School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.
PeerJ. 2024 Sep 20;12:e18128. doi: 10.7717/peerj.18128. eCollection 2024.
Giving birth in a healthcare facility with the guidance of skilled healthcare providers allows access to necessary medical interventions. Ethiopia has implemented several strategies to enhance institutional delivery and decrease maternal mortality; however, the rate of institutional delivery remains low. This study examines the role of distance to healthcare institutions on institutional delivery in Ethiopia, and how this has changed over time.
This study used data from two rounds of the Ethiopian Demographic and Health Survey (2011 and 2016), a spatial database detailing the locations of healthcare facilities, and Ethiopian road network data. The sample included 22,881 women who delivered within the 5 years preceding each survey and lived in 1,295 villages. Bivariate and multivariable logistic regression analyses were used to investigate how the distance to health facilities and other potential determinants influenced institutional delivery trends.
The rate of institutional deliveries in Ethiopia has increased from 10% in 2011 to 26% in 2016. Likewise, the average transportation distance to health facilities has decreased from 22.4 km in 2011 to 20.2 km in 2016 at the national level. Furthermore, a one-kilometer increase in the distance to the nearest health facility was associated with a 1% decrease in the likelihood of delivering at a health facility in 2016 (odds ratio (OR) = 0.99, 95% CI [0.98-0.99], < 0.05). Additionally, mothers who are more educated, have completed more antenatal care visits, live in wealthier households in more urban areas, and cohabit with more educated husbands are more likely to deliver at healthcare facilities. These variables showed consistent relevance in both survey rounds, suggesting that key determinants remained largely unchanged throughout the study period.
The impact of distance from health facilities on institutional delivery in Ethiopia remains evident, although its influence is relatively modest. The other factors, including education, antenatal care, socioeconomic status, urban residence, and partner education, remained consistent between the two surveys. These determinants have consistently influenced institutional delivery, highlighting the importance of a comprehensive approach that addresses both access to and socioeconomic factors to improve maternal and infant health across the country.
在有熟练医护人员指导的医疗机构分娩，可以获得必要的医疗干预。埃塞俄比亚实施了多项策略来增加机构分娩数量，降低产妇死亡率；然而，机构分娩率仍然很低。本研究考察了距离医疗机构的远近对埃塞俄比亚机构分娩的影响，以及这种影响随时间的变化情况。
本研究使用了两轮埃塞俄比亚人口与健康调查（2011 年和 2016 年）的数据、一个详细说明医疗机构位置的空间数据库以及埃塞俄比亚道路网络数据。样本包括在每次调查前 5 年内分娩且居住在 1295 个村庄的 22881 名妇女。使用二变量和多变量逻辑回归分析来调查距离医疗机构的远近和其他潜在决定因素如何影响机构分娩趋势。
埃塞俄比亚的机构分娩率从 2011 年的 10%增加到 2016 年的 26%。同样，全国范围内到医疗机构的平均交通距离从 2011 年的 22.4 公里减少到 2016 年的 20.2 公里。此外，距离最近的医疗机构每增加一公里，2016 年在医疗机构分娩的可能性就会降低 1%（优势比（OR）=0.99，95%置信区间 [0.98-0.99]，<0.05）。此外，受教育程度更高、接受过更多产前护理访问、居住在更富裕的家庭、居住在城市地区和与受过教育的丈夫同居的母亲更有可能在医疗机构分娩。这些变量在两轮调查中都具有一致性，表明在整个研究期间，关键决定因素基本保持不变。
距离医疗机构的远近对埃塞俄比亚机构分娩的影响仍然明显，尽管其影响相对较小。其他因素，包括教育、产前护理、社会经济地位、城市居住和伴侣教育，在两次调查中保持一致。这些决定因素一直影响着机构分娩，这突出表明需要采取一种全面的方法，既要解决获得医疗服务的问题，也要解决社会经济因素，以改善全国的母婴健康。
