Tekeba Berhan, Zegeye Alebachew Ferede, Gebrehana Deresse Abebe, Tamir Tadesse Tarik
Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Ann Glob Health. 2025 Jan 24;91(1):5. doi: 10.5334/aogh.4615. eCollection 2025.
Most maternal deaths are associated with home deliveries, which account for half of births in low‑income countries. To develop appropriate policies and methods that could aid in addressing the issues, it is important to understand the burden of home delivery despite having easy access to health facilities in low‑income nations such as sub‑Saharan Africa. In addition, identifying and prioritizing determinants could help executives to review their perinatal policies. Therefore, this study aimed at assessing the prevalence and factors associated with home delivery among women who have access to health facilities. A population‑based cross‑sectional study was done. The most recent Demographic and Health Survey (DHS) data from 22 sub‑Saharan African (SSA) countries from 2015 to 2022 were used. A total weighted samples of 493,396 women who gave birth at home despite having access to health facilities were included in the study. The data were examined using Stata 17. A multi‑level logistic regression model was used to identify factors associated with lactation-home delivery despite easy access to health facility. The adjusted odds ratio at the 95% confidence interval (Cl) was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a ‑value of < 0.05 are declared statistically significant. The pooled prevalence of home delivery among women who had easy access to health facilities in 22 SSA countries was 23.67% (95% CI, 23.55-23.79). After adjusting for confounders, being above 35 years, being a rural resident, being from the poorest and lowest wealth quintile, and living in rural regions all increase the likelihood of home birth among women in sub‑Saharan Africa who have easy access to healthcare. Women with higher education, women who have optimal antenatal care (ANC) visits, women involved in healthcare decisions in households, and households with health insurance coverage reduce the odds of home delivery among women who have easy access to health facilities in sub‑Saharan Africa. According to this study, a higher portion of women in sub‑Saharan Africa who had easy access to medical facilities gave birth at home. The study's findings demonstrated that factors at the individual and community levels influence home delivery with easy access to health facilities. Policymakers, the government, health planners, and implementers must therefore understand the burden of the problem and should increase media coverage, enhance health insurance coverage, empower women, and mobilize resources for maternal care.
大多数孕产妇死亡与在家分娩有关，在低收入国家，在家分娩占分娩总数的一半。为了制定有助于解决这些问题的适当政策和方法，了解在家分娩的负担很重要，尽管在撒哈拉以南非洲等低收入国家可以方便地使用卫生设施。此外，确定决定因素并确定其优先顺序可以帮助管理人员审查他们的围产期政策。因此，本研究旨在评估有机会使用卫生设施的妇女中在家分娩的患病率及其相关因素。开展了一项基于人群的横断面研究。使用了2015年至2022年来自22个撒哈拉以南非洲（SSA）国家的最新人口与健康调查（DHS）数据样本。本研究纳入了493,396名有机会使用卫生设施但仍在家分娩的妇女的加权样本。使用Stata 17对数据进行了分析。采用多水平逻辑回归模型来确定尽管可以方便地使用卫生设施，但与在家分娩相关的因素。计算95%置信区间（Cl）的调整后比值比，以评估解释变量和结果变量之间关联的强度和显著性。P值<0.05的因素被判定具有统计学意义。在22个撒哈拉以南非洲国家中，可以方便地使用卫生设施的妇女在家分娩的合并患病率为23.67%（95%CI，23.55-23.79）。在对混杂因素进行调整后，35岁以上、农村居民、来自最贫困和最低财富五分位数以及居住在农村地区，都会增加撒哈拉以南非洲有机会获得医疗保健的妇女在家分娩的可能性。受过高等教育的妇女、接受过最佳产前保健（ANC）检查的妇女、参与家庭医疗保健决策的妇女以及有医疗保险覆盖的家庭，会降低撒哈拉以南非洲有机会使用卫生设施的妇女在家分娩的几率。根据这项研究，撒哈拉以南非洲有机会使用医疗设施的妇女中，有更高比例的人在家分娩。该研究结果表明，个人和社区层面的因素会影响在有机会使用卫生设施的情况下在家分娩的情况。因此，政策制定者、政府、卫生规划者和实施者必须了解这一问题的负担，并应增加媒体报道、扩大医疗保险覆盖范围、增强妇女权能以及为孕产妇护理调动资源。
