Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
School of Health Sciences, Western Sydney University, Penrith, NSW, Australia.
PLoS One. 2024 Sep 3;19(9):e0299704. doi: 10.1371/journal.pone.0299704. eCollection 2024.
Postnatal care (PNC) is essential for early identification and management of life-threatening obstetric complications. Despite efforts by the Ethiopian government to improve maternal and child health service use, PNC service has remained low, and disparity across geographic locations is a major public health problem. This study aimed to investigate the change and contributing factors in PNC service use across geographical locations (rural-urban) and over time (2016 to 2019) in Ethiopia.
We analyzed data on women who gave birth from the 2016 and 2019 Ethiopian Demographic and Health Surveys. A total of 6,413 weighted samples (4,308 in 2016 and 2,105 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine the change and identify factors that contributed to the change across geographical locations and over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05.
The prevalence of PNC use was higher among urban residents, and the urban-rural disparity reduced from 32.59% in 2016 to 19.08% in 2019. The difference in the composition of explanatory variables was the only statistically significant for the urban-rural disparity in PNC use in both surveys. Specifically, female household heads (4.51%), delivery at a health facility (83.45%), and birth order of two to three (5.53%) and four or more (-12.24%) in 2016 significantly contributed to the urban-rural gap. However, in 2019, middle wealth index (-14.66%), Muslim religion (3.84%), four or more antennal care contacts (18.29%), and delivery at a health facility (80.66%) significantly contributed to the urban-rural gap. PNC use increased from 16.61% in 2016 to 33.86% in 2019. About 60% of the explained change was due to the difference in the composition of explanatory variables. Particularly, urban residence (-5.79%), a rich wealth index (2.31%), Muslim (3.42%), and other (-2.76%) religions, having radio or television (1.49%), 1-3 (-1.13%), and 4 or more (11.09%) antenatal care contacts, and delivery at a health facility (47.98%) were statistically significant contributors to the observed change. The remaining 40% of the overall change was due to the difference in unknown behaviors (coefficient) of the population towards PNC.
There was a significant change in PNC service use by residence location and over time in Ethiopia, with urban women in both surveys being more likely to use PNC service. The urban-rural disparity in PNC uptake was due to the difference in the composition of explanatory variables, whereas the change over time was due to the change in both the composition of explanatory variables and population behavior towards PNC. Increased antenatal care contacts and delivery at a health facility played a major role in explaining the gap in PNC services across residences and over time in Ethiopia, highlighting the importance of stepping up efforts to enhance their uptake in rural settings.
产后护理（PNC）对于早期识别和处理危及生命的产科并发症至关重要。尽管埃塞俄比亚政府努力改善母婴健康服务的利用情况，但 PNC 服务仍然很低，地理位置之间的差异是一个主要的公共卫生问题。本研究旨在调查埃塞俄比亚地理位置（城乡）和时间（2016 年至 2019 年）之间 PNC 服务利用情况的变化及其影响因素。
我们分析了来自 2016 年和 2019 年埃塞俄比亚人口与健康调查的分娩妇女数据。共有 6413 个加权样本（2016 年 4308 个，2019 年 2105 个）纳入分析。采用多元分解分析技术确定变化，并确定导致地理位置和时间变化的因素。统计显著性定义为 95%置信区间，p 值小于 0.05。
城市居民的 PNC 使用比例较高，城乡差距从 2016 年的 32.59%缩小到 2019 年的 19.08%。两个调查中，解释变量构成的差异是唯一具有统计学意义的城乡 PNC 使用差异。具体来说，2016 年，女性户主（4.51%）、在医疗机构分娩（83.45%）以及生育顺序为 2-3 个（5.53%）和 4 个或更多（-12.24%）显著导致了城乡差距。然而，在 2019 年，中等财富指数（-14.66%）、穆斯林宗教（3.84%）、4 次或更多次产前护理接触（18.29%）以及在医疗机构分娩（80.66%）显著导致了城乡差距。PNC 使用从 2016 年的 16.61%增加到 2019 年的 33.86%。约 60%的解释变化归因于解释变量构成的差异。特别是城市居住（-5.79%）、富裕财富指数（2.31%）、穆斯林（3.42%）和其他（-2.76%）宗教、拥有收音机或电视（1.49%）、1-3 次（-1.13%）和 4 次或更多次（11.09%）产前护理接触，以及在医疗机构分娩（47.98%）是观察到的变化的统计学显著贡献者。总体变化的其余 40%归因于人群对 PNC 行为的未知（系数）差异。
埃塞俄比亚的 PNC 服务利用情况在居住地和时间上都发生了显著变化，两个调查中的城市妇女更有可能使用 PNC 服务。PNC 利用率的城乡差距是由于解释变量构成的差异造成的，而随着时间的推移，这种差距是由于解释变量构成的变化以及人口对 PNC 的行为变化造成的。增加产前护理接触次数和在医疗机构分娩在解释埃塞俄比亚城乡之间 PNC 服务差距方面发挥了重要作用，这突显了加强努力提高农村地区利用率的重要性。
