Hodge Andrew, Byrne Abbey, Morgan Alison, Jimenez-Soto Eliana
School of Population Health, The University of Queensland, Public Health Building, Herston Road, Herston, QLD, 4006, Australia,
Matern Child Health J. 2015 Mar;19(3):566-77. doi: 10.1007/s10995-014-1540-x.
While established that geographical inaccessibility is a key barrier to the utilisation of health services, it remains unknown whether disparities are driven only by limited access to these services, or are also attributable to health behaviour. Significant disparities exist in health outcomes and the coverage of many critical health services between the mountains region of Nepal and the rest of the country, yet the principal factors driving these regional disparities are not well understood. Using national representative data from the 2011 Nepal Demographic and Health Survey, we examine the extent to which observable factors explain the overall differences in the utilisation of maternal health services. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify the effect that differences in measurable characteristics have on the regional coverage gap in facility-based delivery. The mean coverage of facility-based deliveries was 18.6 and 36.3 % in the mountains region and the rest of Nepal, respectively. Between 54.8 and 74.1 % of the regional coverage gap was explained by differences in observed characteristics. Factors influencing health behaviours (proxied by mothers' education, TV viewership and tobacco use, and household wealth) and subjective distance to the health facility were the major factors, contributing between 52.9 and 62.5 % of the disparity. Mothers' birth history was also noteworthy. Policies simultaneously addressing access and health behaviours appear necessary to achieve greater coverage and better health outcomes for women and children in isolated areas.
虽然地理上的交通不便已被确认为利用卫生服务的一个关键障碍，但目前尚不清楚这种差异是否仅由获得这些服务的机会有限所导致，还是也归因于健康行为。尼泊尔山区与该国其他地区在健康结果和许多关键卫生服务的覆盖范围方面存在显著差异，但导致这些地区差异的主要因素尚未得到充分了解。利用2011年尼泊尔人口与健康调查的全国代表性数据，我们研究了可观察因素在多大程度上解释了孕产妇保健服务利用方面的总体差异。我们应用非线性布林德-奥瓦萨卡类型的分解方法，来量化可衡量特征的差异对基于设施分娩的区域覆盖差距的影响。在山区和尼泊尔其他地区，基于设施分娩的平均覆盖率分别为18.6%和36.3%。54.8%至74.1%的区域覆盖差距可由观察到的特征差异来解释。影响健康行为的因素（以母亲的教育程度、电视收视率、烟草使用情况和家庭财富为代表）以及到卫生设施的主观距离是主要因素，占差异的52.9%至62.5%。母亲的生育史也值得关注。为了在偏远地区为妇女和儿童实现更高的覆盖率和更好的健康结果，似乎有必要同时制定解决服务可及性和健康行为问题的政策。
