Chungu Charles, Makasa Mpundu, Chola Mumbi, Jacobs Choolwe Nkwemu
Ministry of Health, Muchinga Provincial Health Office, Chinsali, Zambia.
Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.
Front Public Health. 2018 Apr 6;6:94. doi: 10.3389/fpubh.2018.00094. eCollection 2018.
Postnatal care (PNC) utilization is critical to the prevention of maternal morbidity and mortality. Despite its importance, the proportion of women utilizing this service is still low in Zambia. We investigated if place of delivery was associated with PNC utilization in the first 48 h among childbearing women in Zambia.
Data from the 2013/14 Zambia Demographic and Health Survey for women, aged 15-49 years, who reported giving birth in the 2 years preceding the survey was used. The data comprised of sociodemographic and other obstetric data, which were cleaned, recoded, and analyzed using STATA version 13 (Stata Corporation, College Station, TX, USA). Multivariate logistic regression was used to examine the association of place of delivery and other background variables.
Women who delivered in a health facility were more likely to utilize PNC in the first 48 h compared to those who did not deliver in a health facility: government hospital (AOR 7.24, 95% CI 4.92-11.84), government health center/clinic (AOR 7.15 95% CI 4.79-10.66), other public sector (AOR 23.2 95% CI 3.69-145.91), private hospital/clinic (AOR 10.08 95% CI 3.35-30.35), and Mission hospital/clinic (AOR 8.56 95% CI 4.71-15.53). Additionally, women who were attended to by a skilled personnel during delivery of the baby were more likely to utilize PNC (AOR 2.30, 95% CI 1.57-3.37). Women from rural areas were less likely to utilize PNC in the first 48 h (AOR 0.70, 95% CI 0.53-0.90).
Place of delivery was found to be linked with PNC utilization in this population although access to health care is still driven by inequity-related dynamics and imbalances. Given that inequity stresses are heaviest in the rural and poor groups, interventions should aim to reach this group.
The study results will help program managers to increase access to health facility delivery and direct interventional efforts toward the affected subpopulations, such as the young and rural women. Furthermore, results will help promote maternal health education on importance of health facility delivery and advise policy makers and program implementers.
产后护理（PNC）的利用对于预防孕产妇发病和死亡至关重要。尽管其很重要，但在赞比亚，使用这项服务的女性比例仍然很低。我们调查了分娩地点是否与赞比亚育龄妇女产后48小时内的产后护理利用情况相关。
使用了2013/14年赞比亚人口与健康调查中15 - 49岁女性的数据，这些女性报告在调查前两年内分娩。数据包括社会人口统计学和其他产科数据，对其进行清理、重新编码，并使用STATA 13版（美国德克萨斯州大学站市的Stata公司）进行分析。采用多变量逻辑回归来检验分娩地点与其他背景变量之间的关联。
与未在医疗机构分娩的女性相比，在医疗机构分娩的女性在产后48小时内更有可能接受产后护理：政府医院（调整后比值比[AOR] 7.24，95%置信区间[CI] 4.92 - 11.84）、政府保健中心/诊所（AOR 7.15，95% CI 4.79 - 10.66）、其他公共部门（AOR 23.2，95% CI 3.69 - 145.91）、私立医院/诊所（AOR 10.08，95% CI 3.35 - 30.35）以及教会医院/诊所（AOR 8.56，95% CI 4.71 - 15.53）。此外，在分娩时由专业人员护理的女性更有可能接受产后护理（AOR 2.30，95% CI 1. 57 - 3.37）。农村地区的女性在产后48小时内接受产后护理的可能性较小（AOR 0.70，95% CI 0.53 - 0.90）。
尽管获得医疗保健仍然受到与不平等相关的动态因素和失衡的驱动，但在这一人群中发现分娩地点与产后护理利用情况有关联。鉴于农村和贫困群体所承受的不平等压力最大，干预措施应旨在覆盖这一群体。
研究结果将有助于项目管理人员增加在医疗机构分娩的机会，并将干预努力直接指向受影响的亚人群，如年轻女性和农村女性。此外，结果将有助于促进关于在医疗机构分娩重要性的孕产妇健康教育，并为政策制定者和项目实施者提供建议。
