Makerere University School of Public Health, P,O Box 7072, Kampala, Uganda.
BMC Pregnancy Childbirth. 2012 Nov 20;12:132. doi: 10.1186/1471-2393-12-132.
Among the factors contributing to the high maternal morbidity and mortality in Uganda is the high proportion of pregnant women who do not deliver under supervision in health facilities. This study aimed to identify the independent predictors of health facility delivery in Busia a rural district in Uganda with a view of suggesting measures for remedial action.
In a cross sectional survey, 500 women who had a delivery in the past two years (from November 16 2005 to November 15 2007) were interviewed regarding place of delivery, demographic characteristics, reproductive history, attendance for antenatal care, accessibility of health services, preferred delivery positions, preference for disposal of placenta and mother's autonomy in decision making. In addition the household socio economic status was assessed. The independent predictors of health facility delivery were identified by comparing women who delivered in health facilities to those who did not, using bivariate and binary logistic regression analysis.
Eight independent predictors that favoured delivery in a health facility include: being of high socio-economic status (adjusted odds ratio [AOR] 2.8 95% Confidence interval [95% CI]1.2-6.3), previous difficult delivery (AOR 4.2, 95% CI 3.0-8.0), parity less than four (AOR 2.9, 95% CI 1.6-5.6), preference of supine position for second stage of labour (AOR 5.9, 95% CI 3.5-11.1) preferring health workers to dispose the placenta (AOR 12.1, 95% CI 4.3-34.1), not having difficulty with transport (AOR 2.0, 95% CI 1.2-3.5), being autonomous in decision to attend antenatal care (AOR 1.9, 95% CI 1.1-3.4) and depending on other people (e.g. spouse) in making a decision of where to deliver from (AOR 2.4, 95% CI 1.4-4.6). A model with these 8 variables had an overall correct classification of 81.4% (chi square = 230.3, P < 0.001).
These data suggest that in order to increase health facility deliveries there is need for reaching women of low social economic status and of higher parity with suitable interventions aimed at reducing barriers that make women less likely to deliver in health units such as ensuring availability of transport and involving spouses in the birth plan.
在乌干达导致孕产妇高发病率和死亡率的因素中，有相当大比例的孕妇不在医疗机构中分娩。本研究旨在确定布西亚农村地区（乌干达的一个农村地区）医疗机构分娩的独立预测因素，以期提出补救措施。
在一项横断面调查中，对 500 名在过去两年内分娩的妇女（2005 年 11 月 16 日至 2007 年 11 月 15 日）进行了访谈，内容包括分娩地点、人口统计学特征、生殖史、产前护理就诊情况、卫生服务的可及性、首选分娩体位、胎盘处理方式以及母亲在决策中的自主权。此外，还评估了家庭社会经济状况。通过比较在医疗机构分娩的妇女和不在医疗机构分娩的妇女，使用单变量和二元逻辑回归分析，确定了有利于医疗机构分娩的独立预测因素。
有 8 个独立的预测因素有利于在医疗机构分娩，包括：社会经济地位较高（调整后的优势比[OR]2.8，95%置信区间[95%CI]1.2-6.3）、上次分娩困难（OR 4.2，95%CI 3.0-8.0）、产次小于 4 次（OR 2.9，95%CI 1.6-5.6）、第二产程喜欢仰卧位（OR 5.9，95%CI 3.5-11.1）、更喜欢卫生工作者处理胎盘（OR 12.1，95%CI 4.3-34.1）、运输无困难（OR 2.0，95%CI 1.2-3.5）、在决定接受产前护理时自主（OR 1.9，95%CI 1.1-3.4）以及在做出分娩地点决策时依赖他人（例如配偶）（OR 2.4，95%CI 1.4-4.6）。这个包含这 8 个变量的模型的整体正确分类率为 81.4%（卡方=230.3，P<0.001）。
这些数据表明，为了增加医疗机构分娩的数量，需要针对社会经济地位较低和产次较高的妇女采取适当的干预措施，减少使妇女不太可能在医疗机构分娩的障碍，例如确保交通的可用性，并让配偶参与分娩计划。
