埃塞俄比亚至少一次产前保健就诊后的家庭分娩的空间聚集性及其决定因素：2016 年埃塞俄比亚人口与健康调查。

BACKGROUND: All pregnancies are at risk and have to be attended by skilled professionals. In Ethiopia however nearly half (45.7%) of the women were giving birth at home after antenatal care (ANC) visits in which skilled professionals were not available. Therefore, the aim of this study was to assess spatial clustering and the determinant factors of home delivery after antenatal care visits in Ethiopia. METHODS: A case control study was conducted on 2110 mothers who gave birth at home after ANC (cases), and 2510 mothers who gave birth at health institutions after attending ANC (controls), based on EDHS 2016 data. As per the recommendations of the DHS program, we weighed the data before analysis. ArcGIS 10.3 was used to show spatial pattern and SaTScan™ 9.4 to identify significant clusters. Stata 14 was used for data cleaning, weighing, and the analysis of the determinant factors. Bi variable and multi variable multilevel mixed effect logistic regression was fitted. Finally, the Log-likelihood ratio (LLR) and Relative risk with p-value of spatial scan statistics and AOR with 95% CI for significant determinant factors were reported. RESULTS: Home delivery after ANC was spatially clustered in Ethiopia (Moran's Index = 0.91, p-value< 0.01). Attending, 1-3 ANC visits (AOR = 1.41, 95%CI: 1.17-1.71), no information about birth preparedness plan (AOR = 2.21, 95%CI: 1.83-2.69), pregnancies wanted later (AOR = 1.55, 95%CI: 1.20, 2.06), not having health insurance (AOR = 2.16, 95% CI: 1.29, 3.62), Muslim (AOR = 1.57, 95% CI: 1.13, 2.19) and protestant (AOR = 1.72, 95%CI: 1.16, 2.42) religions were positively associated with home delivery; While being rich (AOR = 0.42, 95%CI: 0.32-0.54), middle wealth index (AOR = O.66, 95%CI: 0.51, 0.86), primary education (AOR = 0.45, 95%CI: 0.36-0.55), secondary education (AOR = 0.11, 95%CI: 0.07-0.16), above secondary education (AOR = 0.06, 95%CI: 0.03-0.11) were negatively associated. CONCLUSIONS: Home delivery after ANC follow ups was spatially clustered. Socio-demographic, health service and pregnancy related factors determined the prevalence of home delivery after antenatal care visits. Strengthening women's education, ANC visit, giving more information about birth preparedness plan, and improving family wealth are vital to reduce home delivery after antenatal care visits.

背景：所有妊娠都存在风险，都需要由熟练的专业人员进行护理。然而，在埃塞俄比亚，近一半（45.7%）的妇女在接受产前护理（ANC）就诊后在家中分娩，而在这些就诊中没有提供熟练的专业人员。因此，本研究旨在评估埃塞俄比亚 ANC 就诊后在家分娩的空间聚集性和决定因素。

方法：根据 2016 年 EDHS 数据，对 2110 名在 ANC 就诊后在家分娩的产妇（病例）和 2510 名在 ANC 就诊后在医疗机构分娩的产妇（对照）进行了病例对照研究。根据 DHS 计划的建议，我们在分析前对数据进行了加权。ArcGIS 10.3 用于显示空间模式，SaTScan™ 9.4 用于识别显著聚类。Stata 14 用于数据清理、加权和决定因素的分析。拟合了双变量和多变量多层混合效应逻辑回归。最后，报告了空间扫描统计的对数似然比（LLR）和相对风险（p 值）和显著决定因素的优势比（AOR）和 95%置信区间。

结果：埃塞俄比亚 ANC 就诊后的分娩呈空间聚集性（Moran's Index=0.91，p 值<0.01）。参加 1-3 次 ANC 就诊（AOR=1.41，95%CI：1.17-1.71）、没有关于生育准备计划的信息（AOR=2.21，95%CI：1.83-2.69）、想要晚育（AOR=1.55，95%CI：1.20-2.06）、没有健康保险（AOR=2.16，95%CI：1.29-3.62）、穆斯林（AOR=1.57，95%CI：1.13-2.19）和新教（AOR=1.72，95%CI：1.16-2.42）宗教与在家分娩呈正相关；而富裕（AOR=0.42，95%CI：0.32-0.54）、中等财富指数（AOR=O.66，95%CI：0.51-0.86）、小学教育（AOR=0.45，95%CI：0.36-0.55）、中学教育（AOR=0.11，95%CI：0.07-0.16）和高等教育（AOR=0.06，95%CI：0.03-0.11）呈负相关。

结论：ANC 随访后的在家分娩呈空间聚集性。社会人口学、卫生服务和妊娠相关因素决定了 ANC 就诊后的在家分娩率。加强妇女教育、ANC 就诊、提供更多关于生育准备计划的信息，以及改善家庭财富，对于降低 ANC 就诊后的在家分娩率至关重要。