Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea.
Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA.
J Glob Health. 2024 May 10;14:04085. doi: 10.7189/jogh.14.04085.
Postnatal care (PNC) utilisation within 24 hours of delivery is a critical component of health care services for mothers and newborns. While substantial geographic variations in various health outcomes have been documented in India, there remains a lack of understanding regarding PNC utilisation and underlying factors accounting for these geographic variations. In this study, we aimed to partition and explain the variation in PNC utilisation across multiple geographic levels in India.
Using India's 5th National Family Health Survey (2019-21), we conducted four-level logistic regression analyses to partition the total geographic variation in PNC utilisation by state, district, and cluster levels, and to quantify how much of theses variations are explained by a set of 12 demographic, socioeconomic, and pregnancy-related factors. We also conducted analyses stratified by selected states/union territories.
Among 149 622 mother-newborn pairs, 82.29% of mothers and 84.92% of newborns were reported to have received PNC within 24 hours of delivery. In the null model, more than half (56.64%) of the total geographic variation in mother's PNC utilisation was attributed to clusters, followed by 26.06% to states/union territories, and 17.30% to districts. Almost 30% of the between-state variation in mother's PNC utilisation was explained by the demographic, socioeconomic, and pregnancy-related factors (i.e. state level variance reduced from 0.486 (95% confidence interval (CI) = 0.238, 0.735) to 0.320 (95% CI = 0.152, 0.488)). We observed consistent results for newborn's PNC utilisation. State-specific analyses showed substantial geographic variation attributed to clusters across all selected states/union territories.
Our findings highlight the consistently large cluster variation in PNC utilisation that remains unexplained by compositional effects. Future studies should explore contextual drivers of cluster variation in PNC utilisation to inform and design interventions aimed to improve maternal and child health.
产后护理（PNC）在分娩后 24 小时内的利用是母婴保健服务的重要组成部分。尽管印度在各种健康结果方面存在显著的地域差异，但对于 PNC 的利用以及导致这些地域差异的潜在因素仍缺乏了解。在这项研究中，我们旨在划分和解释印度多个地理层面上 PNC 利用的差异。
我们使用印度第五次全国家庭健康调查（2019-21 年），进行了四级逻辑回归分析，以划分 PNC 利用在邦、区和聚类层面上的总地理差异，并量化这些差异中有多少可以由一组 12 个人口统计学、社会经济和妊娠相关因素来解释。我们还按选定的邦/联邦属地进行了分层分析。
在 149622 对母婴对中，82.29%的母亲和 84.92%的新生儿在分娩后 24 小时内接受了 PNC。在零模型中，母亲 PNC 利用的总地理差异中有一半以上（56.64%）归因于聚类，其次是邦/联邦属地（26.06%）和区（17.30%）。母亲 PNC 利用的州际差异中有近 30%可以用人口统计学、社会经济和妊娠相关因素来解释（即州级差异从 0.486（95%置信区间（CI）=0.238，0.735）减少到 0.320（95% CI=0.152，0.488））。我们观察到新生儿 PNC 利用的结果一致。针对特定州的分析显示，所有选定的邦/联邦属地都存在归因于聚类的大量地域差异。
我们的研究结果强调了 PNC 利用中始终存在的大量聚类差异，这些差异无法用构成效应来解释。未来的研究应该探索 PNC 利用中聚类差异的背景驱动因素，为改善母婴健康的干预措施提供信息和设计依据。
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