Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
Thamini Uhai, Dar es Salaam, Tanzania.
Glob Health Sci Pract. 2023 Aug 28;11(4). doi: 10.9745/GHSP-D-22-00502.
Postnatal care (PNC) is an underused service in the continuum of care for mothers and infants in sub-Saharan Africa. There is little evidence on health facility characteristics that influence PNC utilization. Understanding PNC use in the context of individual, community, and health facility characteristics may help in the development of programs for increased use.
We analyzed data from 4,353 women with recent births in Kigoma Region, Tanzania, and their use of PNC (defined as at least 1 checkup in a health facility in the region within 42 days of delivery). We used a mixed-effects multilevel logistic regression analysis to explain PNC use while accounting for household, individual, and community characteristics from a regionwide population-based reproductive health survey and for distance to and adequacy of proximal health facilities from a health facility assessment.
PNC utilization rate was low (15.9%). Women had significantly greater odds of PNC if they had a high level of decision-making autonomy (adjusted odds ratio [aOR]: 1.56; 95% confidence interval [CI]=1.11, 2.17); had a companion at birth (aOR: 1.57; 95% CI=1.19, 2.07); had cesarean delivery (aOR: 2.27; 95% CI=1.47, 3.48); resided in Kasulu district (aOR: 3.28; 95% CI=1.94, 5.52); or resided in a community that had at least 1 adequate health facility within 5 km (aOR: 2.15; 95% CI=1.06, 3.88).
Women's decision-making autonomy and presence of companionship at birth, as well as proximity to a health facility with adequate infrastructure, equipment, and workforce, were associated with increased PNC use. More efforts toward advocating for the health benefits of PNC using multiple channels and increasing quality of care in health facilities, including companionship at birth, can increase utilization rates.
在撒哈拉以南非洲，产后护理（PNC）是母婴保健连续服务中未被充分利用的服务。关于影响 PNC 使用的卫生机构特征的证据很少。了解 PNC 在个人、社区和卫生机构特征方面的使用情况，可能有助于制定增加使用的方案。
我们分析了坦桑尼亚基戈马地区 4353 名近期分娩妇女的数据，以及她们对 PNC 的使用情况（定义为在分娩后 42 天内在该地区至少在一家卫生机构进行一次检查）。我们使用混合效应多级逻辑回归分析来解释 PNC 的使用情况，同时考虑了来自全地区生殖健康调查的家庭、个人和社区特征，以及来自卫生机构评估的距离和附近卫生机构的充分性。
PNC 利用率很低（15.9%）。如果女性具有高度的决策自主权（调整后的优势比 [aOR]：1.56；95%置信区间 [CI]=1.11，2.17）；分娩时有陪伴（aOR：1.57；95% CI=1.19，2.07）；进行剖宫产（aOR：2.27；95% CI=1.47，3.48）；居住在卡苏卢区（aOR：3.28；95% CI=1.94，5.52）；或居住在距离至少有 1 家设施齐全的卫生机构 5 公里内的社区（aOR：2.15；95% CI=1.06，3.88），则更有可能进行 PNC。
女性的决策自主权和分娩时的陪伴存在，以及与基础设施、设备和劳动力充足的卫生机构接近，与增加 PNC 使用有关。通过多种渠道倡导 PNC 的健康益处，并提高卫生机构的服务质量，包括分娩时的陪伴，可以提高利用率。
