McMahon Shannon A, Chase Rachel P, Winch Peter J, Chebet Joy J, Besana Giulia V R, Mosha Idda, Sheweji Zaina, Kennedy Caitlin E
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205-2179, USA.
Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany.
BMC Pregnancy Childbirth. 2016 Sep 27;16(1):284. doi: 10.1186/s12884-016-1058-x.
Births before arrival (BBA) to health care facilities are associated with higher rates of perinatal morbidity and mortality compared to facility deliveries or planned home births. Research on such births has been conducted in several high-income countries, but there are almost no studies from low-income settings where a majority of maternal and newborn deaths occur.
Drawing on a household survey of women and in-depth interviews with women and their partners, we examined the experience of BBA in rural districts of Morogoro Region, Tanzania.
Among survey respondents, 59 births (4 %) were classified as BBAs. Most of these births occurred in the presence of a family member (47 %) or traditional birth attendant (24 %). Low socioeconomic status was the strongest predictor of BBA. After controlling for wealth via matching, high parity and a low number of antenatal care (ANC) visits retained statistical significance. While these variables are useful indicators of which women are at greater risk of BBA, their predictive power is limited in a context where many women are poor, multiparous, and make multiple ANC visits. In qualitative interviews, stories of BBAs included themes of partner disagreement regarding when to depart for facilities and financial or logistical constraints that underpinned departure delays. Women described wanting to depart earlier to facilities than partners.
As efforts continue to promote facility birth, we highlight the financial demands associated with facility delivery and the potential for these demands to place women at a heightened risk for BBAs.
与医疗机构分娩或计划在家分娩相比，在到达医疗机构之前分娩（BBA）与围产期发病率和死亡率较高相关。在几个高收入国家已开展了关于此类分娩的研究，但在大多数孕产妇和新生儿死亡发生的低收入地区，几乎没有相关研究。
利用对妇女的家庭调查以及对妇女及其伴侣的深入访谈，我们研究了坦桑尼亚莫罗戈罗地区农村地区的BBA情况。
在调查对象中，59例分娩（4%）被归类为BBA。这些分娩大多发生在有家庭成员在场（47%）或传统助产士在场（24%）的情况下。社会经济地位低是BBA最有力的预测因素。通过匹配控制财富因素后，高胎次和产前检查（ANC）次数少仍具有统计学意义。虽然这些变量是哪些妇女发生BBA风险更高的有用指标，但在许多妇女贫困、多胎且进行多次ANC检查的情况下，它们的预测能力有限。在定性访谈中，BBA的故事包括关于何时前往医疗机构的伴侣分歧以及导致出发延迟的经济或后勤限制等主题。妇女们表示希望比伴侣更早前往医疗机构。
随着促进医疗机构分娩的努力持续进行，我们强调了与医疗机构分娩相关的经济需求以及这些需求可能使妇女发生BBA的风险增加。
