孟加拉国医疗设施的供应和准备情况及其对长效现代避孕措施使用的影响：关联数据分析。
Availability and readiness of healthcare facilities and their effects on long-acting modern contraceptive use in Bangladesh: analysis of linked data.
机构信息
Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, 2222, Bangladesh.
Gender and Women's Health, Centre for Health Equity School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, 3010, Australia.
出版信息
BMC Health Serv Res. 2022 Sep 21;22(1):1180. doi: 10.1186/s12913-022-08565-3.
AIM
Increasing access to long-acting modern contraceptives (LMAC) is one of the key factors in preventing unintended pregnancy and protecting women's health rights. However, the availability and accessibility of health facilities and their impacts on LAMC utilisation (implant, intrauterine devices, sterilisation) in low- and middle-income countries is an understudied topic. This study aimed to examine the association between the availability and readiness of health facilities and the use of LAMC in Bangladesh.
METHODS
In this survey study, we linked the 2017/18 Bangladesh Demographic and Health Survey data with the 2017 Bangladesh Health Facility Survey data using the administrative-boundary linkage method. Mixed-effect multilevel logistic regressions were conducted. The sample comprised 10,938 married women of 15-49 years age range who were fertile but did not desire a child within 2 years of the date of survey. The outcome variable was the current use of LAMC (yes, no), and the explanatory variables were health facility-, individual-, household- and community-level factors.
RESULTS
Nearly 34% of participants used LAMCs with significant variations across areas in Bangladesh. The average scores of the health facility management and health facility infrastructure were 0.79 and 0.83, respectively. Of the facilities where LAMCs were available, 69% of them were functional and ready to provide LAMCs to the respondents. The increase in scores for the management (adjusted odds ratio (aOR), 1.59; 95% CI, 1.21-2.42) and infrastructure (aOR, 1.44; 95% CI, 1.01-1.69) of health facilities was positively associated with the overall uptake of LAMC. For per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities, the aORs for women to report using LAMC were 2.16 (95% CI, 1.18-3.21) and 1.74 (95% CI, 1.15-3.20), respectively. A nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometre increase in the average regional-level distance between women's homes and the nearest health facilities.
CONCLUSION
The proximity of health facilities and their improved management, infrastructure, and readiness to provide LAMCs to women significantly increase their uptake. Policies and programs should prioritise improving health facility readiness to increase LAMC uptake.
目的
增加长效现代避孕药具（LMAC）的可及性是预防意外怀孕和保护妇女健康权利的关键因素之一。然而，在中低收入国家，卫生设施的可及性和可得性及其对 LAMC 利用（植入物、宫内节育器、绝育）的影响是一个研究不足的课题。本研究旨在探讨孟加拉国卫生设施的可用性和准备情况与 LAMC 利用之间的关联。
方法
在这项调查研究中，我们使用行政边界链接方法将 2017/18 年孟加拉国人口与健康调查数据与 2017 年孟加拉国卫生设施调查数据进行了链接。采用混合效应多级逻辑回归分析。样本包括 10938 名年龄在 15-49 岁之间、有生育能力但在调查日期后 2 年内不希望生育的已婚妇女。因变量为当前使用 LAMC（是，否），解释变量为卫生设施、个人、家庭和社区层面的因素。
结果
近 34%的参与者使用了 LAMC，孟加拉国各地存在显著差异。卫生设施管理和卫生设施基础设施的平均得分为 0.79 和 0.83。在有 LAMC 的设施中，有 69%的设施功能齐全，准备向受访者提供 LAMC。卫生设施管理（调整后的优势比（aOR），1.59；95%置信区间，1.21-2.42）和基础设施（aOR，1.44；95%置信区间，1.01-1.69）得分的增加与 LAMC 的总体使用率呈正相关。对于最近的卫生设施提供和准备提供 LAMC 的可得性和准备程度每增加一个单位，女性报告使用 LAMC 的 aOR 分别为 2.16（95%置信区间，1.18-3.21）和 1.74（95%置信区间，1.15-3.20）。女性家庭与最近的卫生设施之间的平均区域水平距离每增加一公里，LAMC 使用率的可能性就会下降近 27%。
结论
卫生设施的临近性以及其管理、基础设施和提供 LAMC 的准备情况的改善显著增加了女性的使用率。政策和方案应优先提高卫生设施的准备情况，以增加 LAMC 的使用率。
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