Makerere University College of Health Sciences and School of Public Health, Kampala, Uganda.
Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
BMC Pregnancy Childbirth. 2020 Aug 27;20(1):497. doi: 10.1186/s12884-020-03194-2.
Delivery in a facility with a skilled health provider is considered the most important intervention to reduce maternal and early newborn deaths. Providing care close to people's homes is an important strategy to facilitate equitable access, but many women are known to bypass the closest delivery facility for a higher level one. The aim of this study was to investigate to what extent mothers in rural Uganda bypassed their nearest facility for childbirth care and the determinants for their choice.
The study used data collected as part of the Expanded Quality Management Using Information power (EQUIP) study in the Mayuge District of Eastern Uganda between 2011 and 2014. In this study, bypassing was defined as delivering in a health facility that was not the nearest childbirth facility to the mother's home. Multilevel logistic regression was used to model the relationship between bypassing the nearest health facility for childbirth and the different independent factors.
Of all women delivering in a health facility, 45% (499/1115) did not deliver in the nearest facility regardless of the level of care. Further, after excluding women who delivered in health centre II (which is not formally equipped to provide childbirth care) and excluding those who were referred or had a caesarean section (because their reasons for bypassing may be different), 29% (204/717) of women bypassed their nearest facility to give birth in another facility, 50% going to the only hospital of the district. The odds of bypassing increased if a mother belonged to highest wealth quintile compared to the lowest quintile (AOR 2.24, 95% CI: 1.12-4.46) and decreased with increase of readiness of score of the nearest facility for childbirth (AOR = 0.84, 95% CI: 0.69-0.99).
The extent of bypassing the nearest childbirth facility in this rural Ugandan setting was 29%, and was associated primarily with the readiness of the nearest facility to provide care as well as the wealth of the household. These results suggest inequalities in bypassing for better quality care that have important implications for improving Uganda's maternal and newborn health outcomes.
在有熟练医护人员的医疗机构分娩被认为是降低孕产妇和新生儿早期死亡的最重要干预措施。在靠近人们家的地方提供护理是促进公平获得服务的一项重要策略，但众所周知，许多妇女会绕过离家最近的分娩机构，而选择级别更高的机构。本研究旨在调查乌干达农村地区的产妇在多大程度上会绕过离家最近的分娩机构寻求分娩护理，以及她们选择的决定因素。
本研究使用了 2011 年至 2014 年期间在乌干达东部马尤盖区开展的“利用信息力量扩大质量管理（EQUIP）”研究中收集的数据。在这项研究中，绕过是指在离家最近的分娩机构之外的医疗机构分娩。使用多水平逻辑回归模型来分析绕过离家最近的分娩机构与不同独立因素之间的关系。
在所有在医疗机构分娩的妇女中，有 45%（499/1115）没有在离家最近的机构分娩，无论其护理水平如何。此外，在排除了在卫生中心二（该中心没有正式配备提供分娩护理的设备）分娩的妇女和转诊或剖腹产的妇女（因为她们绕过的原因可能不同）后，有 29%（204/717）的妇女绕过离家最近的机构，到另一家机构分娩，其中 50%的妇女前往该地区唯一的医院。与最贫穷的五分位数相比，属于最高财富五分位数的母亲更有可能绕过离家最近的机构（优势比 2.24，95%置信区间：1.12-4.46），而随着离家最近的分娩机构准备情况评分的增加，绕过的可能性会降低（优势比=0.84，95%置信区间：0.69-0.99）。
在乌干达农村地区，绕过离家最近的分娩机构的程度为 29%，这主要与离家最近的机构提供护理的准备情况以及家庭的财富有关。这些结果表明，在寻求更好的护理质量方面存在不平等现象，这对改善乌干达的孕产妇和新生儿健康结果具有重要意义。
