Centre for Social Research in Health, UNSW Sydney, Kensington, Australia.
Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Volta Region, Ghana.
PLoS One. 2023 Feb 2;18(2):e0280992. doi: 10.1371/journal.pone.0280992. eCollection 2023.
Several studies have shown that unskilled birth attendance is associated with maternal and neonatal morbidity, disability, and death in sub-Saharan Africa (SSA). However, little evidence exists on prevailing geospatial variations and the factors underscoring the patterns of unskilled birth attendance in the region. This study analysed the geospatial disparities and factors associated with unskilled birth attendance in SSA.
The study is based on data from thirty (30) SSA countries captured in the latest (2010-2019) demographic and health surveys (DHS). A total of 200,736 women aged between 15-49 years were included in the study. Geospatial methods including spatial autocorrelation and hot spot analysis as well as logistic regression models were used to analyse the data.
There were random spatial variations in unskilled birth attendance in SSA, with the main hotspot located in Chad, whereas South Africa and the Democratic Republic of Congo showed coldspots. Residence (urban or rural), wealth status, education, maternal age at the time of the survey and age at birth, desire for birth, occupation, media exposure, distance to a health facility, antenatal care visits, and deaths of under-five children showed significant associations with unskilled birth attendance.
Random geospatial disparities in unskilled birth attendance exist in SSA, coupled with various associated socio-demographic determinants. Specific geospatial hotspots of unskilled birth attendance in SSA can be targeted for specialised interventions to alleviate the prevailing disparities.
多项研究表明，在撒哈拉以南非洲（SSA），非熟练接生与产妇和新生儿发病率、残疾和死亡有关。然而，该地区熟练接生普遍存在的地域差异及其背后的影响因素的证据很少。本研究分析了 SSA 地区熟练接生的地域差异和相关因素。
本研究基于最近（2010-2019 年）的人口与健康调查（DHS）中来自撒哈拉以南 30 个国家的数据。共有 200736 名年龄在 15-49 岁之间的妇女纳入研究。采用空间自相关和热点分析以及逻辑回归模型等空间分析方法来分析数据。
撒哈拉以南非洲熟练接生存在随机空间差异，主要热点位于乍得，而南非和刚果民主共和国则呈现冷点。居住地点（城市或农村）、财富状况、教育程度、调查时产妇年龄和生育年龄、生育愿望、职业、媒体接触、距离医疗机构的远近、产前保健次数以及五岁以下儿童死亡与熟练接生有显著关联。
撒哈拉以南非洲熟练接生存在随机的地域差异，还有各种相关的社会人口决定因素。可以针对撒哈拉以南非洲熟练接生的特定地域热点采取专门的干预措施，以减轻现有的差异。
