Department of Economics, College of Business and Economics, Bahir Dar University, Bahir Dar, Ethiopia.
College of Business and Economics, Jimma University, Jimma, Ethiopia.
Front Public Health. 2024 Sep 18;12:1417883. doi: 10.3389/fpubh.2024.1417883. eCollection 2024.
Poverty poses a significant barrier to accessing healthcare globally, particularly in relation to antenatal care (ANC) visits and the use of childbirth facilities, both of which are crucial for women's health and fetal well-being. In Somaliland, only 47% of pregnant women attend healthcare facilities for ANC, with a mere 33% receiving care from skilled birth attendants. Despite this, no previous studies have examined the relationship between poverty and maternal healthcare utilization in Somaliland. This study aims to investigate the effect of poverty on maternal healthcare utilization with focus on ANC visits and the choice of place of birth in Somaliland.
Utilizing data from the 2020 Somaliland Demographic Health Survey, a cross-sectional study design was employed, analyzing a nationally representative sample. The sample size used in this study was 3,183 women of reproductive age. Descriptive analysis, negative binomial regression, and multinomial logistic regression were conducted using Stata version 18.0. Diagnostic tests, including Chi-square - 2log likelihood statistic, Akaike Information Criterion, and Bayesian Information Criterion, were employed to evaluate model fit.
Poverty, as indicated by wealth quintile, was associated with reduced ANC visits (adjusted incidence rate ratio (aIRR) = 0.884, 95% CI: 0.791-0.987) among women in poorer households compared to those in richer households. Women in Togdheer, Sool, and Sanaag regions had lower ANC visit rates compared to Maroodi Jeex region (aIRR = 0.803, 95% CI: 0.687-0.939; aIRR = 0.710, 95% CI: 0.601-0.839; aIRR = 0.654, 95% CI: 0.558-0.768, respectively). Women from poorer households had lower probabilities of opting for public health facilities (adjusted relative risk ratio (aRRR) = 0.457, 95% CI: 0.352-0.593) and private health facilities (aRRR = 0.195, 95% CI: 0.111-0.341) over home births compared to women in richer households. Women in Togdheer, Sool, and Sanaag regions had lower probabilities of choosing public (aRRR range: 0.331-0.175) and private (aRRR range: 0.350-0.084) health facilities for delivery over home births compared to women in Maroodi Jeex region.
Poverty significantly impedes maternal healthcare utilization, contributing to lower ANC attendance and preference for home births over public or private health facility births. Addressing these disparities requires initiatives to eliminate financial barriers, such as user fees, and enhance equitable access through community-based health insurance and improved healthcare infrastructure.
贫困是全球获得医疗保健的一个重大障碍，尤其是在产前护理 (ANC) 就诊和分娩设施的使用方面，这两者对妇女健康和胎儿福祉都至关重要。在索马里兰，只有 47%的孕妇前往医疗机构进行 ANC，仅有 33%的孕妇接受熟练助产士的护理。尽管如此，之前没有研究调查过索马里兰贫困与孕产妇医疗保健利用之间的关系。本研究旨在探讨贫困对孕产妇医疗保健利用的影响，重点关注 ANC 就诊和分娩地点的选择。
利用 2020 年索马里兰人口与健康调查的数据，采用横断面研究设计，对全国代表性样本进行分析。本研究的样本量为 3183 名育龄妇女。使用 Stata 版本 18.0 进行描述性分析、负二项回归和多项逻辑回归。采用卡方检验-2log 似然统计量、赤池信息量准则和贝叶斯信息量准则等诊断检验来评估模型拟合度。
按财富五分位数衡量的贫困与较贫困家庭的妇女 ANC 就诊次数减少有关（调整后的发病率比 (aIRR)=0.884，95%置信区间：0.791-0.987），而较富裕家庭的妇女 ANC 就诊次数较多。与马尔卡迪杰克斯地区相比，托格代尔、索勒和萨纳格地区的妇女 ANC 就诊率较低（aIRR=0.803，95%置信区间：0.687-0.939；aIRR=0.710，95%置信区间：0.601-0.839；aIRR=0.654，95%置信区间：0.558-0.768）。较贫困家庭的妇女选择公共卫生设施（调整后的相对风险比 (aRRR)=0.457，95%置信区间：0.352-0.593）和私人卫生设施（aRRR=0.195，95%置信区间：0.111-0.341）分娩的概率低于较富裕家庭的妇女。与马尔卡迪杰克斯地区的妇女相比，托格代尔、索勒和萨纳格地区的妇女选择公共（aRRR 范围：0.331-0.175）和私人（aRRR 范围：0.350-0.084）卫生设施分娩的概率较低。
贫困严重阻碍了孕产妇医疗保健的利用，导致 ANC 就诊率降低，以及更倾向于在家分娩而不是在公共或私人卫生设施分娩。消除财务障碍（如使用费用）和通过社区为基础的医疗保险和改善医疗基础设施来增强公平获取机会等举措，对于解决这些差距至关重要。
