Yaya Sanni, Bishwajit Ghose, Ekholuenetale Michael, Shah Vaibhav, Kadio Bernard, Udenigwe Ogochukwu
School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada.
School of Medicine and Health Management, Tongji Medical College. Huazhong University of Science and Technology, Wuhan, Hubei, China.
Int Health. 2018 Jul 1;10(4):310-317. doi: 10.1093/inthealth/ihx073.
As a signatory of the Millennium Development Goals, Ethiopia has made significant achievements towards meeting the maternal mortality related goals since 1990. Despite that, the country is still experiencing unacceptably high maternal mortality rates, and challenges to improving the coverage and utilisation of health facility delivery services which represent a key strategy to combat maternal mortality. Currently, there is limited evidence on the factors associated with health facility delivery in Ethiopia. Therefore, the objective of this study was to identify the correlates of facility delivery among urban and rural women in Ethiopia.
This was a cross-sectional study based on data from the 2011 Ethiopian Demographic and Health Survey. Participants were 7540 women aged between 15 and 49 years with a history of at least one birth. The outcome variable was place of delivery. Data were analyzed using bivariate and multivariable regression techniques.
The overall prevalence of health facility delivery was 17.1% (1447/7540). In the multivariable regression analysis, education, wealth status, frequency of antenatal care visits and mother's age at first birth were found to be significantly associated with women's choice of place of delivery. Among urban women, those who had primary and secondary/higher level education had increased odds of delivering at a health facility compared with those without formal education. Those who were from the richest households had higher odds of delivering at a health facility compared with those in the lowest class. In urban and rural areas, compared with those who had no ANC visits, those who had at least four visits also had increased odds of delivering at a health facility. In the urban areas, those who were over 18 years old at their first childbirth had significantly higher odds of choosing to deliver at a health facility.
Findings show that the prevalence of healthy facility delivery in Ethiopia is remarkably low. Addressing the sociodemographic and wealth inequities can help promote the utilisation of facility delivery in both urban and rural areas. Policy-makers should consider improving access to education as a strategy to meet maternal health related goals and treat education as a multipronged strategy. Providing free healthcare access could be one strategy to achieve the universal coverage of essential maternal healthcare services.
作为千年发展目标的签署国，埃塞俄比亚自1990年以来在实现与孕产妇死亡率相关的目标方面取得了重大成就。尽管如此，该国的孕产妇死亡率仍然高得令人无法接受，并且在提高卫生机构分娩服务的覆盖率和利用率方面面临挑战，而这是降低孕产妇死亡率的一项关键战略。目前，关于埃塞俄比亚与卫生机构分娩相关因素的证据有限。因此，本研究的目的是确定埃塞俄比亚城乡妇女中机构分娩的相关因素。
这是一项基于2011年埃塞俄比亚人口与健康调查数据的横断面研究。参与者为7540名年龄在15至49岁之间且至少有一次生育史的妇女。结局变量是分娩地点。使用双变量和多变量回归技术对数据进行分析。
卫生机构分娩的总体患病率为17.1%（1447/7540）。在多变量回归分析中，教育程度、财富状况、产前检查次数和初产时母亲的年龄被发现与妇女选择分娩地点显著相关。在城市妇女中，接受过小学和中学/高等教育的妇女与未接受正规教育的妇女相比，在卫生机构分娩的几率增加。与最贫困家庭的妇女相比，来自最富裕家庭的妇女在卫生机构分娩的几率更高。在城市和农村地区，与未进行产前检查的妇女相比，至少进行过四次产前检查的妇女在卫生机构分娩的几率也增加。在城市地区，初产时年龄超过18岁的妇女选择在卫生机构分娩的几率显著更高。
研究结果表明，埃塞俄比亚卫生机构分娩的患病率极低。解决社会人口和财富不平等问题有助于促进城乡地区对机构分娩的利用。政策制定者应考虑将改善教育机会作为实现与孕产妇健康相关目标的一项战略，并将教育视为一项多方面的战略。提供免费医疗服务可能是实现基本孕产妇医疗服务普遍覆盖的一项战略。
