南亚贫困社区私立和公立医疗机构剖宫产的患病率及影响因素：对孟加拉国、印度和尼泊尔数据的横断面分析
Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal.
作者信息
Neuman Melissa, Alcock Glyn, Azad Kishwar, Kuddus Abdul, Osrin David, More Neena Shah, Nair Nirmala, Tripathy Prasanta, Sikorski Catherine, Saville Naomi, Sen Aman, Colbourn Tim, Houweling Tanja A J, Seward Nadine, Manandhar Dharma S, Shrestha Bhim P, Costello Anthony, Prost Audrey
机构信息
Institute for Global Health, University College London, London, UK.
Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh.
出版信息
BMJ Open. 2014 Dec 30;4(12):e005982. doi: 10.1136/bmjopen-2014-005982.
OBJECTIVES
To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia.
DESIGN
Cross-sectional study.
SETTING
81 community-based geographical clusters in four locations in Bangladesh, India and Nepal (three rural, one urban).
PARTICIPANTS
45,327 births occurring in the study areas between 2005 and 2012.
OUTCOME MEASURES
Proportion of caesarean section deliveries by location and type of facility; determinants of caesarean section delivery by location.
RESULTS
Institutional delivery rates varied widely between settings, from 21% in rural India to 90% in urban India. The proportion of private and charitable facility births delivered by caesarean section was 73% in Bangladesh, 30% in rural Nepal, 18% in urban India and 5% in rural India. The odds of caesarean section were greater in private and charitable health facilities than in public facilities in three of four study locations, even when adjusted for pregnancy and delivery characteristics, maternal characteristics and year of delivery (Bangladesh: adjusted OR (AOR) 5.91, 95% CI 5.15 to 6.78; Nepal: AOR 2.37, 95% CI 1.62 to 3.44; urban India: AOR 1.22, 95% CI 1.09 to 1.38). We found that highly educated women were particularly likely to deliver by caesarean in private facilities in urban India (AOR 2.10; 95% CI 1.61 to 2.75) and also in rural Bangladesh (AOR 11.09, 95% CI 6.28 to 19.57).
CONCLUSIONS
Our results lend support to the hypothesis that increased caesarean section rates in these South Asian countries may be driven in part by the private sector. They also suggest that preferences for caesarean delivery may be higher among highly educated women, and that individual-level and provider-level factors interact in driving caesarean rates higher. Rates of caesarean section in the private sector, and their maternal and neonatal health outcomes, require close monitoring.
目的
描述南亚服务欠缺社区中私立和公立医疗机构的剖宫产分娩率及其决定因素。
设计
横断面研究。
地点
孟加拉国、印度和尼泊尔四个地区的81个基于社区的地理集群（三个农村地区，一个城市地区）。
参与者
2005年至2012年期间研究地区发生的45327例分娩。
观察指标
按地点和医疗机构类型划分的剖宫产分娩比例；按地点划分的剖宫产分娩决定因素。
结果
不同地区的机构分娩率差异很大，从印度农村的21%到印度城市的90%。在孟加拉国，私立和慈善机构剖宫产分娩的比例为73%，尼泊尔农村为30%，印度城市为18%，印度农村为5%。在四个研究地点中的三个，即使对妊娠和分娩特征、产妇特征及分娩年份进行调整后，私立和慈善医疗机构剖宫产的几率仍高于公立医疗机构（孟加拉国：调整后比值比（AOR）5.91，95%置信区间5.15至6.78；尼泊尔：AOR 2.37，95%置信区间1.62至3.44；印度城市：AOR 1.22，95%置信区间1.09至1.38）。我们发现，受过高等教育的女性在印度城市的私立机构（AOR 2.10；95%置信区间1.61至2.75）以及孟加拉国农村地区（AOR 11.09，95%置信区间6.28至19.57）剖宫产分娩的可能性尤其高。
结论
我们的结果支持以下假设，即这些南亚国家剖宫产率上升可能部分是由私营部门推动的。它们还表明，受过高等教育的女性对剖宫产的偏好可能更高，而且个人层面和医疗服务提供者层面的因素相互作用导致剖宫产率升高。私营部门的剖宫产率及其对孕产妇和新生儿健康的影响需要密切监测。
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