School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
BMC Public Health. 2023 Jun 19;23(1):1174. doi: 10.1186/s12889-023-15938-8.
This study sought to investigate the level and determinants of receiving quality antenatal care (ANC), intrapartum care, and postnatal care (PNC) services by women in Ethiopia. The quality of care a woman receives during ANC, intrapartum care, and PNC services affects the health of the woman and her child and her likelihood of seeking care in the future.
Data from the nationally representative Ethiopia Mini Demographic and Health Survey 2019 were analysed for 5,527 mothers who gave birth within five years preceding the survey. We defined quality ANC as having: blood pressure measurement, urine and blood tests, informed of danger signs, iron supplementation, and nutritional counselling during ANC services; quality intrapartum care as having: a health facility birth, skilled birth assistance, and a newborn put to the breast within one hour of birth during intrapartum care services; and quality PNC as having: PNC within two days; cord examination; temperature measurement, and counselling on danger signs and breastfeeding of the newborn; and healthcare provider's observation of breastfeeding during PNC services. We used multilevel mixed-effects logistic regression analyses specifying three-level models: a woman/household, a cluster, and an administrative region to determine predictors of each care quality. The analyses employed sampling weights and were adjusted for sampling design.
Thirty-six percent (n = 1,048), 43% (n = 1,485), and 21% (n = 374) women received quality ANC, intrapartum care and PNC services, respectively. Private healthcare facilities provided higher-quality ANC and PNC but poor-quality intrapartum care, compared to public health facilities. Having four or more ANC visits, commencing ANC during the first trimester, and higher women's education levels and household wealth indices were positive predictors of quality ANC use. Government health posts were less likely to provide quality ANC. Wealthier, urban-residing women with education and four or more ANC contacts were more likely to receive quality intrapartum care. Women who received quality ANC and skilled birth assistance were more likely to receive quality PNC. Teenage mothers were more likely to receive quality intrapartum care, but were less likely to receive quality PNC than mothers aged 20-49.
We recommend standardizing the contents of ANC provided in all healthcare facilities; and promoting early and four or more ANC contacts, effectiveness, sensitivity and vigilance of care provided to teenage mothers, and women's education and economic empowerment.
本研究旨在探讨埃塞俄比亚妇女获得产前护理（ANC）、分娩期护理和产后护理（PNC）服务的水平和决定因素。妇女在 ANC、分娩期护理和 PNC 服务中获得的护理质量会影响其自身和子女的健康，并影响其未来寻求护理的可能性。
对 2019 年全国代表性埃塞俄比亚小型人口与健康调查中 5527 名在调查前五年内分娩的母亲进行了数据分析。我们将 ANC 服务中的以下内容定义为优质 ANC：血压测量、尿液和血液检查、告知危险信号、铁补充剂和营养咨询；分娩期护理服务中的优质分娩期护理定义为：在分娩期护理服务中，在卫生机构分娩、由熟练的接生人员协助分娩，以及新生儿在出生后 1 小时内进行哺乳；将 PNC 服务中的以下内容定义为优质 PNC：在分娩后两天内进行 PNC；脐带检查；体温测量，以及对新生儿的危险信号和母乳喂养进行咨询；以及医护人员观察母乳喂养情况。我们使用多水平混合效应逻辑回归分析，指定了三级模型：妇女/家庭、聚类和行政区，以确定每项护理质量的预测因素。分析采用了抽样权重，并根据抽样设计进行了调整。
36%（n=1048）、43%（n=1485）和 21%（n=374）的妇女分别接受了优质 ANC、分娩期护理和 PNC 服务。与公立卫生机构相比，私立卫生机构提供的 ANC 和 PNC 质量较高，但分娩期护理质量较差。接受了四次或更多 ANC 就诊、在妊娠早期开始 ANC 以及女性教育水平和家庭财富指数较高，这些都是优质 ANC 使用的积极预测因素。政府卫生所提供的 ANC 质量较差。较富裕、居住在城市、接受过教育并进行了四次或更多 ANC 接触的妇女更有可能接受优质的分娩期护理。接受了优质 ANC 和熟练接生服务的妇女更有可能接受优质 PNC。青少年母亲更有可能接受优质分娩期护理，但比 20-49 岁的母亲更不可能接受优质 PNC。
我们建议标准化所有医疗保健机构提供的 ANC 内容；并促进青少年母亲以及妇女教育和经济赋权的早期和四次或更多 ANC 接触、护理的有效性、敏感性和警惕性。
