Determinants of Birth Attendant Choice of Women in Rural Cambodia and Outcome Differences -Comparison between Skilled and Unskilled Attendants-

目的：增加熟练助产士的使用是通过管理产科并发症来降低孕产妇死亡率的有效干预措施。本研究的目的是1)描述妇女在怀孕和分娩期间的健康寻求行为，2)确定助产士选择的决定因素，以及3)比较熟练和非熟练助产士之间的感知结果。方法：本研究在磅湛省米莫特区进行。研究对象是在调查前三个月内生过孩子的妇女。我们总共找到了1046名孕妇，其中980人被纳入了分析。信息是通过使用结构化问卷的家庭调查收集的。还对选定的患有严重并发症的妇女进行了半结构化访谈，以探讨获得保健服务的障碍。我们使用逻辑回归来确定助产士选择一致性的决定因素……更多的是分娩地点（设施vs.非设施），在家分娩的助产士（熟练vs.不熟练），以及分娩期间助产士的更换（改变vs.不变）。半结构化访谈被录音，然后使用内容分析进行分析。结果：纳入分析的980名妇女中，19.8%在分娩时有熟练的助产士在场。78.5%有不熟练的服务员，1.7%没有服务员。10.9%发生在卫生机构。求医行为分析显示，半数以上认为可能危及生命的妇女没有向专业人员寻求帮助。设施分娩选择的决定因素不同于在家分娩时熟练助产士的选择。在设施交付选择中，重要的决定因素是；上学7年及以上，经常接受产前护理，分娩时间过长。对于家庭分娩，在分娩前选择熟练助产士和非熟练助产士分别与在分娩后选择熟练助产士呈正相关和负相关。设施分娩的新生儿死亡和分娩期间及产后大出血发生率高于非设施分娩。然而，负发生率并没有显示在家中分娩时熟练或不熟练助产士的存在之间的差异。半结构化访谈揭示了三个层次的保健障碍，即1)认识到风险或决定寻求保健，2)获得保健，3)获得优质保健。少

Objectives : An increase in the utilization of skilled attendants at delivery is an effective intervention to reduce maternal mortality by the management of obstetric complications. The objectives of this study were 1) to describe the health seeking behavior of women during pregnancy and childbirth, 2) to identify the determinants of birth attendant choice, and 3) to compare perceived outcomes between skilled and unskilled attendants.Methods : The study was conducted in Memot District, Kompong Cham Province. The study population was women who gave birth to a baby during three months prior to the survey. We located a total of 1046 pregnant women, of whom 980 were included in the analysis. Information was collected by a household survey using a structured questionnaire. Semi-structured interviews of selected women with serious complications were also conducted to explore the barriers to health services. We used logistic regression to identify determinants of birth attendant choice accord … More ing to delivery place (facility vs. non-facility), birth attendant at home births (skilled vs. unskilled), and change of birth attendant during delivery (changed vs. unchanged). Semi-structured interviews were tape-recorded, then analyzed using content analysis.Results : Of 980 women included in the analyses, 19.8% had skilled attendant present during delivery. 78.5% had unskilled attendants, and 1.7% did not have any attendants. 10.9% took place at health facilities. Health seeking behavior analysis revealed that more than half of the women who perceived possible life-threatening conditions did not seek help from skilled personnel.The determinants of facility delivery choices differed from those of skilled attendant choice in home births. In facility delivery choice, the significant determinants were ; school attendance of 7 years and over, frequent antenatal care attendance and having prolonged labor. For home births, the choice of skilled and unskilled attendant in preceding deliveries were positively and negatively associated with skilled attendant choice in the following delivery, respectively.Incidences of neonatal deaths and severe bleeding during delivery and postpartum were more in facility deliveries than non-facility deliveries. However, negative incidences did not show a difference between the presence of skilled or unskilled attendant during home births.The semi-structured interview revealed barriers to health care in all three levels of health seeking, i.e. 1) recognizing risks or deciding to seek health care, 2) reaching health care, 3) acquiring quality health care once it was accessed. Less