Paternal Factors and Inequity Associated with Access to Maternal Health Care Service Utilization in Nepal: A Community Based Cross-Sectional Study
Paternal Factors and Inequity Associated with Access to Maternal Health Care Service Utilization in Nepal: A Community Based Cross-Sectional Study
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DOI：
10.1371/journal.pone.0130380
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发表时间：
2015-06-24
期刊：
影响因子：
3.7
通讯作者：
Aryal, Umesh Raj
中科院分区：
文献类型：
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作者：
Bhatta, Dharma Nand;Aryal, Umesh Raj
背景 增加孕产妇保健服务的使用可以减少孕产妇死亡的威胁。在低收入和中等收入国家，孕产妇死亡和获得孕产妇保健服务的机会不公平。本研究的目的是评估相关的父亲因素以及在获得孕产妇保健服务利用方面的不平等程度。方法分析以多阶段整群抽样后的横断面家庭调查为例。计算浓度曲线和指数。进行二元逻辑回归分析以考虑与利用孕产妇保健服务相关的父亲因素。采用结构方程模型 (SEM) 的路径模型检查了产前护理 (ANC) 和机构分娩的预测因素。结果本研究的结果显示，分别有 39.9% 和 45.5% 的受访者妻子进行了 ANC 就诊并使用了机构分娩服务。与没有受过教育或未受过小学教育的男性相比，受过研究生及更高教育水平的男性更有可能（AOR：5.91，95% CI；4.02，8.70）其妻子患有 ANC。家庭收入较高的男性 (Q5) 更有可能 (1.99, 95% CI; 1.39, 2.86) 为其妻子配备 ANC。同样，较高的家庭收入（Q5）也决定了（2.74，95% CI；1.81，4.15）其妻子在机构分娩。集中曲线和指数也有利于富人而不是穷人。 SEM发现ANC就诊与机构分娩直接相关。结论年龄、家庭财富、子女数量、民族、教育程度、孕期危险信号知识、丈夫寻求母婴保健的决策等父亲因素是影响孕产妇保健服务利用的重要因素。较高的 ANC 覆盖率预示着机构交付的利用率较高。富裕人群更加集中于孕产妇保健服务。穷人和富人之间的不平等必须通过有效的政策和计划来解决。
BackgroundThe threat of maternal mortality can be reduced by increasing use of maternal health services. Maternal death and access to maternal health care services are inequitable in low and middle income countries. The aim of this study is to assess associated paternal factors and degree of inequity in access to maternal health care service utilization.MethodsAnalysis illustrates on a cross-sectional household survey that followed multistage-cluster sampling. Concentration curve and indices were calculated. Binary logistic regression analysis was executed to account paternal factors associated with the utilization of maternal health services. Path model with structural equation modeling (SEM) examined the predictors of antenatal care (ANC) and institutional delivery.ResultsThe finding of this study revealed that 39.9% and 45.5% of the respondents' wives made ANC visits and utilized institutional delivery services respectively. Men with graduate and higher level of education were more likely (AOR: 5.91, 95% CI; 4.02, 8.70) to have ANC of their wives than men with no education or primary level of education. Men with higher household income (Q5) were more likely (1.99, 95% CI; 1.39, 2.86) to have ANC for their wives. Similarly, higher household income (Q5) also determined (2.74, 95% CI; 1.81, 4.15) for institutional delivery of their wives. Concentration curve and indices also favored rich than the poor. SEM revealed that ANC visit was directly associated to institutional delivery.ConclusionsPaternal factors like age, household wealth, number of children, ethnicity, education, knowledge of danger sign during pregnancy, and husband's decision making for seeking maternal and child health care are crucial factors associated to maternal health service utilization. Higher ANC coverage predicts higher utilization of the institutional delivery. Wealthier population is more concentrated to maternal health services. The inequities between the poor and the rich are necessary to be addressed through effective policy and programs.