Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
Institute of Statistical Research and Training, Dhaka, Bangladesh.
BMJ Open. 2022 Sep 5;12(9):e060718. doi: 10.1136/bmjopen-2021-060718.
This study aims to explore the rural-urban differentials in the influences of individual and geospatial preparedness on institutional childbirth in Bangladesh. A related aim of this paper is to derive estimates to measure geospatial preparedness for institutional births, through statistical modelling, when no data are available for measuring this areal indicator.
DESIGN, SETTINGS AND PARTICIPANTS: The paper used data from a large-scale nationally representative Bangladesh Multiple Indicator Cluster Survey 2019. The analytical sample included 9203 currently married women of reproductive age who had a live birth in the 2 years preceding the survey.
Mixed effect logistic regression models were employed to explore the rural-urban differentials in influences of individual and geospatial preparedness on institutional childbirth. The district-level random effect estimation was done to measure geospatial preparedness. The conditional autoregressive model was used to examine the association of geospatial preparedness with areal variation in institutional births.
In rural settings, women who gave birth to a female newborn were 18% less likely to have facility births compared with women who gave birth to a male newborn. Also, women from households in the highest wealth quintile were twice as likely to have facility births compared with those from households in the poorest wealth quintile. In contrast, in urban areas, facility births did not vary by sex of the fetus or by households' socioeconomic status. The geospatial preparedness explained 8% and 9% of the variability in institutional births in rural and urban areas, respectively. Geospatial mapping revealed low preparedness in the hill tracts. Findings identified geospatial preparedness as a potential source of areal variation in facility births.
Findings suggest improving district-level preparedness and developing differential programme strategies for urban and rural areas to increase the national prevalence and more equitable use of institutional childbirth in Bangladesh.
本研究旨在探讨个体和地理准备对孟加拉国机构分娩的城乡差异的影响。本文的一个相关目的是通过统计建模，在没有数据可用于衡量这一地域指标的情况下，推导出衡量机构分娩地理准备的估计值。
设计、地点和参与者：本文使用了 2019 年大规模全国代表性孟加拉国多指标类集调查的数据。分析样本包括 9203 名目前处于生育年龄的已婚妇女，她们在调查前的 2 年内有过活产。
采用混合效应逻辑回归模型探讨个体和地理准备对机构分娩的城乡差异的影响。采用区县级随机效应估计来衡量地理准备情况。使用条件自回归模型检验地理准备与机构分娩的地域差异之间的关联。
在农村地区，与生育男婴的妇女相比，生育女婴的妇女选择到医疗机构分娩的可能性低 18%。此外，来自最富有五分之一家庭的妇女选择到医疗机构分娩的可能性是来自最贫穷五分之一家庭的妇女的两倍。相比之下，在城市地区，机构分娩的数量与胎儿的性别或家庭的社会经济地位无关。地理准备情况分别解释了农村和城市地区机构分娩变化的 8%和 9%。地理空间制图显示，丘陵地带的准备情况较差。研究结果发现，地理准备情况是机构分娩地域差异的一个潜在来源。
研究结果表明，孟加拉国需要提高区县级的准备情况，并为城乡地区制定差异化的方案策略，以提高全国机构分娩的普及率和更公平地利用机构分娩。
