Yaya Sanni, Oladimeji Olanrewaju, Oladimeji Kelechi Elizabeth, Bishwajit Ghose
School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada.
The George Institute for Global Health, The University of Oxford, Hayes House, 75 George Street, Oxford, UK.
BMC Public Health. 2020 Apr 15;20(1):485. doi: 10.1186/s12889-020-08618-4.
Improving the coverage of antenatal care is regarded as an important strategy to reduce the risks of maternal and child mortality in low income settings like Gambia. Nonetheless, a large number of countries in Africa, including Gambia, are struggling to attain an optimum level of healthcare utilization among pregnant women. The role of socioeconomic inequalities in maternal healthcare uptake has received little attention in Gambia. To address this evidence gap, the present study analyses nationally representative data to explore the socioeconomic inequalities in the use of maternal healthcare.
Data on women aged 15-49 years (n = 5351) were extracted from the latest round of Gambia Demographic and Health Survey in 2013 for this study. The outcome measures were early and adequate antenatal visit and HIV tests during the last pregnancy. Data were analyzed using descriptive and multivariate regression methods. Socioeconomic status was assessed through the women's education, type of employment, and household wealth quintile.
From the total of 5351 participants included in the study, 38.7 and 78.8% of the women had early and adequate ANC visits respectively with a 65.4% HIV test coverage during ANC visits. The odds of early [OR = 1.30, 95% confidence interval (CI) =1.06, 1.59] and adequate [OR = 1.45, 95%CI = 1.15, 1.82] ANC visits were higher in the rural areas compared with urban. Women with secondary [OR = 1.24, 95%CI = 1.04, 1.48] and higher education [OR = 1.80, 95%CI = 1.20, 2.70] had higher odds of making early ANC visits. Women from richest wealth quintile households had significantly higher odds of having early [OR = 1.49, 95%CI = 1.14, 1.95] and adequate ANC visits [OR = 2.06, 95%CI = 1.48, 2.87], but not of having HIV tests. Having access to electronic media showed a positive association with adequate ANC visits [OR = 1.32, 95%CI = 1.08, 1.62] and with taking HIV test during ANC [OR = 1.48, 95%CI = 1.21, 1.80]. A fewer odds of having unintended child was associated with early ANC visit [OR = 0.70, 95%CI = 0.59, 0.84], but positively associated with taking HIV test [OR = 1.75, 95%CI = 1.42, 2.15].
A large proportion of women in Gambia were not using antenatal care and HIV tests during pregnancy. There are important sociodemographic differences in using maternal healthcare services such as HIV testing during pregnancy. This calls for strategic direction to promote the utilization of these services.
在冈比亚这样的低收入地区，提高产前保健覆盖率被视为降低孕产妇和儿童死亡率风险的一项重要策略。尽管如此，包括冈比亚在内的非洲许多国家仍在努力实现孕妇医疗保健利用的最佳水平。社会经济不平等在孕产妇医疗保健获取方面所起的作用在冈比亚很少受到关注。为填补这一证据空白，本研究分析了具有全国代表性的数据，以探讨孕产妇医疗保健使用方面的社会经济不平等。
本研究从2013年最新一轮冈比亚人口与健康调查中提取了15至49岁女性（n = 5351）的数据。结果指标为上次怀孕期间的早期和充分产前检查以及艾滋病毒检测。使用描述性和多变量回归方法对数据进行分析。通过女性的教育程度、就业类型和家庭财富五分位数来评估社会经济地位。
在纳入研究的5351名参与者中，分别有38.7%和78.8%的女性进行了早期和充分的产前检查，产前检查期间艾滋病毒检测覆盖率为65.4%。与城市地区相比，农村地区进行早期[比值比（OR）= 1.30，95%置信区间（CI）= 1.06，1.59]和充分[OR = 1.45，95%CI = 1.15，1.82]产前检查的几率更高。接受过中等[OR = 1.24，95%CI = 1.04，1.48]及以上教育[OR = 1.80，95%CI = 1.20，2.70]的女性进行早期产前检查的几率更高。来自最富裕财富五分位数家庭的女性进行早期[OR = 1.49，95%CI = 1.14，1.95]和充分产前检查[OR = 2.06，95%CI = 1.48，2.87]的几率显著更高，但进行艾滋病毒检测的几率并非如此。能够使用电子媒体与充分的产前检查[OR = 1.32，95%CI = 1.08，1.62]以及产前检查期间进行艾滋病毒检测[OR = 1.48，95%CI = 1.21，1.80]呈正相关。意外怀孕几率较低与早期产前检查相关[OR = 0.70，95%CI = 0.59，0.84]，但与进行艾滋病毒检测呈正相关[OR = 1.75，95%CI = 1.42，2.15]。
冈比亚很大一部分女性在孕期未使用产前保健和艾滋病毒检测。在使用孕产妇医疗保健服务（如孕期艾滋病毒检测）方面存在重要的社会人口学差异。这需要战略指导以促进这些服务的利用。
