Columbia University Mailman School of Public Health, Department of Health Policy and Management, 600 W. 168th Street, New York, NY 10032, USA.
Health Policy. 2010 Oct;97(2-3):209-16. doi: 10.1016/j.healthpol.2010.05.002.
Tanzania, a country with high maternal mortality, has many primary health facilities yet has a low rate of facility deliveries. This study estimated the contribution of individual and community factors in explaining variation in the use of health facilities for childbirth in rural Tanzania.
A two-stage cluster population-based survey was conducted in Kasulu District, western Tanzania with women with a recent delivery. Random intercept multilevel logistic regression models were used to assess the association between individual- and village-level factors and likelihood of facility delivery.
1205 women participated in the study. In the fully adjusted two-level model, in addition to several individual factors, positive village perception of doctor and nurse skills (odds ratio (OR) 6.72, 95% confidence interval (CI): 2.47-18.31) and negative perception of traditional birth attendant skills (OR 0.13, 95% CI: 0.04-0.40) were associated with higher odds of facility delivery.
This study suggests that community perceptions of the quality of the local health system influence women's decisions to deliver in a clinic. Improving quality of care at first-level clinics and communicating this to communities may assist efforts to increase facility delivery in sub-Saharan Africa.
坦桑尼亚是一个孕产妇死亡率较高的国家，拥有众多基层卫生设施，但设施分娩率却很低。本研究旨在评估个体和社区因素对解释坦桑尼亚农村地区分娩时使用卫生设施差异的贡献。
在坦桑尼亚西部的卡萨卢区进行了两阶段整群人群的基于人群的调查，对象为最近分娩的妇女。采用随机截距多水平逻辑回归模型评估个体和村庄层面因素与选择在医疗机构分娩的可能性之间的关联。
共有 1205 名妇女参加了这项研究。在完全调整的两水平模型中，除了几个个体因素外，对医生和护士技能的积极村庄认知（比值比 (OR) 6.72，95%置信区间 (CI)：2.47-18.31）和对传统助产士技能的消极认知（OR 0.13，95% CI：0.04-0.40）与更高的医疗机构分娩几率相关。
本研究表明，社区对当地卫生系统质量的看法影响着妇女在诊所分娩的决策。改善一级诊所的护理质量并将其传达给社区，可能有助于努力增加撒哈拉以南非洲地区的医疗机构分娩率。
