自付费用和花在产前保健服务上的时间：尼日尔济宁市选定农村社区孕妇案例研究。
Out-of-pocket costs and time spent attending antenatal care services: a case study of pregnant women in selected rural communities in Zinder, Niger.
机构信息
Department of Nutrition, Institute for Global Nutrition, University of California, One Shields Ave, Davis, CA, 95616, USA.
Department of Agricultural and Resource Economics, University of California, Davis, CA, USA.
出版信息
BMC Health Serv Res. 2021 Jan 8;21(1):47. doi: 10.1186/s12913-020-06027-2.
BACKGROUND
Despite an official policy of exemption from health care costs, pregnant women in Niger still face some out-of-pocket costs (OPC) in addition to time costs when they attend antenatal care (ANC) services. We aimed to: 1) assess the OPC for pregnant woman attending ANC, 2) estimate the time spent to attend ANC and the opportunity cost of that time, and 3) assess how OPC and time spent to attend ANC affected ANC attendance.
METHODS
Data were obtained from a quasi-experimental descriptive study carried out in the region of Zinder, Niger, which compared pre- and post-intervention cohorts of pregnant women (n = 1736 women who reported attending ANC during their current pregnancy). An ANC attendance score was developed to describe the timing of ANC attendance in regard to the WHO recommendation of attending 4 ANC sessions. OPC and time spent were evaluated separately for associations with ANC attendance using Spearman correlations.
RESULTS
The mean (±SD) age of pregnant women was 25.0 ± 6.4 yr, 19.0% were ≤ 19 yr and 99.7% were in their second or third trimester of gestation at the time of the interview. Among those who were > 13 weeks and > 27 weeks of gestation, 4.0 and 74.4% had attended ANC during their first and second trimesters, respectively. The median (1st quartile (Q1), 3rd quartile (Q3)) ANC score was 0 (- 1, 0), reflecting that the majority of women failed to follow the WHO recommendation. More than half of the women (72.5%) experienced OPC related to ANC. The majority of women (> 80%) reported spending ~ 3 h for an ANC visit, including travel and waiting time. Time spent to attend ANC was not associated with ANC attendance score. Women who experienced OPC, and those who received iron folic acid (IFA) or long-lasting insecticide-treated bednets during an ANC visit, were more likely to have a higher ANC attendance score compared to those who did not.
CONCLUSION
OPC and time spent were not identified as barriers to ANC visits, and IFA and long-lasting insecticide-treated bednets distribution could be used to motivate pregnant women to attend ANC.
TRIAL REGISTRATION
The NiMaNu project was registered at www.clinicaltrials.gov as NCT01832688 . Registered 16 April 2013.
背景
尽管尼加拉瓜有免除医疗费用的官方政策，但孕妇在接受产前护理 (ANC) 服务时仍需承担一些自付费用 (OPC)，此外还需花费时间。我们旨在：1) 评估孕妇接受 ANC 时的 OPC；2) 估计接受 ANC 所花费的时间及其机会成本；3) 评估 OPC 和接受 ANC 所花费的时间如何影响 ANC 的参与度。
方法
数据来自于在尼日尔津德尔地区进行的一项准实验性描述性研究，该研究比较了接受 ANC 的孕妇的干预前和干预后队列（n=1736 名在当前妊娠期间报告接受 ANC 的妇女）。我们开发了一个 ANC 参与评分，以描述 ANC 参与的时间，以符合世界卫生组织建议的接受 4 次 ANC 服务的标准。使用 Spearman 相关性分别评估 OPC 和时间花费与 ANC 参与之间的关系。
结果
孕妇的平均（±标准差）年龄为 25.0±6.4 岁，19.0%的孕妇年龄≤19 岁，99.7%的孕妇在访谈时处于妊娠的第二或第三个三个月。在那些怀孕 13 周以上和 27 周以上的孕妇中，分别有 4.0%和 74.4%的孕妇在第一个和第二个三个月接受了 ANC。ANC 评分中位数（第 1 四分位数（Q1），第 3 四分位数（Q3））为 0（-1，0），这反映了大多数孕妇未能遵循世卫组织的建议。超过一半的妇女（72.5%）经历了与 ANC 相关的 OPC。大多数妇女（>80%）报告说，每次 ANC 就诊需要花费~3 小时，包括旅行和等待时间。花在接受 ANC 上的时间与 ANC 参与评分无关。与未经历 OPC 的妇女相比，经历 OPC 的妇女和在 ANC 就诊期间接受铁叶酸 (IFA) 或长效驱虫蚊帐的妇女，更有可能有更高的 ANC 参与评分。
结论
OPC 和时间花费不是 ANC 就诊的障碍，而 IFA 和长效驱虫蚊帐的分发可以用来激励孕妇接受 ANC。
试验注册
NiMaNu 项目在 www.clinicaltrials.gov 上注册为 NCT01832688。注册日期为 2013 年 4 月 16 日。
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