Kruk Margaret E, Hermosilla Sabrina, Larson Elysia, Vail Daniel, Chen Qixuan, Mazuguni Festo, Byalugaba Beatrice, Mbaruku Godfrey
Harvard TH Chan School of Public Health, Boston, MA, USA.
Columbia University Mailman School of Public Health, New York, NY, USA.
Trop Med Int Health. 2015 Aug;20(8):1057-66. doi: 10.1111/tmi.12518. Epub 2015 Apr 30.
To examine factors associated with home delivery among women in Pwani Region, Tanzania, which has experienced a rapid rise in facility delivery coverage.
Cross-sectional data from a population-based survey of women residing in rural areas of Pwani Region were linked to health facility locations. We fitted multilevel logistic models to examine individual and community factors associated with home delivery.
A total of 752 (27.95%) of the 2691 women who completed the survey delivered their last child at home. Women were less likely to deliver at home if they had any primary education [odds ratio (OR) 0.62; 95% confidence interval (CI): 0.50, 0.79], were primiparous (OR: 0.52; 95% CI: 0.37, 0.73), had more exposure to media (OR: 0.80; 95% CI: 0.66, 0.96) or had received more (OR: 0.78; 95% CI: 0.63, 0.96) or better quality antenatal care (ANC) services (OR: 0.48; 95% CI: 0.34, 0.67). Increased wealth was strongly associated with lower odds of home delivery (OR: 0.27; 95% CI: 0.18, 0.39), as was living in a village that grew cash crops (OR: 0.56; 95% CI: 0.35, 0.88). Farther distance to hospital, but not to lower level facilities, was associated with higher likelihood of home delivery (OR 2.49; 95% CI: 1.60, 3.88).
Poverty, multiparity, weak ANC and distance to hospital were associated with persistence of home delivery in a region with high coverage of facility delivery. A pro-poor path to universal coverage of safe delivery requires a greater focus on quality of care and more intensive outreach to poor and multiparous women.
在坦桑尼亚滨海地区，设施分娩覆盖率迅速上升，本研究旨在探讨与在家分娩相关的因素。
对滨海地区农村地区妇女进行基于人群的调查所获得的横断面数据与医疗机构位置相关联。我们采用多水平逻辑模型来研究与在家分娩相关的个体和社区因素。
在完成调查的2691名妇女中，共有752名（27.95%）在家中分娩了她们的最后一个孩子。如果妇女接受过任何小学教育[优势比（OR）0.62；95%置信区间（CI）：0.50，0.79]、是初产妇（OR：0.52；95%CI：0.37，0.73）、接触媒体更多（OR：0.80；95%CI：0.66，0.96）或接受了更多（OR：0.78；95%CI：0.63，0.96）或质量更好的产前保健（ANC）服务（OR：0.48；95%CI：0.34，0.67），则在家分娩的可能性较小。财富增加与在家分娩的较低几率密切相关（OR：0.27；95%CI：0.18，0.39），种植经济作物的村庄也是如此（OR：0.56；95%CI：0.35，0.88）。到医院的距离更远，但到较低级别医疗机构的距离则不然，与在家分娩的可能性较高相关（OR 2.49；95%CI：1.60，3.88）。
在设施分娩覆盖率高的地区，贫困、经产妇、薄弱的产前保健和到医院的距离与在家分娩的持续存在有关。实现安全分娩普遍覆盖的扶贫途径需要更加关注护理质量，并对贫困和经产妇进行更密集的外展服务。
