背景:产后护理(PNC)对于早期识别和管理危及生命的产科并发症至关重要。尽管埃塞俄比亚政府努力改善妇幼保健服务的使用,PNC服务一直很低,不同地理位置的差异是一个主要的公共卫生问题。这项研究旨在调查埃塞俄比亚不同地理位置(农村-城市)和一段时间(2016年至2019年)中PNC服务使用的变化和影响因素。
方法:我们分析了2016年和2019年埃塞俄比亚人口与健康调查中分娩妇女的数据。共有6,413个加权样本(2016年为4,308个,2019年为2,105个)纳入分析。使用多变量分解分析技术来确定变化并识别导致跨地理位置和随时间变化的因素。统计显著性定义为95%置信区间,p值小于0.05。
结果:城市居民使用PNC的患病率较高,城乡差距从2016年的32.59%缩小到2019年的19.08%。解释变量组成的差异是两项调查中PNC使用城乡差异的唯一统计学意义。具体来说,女性户主(4.51%),在医疗机构分娩(83.45%),2016年二至三胎(5.53%)和四胎及以上(-12.24%)的出生顺序对城乡差距有显著贡献。然而,2019年,中等财富指数(-14.66%),穆斯林宗教(3.84%),四名或四名以上触角护理接触者(18.29%),医疗机构的分娩(80.66%)大大加剧了城乡差距。PNC使用量从2016年的16.61%增加到2019年的33.86%。大约60%的解释变化是由于解释变量组成的差异。特别是,城市住宅(-5.79%),富裕财富指数(2.31%),穆斯林(3.42%)和其他(-2.76%)宗教,拥有收音机或电视(1.49%),1-3(-1.13%),和4名或更多(11.09%)的产前护理接触者,在医疗机构分娩(47.98%)是观察到的变化的统计学显著贡献者。其余40%的总体变化是由于人口对PNC的未知行为(系数)的差异。
结论:埃塞俄比亚的PNC服务使用因居住地点和时间而异而发生了重大变化,两项调查中的城市妇女更有可能使用PNC服务。PNC吸收的城乡差距是由于解释变量组成的差异,而随时间的变化是由于解释变量的组成和对PNC的人群行为的变化。在医疗机构增加产前护理接触和提供服务方面发挥了重要作用,解释了埃塞俄比亚各住所和一段时间以来PNC服务的差距,强调加大力度加强在农村环境中的吸收的重要性。
BACKGROUND: Postnatal care (PNC) is essential for early identification and management of life-threatening obstetric complications. Despite efforts by the Ethiopian government to improve maternal and child health service use, PNC service has remained low, and disparity across geographic locations is a major public health problem. This study aimed to investigate the change and contributing factors in PNC service use across geographical locations (rural-urban) and over time (2016 to 2019) in Ethiopia.
METHODS: We analyzed data on women who gave birth from the 2016 and 2019 Ethiopian Demographic and Health Surveys. A total of 6,413 weighted samples (4,308 in 2016 and 2,105 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine the change and identify factors that contributed to the change across geographical locations and over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05.
RESULTS: The prevalence of PNC use was higher among urban residents, and the urban-rural disparity reduced from 32.59% in 2016 to 19.08% in 2019. The difference in the composition of explanatory variables was the only statistically significant for the urban-rural disparity in PNC use in both surveys. Specifically, female household heads (4.51%), delivery at a health facility (83.45%), and birth order of two to three (5.53%) and four or more (-12.24%) in 2016 significantly contributed to the urban-rural gap. However, in 2019, middle wealth index (-14.66%), Muslim religion (3.84%), four or more antennal care contacts (18.29%), and delivery at a health facility (80.66%) significantly contributed to the urban-rural gap. PNC use increased from 16.61% in 2016 to 33.86% in 2019. About 60% of the explained change was due to the difference in the composition of explanatory variables. Particularly, urban residence (-5.79%), a rich wealth index (2.31%), Muslim (3.42%), and other (-2.76%) religions, having radio or television (1.49%), 1-3 (-1.13%), and 4 or more (11.09%) antenatal care contacts, and delivery at a health facility (47.98%) were statistically significant contributors to the observed change. The remaining 40% of the overall change was due to the difference in unknown behaviors (coefficient) of the population towards PNC.
CONCLUSIONS: There was a significant change in PNC service use by residence location and over time in Ethiopia, with urban women in both surveys being more likely to use PNC service. The urban-rural disparity in PNC uptake was due to the difference in the composition of explanatory variables, whereas the change over time was due to the change in both the composition of explanatory variables and population behavior towards PNC. Increased antenatal care contacts and delivery at a health facility played a major role in explaining the gap in PNC services across residences and over time in Ethiopia, highlighting the importance of stepping up efforts to enhance their uptake in rural settings.