乌干达鲁昆吉里和卡农古地区医院服务区内产妇住院分娩的影响因素。
Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda.
机构信息
Department of Disease Control and Environmental Health, School of Public Health, Kampala, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
The Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA.
出版信息
BMC Pregnancy Childbirth. 2021 Apr 26;21(1):329. doi: 10.1186/s12884-021-03789-3.
BACKGROUND
Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda.
METHODS
Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers' sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth.
RESULTS
The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01-1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02-1.17)] favoured facility delivery while a higher parity of 3-4 [APR = 0.93, 95% CI (0.88-0.99)] was inversely associated with health facility delivery as compared to parity of 1-2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05-1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04-1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78-0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08-1.19)].
CONCLUSION
Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.
背景
医疗机构分娩通常与改善母婴健康结果有关。然而，在乌干达，人们对影响农村地区利用医疗机构分娩的因素知之甚少。在这项研究中，我们评估了居住在鲁昆吉里和卡农古地区两家主要医疗机构服务范围内的母亲选择在医疗机构分娩的相关因素。
方法
横断面数据来自鲁昆吉里和卡农古地区两家私立医院服务范围内的 894 名随机抽样母亲。数据收集了最近一次分娩的地点、母亲的社会人口经济学特征以及医疗机构的水、环境卫生和个人卫生（WASH）状况。使用校正泊松回归估计医疗机构分娩的决定因素以及与私人与公共利用医疗机构分娩的相关因素的患病率比（PR）。
结果
大多数母亲（90.2%，806/894）在医疗机构分娩。非医疗机构分娩的原因是劳动进展更快（77.3%，68/88）、缺乏交通工具（31.8%，28/88）和医院分娩费用高（12.5%，11/88）。从事商业活动的母亲[调整后比值比（APR）=1.06，95%置信区间（CI）（1.01-1.11）]和属于最高财富五分位数的母亲[APR=1.09，95%CI（1.02-1.17）]更倾向于选择医疗机构分娩，而三到四个孩子的母亲[APR=0.93，95%CI（0.88-0.99）]与一到两个孩子的母亲相比，选择医疗机构分娩的可能性较低。与公立医疗机构相比，在私立医疗机构分娩的相关因素包括拥有高技能卫生工作者[APR=1.15，95%CI（1.05-1.26）]、感知更高质量的 WASH 服务[APR=1.11，95%CI（1.04-1.17）]、分娩费用[APR=0.85，95%CI（0.78-0.92）]和剖腹产服务的可用性[APR=1.13，95%CI（1.08-1.19）]。
结论
医疗机构分娩服务利用率高，与从事商业活动、属于最富有五分位数和更高的生育次数有关。私立医疗机构分娩的相关因素包括医疗机构 WASH 状况、服务费用以及熟练劳动力和剖腹产服务的可用性。
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