Semali Innocent Antony, Leyna Germana Henry, Mmbaga Elia John, Tengia-Kessy Anna
Department of Epidemiology and Biostatistics, School of public Health and Social sciences, Dar es Salaam, Tanzania.
Department of Community Health, School of public Health and Social sciences, Dar es Salaam, Tanzania.
PLoS One. 2015 Oct 1;10(10):e0138887. doi: 10.1371/journal.pone.0138887. eCollection 2015.
Maternal ill health contributes highly to the global burden of diseases in countries South of Sahara including Tanzania. Ensuring that all deliveries take place in health facilities and hence attended by skilled health personnel is one of the strategies advocated by global and national policies, including the Millennium Development Goals (MDGs). However, the number of women delivered by skilled health personnel has remained low in sub Saharan Africa despite of a number of interventions. We sought to determine the role of social capital in facilitating health facility delivery.
We randomly selected 744 households with children aged less than five years from two randomly selected wards in a rural area in Tanzania. Mothers were enquired about place of delivery of the last child. Social capital was assessed using a modified questionnaire with both structural and cognitive aspects of social capital, administered in face-to-face interviews. Principal Component Analysis (PCA) was used to develop asocial capital index measure. Uni-variate and multivariable regression models were run using STATA 12.
Majority (85.9%) of the mothers reported to have delivered in a health facility during their last birth. Compared to the lowest social capital quintile, delivering in a health facility increased significantly with increase in social capital level: low (Adjusted Odds Ratio (AOR) = 2.9; Confidence Interval (CI): 1.4-6.1, p = 0.004); moderate (AOR = 5.5, CI: 2.3-13.3, p-value<0.001); high (AOR = 4.7; CI: 1.9-11.6, p-value<0.001) and highest (AOR = 5.6, CI: 2.4-13.4, p-value<0.001) and χ2-test for the trend was significant (χ2 = 17.21, p<0.001).
Overall, social capital seems to play an important role in enhancing health facility delivery that may lead to improved maternal and child health. Concerted efforts should focus on promoting and supporting effective social capital and in particular cognitive social capital.
在包括坦桑尼亚在内的撒哈拉以南国家，孕产妇健康问题在全球疾病负担中占比很高。确保所有分娩都在医疗机构进行，从而由熟练的卫生人员接生，这是全球和国家政策（包括千年发展目标）所倡导的策略之一。然而，尽管采取了一系列干预措施，撒哈拉以南非洲地区由熟练卫生人员接生的妇女数量仍然很低。我们试图确定社会资本在促进医疗机构分娩方面的作用。
我们从坦桑尼亚农村地区随机选取的两个病房中随机抽取了744户有5岁以下儿童的家庭。询问母亲们最后一个孩子的出生地点。使用经过修改的问卷评估社会资本，该问卷涵盖社会资本的结构和认知方面，通过面对面访谈进行。主成分分析（PCA）用于制定社会资本指数衡量标准。使用STATA 12运行单变量和多变量回归模型。
大多数（85.9%）母亲报告称她们最后一次分娩是在医疗机构进行的。与社会资本最低的五分位数相比，随着社会资本水平的提高，在医疗机构分娩的比例显著增加：低水平（调整优势比（AOR）=2.9；置信区间（CI）：1.4 - 6.1，p = 0.004）；中等水平（AOR = 5.5，CI：2.3 - 13.3，p值<0.001）；高水平（AOR = 4.7；CI：1.9 - 11.6，p值<0.001）和最高水平（AOR = 5.6，CI：2.4 - 13.4，p值<0.001），趋势的χ2检验具有显著性（χ2 = 17.21，p<0.001）。
总体而言，社会资本似乎在促进医疗机构分娩方面发挥着重要作用，这可能会改善孕产妇和儿童健康。应共同努力，重点促进和支持有效的社会资本，特别是认知社会资本。
