Yebyo Henock, Alemayehu Mussie, Kahsay Alemayehu
Department of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
PLoS One. 2015 Apr 15;10(4):e0124718. doi: 10.1371/journal.pone.0124718. eCollection 2015.
Despite of the existing intensive efforts to improve maternal health in Ethiopia, the proportion of birth delivered at home remains high and is still the top priority among the national health threats.
The study aimed to examine effects of individual women and community-level factors of women's decision on place of delivery in Ethiopia.
Data were obtained from the nationally representative 2011 Ethiopian Demographic and Health Survey (EDHS) which used a two-stage cluster sampling design with rural-urban and regions as strata. The EDHS collected data from a big sample size but our study focused on a sample of 7,908 women whose most recent birth was within five years preceding 2011 and 576 communities in which the women were living in. The data were analyzed using a two-level mixed-effects logistic regression to determine fixed-effects of individual- and community-level factors and random-intercept of between-cluster characteristics.
In the current study, 6980 out of 7908 deliveries (88.3%) took place at home. Lower educational levels (OR=2.74, 95%CI:1.84,4.70; p<0.0001), making no or only a limited number of ANC visits (OR=3.72,95%CI:2.85, 4.83; p<0.0001), non-exposure to media (OR=1.51, 95%CI 1.13, 2.01; p=0.004), higher parity (OR=2.68, 95%CI:1.96,3.68; p<0.0001), and perceived distance problem to reach health facilities (OR=1.29, 95%CI:1.03,1.62; p=0.022) were positively associated with home delivery. About 75% of the total variance in the odds of giving birth at home was accounted for the between-community differences of characteristics (ICC=0.75, p<0.0001). With regard to community-level characteristics, rural communities (OR=4.67, 95%CI:3.06,7.11; p<0.0001), pastoralist communities (OR=4.53, 95%CI:2.81,7.28; p<0.0001), communities with higher poverty levels (OR=1.49 95%CI:1.08,2.22; p=0.048), with lower levels of ANC utilization (OR=2.01, 95%CI:1.42,2.85; p<0.0001) and problem of distance to a health facility (OR=1.29, 95%CI:1.03,1.62; p=0.004) had a positive influence on women to give birth at home.
Not only individual characteristics of women, but also community-level factors determine women's decision to deliver at home.
尽管埃塞俄比亚在改善孕产妇健康方面付出了巨大努力，但在家分娩的比例仍然很高，并且仍然是国家健康威胁中的首要问题。
本研究旨在探讨埃塞俄比亚女性个体因素和社区层面因素对女性分娩地点决策的影响。
数据来自具有全国代表性的2011年埃塞俄比亚人口与健康调查（EDHS），该调查采用两阶段整群抽样设计，以城乡和地区为分层变量。EDHS收集了大量样本数据，但我们的研究聚焦于7908名女性的样本，这些女性最近一次分娩发生在2011年之前的五年内，以及她们所居住的576个社区。使用两级混合效应逻辑回归分析数据，以确定个体和社区层面因素的固定效应以及集群间特征的随机截距。
在本研究中，7908例分娩中有6980例（88.3%）在家中进行。较低的教育水平（OR = 2.74，95%CI：1.84, 4.70；p < 0.0001）、产前检查次数少或没有进行产前检查（OR = 3.72，95%CI：2.85, 4.83；p < 0.0001）、未接触媒体（OR = 1.51，95%CI 1.13, 2.01；p = 0.004）、较高的胎次（OR = 2.68，95%CI：1.96, 3.68；p < 0.0001）以及认为前往医疗机构存在距离问题（OR = 1.29，95%CI：1.03, 1.62；p = 0.022）与在家分娩呈正相关。在家分娩几率的总方差中约75%可由社区间特征差异解释（ICC = 0.75，p < 0.0001）。关于社区层面特征，农村社区（OR = 4.67，95%CI：3.06, 7.11；p < 0.0001）、牧民社区（OR = 4.53，95%CI：2.81, 7.28；p < 0.0001）、贫困水平较高的社区（OR = 1.49，95%CI：1.08, 2.22；p = 0.048）、产前检查利用率较低的社区（OR = 2.01，95%CI：1.42, 2.85；p < 0.0001）以及距离医疗机构较远的社区（OR = 1.29，95%CI：1.03, 1.62；p = 0.004）对女性在家分娩有积极影响。
不仅女性的个体特征，而且社区层面因素也决定了女性在家分娩的决策。
