埃塞俄比亚产前护理就诊后家庭分娩的空间变化及相关因素；空间和多层次分析。
Spatial variation and factors associated with home delivery after ANC visit in Ethiopia; spatial and multilevel analysis.
机构信息
Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
出版信息
PLoS One. 2022 Aug 25;17(8):e0272849. doi: 10.1371/journal.pone.0272849. eCollection 2022.
INTRODUCTION
Institutional delivery is crucial to reduce maternal and neonatal mortality as well as serious morbidities. However, in Ethiopia, home delivery (attended by an unskilled birth attendant) after antenatal care (ANC) visit is highly in practice. Therefore, this study aimed to assess the spatial variation and determinants of home delivery after antenatal care visits in Ethiopia.
METHOD
A secondary data analysis was conducted using the 2019 mini Ethiopian demographic and health survey. A total of 2,923 women who had ANC visits were included. Spatial analysis was done by using GIS 10.7 and SaTscan 9.6. The risk areas for home delivery from GIS and spatial scan statistics results were reported. A multi-level logistic regression model was fitted using Stata14 to identify individual and community-level factors associated with home delivery after ANC visit. Finally, AOR with 95% CI and random effects were reported.
RESULT
Home delivery after ANC visit was spatially clustered in Ethiopia(Moran's index = 0.52, p-value <0.01). The primary clusters were detected in Oromia and SNNP region (LLR = 37.48, p < 0.001 and RR = 2.30) and secondary clusters were located in Benishangul Gumuz, Amhara, Tigray and Afar (LLR = 29.45, p<0.001 and RR = 1.54). Being rural resident (AOR = 2.52; 95%CI 1.09-5.78), having no formal education (AOR = 3.19;95% CI 1.11-9.16), being in the poor (AOR = 2.20;95%CI 1.51-3.22) and middle wealth index (AOR = 2.07;95% CI 1.44-2.98), having one ANC visit (AOR = 2.64; 95% CI 1.41-4.94), and living in the agrarian region (AOR = 3.63; 95%CI 1.03-12.77) had increased the odds of home delivery after ANC visit.
CONCLUSION AND RECOMMENDATION
Home delivery after ANC visit was spatially clustered in Ethiopia. Factors like maternal education, wealth index, number of ANC visits, residency and region were significantly associated with home delivery after ANC visit. Therefore, it is better to increase the number of ANC contact by giving health education, especially for women with low levels of education and better to improve the wealth status of women. A special strategy is also vital to reduce home delivery after ANC visit in those high-risk regions.
介绍
机构分娩对于降低母婴死亡率和严重发病率至关重要。然而，在埃塞俄比亚，在接受产前护理 (ANC) 后在家中分娩（由非熟练的接生员接生）的情况非常普遍。因此，本研究旨在评估埃塞俄比亚接受 ANC 后在家中分娩的空间变化和决定因素。
方法
使用 2019 年迷你埃塞俄比亚人口和健康调查进行二次数据分析。共纳入 2923 名接受 ANC 检查的妇女。使用 GIS 10.7 和 SaTscan 9.6 进行空间分析。报告了来自 GIS 和空间扫描统计结果的在家分娩的风险区域。使用 Stata14 拟合多水平逻辑回归模型，以确定与 ANC 后在家分娩相关的个体和社区层面的因素。最后，报告了具有 95%CI 和随机效应的优势比 (AOR)。
结果
埃塞俄比亚接受 ANC 后在家分娩呈空间聚集（莫兰指数 = 0.52，p 值 <0.01）。主要集群在奥罗米亚和 SNNP 地区检测到（LLR = 37.48，p <0.001 和 RR = 2.30），次要集群位于本尚古勒-古姆兹、阿姆哈拉、提格雷和阿法尔（LLR = 29.45，p <0.001 和 RR = 1.54）。农村居民（AOR = 2.52；95%CI 1.09-5.78）、未受过正规教育（AOR = 3.19；95%CI 1.11-9.16）、贫困（AOR = 2.20；95%CI 1.51-3.22）和中等财富指数（AOR = 2.07；95%CI 1.44-2.98）、接受一次 ANC 检查（AOR = 2.64；95%CI 1.41-4.94）和居住在农业区（AOR = 3.63；95%CI 1.03-12.77）均增加了 ANC 后在家分娩的几率。
结论和建议
埃塞俄比亚接受 ANC 后在家分娩呈空间聚集。母亲教育、财富指数、ANC 就诊次数、居住地和地区等因素与 ANC 后在家分娩显著相关。因此，最好通过提供健康教育来增加 ANC 接触次数，特别是针对教育程度较低的妇女，并更好地改善妇女的财富状况。在这些高风险地区，还需要制定专门的战略来减少 ANC 后在家分娩的情况。
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