背景:基本新生儿保健(ENC)是世界卫生组织设计的高质量的全民新生儿保健,旨在为产后新生儿提供及时的干预措施。尽管进行全面的研究可以提供一种数据驱动的方法来解决服务采用的障碍,在埃塞俄比亚,缺乏评估ENC缺失的地理变异和预测因素的研究.因此,这项研究旨在确定地理,个人,以及在国家一级缺少ENC信息的社区级预测因素。
方法:这项研究使用了2016年埃塞俄比亚人口与健康调查,通过使用调查前两年内分娩的7,590名妇女的加权样本。使用Arc-GIS10.7版和SaTScan9.6版统计软件进行空间分析。检查了空间自相关(Moran\'sI),以确定埃塞俄比亚缺失ENC的空间变化的非随机性。用于构建ENC摄取的复合指标的六项护理是脐带检查,温度测量,关于危险迹象的咨询,母乳喂养咨询,观察母乳喂养,和测量出生体重。为了评估ENC项目的平均数量在协变量之间存在显著差异,进行独立t检验和单因素方差分析.最后,使用STATA16版进行多水平多变量混合效应负二项回归.调整后的发病率比率(aIRR)及其相应的95%CI用作相关性的量度,并且p值<0.05的变量被确定为ENC的重要预测因子。
结果:缺失ENC的总体患病率为4,675(61.6%)(95%CI:60.5,62.7),各地区之间存在显着的空间差异。大多数索马里人,Afar,Amhara南部,SNNPR区域对缺失ENC有统计学意义的热点。收到的ENC项目的平均(±SD)数为1.23(±1.74),方差为3.02,表明过度分散。生活在最贫穷的财富五分之一(aIRR=0.67,95CI:0.51,0.87),缺乏产前保健(aIRR=0.52,95CI:0.49,0.71),在家出生(aIRR=0.27,95%CI:0.17,0.34),生活在农村地区(aIRR=0.39,95%CI:0.24,0.57)是ENC摄取的显著预测因子。
结论:发现埃塞俄比亚的ENC缺失水平很高,各地区之间存在显著的空间差异。因此,政府和政策制定者应该为热点地区制定战略,以提高妇女的经济能力,受教育的机会,产前护理和熟练分娩服务的寻求健康行为,以提高ENC的使用率。
BACKGROUND: Essential Newborn care (ENC) is a High-quality universal newborn health care devised by the World Health Organization for the provision of prompt interventions rendered to newborns during the postpartum period. Even though conducting comprehensive studies could provide a data-driven approach to tackling barriers to service adoption, there was a dearth of studies in Ethiopia that assess the geographical variation and predictors of missing ENC. Hence, this study aimed to identify geographical, individual, and community-level predictors of missing ENC messages at the national level.
METHODS: This study used the 2016 Ethiopian Demographic and Health Survey, by using a weighted sample of 7,590 women who gave birth within two years prior to the survey. The spatial analysis was carried out using Arc-GIS version 10.7 and SaTScan version 9.6 statistical software. Spatial autocorrelation (Moran\'s I) was checked to figure out the non-randomness of the spatial variation of missing ENC in Ethiopia. Six items of care used to construct a composite index.0of ENC uptake were cord examination, temperature measurement, counselling on danger signs, counselling on breastfeeding, observation of breastfeeding, and measurement of birth weight. To assess the presence of significant differences in the mean number of ENC items across covariates, independent t-tests and one-way ANOVA were performed. Finally, a multilevel multivariable mixed-effect negative binomial regression was done by using STATA version 16. The adjusted incidence rate ratio (aIRR) with its corresponding 95% CI was used as a measure of association and variables with a p-value<0.05 were identified as significant predictors of ENC.
RESULTS: The overall prevalence of missing ENC was 4,675 (61.6%) (95% CI: 60.5, 62.7) with a significant spatial variation across regions. The majority of Somali, Afar, south Amhara, and SNNPR regions had statistically significant hotspots for missing ENC. The mean (±SD) number of ENC items received was 1.23(±1.74) with a variance of 3.02 indicating over-dispersion. Living in the poorest wealth quintile (aIRR = 0.67, 95%CI: 0.51, 0.87), lack of Antenatal care (aIRR = 0.52, 95%CI: 0.49, 0.71), birth at home (aIRR = 0.27, 95% CI: 0.17, 0.34), living in rural area (aIRR = 0.39, 95% CI: 0.24, 0.57) were significant predictors of ENC uptake.
CONCLUSIONS: The level of missing ENC was found to be high in Ethiopia with a significant spatial variation across regions. Hence, the government and policymakers should devise strategies for hotspot areas to improve women\'s economic capabilities, access to education, and health-seeking behaviours for prenatal care and skilled delivery services to improve ENC uptake.