Mezmur Markos, Navaneetham Kannan, Letamo Gobopamang, Bariagaber Hadgu
Department of Population Studies, University of Botswana, Gaborone, Botswana.
PLoS One. 2017 Sep 14;12(9):e0184688. doi: 10.1371/journal.pone.0184688. eCollection 2017.
Despite evidence that social contexts are key determinants of health, research into factors associated with maternal health service utilization in Ethiopia has often focused on individual and household factors. The downside is that this underestimates the importance of taking contextual factors into account when planning appropriate interventions in promoting safe motherhood in the country. The purpose of this study is to fill this knowledge gap drawing attention to the largely unexplored contextual factors affecting the uptake of skilled attendance at delivery in a nationally representative sample. Data for the study comes from two rounds of the Ethiopian Demographic and Health Surveys (EDHS) conducted in the year 2005 and 2011. Analysis was done using a two-level multivariable multilevel logistic regression model with data from 14, 242 women who had a live birth in the five years preceding the surveys clustered within 540 (in the year 2005) and 624 (in the year 2011) communities. The results of the study point to multiple levels of measured and unmeasured factors affecting the uptake of skilled delivery care in the country. At community level, place of residence, community level of female education and fertility significantly predict the uptake of skilled delivery care. At individual and household level, maternal age, birth order, maternal education, household wealth and access to media predict the uptake of such service. Thus, there is a need to consider community contexts in the design of maternal health programs and employ multi-sectorial approach to addressing barriers at different levels. For example, improving access and availability of skilled delivery care should eventually enhance the uptake of such services at community level in Ethiopia. At individual level, efforts to promote the uptake of such services should constitute targeted interventions paying special attention to the needs of the youth, the multiparous, the less educated and women in the poorest households.
尽管有证据表明社会环境是健康的关键决定因素，但埃塞俄比亚对与孕产妇保健服务利用相关因素的研究往往侧重于个人和家庭因素。不利之处在于，这低估了在该国规划促进安全孕产的适当干预措施时考虑环境因素的重要性。本研究的目的是填补这一知识空白，提请人们注意在具有全国代表性的样本中，影响分娩时获得熟练护理服务的很大程度上未被探索的环境因素。该研究的数据来自2005年和2011年进行的两轮埃塞俄比亚人口与健康调查（EDHS）。分析采用两级多变量多水平逻辑回归模型，数据来自在调查前五年内有活产的14242名妇女，这些妇女聚集在540个社区（2005年）和624个社区（2011年）。研究结果表明，有多个层面的已测量和未测量因素影响该国熟练分娩护理服务的利用情况。在社区层面，居住地点、社区女性教育水平和生育率显著预测熟练分娩护理服务的利用情况。在个人和家庭层面，孕产妇年龄、生育顺序、孕产妇教育程度、家庭财富和媒体接触情况预测此类服务的利用情况。因此，在设计孕产妇保健项目时需要考虑社区环境，并采用多部门方法来解决不同层面的障碍。例如，改善熟练分娩护理服务的可及性和可得性最终应能提高埃塞俄比亚社区层面此类服务的利用率。在个人层面，促进此类服务利用的努力应构成有针对性的干预措施，特别关注年轻人、经产妇、受教育程度较低者和最贫困家庭中的妇女的需求。
