Gurung Mongal Singh, Pelzom Dorji, Wangdi Sonam, Tshomo Tashi, Lethro Pema, Dema Tashi
Health Research and Epidemiology Unit, Maternal and Newborn Health Programme, Ministry of Health, Thimphu, Bhutan.
Health Management Information System, Maternal and Newborn Health Programme, Ministry of Health, Thimphu, Bhutan.
WHO South East Asia J Public Health. 2018 Apr;7(1):36-42. doi: 10.4103/2224-3151.228426.
Despite Bhutan's remarkable progress in the area of maternal and child health during the era of the Millennium Development Goals, a large proportion of pregnant women are still delivering at home with no skilled attendant. Limited empirical studies have been carried out to understand the factors associated with delivery at home in Bhutan.
This cross-sectional analytical study used secondary data collected in the nationally representative National Health Survey 2012. The survey included a total of 2213 women aged 15-49 years who had a live birth in the 2 years preceding the survey and were selected using multistage stratified cluster sampling. Weighted analysis was done to evaluate determinants for the place of delivery. Unadjusted and adjusted prevalence ratios with 95% confidence intervals (CIs) were calculated to assess the possible association of factors with home delivery.
Out of 2213 women aged 15-49 years who had a live birth in the 2 years preceding the survey, 73.7% had an institutional delivery. Coverage of institutional delivery ranged from 49.4% in Zhemgang district to 96.1% in Paro district. Women in the poorest wealth quintile were 7.35 times more likely to have a birth at home compared to women in the richest quintile (adjusted prevalence ratio [aPR]: 7.35, 95% CI: 2.59-20.9). The older mothers aged 30-49 years were 0.79 times (aPR: 0.79, 95% CI: 0.70-0.88) less likely to have a home delivery than mothers aged 15-19 years. Women who had fewer than four antenatal care visits were 1.50 times (aPR: 1.50, 95% CI: 1.35-1.66) more likely to give birth at home compared to those who had four or more visits. The mothers giving birth for a third or more time were 1.88 times (aPR: 1.88, 95% CI: 1.60-2.22) more likely to give birth at home compared to those giving birth for the first time. Women living in rural areas were 2.87 times (aPR: 2.87, 95% CI: 1.42-5.77) more likely to deliver at home compared to those living in urban areas and women living in the eastern region of the country were 1.35 times (aPR: 1.35, 95% CI: 1.17-1.55) more likely to have a home delivery compared to those living in the western region.
Lower socioeconomic status, rural location, eastern location, non- first birth, and having fewer than four antenatal visits were significant factors associated with home delivery. These findings should inform further research and policy to build on Bhutan's progress in promoting institutional delivery as the key strategy towards improving maternal and child health and achieving the relevant targets of Sustainable Development Goal 3.
尽管不丹在千年发展目标时代的孕产妇和儿童健康领域取得了显著进展，但仍有很大比例的孕妇在家中分娩且无专业医护人员在场。为了解不丹在家中分娩相关因素开展的实证研究有限。
这项横断面分析研究使用了在具有全国代表性的2012年国家卫生调查中收集的二手数据。该调查共纳入了2213名年龄在15 - 49岁之间的女性，她们在调查前两年内有过活产，采用多阶段分层整群抽样选取。进行加权分析以评估分娩地点的决定因素。计算未调整和调整后的患病率比及95%置信区间（CI），以评估各因素与在家分娩之间的可能关联。
在调查前两年内有过活产的2213名15 - 49岁女性中，73.7%在医疗机构分娩。机构分娩覆盖率从哲孟雄区的49.4%到帕罗区的96.1%不等。最贫困财富五分位组的女性在家分娩的可能性是最富有五分位组女性的7.35倍（调整患病率比[aPR]：7.35，95%CI：2.59 - 20.9）。30 - 49岁的高龄母亲在家分娩的可能性比15 - 19岁的母亲低0.79倍（aPR：0.79，95%CI：0.70 - 0.88）。产前检查次数少于4次的女性在家分娩的可能性比进行过4次及以上产前检查的女性高1.50倍（aPR：1.50，95%CI：1.35 - 1.66）。生育三次及以上的母亲在家分娩的可能性比首次生育的母亲高1.88倍（aPR：1.88，95%CI：1.60 - 2.22）。与居住在城市地区的女性相比，居住在农村地区的女性在家分娩的可能性高2.87倍（aPR：2.87，95%CI：1.42 - 5.77），与居住在西部地区的女性相比，居住在该国东部地区的女性在家分娩的可能性高1.35倍（aPR：1.35，95%CI：1.17 - 1.55）。
较低的社会经济地位、农村地区、东部地区、非初产以及产前检查次数少于4次是与在家分娩相关的重要因素。这些发现应为进一步研究和政策提供参考，以巩固不丹在促进机构分娩方面取得的进展，将其作为改善孕产妇和儿童健康以及实现可持续发展目标3相关指标的关键战略。
