利用2008 - 2019年最新人口与健康调查数据，对撒哈拉以南非洲育龄妇女产前检查次数及其相关因素的研究：多层次负二项回归模型
Number of antenatal care visits and associated factors among reproductive age women in Sub-Saharan Africa using recent demographic and health survey data from 2008-2019: A multilevel negative binomial regression model.
作者信息
Gebeyehu Fetene Getnet, Geremew Bisrat Misganaw, Belew Aysheshim Kassahun, Zemene Melkamu Aderajew
机构信息
Department of Epidemiology, Gambella Regional Health Bureau, Gambella, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
PLOS Glob Public Health. 2022 Dec 27;2(12):e0001180. doi: 10.1371/journal.pgph.0001180. eCollection 2022.
BACKGROUND
Antenatal care is one of the best strategies for maternal and neonatal mortality reduction. There is a paucity of evidence on the mean number of ANC visits and associated factors in Sub-Saharan Africa (SSA). This study aimed to investigate the mean number of ANC visits and associated factors among reproductive-age women in Sub-Saharan Africa using the Demographic and Health Survey conducted from 2008 to 2019.
METHOD
A total of 256,425 weighted numbers of women who gave birth five years before the survey were included. We used STATA version 14 for data management and analysis. A multilevel negative binomial regression model was fitted. Finally, the Adjusted Incident Rate Ratio (AIRR) with its 95% CI confidence interval was reported. Statistical significance was declared at P-value < 0.05.
RESULTS
The mean number of ANC visits among women who gave birth five years before the survey in SSA was 3.83 (95% CI = 3.82, 3.84) Individual-level factors such as being aged 36-49 years (AIRR = 1.20, 95% CI = 1.18,1.21), having secondary education &above (AIRR = 1.44, 95% CI = 1.42, 1.45), having rich wealth status (AIRR = 1.08, 95% CI = 1.07, 1.09), media exposure (AIRR = 1.10, 95% CI = 1.09,1.11), and grand multiparity (AIRR = 0.90, 95% CI = 0.89, 0.91) were significantly associated with the number of ANC visits. Furthermore, rural residence (AIRR = 0.90, 95% CI = 0.89, 0.91), Western SSA region (AIRR = 1.19, 95% CI = 1.18, 1.20) and being from a middle-income country (AIRR = 1.09, 95% CI = 1.08, 1.10) were community-level factors that had a significant association with the number of ANC visits.
CONCLUSION
The mean number of ANC visits in SSA approximates the minimum recommended number of ANC visits by the World Health Organization. Women's educational status, women's age, media exposure, parity, planned pregnancy, wealth status, residence, country's income, and region of SSA had a significant association with the frequency of ANC visits. This study suggests that addressing geographical disparities and socio-economic inequalities will help to alleviate the reduced utilization of ANC services.
背景
产前保健是降低孕产妇和新生儿死亡率的最佳策略之一。关于撒哈拉以南非洲地区产前保健就诊的平均次数及相关因素的证据不足。本研究旨在利用2008年至2019年进行的人口与健康调查，调查撒哈拉以南非洲地区育龄妇女产前保健就诊的平均次数及相关因素。
方法
共纳入调查前五年分娩的256,425名加权妇女。我们使用STATA 14版进行数据管理和分析。拟合了一个多层次负二项回归模型。最后，报告了调整后的发病率比（AIRR）及其95%置信区间。P值<0.05时具有统计学意义。
结果
撒哈拉以南非洲地区调查前五年分娩的妇女产前保健就诊的平均次数为3.83次（95%置信区间=3.82, 3.84）。个体层面的因素，如年龄在36 - 49岁（AIRR = 1.20，95%置信区间=1.18, 1.21）、接受过中等及以上教育（AIRR = 1.44，95%置信区间=1.42, 1.45）、拥有富裕的财富状况（AIRR = 1.08，95%置信区间=1.07, 1.09）、接触媒体（AIRR = 1.10，95%置信区间=1.09, 1.11）和多产（AIRR = 0.90，95%置信区间=0.89, 0.91）与产前保健就诊次数显著相关。此外，农村居住（AIRR = 0.90，95%置信区间=0.89, 0.91）、撒哈拉以南非洲西部地区（AIRR = 1.19，95%置信区间=1.18, 1.20）以及来自中等收入国家（AIRR = 1.09，95%置信区间=1.08, 1.10）是与产前保健就诊次数有显著关联的社区层面因素。
结论
撒哈拉以南非洲地区产前保健就诊的平均次数接近世界卫生组织建议的最低就诊次数。妇女的教育状况、年龄、接触媒体情况、产次、计划妊娠、财富状况、居住地区、国家收入以及撒哈拉以南非洲地区的区域与产前保健就诊频率有显著关联。本研究表明，解决地理差异和社会经济不平等问题将有助于缓解产前保健服务利用率降低的情况。
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