Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study
Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study
复制标题
DOI：
10.1016/s0140-6736(06)68070-7
复制
发表时间：
2006-01-28
期刊：
影响因子：
168.9
通讯作者：
Borghi, J
中科院分区：
文献类型：
--
作者：
Chowdhury, ME;Ronsmans, C;Borghi, J
很少有研究评估发展中国家最贫穷的人是否从在家分娩而不是在设施中分娩中受益。我们分析了是否社会经济地位的结果在使用专业助产士在家里和在一个基本的产科设施在农村地区的Bangladesh，产科护理是免费的free.Methods，我们经常从Matlab，孟加拉国在1987年和2001年之间获得的数据的差异。我们使用多项逻辑和二项对数回归分析比较了家庭和设施产科护理的益处，控制了多个混杂因素。（最富有和最贫穷的五分之一人群的调整后优势比，家庭护理为1.94 [95% CI 1.69-2.24]，机构护理为2.05 [1.72-2.43]）。自1996年引入基于设施的护理后，贫富差距差距扩大。最富有和最贫穷的五分之一之间的风险比（RR）为1.91（当大多数助产士在家中分娩时，调整后的RR为1.49 [95% CI 1.16-1.91]，而在基于设施的护理高峰期为2.71（1.66 [1.41-1.96]）。从家庭基本产科护理转向设施基本产科护理是可行的，但可能导致获得保健服务方面的不平等现象增加。然而，也有证据表明，在家中分娩存在严重的不平等。在发展中国家加强由熟练护理人员在家分娩之前，需要进行研究来比较两种方法的可行性、成本、有效性、可接受性以及对医疗保健公平的影响。
Background Few studies have assessed whether the poorest people in developing countries benefit from giving birth at home rather than in a facility. We analysed whether socioeconomic status results in differences in the use of professional midwives at home and in a basic obstetric facility in a rural area of Bangladesh, where obstetric care was free of charge.Methods We routinely obtained data from Matlab, Bangladesh between 1987 and 2001. We compared the benefits of home-based and facility-based obstetric care using a multinomial logistic and binomial log link regression, controlling for multiple confounders.Findings Whether or not a midwife was used at home or in a facility differed significantly with wealth (adjusted odds ratio comparing the wealthiest and poorest quintiles 1.94 [95% CI 1.69-2.24] for home-based care, and 2.05 [1.72-2.43] for facility-based care). The gap between rich and poor widened after the introduction of facility-based care in 1996. The risk ratio (RR) between the wealthiest and poorest quintiles was 1.91 (adjusted RR 1.49 [95% CI 1.16-1.91] when most births with a midwife took place at home compared with 2.71 (1.66 [1.41-1.96]) at the peak of facility-based care.Interpretation In this area of Bangladesh, a shift from home-based to facility-based basic obstetric care is feasible but might lead to increased inequities in access to health care. However, there is also evidence of substantial inequities in home births. Before developing countries reinforce home-based births with a skilled attendant, research is needed to compare the feasibility, cost, effectiveness, acceptability, and implications for health-care equity in both approaches.