Chikandiwa Admire, Burgess Emma, Otwombe Kennedy, Chimoyi Lucy
Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen St, Hillbrow, Johannesburg, 2001, South Africa.
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
BMC Womens Health. 2018 Oct 24;18(1):173. doi: 10.1186/s12905-018-0666-1.
Increasing uptake of modern contraception is done to alleviate maternal and infant mortality in poor countries. We describe prevalence of contraceptive use, high risk births, under-five mortality and their risk factors in Kenya and Zimbabwe.
This was a cross-sectional analysis on DHS data from Kenya (2014) and Zimbabwe (2011) for women aged 15-49. Geospatial mapping was used to compare the proportions of the following outcomes: current use of contraceptives, high-risk births, and under-5 mortality at regional levels after applying sample weights to account for disproportionate sampling and non-responses. Multivariate risk factors for the outcomes were evaluated by multilevel logistic regression and reported as adjusted odds ratios (aOR).
A total of 40,250 (31,079 Kenya vs. 9171 Zimbabwe) women were included in this analysis. Majority were aged 18-30 years (47%), married/cohabiting (61%) and unemployed (60%). Less than half were using contraceptives (36% Kenya vs. 41% Zimbabwe). Spatial maps, especially in the Kenyan North-eastern region, showed an inverse correlation in the current use of contraceptives with high risk births and under-5 mortality. At individual level, women that had experienced high risk births were likely to have attained secondary education in both Kenya (aOR = 5.20, 95% CI: 3.86-7.01) and Zimbabwe (aOR = 1.63, 95% CI: 1.08-2.25). In Kenya, high household wealth was associated with higher contraceptive use among both women who had high risk births (aOR: 1.72, 95% CI: 1.41-2.11) and under-5 mortality (aOR: 1.66, 95% CI: 1.27-2.16). Contraceptive use was protective against high risk births in Zimbabwe only (aOR: 0.79, 95% CI: 0.68-0.92) and under-five mortality in both Kenya (aOR: 0.79, 95% CI: 0.70-0.89) and Zimbabwe (aOR: 0.71, 95% CI: 0.61-0.83). Overall, community levels factors were not strong predictors of the three main outcomes.
There is a high unmet need of contraception services. Geospatial mapping might be useful to policy makers in identifying areas of greatest need. Increasing educational opportunities and economic empowerment for women could yield better health outcomes.
在贫困国家，增加现代避孕措施的采用率是为了降低孕产妇和婴儿死亡率。我们描述了肯尼亚和津巴布韦的避孕措施使用情况、高危分娩情况、五岁以下儿童死亡率及其风险因素。
这是一项对肯尼亚（2014年）和津巴布韦（2011年）15至49岁女性的 DHS 数据进行的横断面分析。在应用样本权重以考虑抽样不均衡和无应答情况后，使用地理空间映射来比较以下结果在区域层面的比例：当前避孕措施的使用情况、高危分娩情况和五岁以下儿童死亡率。通过多水平逻辑回归评估这些结果的多变量风险因素，并报告为调整后的优势比（aOR）。
本分析共纳入40250名女性（肯尼亚31079名，津巴布韦9171名）。大多数女性年龄在18至30岁之间（47%），已婚/同居（61%）且失业（60%）。不到一半的女性使用避孕措施（肯尼亚为36%，津巴布韦为41%）。空间地图显示（尤其是在肯尼亚东北部地区），当前避孕措施的使用与高危分娩和五岁以下儿童死亡率呈负相关。在个体层面，在肯尼亚（aOR = 5.20，95% CI：3.86 - 7.01）和津巴布韦（aOR = 1.63，9% CI：1.08 - 2.25），经历过高危分娩的女性更有可能接受过中等教育。在肯尼亚，高家庭财富与高危分娩女性（aOR：1.72，95% CI：1.41 - 2.11）和五岁以下儿童死亡率（aOR：1.66，95% CI：1.27 - 2.16）中更高的避孕措施使用率相关。避孕措施的使用仅在津巴布韦对高危分娩有保护作用（aOR：0.79，95% CI：0.68 - 0.92），在肯尼亚（aOR：0.79，95% CI：0.70 - 0.89）和津巴布韦（aOR：0.71，95% CI：0.61 - 0.83）对五岁以下儿童死亡率均有保护作用。总体而言，社区层面的因素并非这三个主要结果的有力预测因素。
避孕服务的需求未得到充分满足。地理空间映射可能有助于政策制定者确定最需要服务的地区。增加女性的教育机会和经济赋权可能会带来更好的健康结果。
