Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
BMC Pregnancy Childbirth. 2019 Jul 26;19(1):268. doi: 10.1186/s12884-019-2409-1.
Egypt has seen substantial decreases in maternal mortality and reached near universal coverage for antenatal care (ANC). The objective of this paper is to describe the changes over time (1991-2014) in the use of ANC in Egypt, focusing on sector of provision (public versus private), and the content and equity of this care, to inform future policies for improving maternal and newborn health.
We used Demographic and Health surveys (DHS) conducted in Egypt in 1995, 2000, 2005, 2008 and 2014 to explore national and regional trends in ANC. To assess content of care, we calculated the percentage of ANC users who reported receiving seven ANC components measured in DHS in 2014.
During the period under consideration, the percentage of women in need of ANC who received facility-based ANC increased from 42 to 90%, the majority of which was private-sector ANC. The mean number of ANC visits among ANC users increased over time from 7.5 (95% confidence interval [CI] = 7.1-7.9) in 1991-1995 to 9.7 (95%CI 9.6-9.9) in 2010-2014. In 2010-2014, 44% of women using public ANC reported eight or more visits compared to 71% in private ANC. In the same period, 24% of ANC users received all seven care components. This percentage ranged from 10% of women reporting fewer than four ANC visits to 29% of women reporting eight or more. The poorest ANC users received all seven measured components of care less often than the wealthiest (20% versus 28%, p-value< 0.001).
Egypt's improvements in ANC coverage were characterized by decreasing reliance on public services and a rising number of ANC visits. However, despite rising ANC coverage, less than a third of women received the seven essential ANC components measured at least once during pregnancy, with differences between poorer and wealthier women. Policymakers need to ensure that high ANC coverage translates into equity-focused interventions targeting ANC quality. Further research needs to support this effort by assessing the determinants behind poor quality of ANC and evaluating potential interventions.
埃及的孕产妇死亡率大幅下降，已基本实现了产前保健（ANC）全覆盖。本文旨在描述 1991 年至 2014 年间埃及 ANC 利用情况的变化，重点关注提供服务的部门（公共与私营）以及 ANC 服务的内容和公平性，为改善母婴健康提供未来政策依据。
我们利用 1995 年、2000 年、2005 年、2008 年和 2014 年在埃及开展的人口与健康调查（DHS）数据，探讨全国和地区 ANC 趋势。为了评估服务内容，我们计算了 2014 年 DHS 调查中报告接受了 ANC 七个组成部分的 ANC 使用者所占的百分比。
在所研究期间，需要 ANC 的妇女中接受机构 ANC 的比例从 42%增加到 90%，其中大部分是私营部门的 ANC。随着时间的推移，ANC 使用者接受的 ANC 次数也有所增加，从 1991 年至 1995 年的 7.5 次（95%置信区间[CI]为 7.1-7.9）增加到 2010 年至 2014 年的 9.7 次（95%CI 为 9.6-9.9）。在 2010 年至 2014 年期间，44%的公共 ANC 使用者报告接受了 8 次或更多次 ANC，而在私营 ANC 中，这一比例为 71%。同期，24%的 ANC 使用者接受了所有七个护理组成部分。这一比例从报告少于 4 次 ANC 的妇女的 10%到报告 8 次或更多次 ANC 的妇女的 29%不等。最贫困的 ANC 使用者接受所有七个测量的 ANC 服务组成部分的频率低于最富裕的使用者（20%比 28%，p 值<0.001）。
埃及 ANC 覆盖率的提高特点是减少对公共服务的依赖，以及 ANC 次数的增加。然而，尽管 ANC 覆盖率有所上升，但仍有不到三分之一的妇女在怀孕期间至少接受过一次包括七个基本 ANC 组成部分的服务，而贫困妇女和富裕妇女之间存在差异。决策者需要确保高 ANC 覆盖率转化为以公平为重点的 ANC 质量干预措施。需要进一步的研究来支持这一努力，评估 ANC 质量差的决定因素，并评估潜在的干预措施。
