Liambila Wilson N, Kuria Shiphrah N
Population Council, P,O, Box 17643, Nairobi, 00500, Kenya.
BMC Pregnancy Childbirth. 2014 Sep 8;14:311. doi: 10.1186/1471-2393-14-311.
Skilled birth attendance is critical in the provision of child birth related services. Yet, literature is scanty on the outcomes of child birth related complications in situations where majority of women deliver under the care of non-skilled birth attendants compared to those who are assisted by skilled providers. The study sought to assess the nature of childbirth related complications among the skilled and the non-skilled birth attendants in Western Kenya.
A case-control study was conducted among women aged 15-49 years at the household. Controls were individually matched to cases on the basis of age and socio-economic status. A total of 294 cases and 291 controls were interviewed. Data were collected on various demographic and socio-economic characteristics and women's perception on the quality of care. All independent variables were analysed initially in bivariate models and those that were significantly associated with obstetric complications were included in multiple logistic regression model in order to control for confounding factors. Odds ratios (ORs), with 95% confidence intervals, were computed to show the association between the occurrence, magnitude and the extent to which child birth related complications were managed.
Demographic and socio-economic characteristics of the cases and controls were similar. About 52% of the deliveries were assisted by skilled birth attendants while non-skilled providers attended to 48% of them. The odds of the occurrence of obstetric complications were greater among the women who were attended to by skilled providers in health facilities: adjusted odds ratio (AOR): 1.32 (CI 0.95, 1.84) than among those who were assisted by unskilled birth attendants, AOR 0.76 (CI 0.55, 1.06). Undignified care, high delivery and transport costs and fear of hospital procedures such as HIV tests and mishandling of the placenta were cited as some of the barriers to facility deliveries.
Skilled birth attendants in facilities were associated with higher odds of the occurrence of obstetric complications compared to deliveries that were assisted by non-skilled attendants at home. Women cited many barriers which need to be addressed in order to improve their access to skilled providers for delivery and in managing obstetric complications.
熟练的助产服务在提供与分娩相关的服务中至关重要。然而，与由熟练提供者协助分娩的情况相比，关于大多数妇女在非熟练助产人员护理下分娩时与分娩相关并发症的结果的文献却很少。该研究旨在评估肯尼亚西部熟练和非熟练助产人员中与分娩相关并发症的性质。
在家庭中对15 - 49岁的女性进行了一项病例对照研究。对照在年龄和社会经济地位的基础上与病例进行个体匹配。总共对294例病例和291名对照进行了访谈。收集了各种人口统计学和社会经济特征以及女性对护理质量的看法的数据。所有自变量最初在双变量模型中进行分析，那些与产科并发症显著相关的变量被纳入多因素逻辑回归模型，以控制混杂因素。计算了比值比（OR）及其95%置信区间，以显示与分娩相关并发症的发生、严重程度和处理程度之间的关联。
病例和对照的人口统计学和社会经济特征相似。约52%的分娩由熟练的助产人员协助，而非熟练提供者照料了其中的48%。在医疗机构中由熟练提供者照料的妇女发生产科并发症的几率高于由非熟练助产人员协助的妇女：调整后的比值比（AOR）为1.32（CI 0.95，1.84），后者的AOR为0.76（CI 0.55，1.06）。不体面的护理、高昂的分娩和交通费用以及对诸如艾滋病毒检测和胎盘处理不当等医院程序的恐惧被认为是设施分娩的一些障碍。
与在家中由非熟练助产人员协助分娩相比，医疗机构中的熟练助产人员与产科并发症发生几率较高有关。妇女列举了许多需要解决的障碍，以改善她们获得熟练提供者进行分娩和处理产科并发症的机会。
