Community and health system factors associated with facility delivery in rural Tanzania: A multilevel analysis
Community and health system factors associated with facility delivery in rural Tanzania: A multilevel analysis
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DOI：
10.1016/j.healthpol.2010.05.002
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发表时间：
2010-10-01
期刊：
影响因子：
3.3
通讯作者：
Galea, Sandro
中科院分区：
文献类型：
--
作者：
Kruk, Margaret E.;Rockers, Peter C.;Galea, Sandro
目的：坦桑尼亚是一个孕产妇死亡率高的国家，拥有许多初级卫生设施，但设施接生率较低。这项研究估计了个人和社区因素在解释坦桑尼亚农村地区使用卫生设施分娩的差异方面的贡献。方法：在坦桑尼亚西部的卡苏卢区对最近分娩的妇女进行了一项基于人口的两阶段整群调查。采用随机截距多水平Logistic回归模型评估个人和村级因素与设施交付可能性之间的关系。结果：1205名妇女参与研究。在完全调整的两水平模型中，除了几个个体因素外，村庄对医生和护士技能的积极认知(优势比(OR)6.72，95%可信区间(CI)：2.47~18.31)和对传统助产士技能的负面认知(OR 0.13，95%CI：0.04~0.40)与更高的设施分娩几率有关。结论：本研究表明，社区对当地卫生系统质量的感知影响着妇女在诊所分娩的决定。改善一级诊所的护理质量并向社区传达这一点可能有助于努力增加撒哈拉以南非洲的设施提供。(C)2010爱思唯尔爱尔兰有限公司。保留所有权利。
Objectives: Tanzania, a country with high maternal mortality, has many primary health facilities yet has a low rate of facility deliveries. This study estimated the contribution of individual and community factors in explaining variation in the use of health facilities for childbirth in rural Tanzania.Methods: A two-stage cluster population-based survey was conducted in Kasulu District, western Tanzania with women with a recent delivery. Random intercept multilevel logistic regression models were used to assess the association between individual- and village-level factors and likelihood of facility delivery.Results: 1205 women participated in the study. In the fully adjusted two-level model, in addition to several individual factors, positive village perception of doctor and nurse skills (odds ratio (OR) 6.72, 95% confidence interval (CI): 2.47-18.31) and negative perception of traditional birth attendant skills (OR 0.13, 95% CI: 0.04-0.40) were associated with higher odds of facility delivery.Conclusion:This study suggests that community perceptions of the quality of the local health system influence women's decisions to deliver in a clinic. Improving quality of care at first-level clinics and communicating this to communities may assist efforts to increase facility delivery in sub-Saharan Africa. (C) 2010 Elsevier Ireland Ltd. All rights reserved.