产前护理就诊与阿富汗利用机构分娩护理服务的关联：教育、财富和家庭决策自主权的交叉点。

Associations of antenatal care visit with utilization of institutional delivery care services in Afghanistan: intersections of education, wealth, and household decision-making autonomy.

机构信息

Department of Science and Humanities, Bangabandhu Sheikh Mujibur Rahman Aviation and Aerospace University, Old Airport, Tejgaon, Dhaka, 1215, Bangladesh.

Institute of Statistical Research and Training, University of Dhaka, Dhaka, 1000, Bangladesh.

出版信息

BMC Pregnancy Childbirth. 2022 Mar 26;22(1):255. doi: 10.1186/s12884-022-04588-0.

BACKGROUND

The importance of antenatal care (ANC) visits in safe motherhood and childbirth is well-documented. However, less is known how social determinants of health interact with ANC visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the associations of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant.

METHODS

We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,590 women of reproductive age (15-49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot.

RESULTS

Multivariable adjusted analyses suggest that women who had 4 or more ANC visits were 5.7 times (95% CI = 4.78, 7.11; P < 0.05) more likely to use delivery care at a health facility and 6.5 times (95% CI = 5.23, 8.03; P < 0.05) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions of ANC visits with education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status.

CONCLUSION

Our findings suggest that the associations of ANC visits with institutional delivery care services are stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women's social status.

背景

产前护理 (ANC) 对母婴安全的重要性已有充分记录。然而，对于社会决定因素如何与 ANC 访问相互作用，从而影响低收入国家专业分娩护理服务的利用情况，人们知之甚少。本研究考察了 ANC 访问与阿富汗机构分娩护理利用结果之间的关联。此外，我们评估了 ANC 访问与教育、财富和家庭决策自主权在预测分娩护理利用的两个结果——在医疗机构分娩和由熟练助产士协助分娩方面的交叉程度。

方法

我们使用了 2015 年阿富汗人口与健康调查 (AfDHS)的数据。分析样本包括 15590 名育龄妇女（15-49 岁）。我们使用逻辑回归模型评估关联，使用统计交互作用估计分娩护理结果的预测概率，并在边际图中呈现估计值。

结果

多变量调整分析表明，与没有 ANC 访问的妇女相比，有 4 次或更多 ANC 访问的妇女在医疗机构分娩的可能性高 5.7 倍（95% CI=4.78，7.11；P<0.05），由熟练助产士协助分娩的可能性高 6.5 倍（95% CI=5.23，8.03；P<0.05）。具有 ANC 访问与教育、财富和决策自主权的统计交互作用的模型的估计值表明，与社会地位较低的妇女相比，社会地位较高的妇女在利用机构分娩护理服务方面具有更大的优势。