School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia.
School of Population Health, University of Adelaide, Adelaide, South Australia, Australia.
Health Serv Res. 2019 Oct;54(5):1110-1118. doi: 10.1111/1475-6773.13163. Epub 2019 May 15.
To determine individual- and country-level determinants of utilization of key maternal health services in sub-Saharan Africa (SSA).
We used the most recent standard demographic and health survey data from the period of 2005 to 2015 for 34 SSA countries. Predictors of key maternal health service indicators were determined using a sample of 245 178 women who had at least one live birth 5 years preceding the survey.
We used a two-level hierarchical model, considering individual predictors at level one and country factors at level two of the hierarchy.
While the skilled birth attendance (SBA) utilization rate reached 53 percent during the study period, the recommended four or more antenatal care (ANC) coverage was commonly low with less significant differences among different groups of women and countries. Being in a middle-income country increased the individual-level association between ANC and SBA (OR = 2.34, 95% CI: 1.24, 4.44). Less privileged women with lower education level were less likely to receive maternal health services.
This study reveals the existence of wide gaps between ANC and SBA coverage in SSA. Urgent policy attention is required to improve access, utilization, and quality of maternal health services.
确定撒哈拉以南非洲（SSA）个体和国家层面利用关键孕产妇保健服务的决定因素。
我们使用了 2005 年至 2015 年期间来自 34 个 SSA 国家的最新标准人口与健康调查数据。使用了一个包含至少 5 年前有过一次活产的 245178 名妇女的样本，确定了关键孕产妇保健服务指标的预测因素。
我们使用了一个两水平层次模型，在第一层考虑个体预测因素，在第二层考虑国家因素。
虽然熟练接生（SBA）利用率在研究期间达到了 53%，但推荐的四次或更多次产前护理（ANC）覆盖率通常较低，不同妇女群体和国家之间的差异不显著。处于中等收入国家增加了 ANC 和 SBA 之间的个体水平关联（OR=2.34，95%CI：1.24，4.44）。教育程度较低的社会经济地位较低的妇女获得孕产妇保健服务的可能性较小。
本研究揭示了 SSA 国家 ANC 和 SBA 覆盖率之间存在广泛差距。迫切需要政策关注，以改善孕产妇保健服务的获取、利用和质量。
