Preventing, but Not Caring for, Adolescent Pregnancies? Disparities in the Quality of Reproductive Health Care in Sub-Saharan Africa.
Preventing, but Not Caring for, Adolescent Pregnancies? Disparities in the Quality of Reproductive Health Care in Sub-Saharan Africa.
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预防但不照顾青少年怀孕？撒哈拉以南非洲生殖保健质量的差异。
DOI：
10.1016/j.jadohealth.2022.02.012
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发表时间：
2022-08
影响因子：
7.6
通讯作者：
Shah, Manisha
中科院分区：
文献类型：
--
作者：
Moucheraud, Corrina;McBride, Kaitlyn;Heuveline, Patrick;Shah, Manisha
令人关切的是，青少年的保健质量比老年妇女差。我们比较了四个撒哈拉以南非洲国家青少年（<20岁）与成年妇女（≥25岁）的生殖健康服务（计划生育和产前保健）质量。总共分析了来自刚果民主共和国、马拉维、塞内加尔和坦桑尼亚的2,342次计划生育就诊和8,600次产前保健就诊。服务提供评估调查包括观察护理和客户离职面谈。我们比较了青少年与年龄≥25岁的成年女性的访视内容和护理满意度。所有模型都是多层次的，加权以反映调查设计，并包括客户，供应商和设施协变量（合并模型还包括调查固定效应）。与成年女性相比，青少年接受了更多的计划生育护理活动（调整后的广义线性模型中的2.31项活动，标准误[SE] 1.29，p < .1），以及3.76项更多的讨论活动（例如，咨询）（SE 1.94，p < .1），但产前护理期间的讨论活动明显较少（-3.10活动，SE 0.97，p < .01）。然而，青少年对这两种护理类型的满意度与成年女性没有显着差异。这些关系在使用不同模型规格的国家分层模型中以及在将青少年与≥20岁女性进行比较时基本上持续存在。青少年的计划生育访问是类似的，甚至比成年妇女更全面，但他们的产前检查包括较少的建议护理组成部分，特别是需要提供者-客户对话的活动的差距。这表明有机会加强服务提供者与年轻妇女之间的沟通，并改善整个生殖健康连续体的护理。
There is concern that adolescents experience worse quality of health care than older women. We compare quality of reproductive health services (family planning and antenatal care) for adolescents (<20 years) versus adult women (≥25 years), in four sub-Saharan African countries. In total, 2,342 family planning visits and 8,600 antenatal care visits were analyzed from Democratic Republic of the Congo, Malawi, Senegal, and Tanzania. Service Provision Assessment surveys include observation of care and client exit interviews. We compare visit content and care satisfaction for adolescents versus adult women aged ≥25. All models are multilevel, weighted to reflect survey design, and include client, provider, and facility covariates (pooled models also include survey fixed effects). Adolescents receive more overall family planning care activities compared to adult women (2.31 activities in adjusted generalized linear models, standard error [SE] 1.29, p < .1), and 3.76 more discussion activities (e.g., counseling) on average (SE 1.94, p < .1), but significantly fewer discussion activities during antenatal care (−3.10 activities, SE .97, p < .01). However, adolescents’ satisfaction with both care types was not significantly different than adult women. These relationships largely persist in country-stratified models, using different model specifications, and when comparing adolescents to women aged ≥20. Adolescents’ family planning visits are similar to, or even slightly more comprehensive than, adult women—but their antenatal visits include fewer recommended care components, with particular gaps for activities requiring provider-client dialog. This suggests opportunities for strengthening communication between providers and young women, and improving care across the reproductive health continuum.
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