School of Medicine, Duke University, Durham, U,S,A.
Int J Health Geogr. 2013 Dec 7;12:55. doi: 10.1186/1476-072X-12-55.
The majority of maternal deaths, stillbirths, and neonatal deaths are concentrated in a few countries, many of which have weak health systems, poor access to health services, and low coverage of key health interventions. Early and consistent antenatal care (ANC) attendance could significantly reduce maternal and neonatal morbidity and mortality. Despite this, most Kenyan mothers initiate ANC care late in pregnancy and attend fewer than the recommended visits.
We used survey data from 6,200 pregnant women across six districts in western Kenya to understand demand-side factors related to use of ANC. Bayesian multi-level models were developed to explore the relative importance of individual, household and village-level factors in relation to ANC use.
There is significant spatial autocorrelation of ANC attendance in three of the six districts and considerable heterogeneity in factors related to ANC use between districts. Working outside the home limited ANC attendance. Maternal age, the number of small children in the household, and ownership of livestock were important in some districts, but not all. Village proportions of pregnancy in women of child-bearing age was significantly correlated to ANC use in three of the six districts. Geographic distance to health facilities and the type of nearest facility was not correlated with ANC use. After incorporating individual, household and village-level covariates, no residual spatial autocorrelation remained in the outcome.
ANC attendance was consistently low across all the districts, but factors related to poor attendance varied. This heterogeneity is expected for an outcome that is highly influenced by socio-cultural values and local context. Interventions to improve use of ANC must be tailored to local context and should include explicit approaches to reach women who work outside the home.
大多数孕产妇死亡、死产和新生儿死亡集中在少数几个国家，其中许多国家的卫生系统薄弱，获得卫生服务的机会有限，关键卫生干预措施的覆盖面低。早期和持续的产前保健（ANC）可以显著降低孕产妇和新生儿的发病率和死亡率。尽管如此，大多数肯尼亚母亲在妊娠晚期才开始接受 ANC 护理，且接受的就诊次数少于推荐的次数。
我们使用了来自肯尼亚西部六个地区的 6200 名孕妇的调查数据，以了解与 ANC 使用相关的需求方因素。采用贝叶斯多层次模型来探讨与 ANC 使用相关的个体、家庭和村庄层面因素的相对重要性。
在六个地区中的三个地区，ANC 就诊存在显著的空间自相关，并且在 ANC 使用与地区之间存在相当大的异质性。外出工作限制了 ANC 的就诊。母亲年龄、家中小孩的数量以及牲畜的拥有情况在一些地区很重要，但并非所有地区都是如此。在六个地区中的三个地区，村庄中育龄妇女的怀孕比例与 ANC 的使用显著相关。到卫生设施的地理距离和最近设施的类型与 ANC 的使用没有相关性。在纳入个体、家庭和村庄层面的协变量后，结果中不再存在剩余的空间自相关。
所有地区的 ANC 就诊率都一直很低，但与就诊率低相关的因素各不相同。这种异质性是由高度受社会文化价值观和当地背景影响的结果所预期的。改善 ANC 使用的干预措施必须针对当地情况进行定制，并应包括明确的方法来覆盖外出工作的妇女。
