Sheikh Naima Said, Hussein Ahmed M, Mohamed Shukri Said, Gele Abdi
Department of Public Health Science, Norwegian University of Life Sciences, Ås, Norway.
Department of Maternal and Reproductive Health, Somali Institute for Health Research, Mogadishu, Somalia.
Front Glob Womens Health. 2024 Jul 25;5:1216290. doi: 10.3389/fgwh.2024.1216290. eCollection 2024.
In developing countries, institutional delivery is a key proven intervention that reduces maternal mortality and can reduce maternal deaths by approximately 16%-33%. In Somalia, only 32% of births are delivered in a health facility with the assistance of a skilled healthcare provider. We aimed to investigate the factors hindering women from giving birth at healthcare facilities in major towns in Somalia, where most of the health facilities in the country are concentrated.
A community-based health survey was carried out in 11 major towns in Somalia between October and December 2021. A structured and pretested questionnaire was used to collect data from 430 women who gave birth in the last five years. Women were recruited through convenient sampling. Descriptive statistics were used to summarize the data, and binary and multivariable logistic regression analysis was performed. Adjusted odds ratios (AOR) with 95% CI were estimated to assess the associations.
The overall prevalence of institutional delivery was 57%. Approximately 38% of women living in Mogadishu and 53% living in another ten towns give birth at home. Women who had poor knowledge of the importance of health facility delivery had nearly four times higher odds of delivering at home (AOR 3.64 CI: 1.49-8.93). Similarly, those who did not receive antenatal care (AOR 2.5, CI: 1.02-6.39) and those who did not receive a consultation on the place of delivery (AOR 2.15, CI: 1.17-3.94) were more likely to give birth at home. The reasons for home delivery included financial reasons, the long distance to the health facility, and the fact that it was easier to give birth at home.
The study found that home delivery is high in major towns in Somalia and is associated with a lack of understanding of the importance of health facility delivery, not using ANC, and not receiving consultancy about where to give birth. Primary health care should strengthen information, education, and communication activities. Since the health care system in Somalia is overwhelmingly private, the government may consider access to free and within-reach ANC and health facility delivery for women and girls from families who cannot pay the ANC and childbirth delivery cost.
在发展中国家，机构分娩是一项经证实的关键干预措施，可降低孕产妇死亡率，能减少约16%-33%的孕产妇死亡。在索马里，只有32%的分娩是在熟练医护人员的协助下于医疗机构进行的。我们旨在调查阻碍索马里主要城镇妇女在医疗机构分娩的因素，该国大部分医疗机构都集中在这些城镇。
2021年10月至12月期间，在索马里的11个主要城镇开展了一项基于社区的健康调查。使用一份结构化且经过预测试的问卷，从过去五年内分娩的430名妇女中收集数据。通过方便抽样招募妇女。使用描述性统计来汇总数据，并进行二元和多变量逻辑回归分析。估计调整后的比值比（AOR）及95%置信区间（CI）以评估相关性。
机构分娩的总体患病率为57%。居住在摩加迪沙的妇女中约38%以及居住在其他十个城镇的妇女中53%在家分娩。对医疗机构分娩重要性了解不足的妇女在家分娩的几率几乎高出四倍（AOR 3.64，CI：1.49 - 8.93）。同样，那些未接受产前护理的妇女（AOR 2.5，CI：1.02 - 6.39）以及那些未接受分娩地点咨询的妇女（AOR 2.15，CI：1.17 - 3.94）更有可能在家分娩。在家分娩的原因包括经济原因、距离医疗机构路途遥远以及在家分娩更容易。
该研究发现，索马里主要城镇的在家分娩率较高，且与对医疗机构分娩重要性缺乏认识、未使用产前护理以及未接受分娩地点咨询有关。初级卫生保健应加强信息、教育和宣传活动。由于索马里的医疗保健系统绝大多数是私立的，政府可考虑为无力支付产前护理和分娩费用的家庭中的妇女和女孩提供免费且可及的产前护理和医疗机构分娩服务。
