Diamond-Smith Nadia, Sudhinaraset May
Global Health Group/Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA.
Reprod Health. 2015 Jan 16;12:6. doi: 10.1186/1742-4755-12-6.
In the past few decades many countries have worked to increase the number of women delivering in facilities, with the goal of improving maternal and neonatal health outcomes. The purpose of this study is to explore the current situation of facility deliveries in Africa and Asia to understand where and with whom women deliver. Furthermore, we aim to test potential drivers of facility delivery at the individual, household, and community-level.
Demographic and Health Survey data collected since 2003 from 43 countries in Africa and Asia is explored to understand the patterns of where women are delivering. We look at patterns by region and wealth quintile and urban/rural status. We then run a series of multi-level models looking at relationships between individual, household and community-level factors and the odds of a woman delivering in a facility. We explore this for Asia and Africa separately. We also look at correlates of delivery with a trained provider, in a public facility, in a private facility, with a doctor and in a hospital.
The majority of women deliver in a facility and with a provider; however, about 20% of deliveries are still with no one or a friend/relative or alone. Rates of facility delivery are lower in Asia overall, and a greater proportion of deliveries take place in private facilities in Asia compared to Africa. Most of the individual level factors that have been found in past studies to be associated with delivering in a facility hold true for the multi-country-level analyses, and small differences exist between Asia and Africa. Women who deliver in private facilities differ from women who deliver in public facilities or at home.
Most women in Africa and Asia are delivering in a facility, and drivers of facility delivery identified in smaller level or country specific studies hold true in multi-country national level data. More data and research is needed on other drivers, especially at the country-level and relating to the quality of care and maternal health complications.
在过去几十年里，许多国家致力于增加在医疗机构分娩的妇女数量，目标是改善孕产妇和新生儿健康结局。本研究的目的是探讨非洲和亚洲医疗机构分娩的现状，以了解妇女在何处以及由谁接生。此外，我们旨在检验个体、家庭和社区层面上医疗机构分娩的潜在驱动因素。
对自2003年以来从非洲和亚洲43个国家收集的人口与健康调查数据进行探究，以了解妇女的分娩地点模式。我们按地区、财富五分位数以及城乡状况查看模式。然后，我们运行一系列多层次模型，研究个体、家庭和社区层面因素与妇女在医疗机构分娩几率之间的关系。我们分别对亚洲和非洲进行此项探究。我们还研究了与受过培训的提供者、在公立医疗机构、在私立医疗机构、由医生接生以及在医院分娩的相关因素。
大多数妇女在医疗机构由提供者接生；然而，约20%的分娩仍然是无人接生、由朋友/亲属接生或独自分娩。总体而言，亚洲的医疗机构分娩率较低，与非洲相比，亚洲在私立医疗机构分娩的比例更高。过去研究中发现的大多数与在医疗机构分娩相关的个体层面因素在多国层面分析中依然成立，亚洲和非洲之间存在细微差异。在私立医疗机构分娩的妇女与在公立医疗机构或家中分娩的妇女不同。
非洲和亚洲的大多数妇女在医疗机构分娩，在较小层面或国家特定研究中确定的医疗机构分娩驱动因素在多国层面数据中依然成立。需要更多关于其他驱动因素的数据和研究，尤其是在国家层面以及与护理质量和孕产妇健康并发症相关的方面。
