Wu Yuju, Zhou Huan, Wang Qingzhi, Cao Min, Medina Alexis, Rozelle Scott
Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, No.16, section 3, South Renmin Road, Chengdu City, Sichuan Province, 610041, People's Republic of China.
The Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA.
BMC Health Serv Res. 2019 Mar 19;19(1):179. doi: 10.1186/s12913-019-3996-2.
The use of maternal health services can markedly promote the maternal health and safety, but there has been a low utilization rate in the ethnic rural areas of western China. Furthermore, the correlated factors have not been well studied. This study aims to assess factors related to the use of maternal health services among women in these areas.
A cross-sectional study of 68 villages in China's western Sichuan province was conducted in September 2014. All qualifying women from each sample village were involved. A structured questionnaire was administrated in households through face-to-face interviews by trained enumerators to obtain information of use of maternal health services and related factors. Structural equation modeling (SEM) was used to evaluate the direct and indirect relationships between use of maternal health services and correlated factors.
A total of 760 women from 68 villages were enrolled. The proportion of antenatal care (ANC), hospital delivery and postpartum visits were 68.94, 48.29 and 28.42% respectively. The SEM analysis demonstrated that social economic status (SES) (β= - 0.75, β< 0.01), ANC (β=0.13, β< 0.01), and time from home to the nearest hospital (β= - 0.09, β< 0.05), were positively correlated to hospital delivery and postpartum care visits, while maternal care knowledge and perceived quality of hospital care did not have direct correlation. For ANC, SES (β= - 0.36, β< 0.01), time from home to the nearest hospital (β= - 0.13, β< 0.05), knowledge on maternal care (β=0.12, β< 0.01) and perceived quality of hospital care (β=0.10, β< 0.01) were all directly correlated factors. Treating ANC as an intermediate variable showed the indirect relationship that perceived quality of hospital care (β=0.01, β< 0.01) and maternal care knowledge (β=0.02, β< 0.01) had with hospital delivery and postpartum care rates.
Use of maternal health services is low among women in ethnic rural areas. ANC has important direct and intermediate effects on subsequent use of hospital delivery and postpartum care. Improving ANC behavior should be a priority of maternal health care reforms. Given the long travel times for these women, reforms must also prioritize breaking down practical barriers that prevent this population from accessing care.
孕产妇保健服务的使用可显著促进孕产妇健康与安全，但中国西部民族农村地区的利用率一直较低。此外，相关因素尚未得到充分研究。本研究旨在评估这些地区妇女使用孕产妇保健服务的相关因素。
2014年9月在中国西部四川省的68个村庄进行了一项横断面研究。每个样本村的所有符合条件的妇女均参与其中。由经过培训的调查员通过面对面访谈在家庭中发放结构化问卷，以获取孕产妇保健服务使用情况及相关因素的信息。采用结构方程模型（SEM）评估孕产妇保健服务使用情况与相关因素之间的直接和间接关系。
共纳入了68个村庄的760名妇女。产前检查（ANC）、住院分娩和产后访视的比例分别为68.94%、48.29%和28.42%。SEM分析表明，社会经济地位（SES）（β = -0.75，β < 0.01）、产前检查（β = 0.13，β < 0.01）以及从家到最近医院的时间（β = -0.09，β < 0.05）与住院分娩和产后护理访视呈正相关，而孕产妇保健知识和对医院护理质量的感知没有直接相关性。对于产前检查，社会经济地位（β = -0.36，β < 0.01）、从家到最近医院的时间（β = -0.13，β < 0.05）、孕产妇保健知识（β = 0.12，β < 0.01）和对医院护理质量的感知（β = 0.10，β < 0.01）均为直接相关因素。将产前检查作为中间变量显示了医院护理质量感知（β = 0.01，β < 0.01）和孕产妇保健知识（β = 0.02，β < 0.01）与住院分娩和产后护理率之间的间接关系。
民族农村地区妇女的孕产妇保健服务使用率较低。产前检查对随后的住院分娩和产后护理使用具有重要的直接和中间作用。改善产前检查行为应是孕产妇保健改革的优先事项。鉴于这些妇女的路途时间较长，改革还必须优先消除阻碍这一人群获得护理的实际障碍。
