Global REACH, University of Michigan Medical School, 5115 Med Sci 1, 1301 Catherine St,, Ann Arbor, MI 48109-5611, USA.
Reprod Health. 2013 Aug 20;10:40. doi: 10.1186/1742-4755-10-40.
While the most important factors associated with facility-based delivery (FBD) have been explored within individual countries in Africa, no systematic review has explored the factors associated with FBD across sub-Saharan Africa. A systematic search of the peer-reviewed literature was conducted to identify articles published in English from 1/1995-12/2011 that reported on original research conducted entirely or in part in sub-Saharan Africa and included a primary outcome variable of FBD, delivery location, or skilled birth attendance (SBA). Out of 1,168 citations identified, 65 met inclusion criteria. 62 of 65 were cross-sectional, and 58 of 65 relied upon household survey data. Fewer than two-thirds (43) included multivariate analyses. The factors associated with facility delivery were categorized as maternal, social, antenatal-related, facility-related, and macro-level factors. Maternal factors were the most commonly studied. This may be a result of the overwhelming reliance on household survey data - where maternal sociodemographic factors are likely to be well-represented and non-maternal factors may be less consistently and accurately represented. Multivariate analysis suggests that maternal education, parity / birth order, rural / urban residence, household wealth / socioeconomic status, distance to the nearest facility, and number of antenatal care visits were the factors most consistently associated with FBD. In conclusion, FBD is a complex issue that is influenced by characteristics of the pregnant woman herself, her immediate social circle, the community in which she lives, the facility that is closest to her, and context of the country in which she lives. Research to date has been dominated by analysis of cross-sectional household survey data. More research is needed that explores regional variability, examines longitudinal trends, and studies the impact of interventions to boost rates of facility delivery in sub-Saharan Africa.
虽然在非洲的个别国家已经探讨了与医疗机构分娩（FBD）相关的最重要因素，但尚未有系统综述探讨整个撒哈拉以南非洲地区与 FBD 相关的因素。我们对同行评审文献进行了系统检索，以确定 1995 年 1 月至 2011 年 12 月期间以英文发表的报告在撒哈拉以南非洲完全或部分进行的原始研究的文章，这些文章包括 FBD、分娩地点或熟练接生（SBA）作为主要结局变量。在确定的 1168 篇参考文献中，有 65 篇符合纳入标准。65 篇中有 62 篇为横断面研究，65 篇中有 58 篇依赖于家庭调查数据。不到三分之二（43）包括多变量分析。与医疗机构分娩相关的因素分为产妇、社会、产前相关、医疗机构相关和宏观层面因素。产妇因素是最常见的研究对象。这可能是由于对家庭调查数据的过分依赖造成的，在这些数据中，产妇社会人口统计学因素很可能得到很好的体现，而非产妇因素可能不太一致和准确地体现。多变量分析表明，产妇教育、产次/出生顺序、城乡居住、家庭财富/社会经济地位、离最近医疗机构的距离以及产前检查次数是与 FBD 最密切相关的因素。总之，FBD 是一个复杂的问题，受到孕妇自身特征、她的直接社交圈、她所居住的社区、离她最近的医疗机构以及她所居住国家的背景等因素的影响。迄今为止的研究主要集中在对横断面家庭调查数据的分析上。需要更多的研究来探索区域差异，研究纵向趋势，并研究干预措施对提高撒哈拉以南非洲地区医疗机构分娩率的影响。
