Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Pregnancy Childbirth. 2022 May 19;22(1):422. doi: 10.1186/s12884-022-04757-1.
Many maternal and neonatal deaths are largely preventable by expanding the continuum of care (at least four antenatal visits, skilled birth attendance and postnatal care). Even though ensuring the Continuum of Care (CoC) has advantages over separate services, evidence from the globe suggests that completion of the CoC for maternal health is very low. From our search of the literature, there is limited evidence on the completion of the entire CoC and its associated factors in sub-Saharan Africa (sSA). Therefore, this study aimed to assess coverage and associated factors of completion of the CoC for maternal health in sSA.
Data for the study were drawn from a recent nationally representative survey of 32 Demographic and Health Surveys (DHS). A total weighted sample of 225,135 women of reproductive-age, who gave birth in the two preceding years were included. Due to the hierarchical nature of DHS data, a multilevel logistic regression model was applied to investigate individual and community-level factors that may influence completion of CoC. Adjusted Odds Ratios (aORs) with 95% Confidence Interval (CI) were reported and variables with 95% CI not including 1 were considered as significant factors of the completion of CoC.
Only, 56,172 (25.0%; 95% CI, 20.5%, 29.4%) of the women in sSA utilized the CoC for maternal health which varied from 11,908 (17.9.0%) in East Africa to 7,418 (51.5% in Southern Africa. Factors associated with higher odds of CoC were women aged 24-34 years (aOR 1.22, 95% CI: 1.17, 1.25), aged ≥ 35 years (aOR 1.40, 95% CI: 1.35, 1.47), attending primary education (aOR 1.44, 95% CI: 1.41, 1.49), secondary education (aOR 1.95, 95% CI: 1.89, 2.03), higher education (aOR 2.15, 95% CI: 2.01, 2.25), having mass media exposure (aOR 1.35, 95% CI: 1.28, 1.39), women from female-headed households (aOR 1.18, 95% CI: 1.15, 1.21) and women from communities with high maternal education (aOR 1.12, 95% CI: 1.09, 1.16). However, perceiving distance from the health facility as a big problem (aOR 0.88, 95% CI: 0.85, 0.91), residing in rural areas (aOR 0.78, 95% CI: 0.75, 0.81), delayed ANC initiation (aOR 0.43, 95% CI: 0.41, 0.47) and unintended pregnancy (aOR 0.87, 95% CI: 0.84, 0.91) were associated with lower odds of CoC.
This study showed a low proportion of women, who utilized the CoC in sSA. Both individual and community-level factors were associated with CoC completion rates among women in sSA. Therefore, policymakers in sSA must consider both individual and community-level factors and undertake multi-sectorial approaches to address barriers of CoC at different levels.
通过扩大连续护理（至少四次产前检查、熟练的分娩护理和产后护理），可以在很大程度上预防许多母婴死亡。尽管确保连续护理（CoC）比单独的服务有优势，但来自全球的证据表明，产妇健康的 CoC 完成率非常低。从我们对文献的搜索中，在撒哈拉以南非洲（sSA），关于整个 CoC 的完成情况及其相关因素的证据有限。因此，本研究旨在评估 sSA 中产妇健康 CoC 完成情况的覆盖范围和相关因素。
本研究的数据来自最近一项具有全国代表性的 32 项人口与健康调查（DHS）的调查。共纳入了 225135 名在过去两年内分娩的育龄妇女的加权总样本。由于 DHS 数据具有分层性质，因此应用了多水平逻辑回归模型来研究可能影响 CoC 完成情况的个体和社区层面因素。报告了调整后的优势比（aOR）和 95%置信区间（CI），并认为 95% CI 不包括 1 的变量是 CoC 完成情况的显著因素。
在 sSA，只有 56172 名（25.0%；95% CI，20.5%，29.4%）的妇女利用了 CoC 进行产妇保健，这一比例从东非的 11908 名（17.9%）到南部非洲的 7418 名（51.5%）不等。与较高 CoC 完成率相关的因素包括年龄在 24-34 岁的妇女（aOR 1.22，95% CI：1.17，1.25）、年龄≥35 岁的妇女（aOR 1.40，95% CI：1.35，1.47）、接受小学教育的妇女（aOR 1.44，95% CI：1.41，1.49）、接受中等教育的妇女（aOR 1.95，95% CI：1.89，2.03）、接受高等教育的妇女（aOR 2.15，95% CI：2.01，2.25）、接触大众媒体的妇女（aOR 1.35，95% CI：1.28，1.39）、来自女性户主家庭的妇女（aOR 1.18，95% CI：1.15，1.21）和来自社区中高产妇教育水平的妇女（aOR 1.12，95% CI：1.09，1.16）。然而，认为距离医疗机构远是一个大问题（aOR 0.88，95% CI：0.85，0.91）、居住在农村地区（aOR 0.78，95% CI：0.75，0.81）、延迟开始产前护理（aOR 0.43，95% CI：0.41，0.47）和意外怀孕（aOR 0.87，95% CI：0.84，0.91）与 CoC 完成率较低相关。
本研究显示，在 sSA，利用 CoC 的妇女比例较低。个体和社区层面的因素都与 sSA 妇女的 CoC 完成率相关。因此，sSA 的政策制定者必须考虑个人和社区层面的因素，并采取多部门的方法来解决不同层面的 CoC 障碍。
