Barriers for pregnant women living in rural, agricultural villages to accessing antenatal care in Cambodia: A community-based cross-sectional study combined with a geographic information system.
Barriers for pregnant women living in rural, agricultural villages to accessing antenatal care in Cambodia: A community-based cross-sectional study combined with a geographic information system.
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DOI：
10.1371/journal.pone.0194103
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Mizutani T
中科院分区：
文献类型：
--
作者：
Yasuoka J;Nanishi K;Kikuchi K;Suzuki S;Ly P;Thavrin B;Omatsu T;Mizutani T
孕产妇发病率和死亡率仍然是柬埔寨等低收入和中等收入国家的一个主要公共卫生问题。改善孕妇获得产前护理 (ANC) 服务的机会已被广泛认为是降低孕产妇死亡率和发病率的最有效手段之一。因此，本研究根据在柬埔寨最不发达的省份之一腊塔纳基里省收集的数据，结合基于社区的横断面调查和地理信息系统 (GIS)，探讨了生活在农村、农业村庄的孕妇获得 ANC 的障碍。 2015 年 12 月，我们对柬埔寨腊塔纳基里省 62 个村庄的 377 名有两岁以下儿童的母亲进行了一项基于社区的横断面调查。通过面对面访谈，询问母亲们有关 ANC 服务的使用情况、对 ANC 的了解、使用医疗设施的障碍以及最近一次怀孕期间经历的并发症。同时，还利用全球定位系统（GPS）收集GIS数据，以准确测量孕妇前往医疗机构的实际出行距离，并更详细地检查地理和环境障碍。只有三分之一的母亲符合世界卫生组织 (WHO) 提出的接受四次或以上 ANC 的建议（达到 ANC4+），四分之一的母亲在最近一次怀孕期间从未接受过 ANC。与实现 ANC4+ 呈正相关的因素包括母亲的中等或高等教育（调整后优势比 [AOR] = 5.50，95% 置信区间 [CI]：1.74, 17.37）、意识到建议接受 ANC（AOR = 2.74，95% CI：1.25、6.00）以及了解建议的 ANC 频率（AOR = 2.26， 95% CI：7.22）。实际行驶距离与达到 ANC4+ 呈负相关。与旅行的母亲相比，必须旅行 10.0–14.9 公里的母亲达到 ANC 4+ 的可能性要低 68%（AOR = 0.32，95% CI：0.10，0.99），而必须旅行 15.0 公里或更长的母亲达到 ANC 4+ 的可能性要低 79%（AOR = 0.21，95% CI：0.07，0.62） 5.0公里以下。虽然之前的大多数研究都使用直线来测量行驶距离，但本研究使用 GIS 更准确地测量了实际行驶距离。因此，实际行驶距离与直线距离之间存在统计学上的显着差异。这项研究揭示了生活在柬埔寨偏远农村的孕妇使用 ANC 的促进因素和障碍。此外，这项研究强调了准确测量旅行距离的重要性，以确保 ANC 的针对性干预措施不会被直线距离误导。本研究使用的方法可广泛应用于其他发展中国家，特别是在道路网络有限的偏远地区，这些地区的实际距离和直线距离可能存在较大差异。
Maternal morbidity and mortality is still a major public health issue in low- and middle-income countries such as Cambodia. Improving access to antenatal care (ANC) services for pregnant women has been widely recognized as one of the most effective means of reducing maternal mortality and morbidity. As such, this study examined the barriers for pregnant women living in rural, agricultural villages to accessing ANC based on data collected in the Ratanakiri province, one of the least developed provinces in Cambodia, using a combination of a community-based cross-sectional survey and a geographic information system (GIS). A community-based cross-sectional survey was conducted among 377 mothers with children under the age of two living in 62 villages in the Ratanakiri province, Cambodia, in December 2015. Face-to-face interviews were conducted to ask mothers about their ANC service use, knowledge of ANC, barriers to accessing health facilities, and complications they experienced during the most recent pregnancy. At the same time, GIS data were also collected using a Global Positioning System (GPS) to accurately measure actual travel distance of pregnant women to access health facilities and to examine geographical and environmental barriers in greater detail. Only a third of the mothers met the recommendations made by the World Health Organization (WHO) of receiving ANC four times or more (achieved ANC4+), and a quarter of the mothers had never received ANC during their most recent pregnancy. Factors positively associated with achieving ANC4+ were mother’s secondary or higher education (adjusted odds ratio [AOR] = 5.50, 95% confidence interval [CI]: 1.74, 17.37), being aware that receiving ANC is recommended (AOR = 2.74, 95% CI: 1.25, 6.00), and knowledge about the recommended frequency for ANC (AOR = 2.26, 95% CI: 7.22). Actual travel distance was negatively associated with achieving ANC4+. Mothers who had to travel 10.0–14.9 km were 68% less likely (AOR = 0.32, 95% CI: 0.10, 0.99), and those who had to travel 15.0 km or longer were 79% less likely (AOR = 0.21, 95% CI: 0.07, 0.62) to have achieved ANC 4+, both compared to those who travelled 5.0 km or less. While most previous studies have used a straight-line to measure distance traveled, this study much more accurately measured the actual distance traveled by using a GIS. As a result, there was a statistically significant discrepancy between actual travel distance and straight-line distance. This study revealed promoting factors and barriers for ANC use among pregnant women living in remote, agricultural villages in Cambodia. Furthermore, this study highlights the importance of measuring travel distances accurately to ensure that targeted interventions for ANC are not misguided by straight-line distances. The methodology used in this study can be applied widely to other developing countries, especially in remote areas with limited road networks where there may be a large discrepancy between actual and straight-line distances.
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