Shrestha Sanu, Bell Jacqueline S, Marais Debbi
Division of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom.
PLoS One. 2014 Apr 4;9(4):e93029. doi: 10.1371/journal.pone.0093029. eCollection 2014.
Nepal experienced a steep decline in maternal mortality between 1996 and 2006, which had again dropped by 2010. The aim of this study was to investigate any trends in factors that may be responsible for this decline. The study was based on a secondary data analysis of maternity care services and socio-demographic variables extracted from the Nepal Demographic Health Surveys (1996, 2001, 2006 and 2011). Complex sample analysis was performed to determine the trends in these variables across the four surveys. Univariate logistic regression was performed for selected maternity care service variables to calculate the average change in odds ratio for each survey. Multivariate logistic regression was performed to determine the trends in the health service uptake adjusting for socio-demographic variables. There were major demographic and socio-economic changes observed between 1996 and 2011: notably fewer women delivering at 'high risk' ages, decreased fertility, higher education levels and migration to urban areas. Significant trends were observed for improved uptake of all maternity care services. The largest increase was observed in health facility delivery (odds ratio = 2.21; 95% confidence interval = 1.92, 2.34) and women making four or more antenatal visits (odds ratio = 2.24; 95% confidence interval = 2.03, 2.47). After adjusting for all socio-demographic factors, the trends were still significant but disparities become more pronounced at the extremes of the socio-economic spectrum. The odds ratios for each maternity care service examined decreased slightly after adjusting for education, indicating that improved levels of education could partly explain these trends. The improved utilisation of maternity care services seems essential to the decline in maternal mortality in Nepal. These findings have implications for policy planning in terms of government resources for maternity care services and the education sector.
1996年至2006年期间，尼泊尔的孕产妇死亡率急剧下降，到2010年又有所下降。本研究的目的是调查可能导致这种下降的因素的任何趋势。该研究基于对从尼泊尔人口健康调查（1996年、2001年、2006年和2011年）中提取的孕产妇保健服务和社会人口统计学变量的二次数据分析。进行复杂样本分析以确定这四个调查中这些变量的趋势。对选定的孕产妇保健服务变量进行单变量逻辑回归，以计算每次调查中优势比的平均变化。进行多变量逻辑回归以确定在调整社会人口统计学变量后卫生服务利用情况的趋势。1996年至2011年期间观察到主要的人口和社会经济变化：特别是在“高危”年龄分娩的妇女减少、生育率下降、教育水平提高以及向城市地区迁移。所有孕产妇保健服务的利用情况都有显著改善趋势。在医疗机构分娩方面增幅最大（优势比=2.21；95%置信区间=1.92，2.34），进行四次或更多次产前检查的妇女也是如此（优势比=2.24；95%置信区间=2.03，2.47）。在调整所有社会人口统计学因素后，趋势仍然显著，但在社会经济范围的两端差异变得更加明显。在调整教育因素后，所检查的每项孕产妇保健服务的优势比略有下降，这表明教育水平的提高可以部分解释这些趋势。孕产妇保健服务利用情况的改善似乎对尼泊尔孕产妇死亡率的下降至关重要。这些发现对孕产妇保健服务和教育部门的政府资源政策规划具有启示意义。
