Women's Health and Action Research Centre, Km 11 Benin-Lagos Expressway, Benin City, Edo State, Nigeria.
The University of Medical Sciences, Ondo City, Ondo State, Nigeria.
BMC Pregnancy Childbirth. 2018 Apr 18;18(1):106. doi: 10.1186/s12884-018-1730-4.
Although Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of PHC for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care. The objective of this study was to identify the factors that lead pregnant women to use or not use existing primary health care facilities for antenatal and delivery care.
The study was a cross-sectional community-based study conducted in Esan South East and Etsako East LGAs of Edo State, Nigeria. A total of 1408 randomly selected women of reproductive age were interviewed in their households using a pre-tested structured questionnaire. The data were analyzed with descriptive and multivariate statistical methods.
The results showed antenatal care attendance rate by currently pregnant women of 62.1%, and a skilled delivery of 46.6% by recently delivered women at PHCs, while 25% of women delivered at home or with traditional birth attendants. Reasons for use and non-use of PHCs for antenatal and delivery care given by women were related to perceptions about long distances to PHCs, high costs of services and poor quality of PHC service delivery. Chi-square test of association revealed that level of education and marital status were significantly related to use of PHCs for antenatal care. The results of logistic regression for delivery care showed that women with primary (OR 3.10, CI 1.16-8.28) and secondary (OR 2.37, CI 1.19-4.71) levels education were more likely to receive delivery care in PHCs than the highly educated. Being a Muslim (OR 1.56, CI 1.00-2.42), having a partner who is employed in Estako East (OR 2.78, CI 1.04-7.44) and having more than five children in Esan South East (OR 2.00, CI 1.19-3.35) significantly increased the odds of delivery in PHCs. The likelihood of using a PHC facility was less for women who had more autonomy (OR 0.75, CI 0.57-0.99) as compared to women with higher autonomy.
We conclude that efforts devoted to addressing the limiting factors (distance, costs and quality of care) using creative and innovative approaches will increase the utilization of skilled pregnancy care in PHCs and reduce maternal mortality in rural Nigeria.
尽管初级卫生保健（PHC）旨在为预防产妇死亡提供普遍获得熟练妊娠护理的机会，但对于在尼日利亚农村地区使用 PHC 进行熟练产时护理的预测因素知之甚少——在这些地区，其使用可能会对产妇保健产生更大的积极影响。本研究的目的是确定导致孕妇使用或不使用现有初级卫生保健设施进行产前和分娩护理的因素。
本研究是在尼日利亚江户州埃萨东南和埃特萨科东地方政府区进行的一项基于社区的横断面研究。共对 1408 名随机选择的育龄妇女在其家中进行了访谈，使用了经过预测试的结构化问卷。数据采用描述性和多变量统计方法进行分析。
结果显示，目前怀孕的妇女中，产前护理的就诊率为 62.1%，最近在 PHC 分娩的妇女中，熟练分娩率为 46.6%，而 25%的妇女在家中或由传统助产妇分娩。妇女使用和不使用 PHC 进行产前和分娩护理的原因与对 PHC 距离远、服务费用高和 PHC 服务提供质量差的看法有关。卡方检验显示，教育程度和婚姻状况与 PHC 进行产前护理的使用显著相关。分娩护理的逻辑回归结果表明，接受过小学（OR 3.10，CI 1.16-8.28）和中学（OR 2.37，CI 1.19-4.71）教育的妇女比接受过高等教育的妇女更有可能在 PHC 接受分娩护理。穆斯林（OR 1.56，CI 1.00-2.42）、埃特萨科东的伴侣受雇（OR 2.78，CI 1.04-7.44）和埃萨南东有五个以上孩子（OR 2.00，CI 1.19-3.35）的妇女在 PHC 分娩的几率显著增加。与自主权较高的妇女相比，自主权较低的妇女使用 PHC 设施的可能性较小（OR 0.75，CI 0.57-0.99）。
我们的结论是，通过创造性和创新性的方法解决限制因素（距离、成本和护理质量）的努力将增加对 PHC 熟练妊娠护理的利用，并降低尼日利亚农村地区的产妇死亡率。
