International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
BMC Public Health. 2010 Dec 13;10:762. doi: 10.1186/1471-2458-10-762.
Efforts to reduce neonatal mortality are essential if the Millennium Development Goal (MDG) 4 is to be met. The impact of spatial dimensions of neonatal survival has not been thoroughly investigated even though access to good quality delivery care is considered to be one of the main priorities when trying to reduce neonatal mortality. This study examined the association between distance from the mother's home to the closest health facility and neonatal mortality, and investigated the influence of distance on patterns of perinatal health care utilisation.
A surveillance system of live births and neonatal deaths was set up in eight districts of Quang Ninh province, Vietnam, from July 2008 to December 2009. Case referent design including all neonatal deaths and randomly selected newborn referents from the same population. Interviews were performed with mothers of all subjects and GIS coordinates for mothers' homes and all health facilities in the study area were obtained. Straight-line distances were calculated using ArcGIS software.
A total of 197 neonatal deaths and 11 708 births were registered and 686 referents selected. Health care utilisation prior to and at delivery varied with distance to the health facility. Mothers living farthest away (4th and 5th quintile, ≥1257 meters) from a health facility had an increased risk of neonatal mortality (OR 1.96, 95% CI 1.40 - 2.75, adjusted for maternal age at delivery and marital status). When stratified for socio-economic factors there was an increased risk for neonatal mortality for mothers with low education and from poor households who lived farther away from a health facility. Mothers who delivered at home had more than twice as long to a health facility compared to mothers who delivered at a health care facility. There was no difference in age at death when comparing neonates born at home or health facility deliveries (p = 0.56).
Distance to the closest health facility was negatively associated with neonatal mortality risk. Health care utilisation in the prenatal period could partly explain this risk elevation since there was a distance decay in health system usage prior to and at delivery. The geographical dimension must be taken into consideration when planning interventions for improved neonatal survival, especially when targeting socio-economically disadvantaged groups.
要实现千年发展目标 4，降低新生儿死亡率至关重要。尽管获得高质量的分娩护理被认为是降低新生儿死亡率的主要优先事项之一，但新生儿生存的空间维度的影响尚未得到彻底研究。本研究调查了母亲家到最近的卫生机构的距离与新生儿死亡率之间的关系，并研究了距离对围产期保健利用模式的影响。
2008 年 7 月至 2009 年 12 月，在越南广宁省的 8 个地区建立了活产和新生儿死亡监测系统。采用病例对照设计，包括所有新生儿死亡病例和同一人群中随机选择的新生儿对照。对所有研究对象的母亲进行访谈，并获得研究地区母亲家和所有卫生机构的 GIS 坐标。使用 ArcGIS 软件计算直线距离。
共登记了 197 例新生儿死亡和 11708 例分娩，选择了 686 名对照。分娩前和分娩时的保健服务利用情况随与卫生机构的距离而变化。距离卫生机构最远的母亲（第 4 和第 5 五分位数，≥1257 米）新生儿死亡风险增加（OR 1.96，95%CI 1.40-2.75，调整分娩时产妇年龄和婚姻状况）。按社会经济因素分层时，距离卫生机构较远的低教育程度和贫困家庭的母亲发生新生儿死亡的风险增加。与在医疗保健机构分娩的母亲相比，在家分娩的母亲到达卫生机构的时间要长两倍多。比较在家分娩和在医疗机构分娩的新生儿，其死亡年龄无差异（p=0.56）。
距离最近的卫生机构的距离与新生儿死亡风险呈负相关。产前保健利用情况在一定程度上解释了这种风险的增加，因为在分娩前和分娩时，卫生系统的使用存在距离衰减。在规划改善新生儿生存的干预措施时，必须考虑地理维度，特别是针对社会经济弱势群体。
