Muhajarine Nazeem, Shakurun Nahin, Ahmed Md Sabbir, Andre Fernanda, Chicumbe Sergio
Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Saskatchewan, Canada.
BMJ Glob Health. 2025 May 24;10(5):e018121. doi: 10.1136/bmjgh-2024-018121.
Mozambique has one of the highest maternal mortality rates in sub-Saharan Africa. While some progress has been made, further efforts are required to ensure that women in Mozambique have access to high-quality healthcare. A key strategy for reducing maternal and child mortality is to promote adequate access to and utilisation of maternal healthcare services.
We used the population-based, nationwide, cross-sectional Mozambique Demographic and Health Survey 2022-2023 data (n=3808). The survey employed a two-stage stratified sampling design that yielded a nationally representative sample at the household level. Four essential maternal healthcare services outcomes were defined: adequate (at least four visits) antenatal care by a skilled provider, lab-based test services (blood, urine and ultrasound), births with a skilled birth attendant and postnatal care by a skilled provider.
Overall, 18.6% of women received maternal healthcare services. Maternal healthcare utilisation showed significant inequalities favouring wealthier and more empowered women. Regression model suggests that women who were classified in the highest quintile for empowerment index (adjusted OR (aOR)=2.17, 95% CI=1.41 to 3.33), women in the two highest quintiles for wealth index (richer: aOR=2.37, 95% CI=1.41 to 3.98; richest: aOR=2.60, 95% CI=1.41 to 4.79) and women residing in urban area (aOR=1.35, 95% CI=0.99 to 1.83) were significantly associated with the utilisation of healthcare services. Other factors like exposure to media (television/radio/newspaper), husband's educational status, distance to the nearest health facility and province/region of residence also determined maternal healthcare services utilisation.
Our findings highlight the need for targeted interventions such as improving women's education, healthcare infrastructure and distance barriers and promoting gender equality to ensure greater service utilisation. These findings could help advance further development and implementation of Mozambique's national strategies, and development assistance, for community-based primary healthcare and women-centred care as they provide the latest evidence on this topic.
莫桑比克是撒哈拉以南非洲孕产妇死亡率最高的国家之一。尽管已取得一些进展，但仍需进一步努力，以确保莫桑比克妇女能够获得高质量的医疗保健服务。降低孕产妇和儿童死亡率的一项关键战略是促进孕产妇保健服务的充分可及性和利用。
我们使用了基于人口的全国性横断面2022 - 2023年莫桑比克人口与健康调查数据（n = 3808）。该调查采用两阶段分层抽样设计，在家庭层面产生了具有全国代表性的样本。定义了四项基本的孕产妇保健服务结果：由熟练提供者提供的充足（至少四次就诊）产前护理、基于实验室的检测服务（血液、尿液和超声）、由熟练助产士接生以及由熟练提供者提供产后护理。
总体而言，18.6%的妇女接受了孕产妇保健服务。孕产妇保健服务的利用存在显著不平等，更有利于较富裕和赋权更强的妇女。回归模型表明，在赋权指数最高五分位数组中的妇女（调整后比值比（aOR）= 2.17，95%置信区间= 1.41至3.33）、在财富指数最高两个五分位数组中的妇女（较富裕：aOR = 2.37，95%置信区间= 1.41至3.98；最富裕：aOR = 2.60，95%置信区间= 1.41至4.79）以及居住在城市地区的妇女（aOR = 1.35，95%置信区间= 0.99至1.83）与保健服务的利用显著相关。其他因素，如接触媒体（电视/广播/报纸）、丈夫的教育程度、到最近医疗机构的距离以及居住的省份/地区，也决定了孕产妇保健服务的利用情况。
我们的研究结果凸显了采取针对性干预措施的必要性，如改善妇女教育、医疗保健基础设施和距离障碍，并促进性别平等，以确保更高的服务利用率。这些研究结果有助于推进莫桑比克国家战略以及社区初级医疗保健和以妇女为中心的护理方面的发展援助的进一步制定和实施，因为它们提供了关于这一主题的最新证据。
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