Fagerli Kirsten, O'Connor Katherine, Kim Sunkyung, Kelley Maureen, Odhiambo Aloyce, Faith Sitnah, Otieno Ronald, Nygren Benjamin, Kamb Mary, Quick Robert
Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Biostatistics and Information Management Office, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Trop Med Hyg. 2017 May;96(5):1253-1260. doi: 10.4269/ajtmh.16-0709. Epub 2017 Feb 13.
AbstractReducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of ≥ 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9-4.5), health facility delivery (OR = 5.3, 95% CI = 3.4-8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9-4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1-2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5-7.1) than women with less education. For women who lived ≤ 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5-4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0-2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing ( = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women.
摘要
减少与孕产妇保健服务利用、家庭水处理及卫生改善相关的障碍，对孕产妇和新生儿健康结局至关重要。我们对201名参与肯尼亚一项基于诊所的干预措施的孕妇进行了调查，该干预措施通过分发水处理产品、肥皂、蛋白质强化面粉和清洁分娩包，来增加孕产妇保健服务利用并改善家庭卫生和营养状况。从多变量逻辑回归分析来看，在对人口统计学因素进行调整后，随访时进行≥4次产前检查（ANC4 +）（比值比[OR]=3.0，95%置信区间[CI]=1.9 - 4.5）、在医疗机构分娩（OR = 5.3，95% CI = 3.4 - 8.3）以及进行任何产后检查（OR = 2.8，95% CI = 1.9 - 4.2）的校正后比值均高于基线时。完成小学教育的女性进行ANC4 +检查（OR = 1.8，95% CI = 1.1 - 2.9）和在医疗机构分娩（OR = 4.2，95% CI = 2.5 - 7.1）的几率高于受教育程度较低的女性。对于居住在距离医疗机构≤2.5公里的女性，在医疗机构分娩（OR = 2.4，95% CI = 1.5 - 4.1）和产后检查（OR = 1.6，95% CI = 1.0 - 2.6）的估计几率高于居住在距离医疗机构>2.5公里之外的女性。与基线相比，随访时更高比例的调查参与者能够演示正确的洗手方法（P = 0.001）；水处理行为没有改变。该评估表明，卫生、营养、清洁分娩激励措施、较高的教育水平以及与医疗机构的地理邻近性与孕妇增加利用孕产妇保健服务有关。
