Séraphin Marie Nancy, Ngnie-Teta Ismael, Ayoya Mohamed Ag, Khan Maria R, Striley Catherine W, Boldon Ellen, Mamadoultaibou Aissa, Saint-Fleur Jean Ernst, Koo Leslie, Clermont Miliane
Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA,
Matern Child Health J. 2015 Jun;19(6):1400-7. doi: 10.1007/s10995-014-1646-1.
Institutional delivery is an important factor associated with reduced maternal mortality rate (MMR). MMR in Haiti is high (350 per 100,000) and institutional delivery is low-just over 25 % of women delivered at a health facility in 2010. There also exists substantial rural-urban disparity in delivery with more hospital deliveries in urban than in rural areas. We aimed to study the prevalence and determinants of institutional delivery in a sample of women of childbearing age in rural Haiti. The study took place in Fond des Blancs and Villa, as part of a baseline assessment undertaken prior to implementation of a maternal, child health, nutrition, and water and sanitation program. From October to November 2011, women 15-49 years old (N = 575) were selected using a cross-sectional two-stage sampling strategy. We used descriptive and multivariate logistic regression analyses to assess the prevalence of and factors associated with institutional delivery. The prevalence of institutional delivery was 45.4 %; a rate higher than the national average of 25 %. In adjusted analyses, correlates of institutional delivery were younger maternal age (25 years and younger) (OR 1.82; CI 1.15, 2.90; P = 0.0112), antenatal care receipt (OR 3.70; CI 1.84, 7.43; P = 0.0003) and those who were poor according to our poverty index score classification (OR 2.04; CI 1.13, 3.69; P = 0.0187). This study shows that increased hospital delivery is likely explained by accessibility to antenatal care. Programs that improve access to antenatal care, with concurrent efforts to address structural inequalities that drive socio-economic deprivation, are likely critical to increasing institutional delivery.
机构分娩是与降低孕产妇死亡率相关的一个重要因素。海地的孕产妇死亡率很高（每10万人中有350人），而机构分娩率很低——2010年只有略超过25%的妇女在医疗机构分娩。城乡分娩情况也存在很大差异，城市地区的医院分娩率高于农村地区。我们旨在研究海地农村育龄妇女样本中机构分娩的患病率及其决定因素。该研究在丰德布兰卡和维拉进行，是孕产妇、儿童健康、营养以及水和卫生项目实施前进行的基线评估的一部分。2011年10月至11月，采用横断面两阶段抽样策略选取了15至49岁的妇女（N = 575）。我们使用描述性和多变量逻辑回归分析来评估机构分娩的患病率及其相关因素。机构分娩的患病率为45.4%；高于全国平均水平25%。在调整分析中，机构分娩的相关因素包括较年轻的孕产妇年龄（25岁及以下）（比值比1.82；可信区间1.15，2.90；P = 0.0112）、接受产前护理（比值比3.70；可信区间1.84，7.43；P = 0.0003）以及根据我们的贫困指数评分分类为贫困的人群（比值比2.04；可信区间1.13，3.69；P = 0.0187）。这项研究表明，医院分娩率的提高可能是由于产前护理的可及性。改善产前护理可及性的项目，同时努力解决导致社会经济剥夺的结构性不平等问题，可能对提高机构分娩率至关重要。
