Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda
Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda
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DOI：
10.1186/s12889-018-5695-z
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发表时间：
2018-06-19
影响因子：
4.5
通讯作者：
Abdulsalam-Anibilowo, Maryam
中科院分区：
文献类型：
--
作者：
Doctor, Henry V.;Nkhana-Salimu, Sangwani;Abdulsalam-Anibilowo, Maryam
背景：撒哈拉以南非洲地区仍然是健康状况不佳的区域之一，产妇死亡率和5岁以下儿童死亡率很高就是明证。在怀孕和分娩期间和之后发生的并发症可能会导致产妇死亡；其中大多数是可以预防或治疗的。有证据表明，在训练有素的人员的监督下，在保健机构及早和定期进行产前护理和分娩与改善产妇的健康状况有关。这项研究的目的是使用撒哈拉以南非洲具有国家代表性的调查来评估卫生设施提供的变化和决定因素。这项研究还试图在可持续发展议程的背景下，提出关于卫生设施提供的决定因素的新证据，以产生基于证据的决策，并能够部署有针对性的干预措施，以改善卫生设施提供和妇幼保健成果。方法：我们使用1990年至2015年在撒哈拉以南非洲29个国家进行的58项人口与健康调查(DHS)的汇集数据。这导致在调查之前的5年中总共有110万名新生儿出生。描述性统计用于描述按分娩地点分列的分娩妇女的数目和比例以及她们在分娩时的背景特征。我们使用多水平Logistic回归模型以优势比的形式估计分娩地点和预测因素之间的关联程度。结果：结果显示，财富最富有的五分之一的妇女在医疗机构分娩的可能性比财富最低的五分之一的妇女高68%。至少受过小学教育的妇女在设施中分娩的可能性是没有受过正规教育的妇女的两倍。自2010年以来进行的较新调查的新生儿在设施中出生的可能性比最早(20世纪90年代)调查报告的新生儿高85%。总体而言，在设施中分娩的比例比预期高出2%；不同国家和撒哈拉以南非洲地区的情况有所不同。结论：增加卫生设施提供的有效干预措施应侧重于解决与孕产妇教育、妇女赋权、更多获得卫生设施的机会有关的不平等问题，以及缩小城乡差距。我们在到2030年不让任何人掉队的议程中进一步讨论这些结果。
Background: Sub-Saharan Africa remains one of the regions with modest health outcomes; and evidenced by high maternal mortality ratios and under-5 mortality rates. There are complications that occur during and following pregnancy and childbirth that can contribute to maternal deaths; most of which are preventable or treatable. Evidence shows that early and regular attendance of antenatal care and delivery in a health facility under the supervision of trained personnel is associated with improved maternal health outcomes. The aim of this study is to assess changes in and determinants of health facility delivery using nationally representative surveys in sub-Saharan Africa. This study also seeks to present renewed evidence on the determinants of health facility delivery within the context of the Agenda for Sustainable Development to generate evidence-based decision making and enable deployment of targeted interventions to improve health facility delivery and maternal and child health outcomes.Methods: We used pooled data from 58 Demographic and Health Surveys (DHS) conducted between 1990 and 2015 in 29 sub-Saharan African countries. This yielded a total of 1.1 million births occurring in the 5 years preceding the surveys. Descriptive statistics were used to describe the counts and proportions of women who delivered by place of delivery and their background characteristics at the time of delivery. We used multilevel logistic regression model to estimate the magnitude of association in the form of odds ratios between place of delivery and the predictors.Results: Results show that births among women in the richest wealth quintile were 68% more likely to occur in health facilities than births among women in the lowest wealth quintile. Women with at least primary education were twice more likely to give birth in facilities than women with no formal education. Births from more recent surveys conducted since 2010 were 85% more likely to occur in facilities than births reported in earliest (1990s) surveys. Overall, the proportion of births occurring in facilities was 2% higher than would be expected; and varies by country and sub-Saharan African region.Conclusions: Proven interventions to increase health facility delivery should focus on addressing inequities associated with maternal education, women empowerment, increased access to health facilities as well as narrowing the gap between the rural and the urban areas. We further discuss these results within the agenda of leaving no one behind by 2030.