Amadi-Mgbenka Chioma T, Borrell Luisa N, Jones Heidi E, Maroko Andrew, Bolumar Francisco
Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York City, New York, United States of America.
Universidad de Alcalá, Madrid, Spain.
PLOS Glob Public Health. 2022 Feb 2;2(2):e0000184. doi: 10.1371/journal.pgph.0000184. eCollection 2022.
Proximity of households to comprehensive obstetric care is a key determinant for preventing maternal mortality due to obstetric emergencies. The relationship between proximity to comprehensive care and facility delivery is further complicated by the use of varied methods in measuring facility obstetric capacity-which may misrepresent the real scenario of obstetric care availability in a service environment. We investigated the joint effects of proximity and two emergency obstetric care assessment (EmOC) methods on women's place of delivery in Malawi and Haiti. Household level and health facility data were obtained from the 2013-2018 Demographic and Health Surveys and Service Provision Assessment surveys. Records of women aged 15 to 49 years who had a childbirth in the last 5 years were linked to obstetric facilities within 5km, 10km and 15km from their households using Kernel Density Estimation. Log-binomial models were fitted to estimate the joint effects of proximity to comprehensive facilities on place of delivery and two EmOC methods (1. the facility's recent performance of signal functions only, and 2. a composite index of obstetric care), and whether this varied by urban/rural setting. Proximity to comprehensive facilities was significantly associated with facility delivery in Malawi among women living 5km of a comprehensive facility (using EmOC method 2), in addition, living further (15km) from facilities with high capacity of EmOC was associated with reduced likelihood for facility delivery in urban settings in stratified analyses. In contrast, positive associations were present in Haiti in both urban and rural settings, with the likelihood of facility delivery being higher with greater proximity of women to comprehensive facilities, regardless of methods to define EmOC. Women living within 5km of a comprehensive facility in Haiti were the most likely to deliver in facilities based on EmOC method 1 (APR: 1.81, 95% CI 1.56, 2.09). Findings from Malawi elucidates the relevance of context and suggests the need for research in diverse settings.
家庭与全面产科护理的距离是预防产科紧急情况导致孕产妇死亡的关键决定因素。由于在衡量设施产科能力时使用了多种方法，这使得与全面护理的距离和设施分娩之间的关系变得更加复杂，这些方法可能会歪曲服务环境中产科护理可及性的真实情况。我们调查了距离和两种紧急产科护理评估（EmOC）方法对马拉维和海地妇女分娩地点的联合影响。家庭层面和卫生设施数据来自2013 - 2018年人口与健康调查以及服务提供评估调查。使用核密度估计法，将过去5年中有分娩经历的15至49岁女性的记录与距离其家庭5公里、10公里和15公里范围内的产科设施相联系。采用对数二项式模型来估计靠近综合设施对分娩地点的联合影响以及两种EmOC方法（1. 仅设施近期的信号功能表现，2. 产科护理综合指数），并探究这种影响是否因城乡环境而异。在马拉维，对于居住在距离综合设施5公里范围内的妇女（使用EmOC方法2），靠近综合设施与设施分娩显著相关。此外，在分层分析中发现，在城市环境中，距离具有高EmOC能力的设施更远（15公里）与设施分娩的可能性降低有关。相比之下，在海地的城乡环境中均存在正相关关系，无论采用何种方法定义EmOC，妇女距离综合设施越近，在设施分娩的可能性就越高。在海地，居住在距离综合设施5公里范围内的妇女最有可能根据EmOC方法1在设施中分娩（风险比：1.81，95%置信区间1.56，2.09）。马拉维的研究结果阐明了背景的相关性，并表明需要在不同环境中开展研究。
