Doctoral School of Health Science, Faculty of Health Science, University of Pécs, Vörösmarty u. 4, Pecs, 7621, Hungary.
Ministry of Health, Marsabit County, Moyale Sub-County, PO Box 57 (60 700), Kenya.
Reprod Health. 2024 Sep 2;21(1):126. doi: 10.1186/s12978-024-01865-3.
Improving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya.
A cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05.
Of the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10-74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47-6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34-5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19-5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68-133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99-6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43-350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88-14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77-3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35-21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively).
In conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education.
改善孕产妇医疗服务对于实现可持续发展目标（SDG-3）至关重要，该目标旨在降低孕产妇死亡率和发病率。不同研究人员一致认为，适当利用孕产妇医疗服务可以改善妇女的生殖健康，这可以通过在怀孕期间提供产前护理（ANC）、医疗设施分娩（HFD）和产后护理（PNC）来实现。本研究的主要目的是调查肯尼亚牧民社区育龄妇女对母婴保健服务的利用情况及其相关因素。
2019 年 1 月 2 日至 2 月 29 日，在马萨比特县的 10 个流动村庄对过去两年内分娩的 180 名牧民妇女进行了横断面调查。分析了三个关键结果，即她们是否接受了 4 次以上的 ANC、在 HF 分娩以及接受了 PNC。根据《加强观察性研究报告的流行病学（STROBE）指南》，采用 IBM SPSS27.0 进行了 Pearson χ检验和多变量逻辑回归分析。显著性水平设为 p<0.05。
在 180 名符合条件的牧民妇女（平均年龄 27.44±5.13 岁）中，92.2%为文盲，93.9%已婚，33.3%为一夫多妻制，14.4%有手机。中位数通勤距离为 15.00（10-74）公里，41.7%接受了 4 次以上的 ANC，33.3%接受了 HFD，42.8%接受了 PNC。那些居住在距离卫生机构≤15 公里的妇女，ANC 4+（OR 3.10，95%CI 1.47-6.53）、HFD（OR 2.80，95%CI 1.34-5.84）和 PNC（OR 2.49，95%CI 1.19-5.22）的可能性更高。ANC 4+（OR 29.88，95%CI 6.68-133.62）、HFD（OR 2.56，95%CI 0.99-6.63）和 PNC（OR 60.46，95%CI 10.43-350.55）的可能性分别高出 30 倍、2.5 倍和 60 倍。在有手机的妇女中，一夫一妻制婚姻意味着 ANC 4+（OR 5.17，95%CI 1.88-14.23）、HFD（OR 1.67，95%CI 0.77-3.62）和 PNC（OR 7.05，95%CI 2.35-21.19）的可能性高出五倍。Hosmer Lemeshow 检验表明 ANC 4+、HFD 和 PNC 的模型拟合良好（p=0.790，p=0.441，p=0.937，分别）。
综上所述，三种基本孕产妇保健服务的利用率较低。地理位置接近、一夫一妻制婚姻和拥有手机是显著的预测因素。因此，建议利益相关者通过提供移动医疗外展和健康教育，主动将这项服务带到牧民社区。
