地理可达性对中低收入国家机构分娩护理利用的影响：系统评价和荟萃分析。

The impact of geographic access on institutional delivery care use in low and middle-income countries: Systematic review and meta-analysis.

机构信息

Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.

Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.

出版信息

PLoS One. 2018 Aug 30;13(8):e0203130. doi: 10.1371/journal.pone.0203130. eCollection 2018.

BACKGROUND

Geographic access to obstetric care facilities has a significant influence on women's uptake of institutional delivery care. However, this effect was not consistent across studies. Some studies reported that geographic access to obstetric care facilities had no influence on the use of facility delivery. Therefore, this systematic review and meta-analysis synthesized and pooled the influence of geographic access on institutional delivery service uptake in low and middle-income countries.

METHODS

Multiple combinations of search terms were used to search articles from six databases and a hand search of reference lists performed. We included observational studies conducted in low and middle-income countries which reported the influence of geographic access on delivery care use. The pooled effects of geographic access on institutional delivery care use were calculated using a random-effects model with a 95% confidence interval.

FINDINGS

In this study a total of 31 studies were included. Among these studies, 15 met criteria for inclusion in the meta-analyses, while the remaining 16 were summarized using qualitative synthesis. Studies included in the analysis where women had to walk 60 minutes or less to access a health facility delivery were significantly heterogeneous. Having access to obstetric care facilities within five kilometres was significantly associated with institutional deliveries (pooled OR = 2.27; 95% CI = 1.82, 2.82). Similarly, a travelling time of 60 minutes or less was significantly associated with higher odds of health facility delivery (pooled OR = 3.30; 95% CI = 1.97, 5.53). Every one-hour and one-kilometre increase in travel time and distance, respectively, was negatively associated with institutional delivery care use.

INTERPRETATION

Geographic access measured in either physical distance and/or travel time was significantly associated with women's use of facility delivery. The greater the distance and/or travel time to obstetric care facilities, the greater the barrier and the lesser the service uptake.

背景

地理上获得产科保健设施对妇女获得机构分娩护理有重大影响。然而，这种影响在不同的研究中并不一致。一些研究报告称，获得产科保健设施的地理通道对利用设施分娩没有影响。因此，本系统评价和荟萃分析综合并汇集了地理通道对中低收入国家机构分娩服务利用率的影响。

方法

使用多个组合的搜索词从六个数据库和手工搜索参考文献中搜索文章。我们纳入了在中低收入国家进行的、报告地理通道对分娩护理使用影响的观察性研究。使用随机效应模型计算地理通道对机构分娩护理使用的汇总效应，置信区间为 95%。

结果

本研究共纳入 31 项研究。其中 15 项研究符合纳入荟萃分析的标准，其余 16 项研究采用定性综合分析。纳入分析的研究中，妇女需要步行 60 分钟或更短时间才能到达医疗机构分娩，结果存在显著异质性。在 5 公里范围内获得产科保健设施与机构分娩显著相关（汇总 OR = 2.27；95% CI = 1.82, 2.82）。同样，60 分钟或更短的旅行时间与更高的获得医疗设施分娩的几率显著相关（汇总 OR = 3.30；95% CI = 1.97, 5.53）。旅行时间和距离每增加一小时和一公里，分别与机构分娩护理的使用呈负相关。