Yesuf Elias Ali, Calderon-Margalit Ronit
BMC Pregnancy Childbirth. 2013 Jun 15;13:131. doi: 10.1186/1471-2393-13-131.
Little is known about factors contributing to inequities in antenatal care use in Ethiopia. We aimed to assess inequities in the use of antenatal care on the basis of area of residence, administrative region, economic status and education.
This study was based on data from repeated cross-sectional surveys carried out by Measure Demographic and Health Survey and Central Statistical Authority of Ethiopia. The surveys were conducted in February-June 2000, April-August 2005, and December 2010-June 2011. The surveys employed a cluster sampling design to select a nationally representative sample of 15-49 year-old women. The main outcome variable was at least one antenatal care visit for the last live birth in the 5 years preceding the surveys. Statistical analysis was completed by applying the sampling weights in order to consider the complex sampling design.
A total of 7978, 7307 and 7908 weighted number of women participated in the three surveys, respectively. The rate of antenatal care coverage in Ethiopia has increased from 26.8% in 2000 to 42.7% in 2011. The odds of antenatal care use were 2.4 (95% CI: 1.7-3.2, p < 0.0001), 1.6 (95% CI: 1.2-2.2, p = 0.003) and 1.8 (95% CI: 1.3-2.6, p = 0.001) times higher among women from urban areas than those from rural areas at the three time points, respectively. The odds ratio of antenatal care use among women with secondary or higher education compared with women of no education increased from 2.6 (95% CI: 2.0-3.4, p < 0.0001) in 2000 to 5.1 (95% CI: 2.8-9.4, p < 0.0001) in 2011. Moreover, the odds of use among women from the richest households at the three time points were 2.7 (95% CI: 2.1-3.6, p < 0.0001), 4.4 (95% CI: 3.3-6.0, p < 0.0001), and 3.9 (95% CI: 2.8-5.5, p < 0.0001) times higher compared with their counterparts from the poorest households. Furthermore, we have observed a wide regional variation in the use of ANC in Ethiopia.
The wide inequities between urban and rural areas, across economic and educational strata in the use of antenatal care highlight the need to put more resources to poor households, rural areas, and disadvantage regions. We suggest further study to understand additional factors for the deep unmet need in rural areas and some regions of Ethiopia.
关于埃塞俄比亚产前保健利用不平等的影响因素，人们了解甚少。我们旨在基于居住地区、行政区、经济状况和教育程度评估产前保健利用方面的不平等情况。
本研究基于埃塞俄比亚衡量人口与健康调查及中央统计局进行的重复横断面调查数据。这些调查分别于2000年2月至6月、2005年4月至8月以及2010年12月至2011年6月开展。调查采用整群抽样设计，选取了具有全国代表性的15 - 49岁女性样本。主要结局变量是在调查前5年内为最后一次活产至少进行一次产前检查。为考虑复杂抽样设计，应用抽样权重完成了统计分析。
三次调查分别有7978、7307和7908名加权女性参与。埃塞俄比亚的产前保健覆盖率从2000年的26.8%增至2011年的42.7%。在这三个时间点，城市地区女性进行产前检查的几率分别比农村地区女性高2.4倍（95%置信区间：1.7 - 3.2，p < 0.0001）、1.6倍（95%置信区间：1.2 - 2.2，p = 0.003）和1.8倍（95%置信区间：1.3 - 2.6，p = 0.001）。与未受过教育的女性相比，受过中等及以上教育的女性进行产前检查的几率从2000年的2.6倍（95%置信区间：2.0 - 3.4，p < 0.0001）增至2011年的5.1倍（95%置信区间：2.8 - 9.4，p < 0.0001）。此外，在这三个时间点，最富有家庭的女性进行产前检查的几率分别比最贫困家庭的女性高2.7倍（95%置信区间：2.1 - 3.6，p < 0.0001）、4.4倍（95%置信区间：3.3 - 6.0，p < 0.0001）和3.9倍（95%置信区间：2.8 - 5.5，p < 0.0001）。此外，我们观察到埃塞俄比亚在产前保健利用方面存在广泛的地区差异。
产前保健利用在城乡之间、不同经济和教育阶层之间存在广泛不平等，这凸显了需要向贫困家庭、农村地区和弱势地区投入更多资源。我们建议进一步开展研究，以了解埃塞俄比亚农村地区和一些地区未得到满足的深层次需求的其他因素。
