Gitimu Anne, Herr Christine, Oruko Happiness, Karijo Evalin, Gichuki Richard, Ofware Peter, Lakati Alice, Nyagero Josephat
Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya.
BMC Pregnancy Childbirth. 2015 Feb 3;15:9. doi: 10.1186/s12884-015-0442-2.
Kenya has a maternal mortality ratio of 488 per 100,000 live births. Preventing maternal deaths depends significantly on the presence of a skilled birth attendant at delivery. Kenyan national statistics estimate that the proportion of births attended by a skilled health professional have remained below 50% for over a decade; currently at 44%, according to Kenya's demographic health survey 2008/09 against the national target of 65%. This study examines the association of mother's characteristics, access to reproductive health services, and the use of skilled birth attendants in Makueni County, Kenya.
We carried out secondary data analysis of a cross sectional cluster survey that was conducted in August 2012. Interviews were conducted with 1,205 eligible female respondents (15-49 years), who had children less than five years (0-59 months) at the time of the study. Data was analysed using SPSS version 17. Multicollinearity of the independent variables was assessed. Chi-square tests were used and results that were statistically significant with p-values, p < 0.25 were further included into the multivariable logistic regression model. Adjusted odds ratio (AOR) and their 95% confidence intervals were (95%) calculated. P value less than 0.05 were considered significant.
Among the mothers who were interviewed, 40.3% (489) were delivered by a skilled birth attendant while 59.7% (723) were delivered by unskilled birth attendants. Mothers with tertiary/university education were more likely to use a skilled birth attendant during delivery, adjusted OR 8.657, 95% CI, (1.445- 51.853) compared to those with no education. A woman whose partner had secondary education was 2.9 times more likely to seek skilled delivery, adjusted odds ratio 2.913, 95% CI, (1.337- 6.348). Attending ANC was equally significant, adjusted OR 11.938, 95% CI, (4.086- 34.88). Living within a distance of 1- 5 kilometers from a facility increased the likelihood of skilled birth attendance, adjusted OR 95% CI, 1.594 (1.071- 2.371).
The woman's level of education, her partner's level of education, attending ANC and living within 5kms from a health facility are associated with being assisted by skilled birth attendants. Health education and behaviour change communication strategies can be enhanced to increase demand for skilled delivery.
肯尼亚的孕产妇死亡率为每10万例活产中有488例死亡。预防孕产妇死亡在很大程度上取决于分娩时是否有熟练的助产人员在场。肯尼亚国家统计数据估计，十多年来，由熟练卫生专业人员接生的分娩比例一直低于50%；根据2008/09年肯尼亚人口与健康调查，目前这一比例为44%，而国家目标是65%。本研究调查了肯尼亚马库埃尼县母亲的特征、获得生殖健康服务的情况以及熟练助产人员的使用情况之间的关联。
我们对2012年8月进行的一项横断面整群调查进行了二次数据分析。对1205名符合条件的女性受访者（15 - 49岁）进行了访谈，这些女性在研究时育有不满五岁（0 - 59个月）的子女。使用SPSS 17版软件对数据进行分析。评估了自变量的多重共线性。采用卡方检验，p值小于0.25且具有统计学意义的结果进一步纳入多变量逻辑回归模型。计算了调整后的优势比（AOR）及其95%置信区间（95%CI）。p值小于0.05被认为具有显著性。
在接受访谈的母亲中，40.3%（489名）由熟练的助产人员接生，而59.7%（723名）由非熟练的助产人员接生。与未受过教育的母亲相比，受过高等教育/大学教育的母亲在分娩时更有可能使用熟练的助产人员，调整后的OR为8.657，95%CI为（1.445 - 51.853）。伴侣受过中等教育的女性寻求熟练接生的可能性高出2.9倍，调整后的优势比为2.913，95%CI为（1.337 - 6.348）。参加产前保健同样具有显著性意义，调整后的OR为为11.938，95%CI为（4.086 - 34.88）。居住在距离医疗机构1至5公里范围内会增加由熟练助产人员接生的可能性，调整后的OR为1.594，95%CI为（1.071 - 2.371）。
女性的教育水平、其伴侣的教育水平、参加产前保健以及居住在距离医疗机构5公里范围内与获得熟练助产人员的协助有关。可以加强健康教育和行为改变沟通策略，以增加对熟练接生服务的需求。
