产前护理服务质量与完成四次及以上产前护理访视在埃塞俄比亚的关系：基于人口与健康调查的发现。
Quality of antenatal care services and completion of four or more antenatal care visits in Ethiopia: a finding based on a demographic and health survey.
机构信息
Epidemiology and Biostatistics Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
BMC Pregnancy Childbirth. 2017 Sep 11;17(1):300. doi: 10.1186/s12884-017-1488-0.
BACKGROUND
Antenatal care (ANC) is one of the core interventions for improving maternal outcomes. The average annual decline of maternal mortality rate from 1990 to 2013 was 5% in Ethiopia. This figure was below the least expected 5.5% to achieve the targeted 75% by 1990-2015. Moreover, completion of the recommended four or more ANC visits was only 32%. This study was aimed to examine individual, household and community level potential determinants of completing the recommended visits in the country.
METHODS
The 2014 Ethiopian Mini Demographic and Health Survey data were used. Among women aged 15-49 years 3694 who had given birth in the 5 years preceding the survey were included in the analysis. The robust standard error method of generalized estimation equations were used for binary outcome variable from the clustered data.
RESULTS
Only 33.0% (95% CI 31. 5% 34.5%) of women completed the recommended visits. Out of the total women, 56.5% had at least one ANC visit. Out of those who had at least one ANC visit, 37.4% visited in their first trimester. Completing the recommended visits was negatively associated with women in the lower educational level, lower economic conditions, higher birth order, and rural residence. But, it was positively associated with the community level high quality ANC services received. Difference in age and region also affected the completion of the recommended visits.
CONCLUSION
The finding revealed the need for improving the uptake of ANC services, early arrival in the first trimester for services, and motivating mothers that begin ANC to confirm continuity. Strategies to foster completing the recommended visits should focus on upgrading quality of care services at the community level. Women in low economic level, high birth order, rural residence, and low educational status should be given special attention. Early and late age groups should be given special attention regarding the services.
背景
产前护理（ANC）是改善产妇结局的核心干预措施之一。1990 年至 2013 年，埃塞俄比亚的产妇死亡率平均每年下降 5%。这一数字低于到 1990-2015 年实现 75%目标的最低预期 5.5%。此外，只有 32%的产妇完成了建议的四次或更多次 ANC 访视。本研究旨在研究该国完成建议访视的个人、家庭和社区层面的潜在决定因素。
方法
使用 2014 年埃塞俄比亚迷你人口与健康调查数据。在接受调查前 5 年内生育过的 15-49 岁的 3694 名妇女中，有 3694 名妇女被纳入分析。使用广义估计方程的稳健标准误差方法对来自聚类数据的二项结局变量进行分析。
结果
只有 33.0%（95%CI 31.5%34.5%）的妇女完成了建议的访视。在所有妇女中，56.5%至少接受过一次 ANC 访视。在至少接受过一次 ANC 访视的妇女中，37.4%在孕早期接受了访视。完成建议的访视与受教育程度较低、经济条件较差、出生顺序较高和农村居住的妇女呈负相关。但是，它与在社区层面接受高质量 ANC 服务呈正相关。年龄和地区的差异也影响了建议访视的完成。
结论
研究结果表明，需要提高 ANC 服务的利用率，鼓励母亲在孕早期接受服务，并确保开始 ANC 的母亲能够坚持连续接受服务。促进完成建议访视的策略应侧重于提升社区层面的护理服务质量。应特别关注经济水平低、出生顺序高、农村居住和受教育程度低的妇女。应特别关注年龄较大和较小的年龄组的服务。
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