Kafi Mohammad Abdullah Heel, Ahmmed Faisal, Hassan Md Zakiul, Tariqujjaman Md, Harun Md Golam Dostogir G
Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD.
Internal Medicine, International Centre for Diarrhoeal Disease Research, Dhaka, BGD.
Cureus. 2019 Jan 28;11(1):e3974. doi: 10.7759/cureus.3974.
Introduction Bangladesh has made significant strides in maternal and neonatal death by ensuring qualified antenatal care (ANC) visits during the pregnancy period of women. To ensure this qualified ANC, the government of Bangladesh has increased the number of qualified physicians and skilled birth attendants at health facilities and encouraged pregnant women to take this eligible ANC during pregnancy. Despite this progress, the majority of deliveries among rural women still occur at home, assisted by traditional birth attendants. These traditional birth attendants at home or even skilled birth attendants at the health facility or home are not always cable of helping women to overcome severe delivery complications. Proper birth preparation before pregnancy through qualified ANC might be a solution here. Taking advice for appropriate birth preparation from a qualified physician (medical doctor) would ensure qualified ANC. In this study, we examined how ANC from a qualified physician, as compared to other trained providers, influences rural women delivering at home to prepare for birth and reduces severe delivery complications. Methods The data of 1554 rural women who delivered at home were extracted from the 2014 Bangladesh Demographic and Health Survey data. A mixed-effects logistic regression model was carried out for the binary delivery complications data, to assess the influence of qualified physicians as ANC providers on delivery complications by adjusting the effect of other socio-demographic covariates and clustering. Results Of the women from rural areas who delivered at home, 42% reported delivery complications. Those who received ANC from a qualified physician were 32% less likely (OR 0.68; 95% CI 0.50, 0.91) to report facing delivery complications as compared to those who had received ANC from other trained or unqualified providers adjusted by socio-demographic determinants in Bangladesh. Conclusions Developing a sustained and effective strategy could be a precedent for promoting ANC from qualified physicians for rural women delivering at home, to decrease delivery complications as well as creating healthy environments for safe deliveries.
引言
孟加拉国通过确保妇女在孕期接受合格的产前护理（ANC），在降低孕产妇和新生儿死亡率方面取得了重大进展。为确保提供这种合格的ANC，孟加拉国政府增加了医疗机构中合格医生和熟练助产士的数量，并鼓励孕妇在孕期接受这种符合条件的ANC。尽管取得了这一进展，但农村妇女的大多数分娩仍在家中进行，由传统助产士协助。家中的这些传统助产士，甚至医疗机构或家中的熟练助产士，并不总是能够帮助妇女克服严重的分娩并发症。通过合格的ANC在孕前进行适当的分娩准备可能是解决之道。从合格医生（医学博士）那里获得适当分娩准备的建议将确保获得合格的ANC。在本研究中，我们考察了与其他经过培训的提供者相比，来自合格医生的ANC如何影响在家分娩的农村妇女为分娩做准备，并减少严重的分娩并发症。
方法
从2014年孟加拉国人口与健康调查数据中提取了1554名在家分娩的农村妇女的数据。对二元分娩并发症数据进行了混合效应逻辑回归模型分析，以评估合格医生作为ANC提供者对分娩并发症的影响，并调整其他社会人口统计学协变量和聚类的影响。
结果
在家分娩的农村妇女中，42%报告有分娩并发症。在经孟加拉国社会人口统计学决定因素调整后，与那些从其他经过培训或不合格的提供者那里接受ANC的妇女相比，从合格医生那里接受ANC的妇女报告面临分娩并发症的可能性要低32%（比值比0.68；95%置信区间0.50，0.91）。
结论
制定一项持续有效的策略可能为促进在家分娩的农村妇女从合格医生那里获得ANC树立一个先例，以减少分娩并发症，并为安全分娩创造健康的环境。
