Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.
University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
BMC Public Health. 2021 Dec 19;21(1):2304. doi: 10.1186/s12889-021-12330-2.
Attendance of maternal and infant care services in rural Chad are consistently low. Our study aimed to assess the use of antenatal (ANC) and postnatal care (PNC) services, health facility delivery and infant health services after 4 years of a health systems intervention for improving the infrastructure, supplies, training and sensitization for maternal and infant health in two districts of rural Chad.
Data from a repeated cross-sectional household survey conducted in Yao and Danamadji in 2015 and in 2018 were analyzed. A stratified two-stage cluster sampling methodology was applied to achieve a representative sample of the rural settled and mobile population groups in the study area. A generalized linear model was applied to determine the health care utilization rates. Multivariate regression models were used to assess the association between the programme intervention and utilization outcomes of selected maternal and infant health services.
Complete datasets were available for 1284 households at baseline. The endline analysis included 1175 households with complete survey data. The use of at least one ANC amongst pregnant women increased in both settled communities (from 80% in 2015 to 90% in 2018) and amongst mobile pastoralist communities (from 48% in 2015 to 56% in 2018). The rate of home delivery among settled communities and mobile pastoralists changed little between baseline and endline and remained high for both population groups. Individuals that were covered by the health systems intervention were however significantly more likely to attend ANC and less likely to give birth at home. PNC services only showed improvements amongst the settled communities (of 30%). Infants' reported health outcomes and vaccination coverage considerably improved; the latter especially among mobile pastoralist (from 15% in 2015 to 84% in 2018).
A combination of health systems strengthening interventions was associated with an increased use of certain maternal and infant health services. However, to facilitate equitable access to and use of health care services in particular in times of increased vulnerability and by certain population groups in hard-to-reach areas, reinforced health education and culturally adapted communication strategies, including gender-specific messaging will be needed over a sustained period.
乍得农村地区的孕产妇和婴幼儿保健服务的出勤率一直很低。我们的研究旨在评估在两个农村地区实施了四年的卫生系统干预措施后，基础设施、供应品、培训和母婴保健意识的改善，对产前（ANC）和产后（PNC）保健服务、医疗机构分娩和婴儿健康服务的利用情况。
分析了 2015 年和 2018 年在 Yao 和 Danamadji 进行的重复横断面家庭调查的数据。采用分层两阶段聚类抽样方法，对研究地区农村定居和流动人口群体进行了有代表性的抽样。应用广义线性模型确定保健利用率。多变量回归模型用于评估方案干预与选定母婴保健服务利用结果之间的关系。
基线时有 1284 户家庭提供了完整的数据集。最终分析包括有完整调查数据的 1175 户家庭。在定居社区（从 2015 年的 80%增加到 2018 年的 90%）和流动牧民社区（从 2015 年的 48%增加到 2018 年的 56%）中，至少接受一次 ANC 的孕妇比例有所增加。定居社区和流动牧民的家庭分娩率在基线和最终阶段之间变化不大，这两个群体的家庭分娩率仍然很高。然而，参加卫生系统干预的个人更有可能接受 ANC，不太可能在家分娩。PNC 服务仅在定居社区（增加 30%）方面有所改善。婴儿的健康状况和疫苗接种率显著提高；特别是在流动牧民中（从 2015 年的 15%增加到 2018 年的 84%）。
一系列强化卫生系统的干预措施与某些母婴保健服务的利用率增加有关。然而，为了促进特别是在脆弱时期和在难以到达的地区的某些人群中公平获得和使用保健服务，需要在一个持续的时期内加强健康教育和文化适应的沟通策略，包括针对特定性别的信息传递。
