埃塞俄比亚西部农村妇女不利用分散式初级保健设施进行产后护理的风险因素。

IF 3.1 Q1 OBSTETRICS & GYNECOLOGY Therapeutic advances in reproductive health Pub Date : 2020-06-26 eCollection Date: 2020-01-01 DOI:10.1177/2633494120928340
Habtamu Tolera, Tegegne Gebre-Egziabher, Helmut Kloos
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引用次数: 5

摘要

目的:有证据表明,产后护理有助于降低孕产妇死亡率。在埃塞俄比亚,分娩后不利用产后护理的妇女比例很高,产后检查的频率低于世界卫生组织建议的四次。这项研究调查了埃塞俄比亚西部农村地区吉达阿亚纳沃雷达不利用分散的地方卫生设施(即卫生站、卫生中心和初级医院)提供产后护理服务的相关风险因素。方法:在这项研究中,对454名母亲进行了以下风险因素的检查:分散的卫生保健设施所在的kebele(埃塞俄比亚最小的行政单位)、产后妇女的年龄、产前保健服务就诊、产后并发症的经历、产后并发症的知识、对产后护理的推荐次数的了解、对产后护理的可用性/提供情况的了解、以及卫生推广人员的家访。应用双变量和多变量逻辑回归分析来确定不利用分散的地方产后护理服务设施的预测因素。结果:超过一半(55.7%)的妇女在分娩42天内没有利用产后护理,只有10.0%的妇女利用了世界卫生组织指南认为适当的护理。在对各种潜在的混杂因素进行调整后,我们发现以下风险与未利用分散式卫生保健设施进行产后护理服务密切相关:一些偏远农村行政分权实体,如Angar、Lalistu和Ejere kebeles;年龄35岁及以上(校正优势比= 3.4,95%可信区间:1.4-8.3),本次妊娠未接受产前护理(校正优势比= 2.0,95%可信区间:1.1-3.7),未经历过任何产后并发症(校正优势比= 3.3,95%可信区间:1.7-6.4),不知道至少一种产后并发症(校正优势比= 2.0,95%可信区间:1.2-3.3)。与妇女不利用产后护理服务高度相关但不太密切相关的风险因素是:不了解建议的产后护理的标准次数,不了解当地卫生设施的服务可用性/提供情况,以及在分娩后第3天没有卫生推广工作人员的家访。结论:本研究确定的妇女不利用分散式卫生保健设施进行产后护理的危险因素,需要在加强服务利用和减少埃塞俄比亚西部农村孕产妇和新生儿死亡的干预措施中加以考虑。加强产后护理服务,特别是在较偏远的地区,应包括改进转诊系统和扩大保健推广工作人员对妇女的咨询。
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Risk factors for women's non-utilization of decentralized primary health care facilities for postnatal care in rural western Ethiopia.

Objective: Evidence suggests postnatal care contributes to reductions in maternal mortality. In Ethiopia, the proportion of women who do not utilize postnatal care after birth is high and the frequency of postnatal checks falls short of the four visits recommended by World Health Organization. This study examined risk factors associated with non-utilization of decentralized local health facilities, namely, health posts, health centers, and a primary hospital, for postnatal care services in Gida Ayana Woreda in rural western Ethiopia.

Methods: In this study, 454 mothers were examined for the following risk factors: kebele (the smallest administrative unit in Ethiopia) in which decentralized health care facilities were located, postnatal woman's age, antenatal care service visit, experience of postnatal complications, knowledge of postnatal complications, knowledge of the recommended number of postnatal care visits, knowledge of the availability/provision of postnatal care, and health extension workers' home visits. Bivariate and multivariable logistic regression analyses were applied to identify predictors of non-utilization of decentralized local facilities for postnatal care services.

Results: Over half (55.7%) of the women did not utilize postnatal care within 42 days of delivery, and only 10.0% utilized the care considered appropriate according to World Health Organization guidelines. After adjusting for various potential confounding factors, we found the following risks to be strongly associated with non-utilization of decentralized health care facilities for postnatal care services: some outer rural administrative decentralization entities such as Angar, Lalistu, and Ejere kebeles; age 35 years or older (adjusted odds ratio = 3.4, 95% confidence interval: 1.4-8.3), not receiving antenatal care during this pregnancy (adjusted odds ratio = 2.0, 95% confidence interval: 1.1-3.7), no experience of any postnatal complications (adjusted odds ratio = 3.3, 95% confidence interval: 1.7-6.4), and no knowledge of at least one postnatal complication (adjusted odds ratio = 2.0, 95% confidence interval: 1.2-3.3). Risk factors highly but less strongly associated with women's non-utilization of postnatal care services were no knowledge of the standard number of postnatal care visits recommended, no knowledge about the availability/provision of services at a local health facility, and no home visit from health extension worker by day 3 post-delivery.

Conclusion: The risk factors for women's non-utilization of decentralized health care facilities for postnatal care identified in this study need to be considered in interventions for enhancing the utilization of the service and reducing maternal and newborn deaths in rural western Ethiopia. Strengthening of postnatal care services, especially in the more remote kebeles, should include upgrading of the referral system and expansion of counseling of women by health extension workers.

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