问题，如缺钱、交通不便、分娩突然发作、产程短、医护人员态度、缺乏隐私、传统和文化以及家庭内部决策权模式，被视为分娩地点的关键决定因素。在定量调查中，对9000多名妇女进行了关于其最近一次分娩情况的访谈。不同种族在分娩地点方面存在显著差异（P<0.0001）。与女户主家庭中的妇女相比，男户主家庭中的妇女在医疗机构分娩的可能性较小（相对危险度0.86，95%可信区间0.80 - 0.91）。接受过小学及以上教育的母亲在医疗机构分娩的可能性更大（相对危险度1.30，95%可信区间1.23 - 1.38）。与年龄较大和最贫困的妇女相比，年轻母亲和最不贫困的妇女在医疗机构分娩的可能性也更大。
为解决新生儿死亡率问题，母婴健康项目应特别关注新生儿健康。研究结果强调需要采取系统方法来克服卫生系统限制，开展基于社区的项目，并扩大现有的有效低成本干预措施。
