Supply-side factors influencing demand for facility-based delivery in Tanzania: a multilevel analysis.
Supply-side factors influencing demand for facility-based delivery in Tanzania: a multilevel analysis.
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DOI：
10.1186/s13561-023-00468-1
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发表时间：
2023-11-06
影响因子：
2.4
通讯作者：
Borghi, Josephine
中科院分区：
文献类型：
--
作者：
Binyaruka, Peter;Foss, Anna;Alibrahim, Abdullah;Mziray, Nicholaus;Cassidy, Rachel;Borghi, Josephine
改善获得以设施为基础的分娩护理的机会有可能减少各种环境中的孕产妇和新生儿死亡。然而，获得分娩保健设施的机会仍然很低，特别是在低收入环境中。为了向循证干预措施提供信息，需要更多的证据，特别是考虑到影响获得以设施为基础的分娩护理的需求和供应方面的因素。我们的目标是利用坦桑尼亚的数据来填补这一知识空白。我们使用了(2012年1月进行的)横断面调查的数据，调查对象是坦桑尼亚三个地区的11个区的150家卫生保健机构、1494名患者和2846户在调查前12个月内分娩的妇女家庭。主要结果是分娩地点(在保健机构或其他地方分娩)，而解释变量是在个别妇女和保健机构一级衡量的。考虑到数据的层次结构和不同机构的需求差异，我们使用多水平混合效应Logistic回归来探索基于机构的交付护理的决定因素。在2846名妇女中，有86%的人在医疗机构分娩。对以设施为基础的分娩护理的需求更多地受到需求方因素(76%)的影响，而不是供应方因素(24%)。在需求方面的因素中，顺产在受过教育的女性、穆斯林、较富裕、有第一个孩子的女性以及至少有过四次产前检查的女性中更常见。在供应方面的因素方面，设施分娩在提供外展服务、较长的咨询时间和较高的人际关系质量的设施中更为常见。相比之下，平均等待时间更长、出行时间更长、收取接生费机会更高的设施几乎没有设施分娩。政策对策应着眼于改善需求的战略，如健康教育，以提高受教育程度较低的群体和平等程度较高的群体对寻求护理的认识，减少获得护理的财务障碍(包括获得和获得护理的时间成本)，以及采取政策干预措施，以提高服务提供中的人际质量。网上版载有补充材料，可在10.1186/s13561-023-00468-1查阅。
Improving access to facility-based delivery care has the potential to reduce maternal and newborn deaths across settings. Yet, the access to a health facility for childbirth remains low especially in low-income settings. To inform evidence-based interventions, more evidence is needed especially accounting for demand- and supply-side factors influencing access to facility-based delivery care. We aimed to fill this knowledge gap using data from Tanzania. We used data from a cross-sectional survey (conducted in January 2012) of 150 health facilities, 1494 patients and 2846 households with women who had given births in the last 12 months before the survey across 11 districts in three regions in Tanzania. The main outcome was the place of delivery (giving birth in a health facility or otherwise), while explanatory variables were measured at the individual woman and facility level. Given the hierarchical structure of the data and variance in demand across facilities, we used a multilevel mixed-effect logistic regression to explore the determinants of facility-based delivery care. Eighty-six percent of 2846 women gave birth in a health facility. Demand for facility-based delivery care was influenced more by demand-side factors (76%) than supply-side factors (24%). On demand-side factors, facility births were more common among women who were educated, Muslim, wealthier, with their first childbirth, and those who had at least four antenatal care visits. On supply-side factors, facility births were more common in facilities offering outreach services, longer consultation times and higher interpersonal quality. In contrast, facilities with longer average waiting times, longer travel times and higher chances of charging delivery fees had few facility births. Policy responses should aim for strategies to improve demand like health education to raise awareness towards care seeking among less educated groups and those with higher parity, reduce financial barriers to access (including time costs to reach and access care), and policy interventions to enhance interpersonal quality in service provision. The online version contains supplementary material available at 10.1186/s13561-023-00468-1.
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影响因子：
7.2
作者：
Borghi, Josephine;Mayumana, Iddy;Mamdani, Masuma
通讯作者：
Mamdani, Masuma
DOI：
10.1016/s2214-109x(22)00005-5
发表时间：
2022-05
期刊：
The Lancet. Global health
影响因子：
--
作者：
Hanson K;Brikci N;Erlangga D;Alebachew A;De Allegri M;Balabanova D;Blecher M;Cashin C;Esperato A;Hipgrave D;Kalisa I;Kurowski C;Meng Q;Morgan D;Mtei G;Nolte E;Onoka C;Powell-Jackson T;Roland M;Sadanandan R;Stenberg K;Vega Morales J;Wang H;Wurie H
通讯作者：
Wurie H
影响因子：
120.7
作者：
DONABEDIAN, A
通讯作者：
DONABEDIAN, A
影响因子：
5
作者：
ANDERSEN, RM
通讯作者：
ANDERSEN, RM
DOI：
10.2307/3349613
发表时间：
1973-01-01
期刊：
MILBANK MEMORIAL FUND QUARTERLY-HEALTH AND SOCIETY
影响因子：
--
作者：
ANDERSEN, R;NEWMAN, JF
通讯作者：
NEWMAN, JF