Kimario Florence F, Festo Charles, Shabani Josephine, Mrisho Mwifadhi
Nelson Mandela African Institute of Science and Technology in Collaboration with Ifakara Health Institute. P.O. Box 447, Arusha, Tanzania.
Kilimanjaro Christian Medical Centre, (KCMC), P.O. BOX 3010, Moshi, Tanzania.
Int J MCH AIDS. 2020;9(2):191-199. doi: 10.21106/ijma.361. Epub 2020 Apr 23.
The United Nation's Sustainable Development Goal number 3 aims at reducing the maternal mortality rate by less than 70/100,000 live births globally and 216/100,000 live births in developing regions by 2030. Despite several interventions in Tanzania, maternal mortality has increased from 454/100,000 live births in 2010 to 556/100,000 live births in 2015. Home delivery and maternal young age contribute to maternal deaths. Reducing home deliveries among women aged 15-24 years may likely decrease the prevalence of maternal deaths in Tanzania. This study investigated the determinants of home delivery among women aged 15- 24 years in rural and mainland districts of Tanzania.
This study uses a mixed-methods approach using data collected as part of the evaluation of government and UNICEF interventions in 13 districts of Tanzania mainland from October and November 2011. Results from the secondary analysis were supplemented by qualitative data collected between February and April 2019 from four rural districts: Bagamoyo, Tandahimba, Magu, and Moshi.
A total of 409 adolescents and young women who delivered one year before the quantitative data collection were included in the final analysis. A quarter of them gave birth at home. Having at least four antenatal care (ANC) visits (OR=0.23, 95% CI: 0.12-0.41, p<0.01), planning place of delivery (OR=0.22, 95% CI: 0.14-0.36 p<0.01), and knowledge of the danger signs during pregnancy (OR=0.36, 95% CI: 0.22-0.57, p<0.01) were significantly associated with the place of delivery.
Maternal level of education, number of ANC visits attended, planned place of delivery, and knowledge of danger signs during pregnancy were the determinants of the choice of place of delivery among women aged 15-24 years in Tanzania. Understanding these risk factors is important in designing programs and interventions to reduce maternal deaths from women of this age group which contributes about 18% of all maternal deaths in Tanzania.
联合国可持续发展目标3旨在到2030年将全球孕产妇死亡率降至每10万活产少于70例，将发展中地区降至每10万活产216例。尽管坦桑尼亚采取了多项干预措施，但孕产妇死亡率已从2010年的每10万活产454例增至2015年的每10万活产556例。在家分娩和产妇年龄小导致孕产妇死亡。减少15至24岁女性的在家分娩情况可能会降低坦桑尼亚孕产妇死亡的发生率。本研究调查了坦桑尼亚农村和大陆地区15至24岁女性在家分娩的决定因素。
本研究采用混合方法，使用了2011年10月和11月作为对坦桑尼亚大陆13个地区政府和联合国儿童基金会干预措施评估一部分所收集的数据。二次分析结果得到了2019年2月至4月从四个农村地区（巴加莫约、坦达希姆巴、马古和莫希）收集的定性数据的补充。
共有409名在定量数据收集前一年分娩的青少年和年轻女性纳入最终分析。其中四分之一在家分娩。至少进行四次产前检查（ANC）（比值比=0.23，95%置信区间：0.12 - 0.41，p<0.01）、规划分娩地点（比值比=0.22，95%置信区间：0.14 - 0.36，p<0.01）以及了解孕期危险信号（比值比=0.36，95%置信区间：0.22 - 0.57，p<0.01）与分娩地点显著相关。
孕产妇教育水平、产前检查次数、规划的分娩地点以及孕期危险信号知识是坦桑尼亚15至24岁女性分娩地点选择的决定因素。了解这些风险因素对于设计减少该年龄组女性孕产妇死亡的项目和干预措施很重要，该年龄组女性的孕产妇死亡约占坦桑尼亚所有孕产妇死亡的18%。
