Department of Statistics Data Science and Epidemiology, Swinburne University of Technology, Australia.
Transport and Road Safety Research, University of New South Wales, Australia.
Public Health. 2019 May;170:113-121. doi: 10.1016/j.puhe.2019.02.027. Epub 2019 Apr 13.
Antenatal care (ANC) during pregnancy and skilled birth attendance (SBA) during delivery are important policy concerns to reduce maternal deaths. Bangladesh is one of the developing countries which has made remarkable progress in both services during the last couple of decades by improving the SBA service rate from 16% in 2004 to 42.1% in 2014. However, this rate remains below the targeted level (50%) of the Health Population and Nutrition Sector Development Program set by the Ministry of the Health and Family Welfare of Bangladesh. This article explored the sociodemographic factors associated with the ANC and SBA service attainment. Furthermore, the possible implication of using ANC on SBA was also investigated.
The study followed a cross-sectional design using the Bangladesh demographic and health survey 2014, with a sample of size 4603 women with at least one live birth 3 years preceding the survey.
Following a bivariate analysis, linear mixed-effect models were used to assess the relationship between sociodemographic factors and the outcome indicators (ANC and SBA). Finally, the association between SBA and ANC was evaluated through another mixed-effect model.
Wealth index, participation in household decisions, and partner's and respondent's education were significant predictors of ANC; whereas, residence, age at first birth, wealth index, working status, participation in household decisions, and partner and respondent's education were significant for SBA. Female education and household affordability were the strongest predictors for both ANC and SBA. ANC showed significant association with SBA as women accessing essential ANC during delivery seemed to be 4 times more likely (95% confidence interval: 3.05-5.93) to avail SBA services.
Overall, four factors were significant: residence, wealth index, education, and ANC access. Women residing in urban areas, having higher financial solvency, completing higher education, and accessing ANC by skilled personnel were more likely to receive SBA at delivery than their counterparts. Accessibility to skilled care during pregnancy leads to increased professional care during delivery. Thus, policies to encourage women and heads of families to seek skilled care during pregnancy would be beneficial to reach the maternal healthcare targets of Bangladesh.
产前护理（ANC）和分娩时的熟练接生（SBA）是减少产妇死亡的重要政策关注点。孟加拉国是发展中国家之一，在过去几十年中，通过将 SBA 服务率从 2004 年的 16%提高到 2014 年的 42.1%，在这两项服务上取得了显著进展。然而，这一比例仍低于孟加拉国卫生和家庭福利部制定的《卫生、人口和营养部门发展方案》（Health Population and Nutrition Sector Development Program）设定的 50%目标。本文探讨了与 ANC 和 SBA 服务获得相关的社会人口因素。此外，还调查了 ANC 对 SBA 的可能影响。
本研究采用 2014 年孟加拉国人口与健康调查的横断面设计，样本量为 4603 名至少有一次活产且在调查前 3 年内生育过的妇女。
在进行双变量分析后，使用线性混合效应模型评估社会人口因素与结局指标（ANC 和 SBA）之间的关系。最后，通过另一个混合效应模型评估 SBA 和 ANC 之间的关联。
财富指数、参与家庭决策以及伴侣和受访者的教育是 ANC 的重要预测因素；而居住地、首次生育年龄、财富指数、工作状况、参与家庭决策以及伴侣和受访者的教育是 SBA 的重要预测因素。女性教育和家庭负担能力是 ANC 和 SBA 的最强预测因素。ANC 与 SBA 显著相关，因为在分娩期间接受基本 ANC 的女性获得 SBA 服务的可能性似乎是 4 倍（95%置信区间：3.05-5.93）。
总体而言，有四个因素具有显著意义：居住地、财富指数、教育和 ANC 的可及性。居住在城市地区、经济状况较好、完成高等教育以及由熟练医务人员提供 ANC 的女性，在分娩时更有可能获得 SBA 服务，而非上述条件的女性。在怀孕期间获得熟练护理会增加分娩时的专业护理。因此，鼓励妇女和家庭户主在怀孕期间寻求熟练护理的政策将有利于实现孟加拉国的产妇保健目标。
