Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Gondar, Ethiopia.
BMC Pregnancy Childbirth. 2022 Jul 27;22(1):601. doi: 10.1186/s12884-022-04933-3.
Postnatal care (PNC) services are an essential intervention for improving maternal and child health. In Ethiopia, PNC service has been poorly implemented, despite the governments and partners' attempt to improve maternal and child health service utilization. Moreover, many literatures identified that women with no education are significantly underutilized the PNC services. Thus, this study aimed to assess the PNC service uptake among women at high risk for underutilization of PNC services and to identify the individual and community level determinants of PNC services uptake in Ethiopia using the positive deviance approach.
Data from the Ethiopia Demographic and Health Survey 2016 were used. A total of 2417 deviant women (women with no education) were identified through a two-stage stratified sampling technique and included in this analysis. A multilevel mixed-effect binary logistic regression analysis was computed to identify the individual and community-level determinants of PNC services uptake among deviant women. In the final model, a p-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistically significant determinants of PNC services uptake.
In this analysis, the uptake of PNC service among deviant women was 5.8% [95% CI: 4.9-6.8]. Working in the agriculture (AOR = 2.15, 95% CI: 1.13-3.52), being Orthodox religion follower (AOR = 2.56, 95% CI: 1.42-4.57), living in the highest wealth quantile (AOR = 2.22, 95% CI: 1.25-3.91) were the individual level determinants, whereas residing in the city administration (AOR: 3.17, 95% CI: 1.15-8.71), and living closer to health facility (AOR: 1.57, 95% CI: 1.03-2.39) were the community level determinants.
The study highlighted a better PNC service uptake among deviant women who are working in the agriculture, follows orthodox religion, lives in highest household wealth status, resides in city administration, and living closer to the health facility. The positive deviance approach provides evidences for health policy makers and program implementers to improve health behavior in specific target population, and ultimately to bring better maternal and child health outcomes, despite acknowledged adverse risk profile. Such strategy and knowledge could facilitate targeted efforts aimed at achieving national goals of maternal and newborn mortality reduction in the country.
产后护理 (PNC) 服务是改善母婴健康的重要干预措施。尽管政府和合作伙伴试图改善孕产妇和儿童健康服务的利用，但在埃塞俄比亚，PNC 服务的实施情况仍然不佳。此外，许多文献表明，没有受过教育的妇女在很大程度上没有充分利用 PNC 服务。因此，本研究旨在使用正向偏差方法评估高风险妇女对 PNC 服务的利用情况，并确定影响 PNC 服务利用的个体和社区层面的决定因素。
本研究使用了 2016 年埃塞俄比亚人口与健康调查的数据。通过两阶段分层抽样技术确定了 2417 名偏差妇女（未受过教育的妇女），并将其纳入本分析。使用多水平混合效应二项逻辑回归分析来确定偏差妇女对 PNC 服务利用的个体和社区层面的决定因素。在最终模型中，p 值小于 0.05 和调整后的优势比 (AOR) 及其 95%置信区间 (CI) 用于确定 PNC 服务利用的统计学显著决定因素。
在本分析中，偏差妇女对 PNC 服务的利用率为 5.8%[95%CI：4.9-6.8]。从事农业工作 (AOR=2.15, 95%CI：1.13-3.52)、信仰东正教 (AOR=2.56, 95%CI：1.42-4.57)、处于最高财富阶层 (AOR=2.22, 95%CI：1.25-3.91) 是个体层面的决定因素，而居住在城市行政区域 (AOR:3.17, 95%CI：1.15-8.71) 和居住在离卫生设施较近的地方 (AOR:1.57, 95%CI：1.03-2.39) 是社区层面的决定因素。
本研究强调了从事农业工作、信仰东正教、处于最高家庭财富地位、居住在城市行政区域以及居住在离卫生设施较近的偏差妇女中 PNC 服务利用率更高。正向偏差方法为卫生政策制定者和方案实施者提供了证据，以改善特定目标人群的健康行为，最终改善母婴健康结果，尽管这些人群存在公认的不利风险状况。这种策略和知识可以促进有针对性的努力，以实现国家降低孕产妇和新生儿死亡率的目标。
