The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia.
Addis Ababa University School of Public Health, Addis Ababa, Ethiopia.
BMC Pregnancy Childbirth. 2020 Sep 21;20(1):549. doi: 10.1186/s12884-020-03254-7.
The expansion of primary health care services in Ethiopia made basic health services available and accessible. The Last Ten Kilometers (L10K) project has strengthened the primary health care system through implementing innovative strategies to engage local communities to improve maternal and newborn health care behavior and practices in Amhara, Oromia, Southern Nations, Nationalities and Peoples [SNNP], and Tigray regions over a decade. Despite the efforts of the government and its partners to improve the use of maternal health services, the coverage of postnatal care is persistently low in the country. This study examined the individual and community level determinants for the persistently low uptake of postnatal care in the project areas.
The study used a cross-sectional population-based survey that measured maternal and newborn health care practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions. Multilevel random effects binary logistic regression analysis was used to assess the independent effects of community-and individual-level factors and moderating effects on the uptake of postnatal care.
This study identified region of residence, obstetric factors, and health service-related factors to be significant determinants for use of postnatal care. Obstetric factors include knowledge of obstetric danger signs (AOR: 1.30; 95% CI: 1.05-1.60), cesarean section mode of delivery (AOR: 1.96; 95% CI: 1.28-3.00), and institutional delivery (AOR: 10.29; 95% CI: 7.57-13.98). While the health service-related factors include attended family conversation during pregnancy (AOR: 1.48; 95% CI: 1.04-2.12), birth notification (AOR: 2.66; 95% CI: 2.15-3.29), home visits by community health workers (AOR: 1.98; 95% CI: 1.58-2.50), and being recognized as a model family (AOR: 1.27; 95% CI: 1.03-1.57).
This study demonstrated that community-level interactions and promotive health services including antepartum home visits by community health workers, family conversation, birth notification, and model family, are important determinants to seek postnatal care. The findings also highlight the need for expansion of health facilities or design appropriate strategies to reach the disadvantaged communities. Program managers are recommended to strengthen community-based interventions to improve postnatal care utilization.
埃塞俄比亚扩大初级卫生保健服务，使基本卫生服务得以普及和获取。“最后十公里”（L10K）项目通过实施创新战略，加强了初级卫生保健系统，使当地社区参与其中，以改善孕产妇和新生儿保健行为和做法，该项目在过去十年中一直在阿姆哈拉、奥罗莫、南方各族人民州和提格雷地区开展。尽管政府及其合作伙伴努力提高产妇保健服务的利用率，但该国的产后护理覆盖率仍然很低。本研究调查了项目地区持续低吸收率的个体和社区层面决定因素。
本研究采用了一项基于人群的横断面调查，该调查衡量了过去 12 个月内在阿姆哈拉、奥罗莫、南方各族人民州和提格雷地区分娩的妇女的母婴保健做法。多水平随机效应二元逻辑回归分析用于评估社区和个体层面因素的独立影响以及对产后护理利用率的调节作用。
本研究确定了居住地区、产科因素和与卫生服务相关的因素是使用产后护理的重要决定因素。产科因素包括了解产科危险信号（AOR：1.30；95%CI：1.05-1.60）、剖宫产分娩方式（AOR：1.96；95%CI：1.28-3.00）和机构分娩（AOR：10.29；95%CI：7.57-13.98）。而与卫生服务相关的因素包括在怀孕期间参加家庭对话（AOR：1.48；95%CI：1.04-2.12）、出生通知（AOR：2.66；95%CI：2.15-3.29）、社区卫生工作者的家访（AOR：1.98；95%CI：1.58-2.50）和被认定为模范家庭（AOR：1.27；95%CI：1.03-1.57）。
本研究表明，社区层面的互动和促进性保健服务，包括社区卫生工作者的产前家访、家庭对话、出生通知和模范家庭，是寻求产后护理的重要决定因素。研究结果还强调需要扩大卫生设施或设计适当的战略，以覆盖弱势社区。建议项目管理人员加强以社区为基础的干预措施，以提高产后护理利用率。
