Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Pregnancy Childbirth. 2022 Jul 8;22(1):553. doi: 10.1186/s12884-022-04880-z.
Maternal and neonatal health significantly improves when birth is attended at health institutions where there are quality services and skilled attendants. In contrary, home birth results in high rates of maternal and neonatal mortality. Thus, this study aimed to determine the spatial distribution of home birth and to identify determinants of place of birth in Ethiopia based on the recent national survey.
Ethiopian mini-DHS-2019 data was used in this analysis. A weighted sample of 5423 mothers were included. While health facility was a reference, home and health post were used as comparison categories to identify determinants of place of birth in a survey multinomial logistic regression model. An adjusted relative risk ratio, marginal effect, and a corresponding 95% confidence interval and a p-value of < 0.05 were used to declare statistical significance. The Global Moran's I analysis was done by using ArcMap 10.8 to evaluate the clustering of home birth. The prevalence of home birth was predicted by ordinary kriging interpolation. Then, scanning was done by SaTScan V.9.6 software to detect scanning windows with low or high rates of home birth.
Prevalence of home birth in Ethiopia was 52.19% (95% CI: 46.49 - 57.83). Whereas, only 2.99% (95% CI: 1.68 - 5.25) of mothers gave birth in the health posts. Bigger family size, family wealth, multiparity, none and fewer antenatal visits, and low coverage of cluster level 4 + antenatal visits were predictors of home birth. Also, home birth was clustered across enumeration areas and it was over 40% in most parts of the country with > 75% in the Somali region. SaTScan analysis detected most likely primary clusters in the Somali region and secondary clusters in the rest five regions of the country.
Home birth is a common practice in Ethiopia. Among public health facilities, health posts are the least utilized institutions for labor and delivery care. Nationally, implementing the 2016 WHO's recommendations on antenatal care for a positive pregnancy experience and providing quality antenatal and delivery care in public facilities by qualified providers and back-up systems in place could be supportive.
在提供优质服务和有技术的医护人员的医疗机构分娩可显著改善母婴健康。相比之下，在家中分娩会导致母婴死亡率居高不下。因此，本研究旨在根据最近的全国调查，确定在家分娩的空间分布，并确定影响分娩地点的因素。
本分析使用了埃塞俄比亚迷你 DHS-2019 数据。共纳入了 5423 名母亲的加权样本。以医疗机构为参照，将在家中分娩和卫生所分娩作为比较类别，在一项调查多分类逻辑回归模型中确定分娩地点的决定因素。使用调整后的相对风险比、边际效应和相应的 95%置信区间和 p 值<0.05 来表示统计学意义。通过使用 ArcMap 10.8 进行全局 Moran's I 分析来评估在家分娩的聚类情况。通过普通克里金插值法预测在家分娩的流行率。然后，使用 SaTScan V.9.6 软件进行扫描，以检测在家分娩率较低或较高的扫描窗口。
埃塞俄比亚在家分娩的流行率为 52.19%（95%CI：46.49-57.83）。而只有 2.99%（95%CI：1.68-5.25）的母亲在卫生所分娩。更大的家庭规模、家庭财富、多胎、较少的产前检查次数和较低的 4+级簇产前检查覆盖率是在家分娩的预测因素。此外，在家分娩在普查区呈聚类分布，该国大部分地区的比例超过 40%，在索马里地区的比例超过 75%。SaTScan 分析检测到索马里地区最有可能的一级聚类，以及该国其他五个地区的二级聚类。
在家分娩在埃塞俄比亚是一种常见做法。在公共卫生机构中，卫生所是用于分娩护理的利用率最低的机构。在国家层面上，实施 2016 年世卫组织关于产前护理的建议，以获得积极的妊娠体验，并在公共设施中由合格的提供者提供优质的产前和分娩护理，并建立后备系统，可能会有所帮助。
