Ensor Tim, Quigley Paula, Green Cathy, Razak Badru Abdul, Kaluba Dynes, Siziya Seter
Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9JZ, UK, Health Partners International, Waterside Centre, North Street, Lewes, East Sussex, BN7 2PE, UK and Department of Community Medicine, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia
Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9JZ, UK, Health Partners International, Waterside Centre, North Street, Lewes, East Sussex, BN7 2PE, UK and Department of Community Medicine, School of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia.
Health Policy Plan. 2014 Aug;29(5):580-8. doi: 10.1093/heapol/czt044. Epub 2013 Jul 26.
The link between antenatal care (ANC) and facility delivery is a specific example of the effect of early medical contacts on later use of essential services. The role of ANC in improving maternal health remains unclear. High levels of ANC are reported in a number of countries where skilled delivery remains uncommon. ANC may influence the use of services by increasing willingness to use services and educating about maternal health. The objective of this study is to understand the interaction between use of skilled and unskilled ANC, knowledge of obstetric complications and danger signs, and the eventual use of a facility for delivery. The study makes use of data from a survey of around 1700 women who had recently given birth across 11 districts of Zambia in 2011. Multivariate analysis is used to explore the associations between ANC use, knowledge and place of delivery. The results suggest that place of care and number of visits is strongly associated with the eventual use of a facility for delivery; an effect that is stronger in remote areas. Both skilled and unskilled ANC and obstetric knowledge is linked to higher use of facility delivery care while care provided at home appears to have an opposite effect. The research suggests that ANC influences later use of delivery care in two ways: by developing a habit to use formal care services and in increasing maternal knowledge. The work might be generalized to other health seeking behaviour to explore how the quantity and quality of initial contacts influence later use of services.
产前保健（ANC）与医疗机构分娩之间的联系，是早期医疗接触对后期基本服务利用产生影响的一个具体例子。ANC在改善孕产妇健康方面的作用仍不明确。在一些熟练接生仍不常见的国家，报告显示产前保健水平较高。ANC可能通过提高使用服务的意愿和开展孕产妇健康教育来影响服务的使用。本研究的目的是了解熟练和非熟练产前保健的使用、产科并发症及危险信号的知识，与最终医疗机构分娩使用情况之间的相互作用。该研究利用了2011年在赞比亚11个地区对约1700名近期分娩妇女进行调查的数据。采用多变量分析来探讨产前保健使用、知识与分娩地点之间的关联。结果表明，护理地点和就诊次数与最终医疗机构分娩的使用密切相关；在偏远地区这种影响更强。熟练和非熟练的产前保健以及产科知识都与更高的医疗机构分娩护理使用率相关，而在家中提供的护理似乎有相反的效果。研究表明，产前保健通过养成使用正规护理服务的习惯和增加孕产妇知识这两种方式影响后期分娩护理的使用。这项工作可能推广到其他寻求医疗行为，以探讨初始接触的数量和质量如何影响后期服务的使用。
