McCarthy Katharine J, Braganza Sandra, Fiori Kevin, Gbeleou Christophe, Kpakpo Vivien, Lopez Andrew, Schechter Jennifer, Singham Goodwin Alicia, Jones Heidi E
Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America.
Population Council, New York, New York, United States of America.
PLoS One. 2017 Mar 16;12(3):e0173445. doi: 10.1371/journal.pone.0173445. eCollection 2017.
In Togo, substantial progress in maternal and child health is needed to reach global development goals. To better inform clinic and community-based health services, this study identifies factors associated with maternal and child health care utilization in the Kara region of Northern Togo.
We conducted a population-representative household survey of four health clinic catchment areas of 1,075 women of reproductive age in 2015. Multivariable logistic regression was used to model individual and structural factors associated with utilization of four maternal and child health services. Key outcomes were: facility-based delivery, maternal postnatal health check by a health professional within the first six weeks of birth, childhood vaccination, and receipt of malaria medication for febrile children under age five within 72 hours of symptom onset.
83 percent of women who gave birth in the last 2 years delivered at a health facility. In adjusted models, the strongest predictor of facility delivery in the rural catchment areas was proximity to a health center, with women living under three kilometers having 3.7 (95% CI 1.7, 7.9) times the odds of a facility birth. Only 11 percent of women received a health check by a health provider at any time in the postnatal period. Postnatal health checks were less likely for women in the poorest households and for women who resided in rural areas. Children of polygamous mothers had half the odds of receiving malaria medication for fever within 72 hours of symptom onset, while children with increased household wealth status had increased odds of childhood vaccination and receiving treatment for malaria.
Our analysis highlights the importance of risk stratification analysis to inform the delivery and scope of maternal and child health programs needed to reach those with the least access to care.
在多哥，为实现全球发展目标，母婴健康方面需要取得重大进展。为了更好地为基于诊所和社区的卫生服务提供信息，本研究确定了多哥北部卡拉地区与母婴保健服务利用相关的因素。
2015年，我们对四个健康诊所集水区的1075名育龄妇女进行了具有人口代表性的家庭调查。采用多变量逻辑回归对与四项母婴保健服务利用相关的个体和结构因素进行建模。主要结果包括：在医疗机构分娩、产妇在产后六周内由卫生专业人员进行产后健康检查、儿童接种疫苗以及五岁以下发热儿童在症状出现后72小时内接受疟疾药物治疗。
在过去两年中分娩的妇女中有83%在医疗机构分娩。在调整后的模型中，农村集水区医疗机构分娩的最强预测因素是距离健康中心的远近，居住在三公里以内的妇女在医疗机构分娩的几率是其他妇女的3.7倍（95%可信区间为1.7，7.9）。只有11%的妇女在产后任何时候接受过卫生保健人员的健康检查。最贫困家庭的妇女和农村地区的妇女接受产后健康检查的可能性较小。一夫多妻制母亲的孩子在症状出现后72小时内接受疟疾药物治疗的几率只有其他孩子的一半，而家庭财富状况改善的孩子接种疫苗和接受疟疾治疗的几率增加。
我们的分析强调了风险分层分析对于为那些获得医疗服务机会最少的人群提供母婴健康项目的提供方式和范围提供信息的重要性。
