Dunlop Catherine L, Benova Lenka, Campbell Oona
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Department of Infectious Disease Epidemiology and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Open. 2018 Apr 13;8(4):e020231. doi: 10.1136/bmjopen-2017-020231.
Increasing access to skilled birth attendance, usually via childbirth in health facilities, is a key intervention to reduce maternal and perinatal mortality and morbidity. Yet, in some countries of sub-Saharan Africa, the uptake is <50%. Age and parity are determinants of facility-based delivery, but are strongly correlated in high fertility settings. This analysis assessed the independent effect of age on facility-based delivery by restricting to first-order births. It was hypothesised that older first-time mothers in this setting might have lower uptake of facility-based deliveries than women in the most common age groups for first birth.
The most recent Demographic and Health Surveys from 34 sub-Saharan African countries were used to assess women's delivery locations.
72 772 women having their first birth in the 5 years preceding the surveys were included in the analysis.
Proportions and 95% CIs of facility-based deliveries were estimated overall and by country. Multivariable logistic regression was used to calculate the odds of facility-based delivery for different maternal age groups (15-19, 20-24 and ≥25 years) for a pooled sample of all countries.
59.9% of women had a facility-based delivery for their first birth (95% CI 58.6 to 61.2), ranging from 19.4% in Chad to 96.6% in Rwanda. Compared with women aged 15-19 years, the adjusted odds of having a facility-based delivery for those aged 20-24 was 1.4 (95% CI 1.3 to 1.5, p<0.001) and for those aged ≥25, 1.9 (95% CI 1.6 to 2.2, p<0.001).
Older age at first birth was independently associated with significantly higher odds of facility-based delivery. This went against the hypothesis. Further mixed-method research is needed to explore how increased age improves uptake of facility-based delivery. Promoting facility-based delivery, while ensuring quality of care, should be prioritised to improve birth outcomes in sub-Saharan Africa.
增加获得熟练接生服务的机会，通常是通过在医疗机构分娩，是降低孕产妇和围产期死亡率及发病率的关键干预措施。然而，在撒哈拉以南非洲的一些国家，这一比例低于50%。年龄和胎次是基于医疗机构分娩的决定因素，但在高生育率环境中二者密切相关。本分析通过限制在头胎分娩情况来评估年龄对基于医疗机构分娩的独立影响。研究假设，在这种情况下，年龄较大的初产妇在基于医疗机构分娩方面的接受率可能低于最常见初产年龄组的女性。
使用来自34个撒哈拉以南非洲国家的最新人口与健康调查来评估女性的分娩地点。
分析纳入了在调查前5年内首次分娩的72772名女性。
总体及按国家估计基于医疗机构分娩的比例和95%置信区间。使用多变量逻辑回归计算所有国家汇总样本中不同孕产妇年龄组（15 - 19岁、20 - 24岁和≥25岁）基于医疗机构分娩的几率。
59.9%的女性头胎在医疗机构分娩（95%置信区间58.6至61.2），范围从乍得的19.4%到卢旺达的96.6%。与15 - 19岁的女性相比，20 - 24岁女性基于医疗机构分娩的调整后几率为1.4（95%置信区间1.3至1.5，p<0.001），≥25岁女性为1.9（95%置信区间1.6至2.2，p<0.001）。
初产年龄较大与基于医疗机构分娩的几率显著较高独立相关。这与假设相悖。需要进一步开展混合方法研究，以探讨年龄增长如何提高基于医疗机构分娩的接受率。在撒哈拉以南非洲，应优先推广基于医疗机构的分娩，同时确保医疗服务质量，以改善分娩结局。
