Oyedele Oyewole K, Lawal Temitayo V
International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Glob Health Res Policy. 2025 Feb 27;10(1):10. doi: 10.1186/s41256-025-00409-x.
Despite 70% of global maternal death occurring in Sub-Saharan Africa (SSA) and the high rate of non-institutional delivery (NID), studies that inspect the connections are needed but lacking. Thus, we investigated the urban-rural burden and risk factors of NID and the correlate with maternal mortality to extend strategies for sinking the mortality spike towards sustainable development goal (SDG-3.1) in SSA.
Secondary analysis of recent (2014-2021) cross-sectional demographic-health-survey (DHS) were conducted across 25-countries in SSA. Primary outcome was institutional versus non-institutional delivery and secondary outcome was maternal-mortality-ratio (MMR) per 100,000 livebirths and the lifetime risk (LTR), while predictors were grouped by socio-economic, obstetrics and country-level factors. Data were weighted to adjust for heterogeneity and descriptive analysis was performed. Pearson chi-square, correlation, and simple linear regression anlyses were performed to assess relationships. Multivariable logistic regression further evaluated the predictor likelihood and significance at alpha = 5% (95% confidence-interval 'CI').
Prevalence of NID was highest in Chad (78.6%), Madagascar (60.6%), then Nigeria (60.4%) and Angola (54.3%), with rural SSA dominating NID rate by about 85%. Odds of NID were significantly lower by 60% and 98% among women who had at least four antenatal care (ANC) visits (aOR = 0.40, 95%CI = 0.38-0.41) and utilized skilled birth attendants (SBA) at delivery (aOR = 0.02, 95%CI = 0.01-0.02), respectively. The odds of NID reduces by women age, educational-level, and wealth-quintiles. Positive and significant linear relationship exist between NID and MMR (ρ = 0.5453), and NID and LTR (ρ = 0.6136). Consequently, 1% increase in NID will lead to about 248/100000 and 8.2/1000 increase in MMR and LTR in SSA respectively.
Only South Africa, Rwanda and Malawi had achieved the WHO 90% coverage for healthcare delivery. ANC and SBA use reduced NID likelihood but, MMR is significantly influenced by NID. Hence, strategic decline in NID will proportionately influence the sinking of MMR spike to attain SDG-3.1 in SSA.
尽管全球70%的孕产妇死亡发生在撒哈拉以南非洲地区（SSA），且该地区非机构分娩率（NID）很高，但仍需要开展研究来探究两者之间的联系，然而相关研究却较为匮乏。因此，我们调查了非机构分娩的城乡负担及风险因素，以及其与孕产妇死亡率的关联，以拓展相关策略，降低SSA地区的死亡率峰值，朝着可持续发展目标（SDG-3.1）迈进。
对SSA地区25个国家近期（2014 - 2021年）的横断面人口健康调查（DHS）进行二次分析。主要结局为机构分娩与非机构分娩，次要结局为每10万例活产的孕产妇死亡率（MMR）及终身风险（LTR），预测因素则按社会经济、产科和国家层面因素进行分组。对数据进行加权以调整异质性，并进行描述性分析。采用Pearson卡方检验、相关性分析和简单线性回归分析来评估关系。多变量逻辑回归进一步评估预测因素在α = 5%（95%置信区间‘CI’）时的可能性和显著性。
非机构分娩率在乍得最高（78.6%），其次是马达加斯加（60.6%）、尼日利亚（60.4%）和安哥拉（54.3%），SSA地区农村地区的非机构分娩率约占85%。至少进行过四次产前检查（ANC）的女性发生非机构分娩的几率显著降低60%，而分娩时使用熟练接生员（SBA）的女性发生非机构分娩的几率显著降低98%（调整后比值比分别为aOR = 0.40，95%CI = 0.38 - 0.41；aOR = 0.02，95%CI = 0.01 - 0.02）。非机构分娩的几率随女性年龄、教育水平和财富五分位数的增加而降低。非机构分娩与MMR（ρ = 0.5453）以及非机构分娩与LTR（ρ = 0.6136）之间存在正相关且显著的线性关系。因此，在SSA地区，非机构分娩率每增加1%，MMR和LTR将分别增加约248/100000和8.2/1000。
只有南非、卢旺达和马拉维实现了世界卫生组织规定的90%的医疗服务覆盖率。ANC和SBA的使用降低了非机构分娩的可能性，但MMR受非机构分娩的显著影响。因此，非机构分娩率的战略性下降将相应地影响MMR峰值的降低，从而在SSA地区实现SDG-3.1。
