Phiri Precious William C, Rattanapan Cheerawit, Mongkolchati Aroonsri
ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand.
Health Soc Care Community. 2015 Sep;23(5):493-501. doi: 10.1111/hsc.12165. Epub 2014 Oct 15.
The aim of this study was to determine significant predictors for the utilisation of postnatal service among mothers. A total of 295 postnatal mothers were enrolled in a cross-sectional study design undertaken in six health facilities of Lilongwe District using two-stage cluster sampling with a response rate of 100%. The data were collected by interview from December 2012 to January 2013 using a structured questionnaire. The result showed that over half of the mothers (56.6%) utilised postnatal service within 6 weeks after delivery. A stepwise multiple logistic regression was used to determine significant determinants of utilisation of postnatal service among mothers. After adjusting for confounding factors, utilisation of an alternative local source of care in home after delivery [adjusted odds ratio (aOR): 7.77, 95% CI: 4.14-14.58], women's perception on performance of health workforce during delivery and postnatal service (aOR: 6.56, 95% CI: 3.09-13.94), health education before hospital discharge of postnatal mothers (aOR: 4.08, 95% CI: 2.11-7.92), place of delivery (aOR: 4.32, 95% CI: 1.32-14.12), family income (aOR: 1.89, 95% CI: 1.03-3.46) and the occurrence of no complications during delivery (aOR: 1.90, 95% CI: 1.03-3.50) were significantly associated with the utilisation of postnatal service. Hence, this study suggests that improved health workforce performance coupled with effective health education may increase the utilisation of postnatal service. Furthermore, the utilisation of postnatal service may also be increased through reducing home deliveries, delivery complications and the use of alternative local care at home after delivery. Integration of postnatal service in outreach clinics might also assist through reducing the cost of accessing postnatal service among mothers.
本研究的目的是确定母亲产后服务利用情况的重要预测因素。采用两阶段整群抽样方法，在利隆圭区的六个卫生机构开展了一项横断面研究，共纳入295名产后母亲，应答率为100%。2012年12月至2013年1月期间，使用结构化问卷通过访谈收集数据。结果显示，超过半数的母亲（56.6%）在分娩后6周内利用了产后服务。采用逐步多元逻辑回归分析来确定母亲产后服务利用情况的重要决定因素。在对混杂因素进行调整后，分娩后在家中使用替代当地护理来源（调整后的优势比[aOR]：7.77，95%置信区间[CI]：4.14 - 14.58）、妇女对分娩和产后服务期间卫生工作人员表现的看法（aOR：6.56，95% CI：3.09 - 13.94）、产后母亲出院前的健康教育（aOR：4.08，95% CI：2.11 - 7.92）、分娩地点（aOR：4.32，95% CI：1.32 - 14.12）、家庭收入（aOR：1.89，95% CI：1.03 - 3.46）以及分娩期间无并发症的发生情况（aOR：1.90，95% CI：1.03 - 3.50）与产后服务的利用显著相关。因此，本研究表明，改善卫生工作人员的表现并结合有效的健康教育可能会提高产后服务的利用率。此外，通过减少家庭分娩、分娩并发症以及分娩后在家中使用替代当地护理，也可能提高产后服务的利用率。将产后服务纳入外展诊所也可能有助于降低母亲获得产后服务的成本。
