Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Calle Pino, El Roble, Acapulco, Mexico.
BMC Health Serv Res. 2011 Dec 21;11 Suppl 2(Suppl 2):S7. doi: 10.1186/1472-6963-11-S2-S7.
Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy.
In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering.
The most consistent and prominent of 28 candidate risk factors and underlying determinants for non-fatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5).
Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their lives--genital mutilation, domestic violence, and steep power gradients--is accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women's fear of husbands or partners and not discussing pregnancy are all within men's capacity to change.
尼日利亚的产妇发病率和死亡率仍然很高。这部分与缺乏足够的产科护理有关，部分与妊娠期间的高风险有关，包括繁重的工作。我们在尼日利亚的包奇州和十字河州检查了社区层面的可采取行动的风险因素和潜在决定因素，包括与妊娠期间男性责任有关的几个因素。
2009 年，实地小组对包奇州和十字河州最近的人口普查中抽取的每个州的 180 个最后阶段的分层（城市/农村）随机抽样区进行了访问。在与 15-49 岁的妇女进行的面对面访谈中，使用结构化问卷记录了教育、收入、最近的生育史、与安全分娩相关的知识和态度，以及过去三年的分娩情况。封闭问题涵盖了女性割礼、去年的亲密伴侣暴力（IPV）、妊娠期间的 IPV、妊娠期间的工作以及妊娠期间的支持。结局是过去三年中分娩幸存者的妊娠和分娩并发症（子痫、败血症、出血）。我们为聚类调整了双变量和多变量分析。
在 28 个候选风险因素和非致命性产妇发病率的潜在决定因素中，最一致和突出的是妊娠期间的亲密伴侣暴力（IPV）（在包奇的 ORa 为 2.15，95%置信区间为 1.43-3.24，在十字河的 ORa 为 1.5，95%置信区间为 1.20-2.03）。多变量模型中的其他与配偶相关的因素包括与配偶不讨论怀孕以及独立的去年 IPV。过去一周食物短缺是包奇（ORa 1.66，95%置信区间为 1.22-2.26）和十字河（ORa 1.32，95%置信区间为 1.15-1.53）的因素。在不太富裕的包奇妇女中，女性割礼是一个因素（ORa 2.1，95%置信区间为 1.39-3.17），而所有十字河妇女（ORa 1.23，95%置信区间为 1.1-1.5）也是如此。
加强临床方案和技能只能使尼日利亚和其他地方的妇女受益。但是，女性在整个生命周期中所经历的暴力——女性割礼、家庭暴力和陡峭的权力梯度——在怀孕和分娩期间会更加严重，因为此时女性最为脆弱。IPV 尤其是妊娠期间的 IPV、女性对丈夫或伴侣的恐惧以及不讨论怀孕，这些都是男性有能力改变的。
