Kruk Margaret E, Hermosilla Sabrina, Larson Elysia, Mbaruku Godfrey M
600 West 168th Street, Room 606, Mailman School of Public Health, Columbia University, New York, NY 10032, United States of America .
Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania .
Bull World Health Organ. 2014 Apr 1;92(4):246-53. doi: 10.2471/BLT.13.126417. Epub 2014 Feb 5.
To measure the extent, determinants and results of bypassing local primary care clinics for childbirth among women in rural parts of the United Republic of Tanzania.
Women were selected in 2012 to complete a structured interview from a full census of all 30076 households in clinic catchment areas in Pwani region. Eligibility was limited to those who had delivered between 6 weeks and 1 year before the interview, were at least 15 years old and lived within the catchment areas. Demographic and delivery care information and opinions on the quality of obstetric care were collected through interviews. Clinic characteristics were collected from staff via questionnaires. Determinants of bypassing (i.e. delivery of the youngest child at a health centre or hospital without provider referral) were analysed using multivariate logistic regression. Bypasser and non-bypasser birth experiences were compared in bivariate analyses.
Of 3019 eligible women interviewed (93% response rate), 71.0% (2144) delivered in a health facility; 41.8% (794) were bypassers. Bypassing likelihood increased with primiparity (odds ratio, OR: 2.5; 95% confidence interval, CI: 1.9-3.3) and perceived poor quality at clinics (OR: 1.3; 95% CI: 1.0-1.7) and decreased if clinics recently underwent renovations (OR: 0.39; 95% CI: 0.18-0.84) and/or performed ≥ 4 obstetric signal functions (OR: 0.19; 95% CI: 0.08-0.41). Bypassers reported better quality of care on six of seven quality of care measures.
Many pregnant women, especially first-time mothers, choose to bypass local primary care clinics for childbirth. Perceived poor quality of care at clinics was an important reason for bypassing. Primary care is failing to meet the obstetric needs of many women in this rural, low-income setting.
评估坦桑尼亚联合共和国农村地区妇女分娩时绕过当地初级保健诊所的程度、决定因素及后果。
2012年，从滨海地区诊所服务范围内的30076户家庭的全面普查中选取妇女进行结构化访谈。入选条件仅限于在访谈前6周至1年之间分娩、年龄至少15岁且居住在服务范围内的妇女。通过访谈收集人口统计学和分娩护理信息以及对产科护理质量的看法。通过问卷从工作人员处收集诊所特征。使用多因素逻辑回归分析绕过（即在没有医生转诊的情况下在医疗中心或医院分娩最小的孩子）的决定因素。在双变量分析中比较绕过者和非绕过者的分娩经历。
在接受访谈的3019名符合条件的妇女中（应答率为93%），71.0%（2144名）在医疗机构分娩；41.8%（794名）为绕过者。绕过的可能性随着初产（比值比，OR：2.5；95%置信区间，CI：1.9 - 3.3）和认为诊所质量差（OR：1.3；95%CI：1.0 - 1.7）而增加，如果诊所最近进行了翻新（OR：0.39；95%CI：0.18 - 0.84）和/或执行了≥4项产科信号功能（OR：0.19；95%CI：0.08 - 0.41）则降低。在七项护理质量指标中的六项上，绕过者报告的护理质量更好。
许多孕妇，尤其是初产妇，选择绕过当地初级保健诊所进行分娩。认为诊所护理质量差是绕过的一个重要原因。在这个农村低收入环境中，初级保健未能满足许多妇女的产科需求。
