地理上接近医疗机构对贝宁产前护理和分娩服务利用的影响：一项横断面研究。
The effects of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin: a cross-sectional study.
机构信息
Ministry of Infrastructure, Building Lamizana, 03BP7011, Ouagadougou, Burkina Faso.
Graduate School of International Cooperation Studies, Kobe University, 2-1 Rokkodai, Nada-ku, Kobe, 657-8501, Japan.
出版信息
Reprod Health. 2021 Oct 14;18(1):205. doi: 10.1186/s12978-021-01249-x.
BACKGROUND
The world is making progress toward achieving maternal and child health (MCH) related components of the Sustainable Development Goals. Nevertheless, the progress of many countries in Sub-Saharan Africa is lagging. Geographical accessibility from residence to health facilities is considered a major obstacle hampering the use of appropriate MCH services. Benin, a country where the southern and northern parts belong to different geographical zones, has among the highest maternal mortality rate in the world. Adequate use of MCH care is important to save lives of women and their babies. This study assessed the effect of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin, with an emphasis on geographical zones.
METHODS
We pooled two rounds of Benin Demographic and Health Surveys (BDHS). The sample included 18,105 women aged 15-49 years (9111 from BDHS-2011/2012 and 8994 from BDHS-2017/2018) who had live births within five years preceding the surveys. We measured the distance and travel time from residential areas to the closest health center by merging the BDHS datasets with Benin's geographic information system data. Multivariate logistic regression analysis was performed to estimate the effect of geographical access on pregnancy and delivery services utilization. We conducted a propensity score-matching analysis to check for robustness.
RESULTS
Regression results showed that the distance to the closest health center had adverse effects on the likelihood of a woman receiving appropriate maternal healthcare. The estimates showed that one km increase in straight-line distance to the closest health center reduces the odds of the woman receiving at least one antenatal care by 0.042, delivering in facility by 0.092, and delivering her baby with assistance of skilled birth attendants by 0.118. We also confirmed the negative effects of travel time and altitude of women's residence on healthcare utilization. Nonetheless, these effects were mainly seen in the northern part of Benin.
CONCLUSIONS
Geographical accessibility to health facilities is critically important for the utilization of antenatal care and delivery services, particularly in the northern part of Benin. Improving geographical accessibility, especially in rural areas, is significant for further use of maternal health care in Benin.
背景
全球在实现与可持续发展目标相关的母婴健康（MCH）组成部分方面取得了进展。然而，撒哈拉以南非洲许多国家的进展较为滞后。从居住地到医疗机构的地理可达性被认为是阻碍适当 MCH 服务利用的主要障碍。贝宁南部和北部属于不同地理区域，其孕产妇死亡率在全球属于最高之列。充分利用 MCH 护理对拯救妇女及其婴儿的生命非常重要。本研究评估了贝宁的医疗机构地理可达性对产前护理和分娩服务利用的影响，重点关注地理区域。
方法
我们汇总了两轮贝宁人口与健康调查（BDHS）数据。样本包括 18105 名年龄在 15-49 岁的妇女（2011/2012 年 BDHS 中的 9111 名和 2017/2018 年 BDHS 中的 8994 名），她们在调查前五年内有活产。我们通过合并 BDHS 数据集和贝宁地理信息系统数据，测量了从居住地到最近保健中心的距离和旅行时间。我们采用多变量逻辑回归分析来估计地理可达性对妊娠和分娩服务利用的影响。我们进行了倾向评分匹配分析以检查稳健性。
结果
回归结果表明，到最近保健中心的距离对妇女获得适当母婴保健的可能性有不利影响。估计表明，距离最近保健中心每增加一公里，妇女接受至少一次产前护理的几率就会降低 0.042，在机构分娩的几率降低 0.092，接受熟练助产士帮助分娩的几率降低 0.118。我们还证实了妇女居住地的旅行时间和海拔对医疗保健利用的负面影响。然而，这些影响主要出现在贝宁北部。
结论
医疗机构的地理可达性对产前护理和分娩服务的利用至关重要，特别是在贝宁北部。改善地理可达性，特别是在农村地区，对进一步利用贝宁的孕产妇保健具有重要意义。
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