埃塞俄比亚居家分娩的时空分布及相关因素。对埃塞俄比亚 2005-2016 年人口与健康调查的进一步多水平和空间分析。
Spatio-temporal distribution and associated factors of home delivery in Ethiopia. Further multilevel and spatial analysis of Ethiopian demographic and health surveys 2005-2016.
机构信息
Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Public Health, College of Health Sciences, Debre Tabor University, P.O. Box. 272, Debre Tabor, Ethiopia.
出版信息
BMC Pregnancy Childbirth. 2020 Jun 3;20(1):342. doi: 10.1186/s12884-020-02986-w.
BACKGROUND
Globally, between 2012 and 2017, 80% of live births occurred at health facilities assisted by skilled health personnel. In Ethiopia, in 2016 only 26% of live births attended by skilled health personal. This study aimed to assess the spatial patterns and associated factors of home delivery in Ethiopia using 2005, 2011, and 2016 Ethiopian Demographic and Health Surveys.
METHODS
A total of 33,482 women who gave live birth in the 5 years preceding each survey were included for this study. ArcGIS version 10.7 software was used to visualize the spatial distribution of home delivery. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant purely spatial clusters for home delivery in Ethiopia. A multilevel logistic regression model was fitted to identify factors associated with home delivery. A p-value < 0.05 was taken to declare statistically significant predictors.
RESULTS
Home delivery was declined from 94.78% in 2005, 90.05% in 2011, and 73.44% in 2016 in Ethiopia. Among the three surveys, consistently high clustering of home delivery was observed in Amhara and Southern Nations Nationalities and People's Regions (SNNPR) of Ethiopia. In spatial scan statistics analysis, a total of 128 clusters (RR = 1.04, P-value < 0.001) in 2005, and 90 clusters (RR = 1.11, P-value < 0.001) in 2011, and 55 clusters (RR = 1.29, P-value < 0.001) in 2016 significant primary clusters were identified. Educational status of women and husband, religion, distance to the health facility, mobile access, antenatal care visit, birth order, parity, wealth index, residence, and Region were statistically significant predictors of home delivery.
CONCLUSION
The spatial distribution of home delivery among the three consecutive surveys were non-random in Ethiopia. Educational status of women and husband, religion, distance to the health facility, wealth index, residence, parity, mobile access, Region, and antenatal care visit were statistically significant predictors of home delivery in Ethiopia. Therefore, an intervention needs to improve the coverage of antenatal care visit, and health care facilities. Ministry of health and other stakeholders should give special attention to women living in Amhara and SNNPR states of Ethiopia.
背景
在全球范围内，2012 年至 2017 年期间，80%的活产在有熟练卫生人员协助的卫生机构中发生。在埃塞俄比亚，2016 年仅有 26%的活产由熟练卫生人员接生。本研究旨在使用 2005 年、2011 年和 2016 年埃塞俄比亚人口与健康调查数据，评估埃塞俄比亚在家分娩的空间模式和相关因素。
方法
本研究共纳入了在每次调查前 5 年内分娩的 33482 名妇女。使用 ArcGIS 版本 10.7 软件可视化在家分娩的空间分布。使用 Kilduff SaTScan 版本 9.6 软件中的 Bernoulli 模型，确定埃塞俄比亚在家分娩的显著纯空间聚类。使用多水平逻辑回归模型确定与在家分娩相关的因素。p 值<0.05 被认为具有统计学意义的预测因子。
结果
埃塞俄比亚在家分娩的比例从 2005 年的 94.78%、2011 年的 90.05%和 2016 年的 73.44%下降。在这三次调查中，阿姆哈拉和南部地区的家庭分娩一直高度集中在埃塞俄比亚的民族和人民地区（SNNPR）。在空间扫描统计分析中，2005 年共发现 128 个聚类（RR=1.04，P 值<0.001），2011 年发现 90 个聚类（RR=1.11，P 值<0.001），2016 年发现 55 个聚类（RR=1.29，P 值<0.001）。这些聚类均具有统计学意义。妇女和丈夫的教育状况、宗教信仰、到卫生机构的距离、移动接入、产前保健访问、出生顺序、胎次、财富指数、居住地和地区是在家分娩的统计学显著预测因子。
结论
埃塞俄比亚三次连续调查的家庭分娩空间分布均为非随机的。妇女和丈夫的教育状况、宗教信仰、到卫生机构的距离、财富指数、居住地、胎次、移动接入、地区和产前保健访问是埃塞俄比亚家庭分娩的统计学显著预测因子。因此，需要采取干预措施提高产前保健访问和医疗保健设施的覆盖率。卫生部门和其他利益攸关方应特别关注居住在阿姆哈拉和 SNNPR 州的埃塞俄比亚妇女。
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