尼日利亚女性产后禁欲持续时间的影响因素：半参数生存分析

Factors contributing to the duration of postpartum abstinence among Nigerian women: semi-parametric survival analysis.

作者信息

Fagbamigbe A F, Awoyelu I E, Akinwale O L, Akinwande T Y, Enitilo B K, Bankole O

机构信息

Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria.

Centre for AIDS Research, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.

出版信息

Heliyon. 2018 Dec 17;4(12):e01032. doi: 10.1016/j.heliyon.2018.e01032. eCollection 2018 Dec.

DOI:10.1016/j.heliyon.2018.e01032

PMID:30582049

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6298193/

Abstract

BACKGROUND

The duration of postpartum abstinence is on the decrease but has not been met with increased uptake of contraceptive in Nigeria. This imbalanced transition could result in shorter birth intervals and worsen maternal and child health outcomes. There is a paucity of information on the duration and predictors of time to end of postpartum abstinence in Nigeria. This study was aimed at understanding the time to end of postpartum abstinence and factors predicting the duration in Nigeria.

METHODS

The NDHS 2013 data was used. Data of all women who had ever given birth were included. The time to end of postpartum abstinence was censored among currently breastfeeding mothers. The Kaplan Meier Product Limit method was used to estimate the survival and hazard function while the Cox regression was used to fit a model for time to end of postpartum abstinence at 5% significance level. Data were weighed and provisions were made for multicollinearity.

RESULTS

The overall average duration of postpartum abstinence in Nigeria is 3 month. In all, 58% ended postpartum abstinence within the first three months while 18%, 10%, and 14% ended it within 4-6 months, 7-12 months and after one year respectively. Postpartum abstinence did not last beyond 3 months among 83% of the women in the North-West region, compared with 23% in the North Central region, and 34% in the South East. The Muslims had the highest proportion of women who ended postpartum abstinence within the first three months after delivery at 72% compared with Catholic women (31%). The median time to end of postpartum abstinence was lowest (2 months) among women from North West, Muslims, in poorest wealth quintiles and those with no education. The "hazard" of earlier resumption of sexual activity after birth was over 3 times more likely among women in the North West than those in the North Central (aHR = 3.09, 95% CI: 2.95-3.24). Women using contraceptives had a 40% hazard of ending postpartum abstinence earlier. Rural women were 7.6% times less likely to end postpartum abstinence compared to their urban counterpart. Women from rich households have an excess risk of 14% to end postpartum abstinence early compared to women from poor households.

CONCLUSION

Women of reproductive age in the North West, who are Muslims and with no education are at higher risk of ending postpartum abstinence early. Hence, policymakers and reproductive health stakeholders should design effective intervention targeted at this group of women as a means of controlling fertility.

摘要

背景

在尼日利亚，产后禁欲的持续时间正在缩短，但避孕措施的采用率却没有相应增加。这种不平衡的转变可能导致生育间隔缩短，并使母婴健康状况恶化。关于尼日利亚产后禁欲结束时间及其预测因素的信息匮乏。本研究旨在了解尼日利亚产后禁欲结束的时间以及预测其持续时间的因素。

方法

使用2013年尼日利亚人口与健康调查（NDHS）数据。纳入所有曾经生育过的女性的数据。对于目前正在哺乳的母亲，产后禁欲结束时间进行了截尾处理。采用Kaplan-Meier乘积限估计法来估计生存和风险函数，同时使用Cox回归在5%的显著性水平下拟合产后禁欲结束时间的模型。数据进行了加权处理，并考虑了多重共线性问题。

结果

尼日利亚产后禁欲的总体平均持续时间为3个月。总体而言，58%的女性在头三个月内结束了产后禁欲，而分别有18%、10%和14%的女性在4 - 6个月、7 - 12个月以及一年后结束。在西北地区，83%的女性产后禁欲持续时间不超过3个月，相比之下，中北部地区为23%，东南部为34%。穆斯林女性在分娩后头三个月内结束产后禁欲的比例最高，为72%，而天主教女性这一比例为31%。西北地区的女性、穆斯林女性、最贫困财富五分位组的女性以及未受过教育的女性，产后禁欲结束的中位时间最短（2个月）。产后较早恢复性活动的“风险”，西北地区的女性是中北部地区女性的3倍多（调整后风险比aHR = 3.09，95%置信区间：2.95 - 3.24）。使用避孕药具的女性提前结束产后禁欲的风险为40%。农村女性结束产后禁欲的可能性比城市女性低7.6%。与贫困家庭的女性相比，富裕家庭的女性提前结束产后禁欲的额外风险为14%。