Departement of Statistics, Assosa University, Assosa, Ethiopia.
Departement of Statistics, Bahir Dar University, Bahir Dar, Ethiopia.
BMC Public Health. 2023 Mar 15;23(1):499. doi: 10.1186/s12889-023-15369-5.
Antenatal care (ANC) is a maternal health care service given by skilled health professionals to pregnant women. Women may give birth at home or in health institutions. Home delivery care (DC) increases the likelihood of mortality of the mother and the newborn. Globally, each year nearly 303,000 maternal deaths occurred from complications of pregnancy and childbirth. Ethiopia alone accounted for 13,000 deaths, which disproportionately affects women living in different places of the country. Thus, this study aimed to assess the spatiotemporal patterns and associated factors of antenatal and delivery care utilization in Ethiopia.
This study used the 2000 to 2016 EDHS (Ethiopian and Demographic Health Survey) data as a source. A total weighted sample of 30,762 women (7966 in 2000, 7297 in 2005, 7908 in 2011, and 7591 in 2016) was used. The separate and bivariate logistic regression analyses with and without the spatial effect were modeled using SAS version 9.4 and ArcGIS version 10.8.
The spatial distribution of ANC and DC was non-random in Ethiopia. The overall odds ratio of ANC and DC was 2.09. In 2016, 31.8% and 33.2% of women had ANC and DC respectively. The estimated odds of following ANC among mothers from middle and rich households were 1.346 and 1.679 times the estimated odds of following ANC among mothers from poor households respectively. Women who had attained higher education were 1.56 and 2.03 times more likely to have ANC and DC respectively compared to women who had no formal education.
Despite the government's report that women now have better access to maternal health care, a sizable proportion of women continue to give birth at home without going to the advised antenatal care appointment. Women and husbands with low education, having non-working partners, religion, regions of dwelling, residing in rural, lower birth order, low birth interval, unable to access mass media, low wealth status, and earlier EDHS survey years were significant predictors that hinder antenatal and delivery care utilization simultaneously in Ethiopia. Whereas the spatial variable significantly affects antenatal care and being unable to access mobile phones lead to low utilization of delivery care. We recommend that policymakers, planners, and researchers consider these variables and the spatiotemporal distribution of ANC and DC to reduce maternal mortality in Ethiopia. Besides, it is recommended that further studies use the latest EDHS survey data.
产前护理（ANC）是由熟练的卫生专业人员为孕妇提供的一项妇幼保健服务。妇女可以在家中或医疗机构分娩。家庭分娩护理（DC）增加了母亲和新生儿死亡的可能性。全球范围内，每年约有 303,000 名产妇死于妊娠和分娩并发症。埃塞俄比亚 alone 就有 13,000 人死亡，这不成比例地影响了生活在该国不同地方的妇女。因此，本研究旨在评估埃塞俄比亚产前和分娩护理利用的时空模式及相关因素。
本研究使用了 2000 年至 2016 年 EDHS（埃塞俄比亚和人口健康调查）数据作为数据源。使用了总计 30,762 名妇女的加权样本（2000 年 7966 名，2005 年 7297 名，2011 年 7908 名，2016 年 7591 名）。使用 SAS 版本 9.4 和 ArcGIS 版本 10.8 分别对带有和不带有空间效应的单独和双变量逻辑回归分析进行建模。
埃塞俄比亚 ANC 和 DC 的空间分布是非随机的。ANC 和 DC 的总体优势比为 2.09。2016 年，分别有 31.8%和 33.2%的妇女接受了 ANC 和 DC。来自中高收入家庭的母亲接受 ANC 的估计几率是来自贫困家庭的母亲的 1.346 倍和 1.679 倍。接受过高等教育的妇女比没有接受过正规教育的妇女更有可能接受 ANC 和 DC，分别为 1.56 倍和 2.03 倍。
尽管政府报告称妇女现在可以更好地获得孕产妇保健，但仍有相当一部分妇女继续在家中分娩，而不去接受建议的产前护理预约。教育程度低、无工作伴侣、宗教信仰、居住地、居住在农村、较低的出生顺序、较短的出生间隔、无法接触大众媒体、较低的财富状况以及较早的 EDHS 调查年份的妇女和丈夫是同时阻碍产前和分娩护理利用的重要预测因素。然而，空间变量显著影响 ANC，无法使用移动电话导致 DC 的利用率低。我们建议政策制定者、规划者和研究人员考虑这些变量以及 ANC 和 DC 的时空分布，以降低埃塞俄比亚的孕产妇死亡率。此外，建议进一步研究使用最新的 EDHS 调查数据。
