撒哈拉以南非洲地区产后护理利用的决定因素：来自 36 个撒哈拉以南非洲国家数据的荟萃分析和多层次分析。

Determinants of postnatal care utilization in sub-Saharan Africa: a meta and multilevel analysis of data from 36 sub-Saharan countries.

机构信息

Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

出版信息

Ital J Pediatr. 2020 Nov 27;46(1):175. doi: 10.1186/s13052-020-00944-y.

DOI:10.1186/s13052-020-00944-y

PMID:33246475

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7693498/

Abstract

INTRODUCTION

Globally, over 65% of maternal deaths occur during the first 42 days of postpartum while the same proportion of neonatal deaths occur during the first 7 days of life. In sab- Saharan Africa, 4.7 million mothers, newborns, and children die on annual basis. As to our knowledge, there is no study on postnatal care utilization that incorporates all sub-Saharan Africa countries that had DHS data. Therefore, this study aimed at identifying pooled magnitude and determinants of postnatal care utilization in sub-Saharan Africa.

METHOD

A population-based cross-sectional study from the most recent Demographic and Health Surveys data from the period of 2006 to 2018 of 36 SSA countries were used. A total weighted sample of 286,255 reproductive-age women who gave birth 5 years preceding the survey were included in the study. A meta-analysis of DHS data of each Sub-Saharan countries was conducted to generate pooled magnitude and a forest plot was used to present it. A multilevel logistic regression model was fitted to identify determinants of postnatal care utilization. The AOR (Adjusted Odds Ratio) with their 95% CI and p-value ≤0.05 was used to declare that determinates associated with postnatal care utilization.

RESULT

The pooled magnitude of postnatal care utilization in sub-Saharan Africa countries was 52.48% [95% CI: 52.33, 52.63], with the highest postnatal care utilization in the Central Region of Africa (73.51%) and the low postnatal care utilization in Eastern Regions of Africa (31.71%). In the multilevel logistic regression model region, residence, age group, maternal education, maternal occupation, media exposure, ANC visit, place of delivery, and accessing health care were determinants of postnatal care utilization in Sub-Saharan Africa.

CONCLUSION

The coverage of postnatal care service utilization was low with high disparities among the region. Being in rural residence, young age group, low education level, had no occupation, not exposed to media, a big problem to access health care, not had ANC visit, and home delivery was associated with low postnatal care service utilization. This study evidenced that there is a wide gap in postnatal care utilization between SSA countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services to increase postnatal care service utilization in the region.

摘要

简介

在全球范围内，超过 65%的产妇死亡发生在产后的头 42 天，而同样比例的新生儿死亡发生在生命的头 7 天。在撒哈拉以南非洲，每年有 470 万母亲、新生儿和儿童死亡。据我们所知，没有一项研究将所有有 DHS 数据的撒哈拉以南非洲国家纳入产后护理利用情况。因此，本研究旨在确定撒哈拉以南非洲地区产后护理利用的综合规模和决定因素。

方法

本研究采用了 2006 年至 2018 年期间最新的人口为基础的横断面调查数据，来自 36 个撒哈拉以南非洲国家的人口动态调查数据。该研究共纳入了 286255 名在调查前 5 年内分娩的育龄妇女的加权总样本。对每个撒哈拉以南非洲国家的人口动态调查数据进行了荟萃分析，以生成综合规模，并使用森林图进行呈现。使用多水平逻辑回归模型来确定产后护理利用的决定因素。使用调整后的优势比（调整后的优势比）及其 95%置信区间和 p 值≤0.05 来表示与产后护理利用相关的决定因素。

结果

撒哈拉以南非洲国家的产后护理利用综合规模为 52.48%[95%置信区间：52.33，52.63]，其中非洲中部地区的产后护理利用最高（73.51%），而非洲东部地区的产后护理利用最低（31.71%）。在多水平逻辑回归模型中，区域、居住地、年龄组、母亲教育、母亲职业、媒体接触、ANC 就诊、分娩地点和获得医疗保健是撒哈拉以南非洲地区产后护理利用的决定因素。

结论

该地区的产后护理服务利用覆盖率较低，地区间差距较大。居住在农村、年龄较小、教育程度较低、没有职业、没有接触媒体、难以获得医疗保健、没有接受 ANC 就诊和在家分娩与低产后护理服务利用有关。本研究表明，撒哈拉以南非洲国家在产后护理利用方面存在很大差距。需要特别注意改善卫生可及性、利用和孕产妇保健服务质量，以提高该地区的产后护理服务利用水平。