乌干达与使用医疗机构提供的分娩协助相关的社区层面因素：一项多水平分析。
Community-level factors associated with the use of facility-based delivery assistance in Uganda: a multilevel analysis.
机构信息
Institute for Health Metrics and Evaluation, Seattle, USA.
Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.
出版信息
BMC Pregnancy Childbirth. 2020 Apr 3;20(1):195. doi: 10.1186/s12884-020-2851-0.
BACKGROUND
In low- and middle-income countries, the proportion of pregnant women who use health facilities for delivery remains low. Although delivering in a health facility with skilled health providers can make the critical difference between survival and death for both mother and child, in 2016, more than 25% of pregnant women did not deliver in a health facility in Uganda. This study examines the association of contextual factors measured at the community-level with use of facility-based delivery in Uganda, after controlling for household and individual-level factors.
METHODS
Pooled household level data of 3310 observations of women who gave birth in the last five years is linked to community level data from the Uganda National Panel Survey (UNPS). A multilevel model that adequately accounted for the clustered nature of the data and the binary outcome of whether or not the woman delivered in a health facility was estimated.
RESULTS
The study findings show a positive association at the county level between place of delivery, education and access to health services, and a negative association between place of delivery and poverty. Individuals living in communities with a high level of education amongst the household heads were 1.67 times (95% Confidence Interval: 1.07-2.61) more likely to have had a facility-based delivery compared to women living in communities where household heads did not have high levels of education. Women who lived in counties with a short travel time (less than 33 min) were 1.66 times (95% CI: 1.11-2.48) more likely to have had a facility-based delivery compared to women who lived in counties with longer travel time to any health facility. Women living in poor counties were only 0.64 times (95% CI: 0.42-0.97) as likely to have delivered in a health facility compared to pregnant women from communities with more affluent individuals.
CONCLUSIONS
The findings on household head's education, community economic status and travel time to a health facility are useful for defining the attributes for targeting and developing relevant nation-wide community-level health promotion campaigns. However, limited evidence was found in broad support of the role of community level factors.
背景
在中低收入国家，使用医疗设施分娩的孕妇比例仍然较低。虽然在有熟练卫生保健提供者的医疗机构分娩可以为母婴的生存和死亡带来至关重要的区别，但在 2016 年，乌干达仍有超过 25%的孕妇没有在医疗机构分娩。本研究在控制家庭和个人层面因素的基础上，考察了社区层面的背景因素与乌干达利用医疗机构分娩之间的关联。
方法
将最近五年内分娩的 3310 名妇女的家庭层面数据与乌干达国家面板调查（UNPS）的社区层面数据进行了汇总。使用充分考虑到数据聚类性质和是否在医疗机构分娩的二元结果的多水平模型进行了估计。
结果
研究结果表明，在县一级，分娩地点、教育程度和获得卫生服务的机会与分娩地点之间存在正相关，而分娩地点与贫困之间存在负相关。与生活在没有高教育程度家庭户主的社区的妇女相比，生活在户主受教育程度高的社区的个人更有可能在医疗机构分娩，几率为 1.67 倍（95%置信区间：1.07-2.61）。与生活在前往任何医疗机构旅行时间较长（超过 33 分钟）的县的妇女相比，生活在旅行时间较短（少于 33 分钟）的县的妇女更有可能在医疗机构分娩，几率为 1.66 倍（95%CI：1.11-2.48）。与来自较富裕社区的孕妇相比，生活在贫困县的孕妇在医疗机构分娩的可能性仅为 0.64 倍（95%CI：0.42-0.97）。
结论
关于家庭户主教育、社区经济状况和前往医疗机构的旅行时间的发现，对于确定目标和制定相关的全国性社区一级健康促进活动的属性很有用。然而，没有发现广泛支持社区一级因素作用的证据。
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