Factors affecting home delivery among women living in remote areas of rural Zambia: a cross-sectional, mixed-methods analysis.
Factors affecting home delivery among women living in remote areas of rural Zambia: a cross-sectional, mixed-methods analysis.
复制标题
DOI：
10.2147/ijwh.s169067
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Lori JR
中科院分区：
文献类型：
--
作者：
Scott NA;Henry EG;Kaiser JL;Mataka K;Rockers PC;Fong RM;Ngoma T;Hamer DH;Munro-Kramer ML;Lori JR
获得熟练的护理和有能力提供紧急产科和新生儿护理的设施对于降低孕产妇死亡率至关重要。在赞比亚农村地区，42% 的妇女在家分娩，这表明妇女在寻求、获得和接受优质产妇护理方面持续面临挑战。这项研究评估了赞比亚农村偏远妇女在家分娩的决定因素。对居住在 40 个地点距其服务区卫生机构 10 公里或更远的最近分娩的妇女进行了一项家庭调查。一部分受访者完成了深度访谈。使用多元回归和内容分析来分析数据。最终样本包括 2,381 名女性，其中 240 名还完成了访谈。家庭距其服务区卫生机构的中位数为 12.8 公里（四分位数间距 10.9、16.2）。尽管 1% 的受访者打算在家送货，但实际上有 15.3% 的受访者在家送货，3.2% 在前往设施的途中送货。受访者表示，劳动力不足、供应有限、运输成本高、距离远以及所需物资成本高是不在医疗机构分娩的原因。调整混杂因素后，首次怀孕的女性（调整后 OR [aOR]：0.1，95% CI：0.1，0.2）和在等待分娩期间留在待产家庭（MWH）的女性与在家分娩的几率降低相关（aOR 0.1，95% CI：0.1，0.2）。年龄超过 35 岁（aOR 1.3，95% CI：0.9，1.9），从未结婚（aOR 2.1，95% CI：1.2，3.7），未完成建议的四次或以上产前检查（aOR 2.0，95% CI：1.5，2.5），并且不居住在接受大规模孕产妇保健计划的地区（aOR 3.2， 95% CI: 2.3, 4.5) 是送货上门的重要预测因素。调整混杂因素后，居住地距离设施较近（9.5-10 公里）与送货上门的几率降低无关，尽管置信区间显示出显着趋势（aOR 0.7，95% CI：0.4，1.1）。调查结果突显了生活在偏远地区的妇女在实现分娩地点意图时面临的持续挑战。减少在家分娩的干预措施不仅应针对居住最远的妇女，还应针对多孕妇、产前检查较少的妇女以及不使用 MWH 的妇女。
Access to skilled care and facilities with capacity to provide emergency obstetric and newborn care is critical to reducing maternal mortality. In rural areas of Zambia, 42% of women deliver at home, suggesting persistent challenges for women in seeking, reaching, and receiving quality maternity care. This study assessed the determinants of home delivery among remote women in rural Zambia. A household survey was administered to a random selection of recently delivered women living 10 km or more from their catchment area health facility in 40 sites. A subset of respondents completed an in-depth interview. Multiple regression and content analysis were used to analyze the data. The final sample included 2,381 women, of which 240 also completed an interview. Households were a median of 12.8 km (interquartile range 10.9, 16.2) from their catchment area health facility. Although 1% of respondents intended to deliver at home, 15.3% of respondents actually delivered at home and 3.2% delivered en route to a facility. Respondents cited shorter than expected labor, limited availability and high costs of transport, distance, and costs of required supplies as reasons for not delivering at a health facility. After adjusting for confounders, women with a first pregnancy (adjusted OR [aOR]: 0.1, 95% CI: 0.1, 0.2) and who stayed at a maternity waiting home (MWH) while awaiting delivery were associated with reduced odds of home delivery (aOR 0.1, 95% CI: 0.1, 0.2). Being over 35 (aOR 1.3, 95% CI: 0.9, 1.9), never married (aOR 2.1, 95% CI: 1.2, 3.7), not completing the recommended four or more antenatal visits (aOR 2.0, 95% CI: 1.5, 2.5), and not living in districts exposed to a large-scale maternal health program (aOR 3.2, 95% CI: 2.3, 4.5) were significant predictors of home delivery. After adjusting for confounders, living nearer to the facility (9.5–10 km) was not associated with reduced odds of home delivery, though the CIs suggest a trend toward significance (aOR 0.7, 95% CI: 0.4, 1.1). Findings highlight persistent challenges facing women living in remote areas when it comes to realizing their intentions regarding delivery location. Interventions to reduce home deliveries should potentially target not only those residing farthest away, but multigravida women, those who attend fewer antenatal visits, and those who do not utilize MWHs.