Altijani Noon, Khogali Mustafa, Hinton Lisa, Opondo Charles, Eljack Eman, Knight Marian, Nair Manisha
Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
School of Medicine, Ahfad University for Women, Omdurman, Sudan.
Front Glob Womens Health. 2023 Aug 29;4:1012676. doi: 10.3389/fgwh.2023.1012676. eCollection 2023.
Improving maternal health and survival remains a public health priority for Sudan. Significant investments were made to expand access to maternal health services, such as through the training and deployment of providers with varying skills and competencies to work across the country. This study investigates trends in the coverage of different birth attendants and their relationship with the maternal mortality ratio (MMR).
Trend analyses were conducted using data from the 2006, 2010, and 2014 Sudan Household surveys. Three categories of birth attendants were identified: (1) skilled birth attendants (SBA) such as doctors, nurse-midwives, and health visitors, (2) locally certified midwives, and (3) traditional birth attendants (TBA). Multivariable logistic regression models were used to examine trends in SBAs (vs. locally certified midwives and TBAs), locally certified midwives (vs SBAs and TBAs), and SBAs and locally certified midwives by place of birth (health facility and home). The analyses were adjusted for potential confounders. An ecological analysis was conducted to assess the relationship between birth attendants by place of birth and MMR at the state level.
Births by 15,848 women were analysed. Locally certified midwives attended most births in each survey year, with their contribution increasing from 36.3% in 2006 to 55.5% in 2014. The contributions of SBAs and TBAs decreased over the same period. In 2014 compared with 2006, births were more likely to be attended by a locally certified midwife (aOR: 2.19; 95%CI: 1.82-2.63) but less likely to be attended by a SBA (aOR: 0.46; 95%CI: 0.37-0.56). The decrease in SBA was more substantial for births taking place at home (aOR: 0.17; 95%CI: 0.12-0.23) than for health facility births (aOR: 0.45; 95%CI: 0.31-0.65). In the ecological analysis 2014-2016, the proportion of births attended by SBA in health facilities correlated negatively with MMR at state level (rho -0.55; : 0.02).
This analysis suggests that although an improved coverage of maternal health with locally certified midwives has been observed, it has not provided the skill level reached by SBA. SBAs working in facility settings were a key correlating factor to reduced maternal mortality. Urgent action is needed to improve access to SBAs in health facilities, thereby accelerating progress in reducing maternal mortality.
改善孕产妇健康和生存状况仍是苏丹的一项公共卫生重点工作。已投入大量资金以扩大孕产妇保健服务的可及性，比如通过培训和部署具备不同技能和能力的医护人员到全国各地工作。本研究调查了不同接生人员的覆盖率趋势及其与孕产妇死亡率（MMR）的关系。
利用2006年、2010年和2014年苏丹家庭调查的数据进行趋势分析。确定了三类接生人员：（1）熟练接生人员（SBA），如医生、护士 - 助产士和健康访视员；（2）当地认证的助产士；（3）传统接生员（TBA）。使用多变量逻辑回归模型来研究SBA（与当地认证的助产士和传统接生员相比）、当地认证的助产士（与SBA和传统接生员相比）以及按出生地（医疗机构和家中）划分的SBA和当地认证的助产士的趋势。分析对潜在混杂因素进行了调整。进行了一项生态分析，以评估按出生地划分的接生人员与州一级孕产妇死亡率之间的关系。
分析了15848名妇女的分娩情况。在每个调查年份，当地认证的助产士接生的分娩数量最多，其贡献从2006年的36.3%增至2014年的55.5%。同期，SBA和传统接生员的贡献有所下降。与2006年相比，2014年分娩更有可能由当地认证的助产士接生（调整后比值比：2.19；95%置信区间：1.82 - 2.63），但由SBA接生的可能性较小（调整后比值比：0.46；95%置信区间：0.37 - 0.56）。在家中分娩时SBA的减少幅度比在医疗机构分娩时更大（调整后比值比：0.17；95%置信区间：0.12 - 0.23）（调整后比值比：0.45；95%置信区间：0.31 - 0.65）。在2014 - 2016年的生态分析中，医疗机构中由SBA接生的分娩比例与州一级的孕产妇死亡率呈负相关（相关系数 -0.55；P：0.02）。
该分析表明，尽管观察到当地认证的助产士对孕产妇保健的覆盖率有所提高，但未达到SBA的技能水平。在医疗机构工作的SBA是降低孕产妇死亡率的关键相关因素。需要采取紧急行动，以改善在医疗机构获得SBA服务的机会，从而加快降低孕产妇死亡率的进展。
