Sikder Shegufta S, Labrique Alain B, Craig Ian M, Wakil Mohammad Abdul, Shamim Abu Ahmed, Ali Hasmot, Mehra Sucheta, Wu Lee, Shaikh Saijuddin, West Keith P, Christian Parul
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
The JiVitA Maternal and Child Health Research Project, Gaibandha, Bangladesh.
BMC Health Serv Res. 2015 Apr 18;15:166. doi: 10.1186/s12913-015-0832-1.
In communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions.
Utilizing data from a community-randomized controlled trial enrolling 42,214 pregnant women between 2007 and 2011, we used multivariable multinomial logistic regression to explore the association of demographic and socioeconomic factors, perceived need, and service availability with care seeking for obstetric complications or near misses. We also used multivariable multinomial logistic regression to analyze the factors associated with care seeking by type of obstetric complication (eclampsia, sepsis, hemorrhage, and obstructed labor).
Out of 9,576 women with data on care seeking for obstetric complications, 77% sought any care, with 29% (n = 2,150) visiting at least one formal provider and 70% (n = 5,149) visiting informal providers only. The proportion of women seeking at least one formal provider was highest among women reporting eclampsia (57%), followed by hemorrhage (28%), obstructed labor (22%), and sepsis (17%) (p < 0.001). In multivariable analyses, socioeconomic factors such as living in a household from the highest wealth quartile (Relative Risk Ratio of 1.49; 95% CI of [1.33-1.73]), women's literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women's employment (RRR of 1.10; 95% CI of [1.01-1.18]) were significantly associated with care seeking from formal providers. Service factors including living less than 10 kilometers from a health facility (RRR of 1.16; 95% CI of [1.05-1.28]) and facility availability of comprehensive obstetric services (RRR of 1.25; 95% CI of 1.04-1.36) were also significantly associated with seeking care from formal providers.
While the majority of women reporting obstetric complications sought care, less than a third visited health facilities. Improvements in socioeconomic factors such as maternal literacy, coupled with improved geographic access and service availability, may increase care seeking from formal facilities. Enhancing community awareness on symptoms of hemorrhage, sepsis, and obstructed labor and their consequences may promote care seeking for obstetric complications in rural Bangladesh.
NCT00860470 .
在机构分娩率较低的社区，关于危及生命的产科并发症的就医行为的数据很少。在本分析中，我们试图描述孟加拉国农村地区自我报告的并发症及接近死亡情况的就医模式，并确定与这些情况就医相关的因素。
利用2007年至2011年间纳入42214名孕妇的社区随机对照试验的数据，我们使用多变量多项逻辑回归来探讨人口统计学和社会经济因素、感知需求以及服务可及性与产科并发症或接近死亡情况就医之间的关联。我们还使用多变量多项逻辑回归来分析按产科并发症类型（子痫、败血症、出血和难产）划分的就医相关因素。
在9576名有产科并发症就医数据的女性中，77%寻求了某种护理，其中29%（n = 2150）至少就诊过一名正规医疗服务提供者，70%（n = 5149）仅就诊过非正规医疗服务提供者。报告子痫的女性中至少就诊过一名正规医疗服务提供者的比例最高（57%），其次是出血（28%）、难产（22%）和败血症（17%）（p < 0.001）。在多变量分析中，社会经济因素如居住在最高财富四分位数家庭（相对风险比为1.49；95%置信区间为[1.33 - 1.73]）、女性识字率（相对风险比为1.21；95%置信区间为[1.05 - 1.42]）以及女性就业情况（相对风险比为1.10；95%置信区间为[1.01 - 1.18]）与向正规医疗服务提供者就医显著相关。包括居住在距离医疗机构不到10公里处（相对风险比为1.16；95%置信区间为[1.05 - 1.28]）以及医疗机构具备综合产科服务（相对风险比为1.25；95%置信区间为1.04 - 1.36）等服务因素也与向正规医疗服务提供者就医显著相关。
虽然大多数报告有产科并发症的女性寻求了护理，但不到三分之一的人就诊于医疗机构。提高诸如孕产妇识字率等社会经济因素，再加上改善地理可及性和服务可及性，可以增加向正规医疗机构的就医率。提高社区对出血、败血症和难产症状及其后果的认识，可能会促进孟加拉国农村地区产科并发症的就医行为。
NCT00860470 。
