The Department of Geography, University of Western Ontario, Social Science Centre, 1151 Richmond Street, London, Ontario, N6A 5C2, Canada.
Department of Schulich, School of Medicine and Dentistry, University of Western Ontario, London, Ontario, N6G 5C2, Canada.
Global Health. 2020 May 5;16(1):40. doi: 10.1186/s12992-020-00570-7.
Achieving maternal health outcomes in the SDGs requires the implementation of more targeted policies and strategies. While the MDGs may have deepened our understanding in this regard, we know little about the trends in maternal health services utilisation among primigravidas, and how age and geographical regions could have influenced these trends. In this study, we examined utilisation of antenatal and skilled delivery services among primigravidas in Uganda, a country with one of the highest maternal mortality ratios, and where early childbearing and its attendant challenges are common.
Guided by Andersen's Behavioural Model, we fitted multivariate regression models to a pooled dataset of the 2006, 2011 and 2016 Ugandan Demographic and Health Survey (n = 3477) to understand the dynamics in Antenatal Care (ANC) and Skilled Birth Attendance (SBAs) utilisation among primigravidas. Post-estimation margins were employed to further highlight the effect of age and geographical regions.
The analyses show an improvement in access to maternal health services among primigravidas from 2006 to 2016. Compared to 2006, primigravidas in 2016 were 48%, 24% and 2.98 times more likely to have early ANC, four or more ANC visits, and SBAs, respectively. Altogether, a primigravida in 2016 relative to 2006 was 42% more likely to meet all three maternal health service indicators. Post-estimation margins analyses on age and geographical disparities revealed that younger primigravidas have lower probability, while primigravidas in Eastern Region, one of the most deprived in the country, have the lowest probability of accessing maternal health services. Also, the study found education, wealth, women's household decision-making power, place of residence as important determinants of ANC visits and SBAs.
Based on our findings, it is important to address the vulnerabilities of primigravidas, particularly younger individuals, in accessing early ANC. Uganda should scale-up decentralisation and integration of maternal health delivery in local communities as a strategy of addressing lingering geographical disparities, and ultimately improve maternal health outcomes in the SDGs period.
要实现可持续发展目标中的母婴健康成果，就需要实施更有针对性的政策和战略。虽然千年发展目标可能使我们对此有了更深入的了解，但我们对初产妇利用孕产妇保健服务的趋势知之甚少，也不清楚年龄和地理位置如何影响这些趋势。在这项研究中，我们考察了乌干达初产妇利用产前和熟练接生服务的情况，乌干达是孕产妇死亡率最高的国家之一，早育及其伴随的挑战很常见。
本研究以安德森行为模式为指导，对 2006 年、2011 年和 2016 年乌干达人口与健康调查的汇总数据集进行了多变量回归模型拟合，以了解初产妇利用产前护理和熟练接生服务的动态。我们采用后估计边际进一步强调了年龄和地理位置的影响。
分析结果表明，2006 年至 2016 年期间，初产妇获得孕产妇保健服务的机会有所改善。与 2006 年相比，2016 年的初产妇接受早期产前护理、进行四次或更多次产前检查和利用熟练接生服务的可能性分别增加了 48%、24%和 2.98 倍。总体而言，与 2006 年相比，2016 年的初产妇有 42%的可能性同时满足所有三项孕产妇保健服务指标。关于年龄和地域差异的后估计边际分析表明，年轻的初产妇获得服务的可能性较低，而在该国最贫困的东部地区，初产妇获得服务的可能性最低。此外，研究还发现，教育、财富、妇女在家庭中的决策权、居住地是影响产前检查和熟练接生服务利用的重要决定因素。
根据我们的研究结果，必须解决初产妇，特别是年轻初产妇在获得早期产前护理方面的脆弱性问题。乌干达应扩大孕产妇保健服务提供的权力下放和整合，将其作为解决持续存在的地域差异的战略，并最终改善可持续发展目标时期的母婴健康成果。
