World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt.
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
J Glob Health. 2019 Dec;9(2):020406. doi: 10.7189/jogh.09.020406.
Africa, and sub-Saharan Africa in particular, remains one of the regions with modest improvements to maternal and newborn survival and morbidity. Good quality intrapartum and early postpartum care in a health facility as well as delivery under the supervision of trained personnel is associated with improved maternal and newborn health outcomes and decreased mortality. We describe and contrast recent time trends in the scale and socio-economic inequalities in facility-based and private facility-based childbirth in sub-Saharan Africa.
We used Demographic and Health Surveys in two time periods (2000-2007 and 2008-2016) to analyse levels and time trends in facility-based and private facility-based deliveries for all live births in the five-year survey recall period to women aged 15-49. Household wealth quintiles were used for equity analysis. Absolute numbers of births by facility sector were calculated applying UN Population Division crude birth rates to the total country population.
The percentage of all live births occurring in health facilities varied across countries (5%-85%) in 2000-2007. In 2008-2016, this ranged from 22% to 92%. The lowest percentage of all births occurring in private facilities in 2000-2007 period was in Ethiopia (0.3%) and the highest in the Democratic Republic of Congo at 20.5%. By 2008-2016, this ranged from 0.6% in Niger to 22.3% in Gabon. Overall, the growth in the absolute numbers of births in facilities outpaced the growth in the percentage of births in facilities. The largest increases in absolute numbers of births occurred in public sector facilities in all countries. Overall, the percentage of births occurring in facilities was significantly lower for poorest compared to wealthiest women. As the percentage of facility births increased in all countries over time, the extent of wealth-based differences had reduced between the two time periods in most countries (median risk ratio in 2008-2016 was 2.02). The majority of countries saw a narrowing in both the absolute and relative difference in facility-based deliveries between poorest and wealthiest.
The growth in facility-based deliveries, which was largely driven by the public sector, calls for increased investments in effective interventions to improve service delivery and quality of life for the mother and newborn. The goal of universal health coverage to provide better quality services can be achieved by deploying interventions that are holistic in managing and regulating the private sector to enhance performance of the health care system in its entirety rather than interventions that only target service delivery in one sector.
非洲，特别是撒哈拉以南非洲地区，在改善母婴生存和发病率方面仅有适度的进展。在医疗机构中提供高质量的分娩期和产后早期护理，并由经过培训的人员进行分娩，可改善母婴健康结局并降低死亡率。我们描述并对比了最近一段时间撒哈拉以南非洲地区以设施为基础和私立机构为基础的分娩规模和社会经济不平等的变化趋势。
我们使用两个时期的人口与健康调查（2000-2007 年和 2008-2016 年），分析了在五年调查回顾期内，15-49 岁妇女所有活产儿在设施内分娩和私立机构分娩的水平和时间趋势。使用家庭财富五分位数进行公平性分析。通过将联合国人口司的粗出生率应用于全国总人口，计算出各设施部门的出生绝对数量。
在 2000-2007 年期间，各国所有活产儿在医疗机构中分娩的比例不同（5%-85%）。在 2008-2016 年期间，这一比例从 22%到 92%不等。2000-2007 年期间，所有分娩中在私立机构中分娩的比例最低的国家是埃塞俄比亚（0.3%），最高的是刚果民主共和国（20.5%）。到 2008-2016 年期间，这一比例从尼日尔的 0.6%到加蓬的 22.3%不等。总体而言，设施内分娩的绝对数量增长速度超过了设施内分娩比例的增长速度。在所有国家中，公共部门设施的分娩绝对数量增长最大。总体而言，与最富裕的妇女相比，最贫穷的妇女在设施内分娩的比例要低得多。随着所有国家设施分娩比例的增加，在大多数国家，两个时期之间基于财富的差异有所缩小（2008-2016 年的中位数风险比为 2.02）。大多数国家的设施分娩绝对和相对差异都有所缩小，无论是最贫穷的还是最富裕的妇女。
设施内分娩的增长主要是由公共部门推动的，这需要增加投资，以改善服务提供和母婴生活质量。全民健康覆盖的目标是提供更好质量的服务，可以通过实施整体管理和监管私营部门的干预措施来实现，以增强整个医疗保健系统的绩效，而不是仅针对一个部门的服务提供实施干预措施。
