Mazalale Jacob, Kambala Christabel, Brenner Stephan, Chinkhumba Jobiba, Lohmann Julia, Mathanga Don P, Robberstad Bjarne, Muula Adamson S, De Allegri Manuela
Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
Trop Med Int Health. 2015 May;20(5):617-626. doi: 10.1111/tmi.12473. Epub 2015 Mar 2.
To identify factors associated with delivery outside a health facility in rural Malawi.
A cross-sectional survey was conducted in Balaka, Dedza, Mchinji and Ntcheu districts in Malawi in 2013 among women who had completed a pregnancy 12 months prior to the day of the survey. Multilevel logistic regression was used to assess factors associated with delivery outside a facility.
Of the 1812 study respondents, 9% (n = 159) reported to have delivered outside a facility. Unmarried women were significantly more likely [OR = 1.88; 95% CI (1.086-3.173)] to deliver outside a facility, while women from households with higher socio-economic status [third-quartile OR = 0.51; 95% CI (0.28-0.95) and fourth-quartile OR = 0.48; 95% CI (0.29-0.79)] and in urban areas [OR = 0.39; 95%-CI (0.23-0.67)] were significantly less likely to deliver outside a facility. Women without formal education [OR 1.43; 95% CI (0.96-2.14)] and multigravidae [OR = 1.14; 95% CI (0.98-1.73)] were more likely to deliver outside a health facility at 10% level of significance.
About 9% of women deliver outside a facility. Policies to encourage facility delivery should not only focus on health systems but also be multisectoral to address women's vulnerability and inequality. Facility-based delivery can contribute to curbing the high maternal illness burden if authorities provide incentives to those not delivering at the facility without losing existing users.
确定马拉维农村地区在医疗机构外分娩的相关因素。
2013年在马拉维的巴拉卡、代扎、姆钦吉和恩切乌地区对在调查当天前12个月已完成妊娠的妇女进行了一项横断面调查。采用多水平逻辑回归分析评估与在医疗机构外分娩相关的因素。
在1812名研究对象中，9%（n = 159）报告在医疗机构外分娩。未婚女性在医疗机构外分娩的可能性显著更高[比值比（OR）= 1.88；95%置信区间（CI）（1.086 - 3.173）]，而社会经济地位较高家庭的女性[第三四分位数OR = 0.51；95% CI（0.28 - 0.95），第四四分位数OR = 0.48；95% CI（0.29 - 0.79）]以及城市地区的女性[OR = 0.39；95% CI（0.23 - 0.67）]在医疗机构外分娩的可能性显著更低。未接受正规教育的女性[OR 1.43；95% CI（0.96 - 2.14）]和经产妇[OR = 1.14；95% CI（0.98 - 1.73）]在10%的显著水平下更有可能在医疗机构外分娩。
约9%的女性在医疗机构外分娩。鼓励在医疗机构分娩的政策不应仅关注卫生系统，还应具有多部门性质，以解决女性的脆弱性和不平等问题。如果当局在不流失现有使用者的情况下为未在医疗机构分娩者提供激励措施，那么在医疗机构分娩有助于减轻高孕产妇疾病负担。
